2012-11-14T15:00:56-06:00 2011-12-31 440160260 BKD LLP 312 WALNUT STREET SUITE 300 CINCINNATI OH 45202 990 2011-01-01 344431174 MERCY HOSPITAL OF TIFFIN OHIO MERC 4194473130 45 ST LAWRENCE DRIVE Tiffin OH 44883 ROBERT MOON 2012-11-05 true P00961884 5136218300 2011 2016-02-24 21:20:13Z DALE THORNTON CEO 45 ST LAWRENCE DRIVE TIFFIN OH 44833 59092548 false 0928 X WWW.MERCYWEB.ORG X 1970 OH TO EXTEND THE HEALING MINISTRY OF JESUS BY IMPROVING THE HEALTH OF OUR COMMUNITIES, WITH EMPHASIS ON PEOPLE WHO ARE POOR AND UNDER-SERVED. 12 9 694 152 0 0 112447 122681 55935932 58086336 2077183 532050 295267 341983 58420829 59083050 0 0 0 0 22076095 23597821 0 0 0 32557316 30460290 54633411 54058111 3787418 5024939 116898676 115749053 50244962 49662866 66653714 66086187 TO EXTEND THE HEALING MINISTRY OF JESUS BY IMPROVING THE HEALTH OF OUR COMMUNITIES, WITH EMPHASIS ON PEOPLE WHO ARE POOR AND UNDER-SERVED. MERCY HOSPITAL TIFFIN IS THE ONLY FULL-SERVICE COMMUNITY HOSPITAL BASED IN TIFFIN AND SERVING THE TRI-COUNTY AREA. IT IS ALSO THE ONLY FAITH-BASED HOSPITAL IN ITS PRIMARY, SECONDARY, AND TERTIARY SERVICE AREA. false false 42461953 0 57769958 THE PRIMARY EXEMPT PURPOSE OF MERCY HOSPITAL OF TIFFIN OHIO 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. MERCY HOSPITAL OF TIFFIN OHIO ACCOMPLISHES THIS PURPOSE BY DEMONSTRATING BEHAVIORS REFLECTING OUR CORE VALUES OF COMPASSION, EXCELLENCE, HUMAN DIGNITY, JUSTICE, SACREDNESS OF LIFE AND SERVICE. 602779 0 201495 UROLOGY SERVICES: EMPLOYED PHYSICIAN OFFICE WHICH IS THE SOLE PROVIDER OF COMPREHENSIVE UROLOGY HEALTHCARE (OP, IP AND PROCEDURAL) TO THE ADULT POPULATION OF THE COMMUNITY, REGARDLESS OF THE PATIENT'S ABILITY TO PAY FOR THESE SERVICES. SERVED 1,679 PEOPLE. 567878 0 114883 CARDIOLOGY SERVICES: EMPLOYED PHYSICIAN OFFICE WHICH IS SOLE PROVIDER OF COMPREHENSIVE CARDIOLOGY HEALTHCARE (OP, IP AND PROCEDURAL) TO THE ADULT POPULATION OF THE COMMUNITY, REGARDLESS OF PATIENT'S ABILITY TO PAY FOR THOSE SERVICES. SERVED 1,252 PEOPLE. 43632610 true true false true false false false false false true true false false 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 false true true true false false true 0 0 694 true false false false false false false false false false false X 12 9 false false false false true true true true true false false true true true true true true false false true true X JULIE ALFORD 4194557052 45 ST LAWRENCE DRIVE TIFFIN OH 44883 X CHRIS ENGLISH 1.00 X X 0 0 0 DALE THORNTON 53.00 X X 358258 0 85818 JERRY BUPP 1.00 X X 0 0 0 KRIS KLEPPER 1.00 X X 0 0 0 STEVEN L MICKUS 0.50 X X 0 1393505 322574 ANDREA PRICE 0.50 X 0 692861 164756 BRIAN SMITH 1.00 X 0 0 0 JEANNINE CURNS 1.00 X 0 0 0 JOHN M STARCHER JR 0.50 X 0 906582 167409 JUDY CLEM 1.00 X 0 0 0 LEE MARTIN 1.00 X 0 0 0 SR NOEL FREY RSM 1.00 X 0 0 0 WADE YOUNG MD 1.00 X 3820 0 0 ROBERT MOON 0.50 X 0 376867 99135 TODD WARNER 0.50 X 0 255850 58604 BARRY HUDGIN 1.00 X 0 291826 38509 CAROL WHITTAKER 0.50 X 0 404570 187826 GARY GEORGE 1.00 X 0 346485 118311 H TERRENCE SMITH 1.00 X 0 432002 100039 IMRAN ANDRABI MD 1.00 X 0 540003 78135 JOSEPH GLASS 1.00 X 0 280812 45744 THOMAS ARQUILLA 1.00 X 0 219208 32080 AJITKUMAR DESAI MD 55.00 X 429535 0 250 CHRISTIAN MEADE MD 55.00 X 142635 0 0 ROBERT CECCHINO MD 55.00 X 277731 0 250 STEVEN BRUHL MD 55.00 X 181305 0 0 STEVEN WAGNER MD 55.00 X 224507 0 0 DAVID AROSE 0.00 X 0 261788 25358 JIM ALBIN 0.00 X 0 144065 12187 1617791 6546424 1536985 13 true true false 0 33780 50000 25891 13010 122681 NET PATIENT SERVICE REV 621990 57448268 57448268 JOINT VENTURE 900099 223527 223527 PHARMACY 621990 3183 3183 CLINICS 621990 137011 137011 RADIOLOGY 621990 11093 11093 263254 263254 0 0 58086336 541548 541548 0 0 23548 23548 0 23548 23548 9498 0 -9498 -9498 -9498 0 0 0 CAFETERIA 624210 236710 236710 5% EMPLOYEE SALARY INCREASE PER CONTRACT W/TASA 900099 68845 68845 MEDICAL RECORD 561000 12880 12880 0 0 0 0 318435 59083050 58109884 0 850485 0 0 0 0 447896 392832 55064 0 18007167 15793374 2213793 711310 711310 3195612 3182714 12898 1235836 1235836 377731 41657 336074 49095 49095 4835 4835 0 0 0 11767432 5207655 6559777 245304 245304 0 7646 7646 0 1673663 1401250 272413 229783 160349 69434 0 0 2402636 2402636 0 4319254 4319254 334810 334810 STATE & CORP ASSESSMENTS 952692 407634 545058 DUES AND MEMBERSHIPS 105091 43335 61756 MEDICAL SUPPLIES 7990318 7990318 0 0 0 0 54058111 43632610 10425501 0 0 5761818 2368758 7738360 8838675 823047 860365 432986 383235 88728787 27053241 65078029 61675546 33842839 40944444 0 0 3221597 678030 116898676 115749053 3847486 3710755 63400 46334076 45952111 50244962 49662866 X 66633510 66054193 20204 31994 66653714 66086187 116898676 115749053 X 5024939 -5592466 X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED true false false false false true 3110 false false false 3110 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. 2920320 2920320 56963107 8215289 48747818 4070579 962748 3107831 24544094 17622676 6921418 230687 252528 -21841 61675546 0 0 CATHOLIC HEALTH PARTNERS-INVESTMENT MANAGEMENT PROGRAM 40944444 F 40944444 0 PENSION-DEFINED CONTRIBUTION PLAN 260000 OTHER LONG TERM LIABILITIES 3193695 ACCOUNTS PAYABLE INTERCOMPANY 285392 LOAN PAYABLE TO AFFILIATE 42213024 45952111 61473533 56460384 5013149 0 0 5013149 0 0 0 0 0 0 0 0 0 0 0 0 FIN 48 (ASC 740) footnote Schedule D, Part X, Line 2 THE COMPANY [CATHOLIC HEALTH PARTNERS AND AFFILIATED ENTITIES] COMPLETED AN ANALYSIS OF ITS TAX POSITIONS IN ACCORDANCE WITH APPLICABLE ACCOUNTING GUIDANCE AT DECEMBER 31, 2011 AND 2010, AND DETERMINED THAT NO AMOUNTS WERE REQUIRED TO BE RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS AT DECEMBER 31, 2011 OR 2010. true true X true X true X true true true false true true 4200 2191726 257647 1934079 0.03580 10356 5668437 3530744 2137693 0.03950 0 0 0 0.00000 0 14556 7860163 3788391 4071772 0.07530 1764 244873 120 244753 0.00450 339 104777 0 104777 0.00190 8298 5511346 3137154 2374192 0.04390 0 0 0 0 0.00000 646 64982 0 64982 0.00120 0 11047 5925978 3137274 2788704 0.05150 0 25603 13786141 6925665 6860476 0.12680 0 0.00000 0 0.00000 0 0.00000 3063 0 3063 0.00010 0 0.00000 0 0.00000 0 0.00000 12 259400 0 259400 0.00480 0 0.00000 0 12 262463 0 262463 0.00490 false 2402273 0 12348651 15250051 -2901400 X true true TIFFIN AMBULATORY SURGICAL ASSOCIATION LLC AMBULATORY SURGERY 0.51 0 0.49 1 1 MERCY TIFFIN HOSPITAL

45 ST LAWRENCE DRIVE TIFFIN OH 44883

X X X 12 MERCY COMMUNITY LAB

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COMMUNITY LAB MERCY CANCER CENTER AT TIFFIN

40 FAIR LANE TIFFIN OH 44883

RADIATION THERAPY AND ONCOLOGY INFUSION SERVICES MERCY HOME CARE

435 W MARKET ST TIFFIN OH 44883

HOME CARE MERCY TIFFIN HOSPITAL SPECIALTY CLINICS

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OUTPATIENT CLINICS MERCY UROLOGY SPECIALISTS

27 ST LAWRENCE DRIVE SUITE 204 TIFFIN OH 44883

PHYSICIANS OFFICES - UROLOGY MCCAULEY HEALTH SERVICES

437 W MARKET ST TIFFIN OH 44883

FAMILY CARE MERCY SURGICAL SPECIALISTS

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PHYSICIAN OFFICES - SURGERY TIFFIN AMBULATORY SURGERY ASSOCIATES

45 ST LAWRENCE DRIVE TIFFIN OH 44833

AMBULATORY SURGERY CENTER OPTIMA REHABILITATION SERVICES

45 ST LAWRENCE DR SUITE 204 TIFFIN OH 44883

PHYSICIAL THERAPY, SPEECH, OCCUPATIONAL THERAPY, AQUATIC THERAPY SENECA DIALYSIS

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DIALYSIS CLINIC MERCY PEDIATRICS

433 W MARKET STREET TIFFIN OH 44883

PHYSICIAN OFFICES - PEDIATRICS MERCY OBGYN ASSOCIATES

2495 W MARKET STREET TIFFIN OH 44883

PHYSICIAN OFFICES - OB/GYN 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 THE HOSPITAL COST ACCOUNTING SYSTEM 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 EXCLUDING TRADITIONAL MEDICAID AND MEDICAID MANAGED CARE PATIENTS. COSTS FOR CHARITY AND BAD DEBT ACCOUNTS ARE DEDUCTED USING A RATIO OF OF COST TO CHARGE SPECIFIC TO THAT SUBSIDIZED SERVICE. 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 Subsidized Health Services Schedule H, Part I, Line 7g $3,381,200 OF COSTS ATTRIBUTABLE TO PHYSICIAN CLINICS WAS INCLUDED AS SUBSIDIZED HEALTH SERVICES. Community Building Activities Schedule H, Part II MERCY TIFFIN HOSPITAL CONDUCTS COMMUNITY HEALTH EDUCATION AND SUPPORT GROUPS, HEALTH FAIRS, AND SCREENINGS FOR THE COMMUNITY. THE HOSPITAL SUPPORTS HEALTH MINISTRIES PROGRAMS FOR CHURCHES IN THE AREA. MERCY TIFFIN HOSPITAL PROVIDES A MERCY EXPRESS VAN SERVICE TO TRANSPORT PATIENTS TO NEEDED HEALTH CARE SERVICES. THE HOSPITAL PROVIDES HEALTH INFORMATION TO THE COMMUNITY THROUGH A TELEPHONE INFORMATION PROGRAM, AND PROVIDES CLINICS TO INCREASE ACCESS TO PRIMARY CARE AND SPECIALTY CARE, INCLUDING WOMEN'S HEALTH. 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 AN OPERATING EXPENSE. 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. 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. 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. 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 19d (1) MERCY TIFFIN 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 TIFFIN HOSPITAL ASSESSES AND CONTINUALLY RESPONDS TO CHANGING COMMUNITY NEEDS THROUGH THE SERVICES OFFERED. THE HOSPITAL CONDUCTS A COMMUNITY NEEDS ASSESSMENT EVERY 3 YEARS AND UPDATES ARE PROVIDED BETWEEN ASSESSMENTS. MERCY TIFFIN HOSPITAL INCORPORATES PLANNING FOR COMMUNITY BENEFITS AS PART OF ITS ANNUAL BUSINESS AND STRATEGIC PLANNING PROCESSES. THE HOSPITAL RECOGNIZES THAT 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 TIFFIN HOSPITAL HAS A DEDICATED STAFF TO ASSIST IN THE COMMUNITY BENEFIT EFFORT. THE HOSPITAL'S COMMUNITY BENEFITS COMMITTEE MEETS QUARTERLY TO PROVIDE OVERSIGHT TO THE ORGANIZATION'S COMMUNITY BENEFITS PROGRAM. MERCY TIFFIN 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 TIFFIN HOSPITAL 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. THE HOSPITAL 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 TIFFIN HOSPITAL 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 MERCY TIFFIN HOSPITAL ELIGIBILITY LINK PROGRAM (HELP) IS A FREE REFERRAL SERVICE PROVIDED BY MERCY TIFFIN HOSPITAL. 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 TIFFIN HOSPITAL 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 THE HOSPITAL'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. IN 2011, HELP MANAGED 4,394 PATIENT REFERRALS. MERCY TIFFIN HOSPITAL 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 TIFFIN HOSPITAL SERVES A FOUR-COUNTY GEOGRAPHIC AREA FEATURING THE FOLLOWING COUNTIES: SANDUSKY, SENECA, WOOD, AND WYANDOT IN OHIO. THE POPULATION OF MERCY TIFFIN HOSPITAL'S PRIMARY SERVICE AREA IS APPROXIMATELY 56,000 AND IS OLDER, POORER AND HAS WORSE HEALTH STATISTICS THAN STATE AND NATIONAL AVERAGES. OUR COMMUNITY IS CHANGING AND WE ALSO SERVE A GROWING UNINSURED AND UNDERINSURED POPULATION. MERCY TIFFIN HOSPITAL IS THE ONLY HOSPITAL IN THE COMMUNITY, AND IT IS A NOT-FOR-PROFIT HOSPITAL. TIFFIN IS NOT FEDERALLY DESIGNATED AS A MEDICALLY UNDERSERVED AREA OR POPULATION. THE DEMOGRAPHIC AREA SERVED BY MERCY TIFFIN HOSPITAL SERVES THE FOLLOWING ETHNIC AND CULTURAL GROUPS: CAUCASIAN (91.6%), HISPANIC/LATINO (4.3%), BLACK (2.1%), TWO OR MORE RACES (1.2%), ASIAN (.5%), AMERICAN INDIAN/ALASKA NATIVE (.3%), 11.1% OF RESIDENTS ARE IN HOUSEHOLDS BELOW THE FEDERAL POVERTY GUIDELINES. 18.4% OF FAMILIES ARE ON MEDICAID OR OTHER ASSISTANCE. IN THE COMMUNITY SERVED BY MERCY TIFFIN HOSPITAL HEART DISEASE, CANCER, AND STROKE ARE THE MAJOR HEALTH PROBLEMS AND/OR LEADING CAUSES OF DEATH. EACH OF THESE ARE PREVENTABLE THROUGH PROPER CARE AND MAINTAINING CONTROL OF THE ILLNESS/DISEASE AS WELL AS LEADING HEALTHIER LIVES. THE SMOKING RATE IS 19% OF THE POPULATION. MERCY TIFFIN HOSPITAL WORKS CLOSELY WITH LOCAL COMMUNITY AGENCIES AND HEALTH DEPARTMENTS TO ADDRESS THESE PROBLEMS AND MINIMIZE THE EFFECTS ON THOSE WHO SUFFER. IN 2011, MERCY TIFFIN HOSPITAL HAD 2,303 ADMISSIONS, 87,876 OUTPATIENT VISITS, AND 17,704 EMERGENCY ROOM VISITS. Promotion of community health Schedule H, Part VI, Line 5 MERCY TIFFIN HOSPITAL OPERATES AN EMERGENCY ROOM OPEN TO ALL PERSONS REGARDLESS OF ABILITY TO PAY. IN ADDITION TO PROVIDING EMERGENCY SERVICES, MERCY TIFFIN HOSPITAL ALSO PROVIDES MINOR EMERGENCY AND URGENT CARE SERVICES TO ALL REGARDLESS OF ABILITY TO PAY. THE HOSPITAL OPERATES RURAL HEALTH CLINICS, PSYCHIATRIC, SKILLED NURSING, RENAL DIALYSIS, NEWBORN NURSERY, WOUND CARE, AND DIABETES MANAGEMENT DEPARTMENTS. MERCY TIFFIN 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 THE HOSPITAL. MERCY TIFFIN HOSPITAL PARTICIPATES IN MEDICAID, MEDICARE, CHAMPUS, AND/OR OTHER GOVERNMENT-SPONSORED HEALTH CARE PROGRAMS. MERCY TIFFIN HOSPITAL'S EMERGENCY DEPARTMENT TREATS AN INCREASING NUMBER OF PATIENTS WHO USE THE FACILITY FOR PRIMARY CARE NEEDS. PATIENT DEMOGRAPHICS REFLECT THE CHANGING COMMUNITY. AS IN OTHER COMMUNITIES, SOME AREA PHYSICIANS PLACE LIMITS ON THEIR ACCEPTANCE OF MEDICAID PATIENTS. IN ADDITION, SOME PRIMARY CARE PHYSICIANS REFER PATIENTS WITH AFTER-HOURS NEEDS DIRECTLY TO AREA EMERGENCY ROOMS. Affiliated health care system Schedule H, Part VI, Line 6 MERCY TIFFIN HOSPITAL IS A MEMBER OF MERCY HEALTH PARTNERS-NORTHERN REGION AND IS AFFILIATED WITH ST. VINCENT MERCY MEDICAL CENTER, ST. CHARLES MERCY HOSPITAL, MERCY ST. ANNE HOSPITAL, 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 HAS BEEN AN INTEGRAL PART OF THE COMMUNITY SINCE 1913. MERCY TIFFIN HOSPITAL IS AN ACUTE CARE HOSPITAL WITH APPROXIMATELY 120 LICENSED BEDS. MERCY HEALTH PARTNERS-NORTHERN REGION COMMUNITY BENEFIT FOR 2011 PER THE AUDIT FOOTNOTE IS AS FOLLOWS: TOTAL 2011 COMMUNITY BENEFIT: $79.1 MILLION BENEFITS TO THE BROADER COMMUNITY: $19.0 MILLION UNREIMBURSED CARE FOR THOSE WHO ARE POOR AND QUALIFY FOR MEDICAID: $18.0 MILLION COST OF CARE FOR THOSE WHO COULD NOT AFFORD TO PAY: $27.0 MILLION SUPPORT FOR OTHER PROGRAMS FOR THOSE WHO ARE POOR: $15.1 MILLION COMMUNITY BENEFIT AS PERCENT OF TOTAL EXPENSE: 10.0 PERCENT MERCY TIFFIN 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 2011 PER THE AUDIT FOOTNOTE IS AS FOLLOWS: TOTAL 2011 COMMUNITY BENEFIT: $345.7 MILLION BENEFITS TO THE BROADER COMMUNITY $76.0 MILLION UNREIMBURSED CARE FOR THOSE WHO ARE POOR AND QUALIFY FOR MEDICAID $124.3 MILLION COST OF CARE FOR THOSE WHO COULD NOT AFFORD TO PAY $116.7 MILLION SUPPORT FOR OTHER PROGRAMS FOR THOSE WHO ARE POOR $28.7 MILLION COMMUNITY BENEFIT AS PERCENT OF TOTAL EXPENSE: 10.0 PERCENT true true false false false false false true false AJITKUMAR DESAI MD 422677 0 0 0 6858 0 0 0 250 0 429785 0 0 0 ANDREA PRICE 0 508553 0 174752 0 9556 0 133810 0 30946 0 857617 0 0 BARRY HUDGIN 0 233525 0 48616 0 9685 0 29225 0 9284 0 330335 0 0 CAROL WHITTAKER 0 324182 0 65686 0 14702 0 172875 0 14951 0 592396 0 0 DALE THORNTON 262153 0 70441 0 25664 0 80083 0 5735 0 444076 0 0 0 DAVID AROSE 0 211381 0 47769 0 2638 0 15206 0 10152 0 287146 0 0 GARY GEORGE 0 263407 0 71249 0 11829 0 107989 0 10322 0 464796 0 0 H TERRENCE SMITH 0 200629 0 84100 0 147273 0 74692 0 25347 0 532041 0 0 IMRAN ANDRABI MD 0 415318 0 115415 0 9270 0 54337 0 23798 0 618138 0 0 JIM ALBIN 0 0 0 0 0 144065 0 12187 0 0 0 156252 0 0 JOHN M STARCHER JR 0 554955 0 211413 0 140214 0 140693 0 26716 0 1073991 0 0 JOSEPH GLASS 0 213439 0 59448 0 7925 0 23647 0 22097 0 326556 0 0 ROBERT CECCHINO MD 274167 0 0 0 3564 0 0 0 250 0 277981 0 0 0 ROBERT MOON 0 374752 0 0 0 2115 0 72189 0 26946 0 476002 0 0 STEVEN BRUHL MD 141184 0 40000 0 121 0 0 0 0 0 181305 0 0 0 STEVEN L MICKUS 0 835062 0 338741 0 219702 0 296067 0 26507 0 1716079 0 0 STEVEN WAGNER MD 162983 0 61524 0 0 0 0 0 0 0 224507 0 0 0 THOMAS ARQUILLA 0 193307 0 20000 0 5901 0 20868 0 11212 0 251288 0 0 TODD WARNER 0 193493 0 54454 0 7903 0 37112 0 21492 0 314454 0 0 Arrangement used to establish the top management official's compensation Schedule J, Part I, Line 3 THE COMPENSATION OF DALE THORNTON, PRESIDENT AND CEO OF MERCY HOSPITAL TIFFIN, IS DETERMINED BY MERCY HEALTH PARTNERS - NORTHERN REGION (MHP), A RELATED TAX-EXEMPT ORGANIZATION. MHP UTILIZES AN INDEPENDENT COMPENSATION CONSULTANT, A COMPENSATION SURVEY, AND APPROVAL BY BOARD OR COMPENSATION COMMITTEE WHEN DETERMINING MR. THORNTON'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: H. TERRENCE SMITH $117,577. 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: DALE THORNTON $11,851; JIM ALBIN $144,065; GARY GEORGE $0; IMRAN ANDRABI, MD $0; H. TERRENCE SMITH $0; CAROL WHITTAKER $0. THE CHP SERP PLAN 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. $118,835; STEVEN L. MICKUS $184,461; ANDREA PRICE $0. THE CHP EXECUTIVE RETENTION PLAN 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. $0; STEVEN L. MICKUS $0; ROBERT MOON $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. CONSOLIDATED AUDITED FINANCIAL STATEMENTS FORM 990, PART IV, LINE 20B THE FILING ORGANIZATION DOES NOT HAVE SEPARATE, INDEPENDENT AUDITED FINANCIAL STATEMENTS. THE ORGANIZATION IS INCLUDED IN CATHOLIC HEALTH PARTNERS' CONSOLIDATED AUDITED FINANCIAL STATEMENTS, WHICH ARE PREPARED IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES. CATHOLIC HEALTH PARTNERS' AUDIT AND CORPORATE RESPONSIBILITY COMMITTEE HAS RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND THE SELECTION OF AN INDEPENDENT ACCOUNTANT. Classes of members or stockholders Form 990, Part VI, Section A, Line 6 MERCY HEALTH PARTNERS NORTHERN REGION IS THE MEMBER OF MERCY HOSPITAL OF TIFFIN, OHIO. 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 CHP'S 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 GOVERNING BODY AND BOARD FOR REVIEW, THEN 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 ANNUALLY, ALL BOARD MEMBERS COMPLETE AND SIGN A CONFLICT OF INTEREST STATEMENT. THIS IS REVIEWED BY THE REGIONAL AUDIT AND CORPORATE RESPONSIBILITY COMMITTEE. TO REINFORCE THE CONFLICT OF INTEREST POLICY AT EACH BOARD MEETING, THE CHAIRMAN MAKES A STATEMENT AND ASKS EVERYONE WHO MAY HAVE A CONFLICT OF INTEREST FOR ANY ITEM TO EXCUSE THEMSELVES. Governing documents, conflict of interest policy and financial statements available to the public Form 990, Part VI, Section C, Line 19 THE SYSTEM WIDE CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE POSTED ON THE CATHOLIC HEALTH PARTNER'S WEBSITE. Average number of hours devoted per week to related organization Form 990, Part VII, Section A, Column B DALE THORNTON - 2 STEVEN L. MICKUS - 57.4 ANDREA PRICE - 56.5 JOHN M. STARCHER, JR. - 58.8 SR. NOEL FREY, RSM - 1 ROBERT MOON - 58.5 TODD WARNER - 58.5 BARRY HUDGIN - 55 CAROL WHITTAKER - 54.5 GARY GEORGE - 54 H. TERRENCE SMITH - 54 IMRAN ANDRABI, MD - 56 JOSEPH GLASS - 54 THOMAS ARQUILLA - 54 Other changes in net assets or fund balances Form 990, Part XI, Line 5 NET UNREALIZED GAINS (LOSSES) ON INVESTMENTS - -1439944; PENSION ADJUSTMENT CHANGE IN PLAN - -4002224; MEDICAL RETIREE - 91924; DISTRIBUTIONS TO PARTNERS - -50453; ADJUST MINORITY INTEREST ELIMINATION - -191769; CATHOLIC HEALTH PARTNERS 615 ELSINORE PLACE CINCINNATI OH 45202 311161086 HEALTHCARE SYSTEM PARENT OH 501(C)(3) 11 - Type III - FI NA false CATHOLIC HEALTH PARTNERS FOUNDATION 615 ELSINORE PLACE CINCINNATI OH 45202 201072726 FUNDRAISING OH 501(C)(3) 7 CATHOLIC HEALTH PARTNERS false CATHOLIC HEALTHCARE PARTNERS HOUSING DEVELOPMENT 615 ELSINORE PLACE CINCINNATI OH 45202 208943658 HUD PARENT OH 501(C)(3) 9 CATHOLIC HEALTH PARTNERS false CATHOLIC HEALTHCARE PARTNERS RETIREMENT TRUST 615 ELSINORE PLACE CINCINNATI OH 45202 316046304 RETIREMENT TRUST OH 501(C)(3) 8 CATHOLIC HEALTH PARTNERS false COMMUNITY HEALTH PARTNERS REGIONAL HEALTH SYSTEM 3700 KOLBE ROAD LORAIN OH 44053 270071694 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 340714704 HOSPITAL OH 501(C)(3) 3 COMMUNITY HEALTH PARTNERS REGIONAL HEALTH SYSTEM false ALLEN MEDICAL CENTER 200 WEST LORAIN ST OBERLIN OH 44074 340864230 HOSPITAL OH 501(C)(3) 3 COMMUNITY HEALTH PARTNERS REGIONAL HEALTH SYSTEM false COMMUNITY HEALTH PARTNERS REGIONAL FOUNDATION 3700 KOLBE ROAD LORAIN OH 44053 341504558 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 341268828 MEDICAL OFFICE RENTAL OH 501(C)(3) 9 COMMUNITY HEALTH PARTNERS REGIONAL MEDICAL CENTER false ALLEN MEDICAL CENTER FOUNDATION 200 WEST LORAIN ST OBERLIN OH 44074 341675592 FOUNDATION OH 501(C)(3) 11 - Type I ALLEN MEDICAL CENTER false ALLEN MEDICAL CENTER MEDICAL OFFICE BUILDING 200 WEST LORAIN ST OBERLIN OH 44074 364504991 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 311063783 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 311217563 FOUNDATION OH 501(C)(3) 7 MERCY HEALTH PARTNERS OF SOUTHWEST OHIO false MERCY HOSPITALS WEST 2446 KIPLING AVENUE CINCINNATI OH 45239 311091597 HOSPITAL OH 501(C)(3) 3 MERCY HEALTH PARTNERS OF SOUTHWEST OHIO false MERCY HOSPITAL ANDERSON 7500 STATE ROAD CINCINNATI OH 45255 310537085 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 310538532 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 310830955 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 311308729 RETIREMENT HOME OH 501(C)(3) 9 MERCY HEALTH PARTNERS OF SOUTHWEST OHIO false MERCY SACRED HEART INC 2120 PAYNE STREET LOUISVILLE KY 40206 611318326 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 311332491 RETIREMENT HOME IN 501(C)(3) 9 MERCY HEALTH PARTNERS OF SOUTHWEST OHIO false MERCY FRANCISCAN SOCIAL MINISTRIES INC 1800 LOGAN STREET CINCINNATI OH 45210 311222942 LOW INCOME HOUSING OH 501(C)(3) 7 MERCY HEALTH PARTNERS OF SOUTHWEST OHIO false MERCY FRANCISCAN AT ST RAPHAEL INC 610 HIGH STREET HAMILTON OH 45011 202934871 SERVICES TO THE POOR OH 501(C)(3) 7 MERCY HEALTH PARTNERS OF SOUTHWEST OHIO false COMMUNITY MERCY HEALTH SYSTEM ONE S LIMESTONE ST SPRINGFIELD OH 45502 300272454 REGIONAL PARENT OH 501(C)(3) 11 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PROPERTY HOLDINGS 2200 JEFFERSON AVENUE TOLEDO OH 43604 300699825 TITLE HOLDING COMPANY OH 501(C)(2) N/A MERCY HEALTH SYSTEM - NORTHERN REGION false ST CHARLES MERCY HOSPITAL OF OREGON OHIO 2600 NAVARRE AVENUE OREGON OH 43616 344445373 HOSPITAL OH 501(C)(3) 3 MERCY HEALTH SYSTEM - NORTHERN REGION false ST CHARLES MERCY HEALTH FOUNDATION 2600 NAVARRE AVENUE OREGON OH 43616 341414900 FOUNDATION OH 501(C)(3) 11 - Type III - FI ST CHARLES MERCY HOSPITAL OF OREGON OHIO false RIVERSIDE MERCY HOSPITAL 3404 W SYLVANIA AVE TOLEDO OH 43623 311556401 HOSPITAL OH 501(C)(3) 3 MERCY HEALTH SYSTEM - NORTHERN REGION false MERCY HOME CARE INC 2200 JEFFERSON AVENUE TOLEDO OH 43604 341587572 HOME HEALTHCARE OH 501(C)(3) 9 MERCY HEALTH SYSTEM - NORTHERN REGION false MERCY COLLEGE OF OHIO 2221 MADISON AVENUE TOLEDO OH 43604 341726619 MEDICAL COLLEGE OH 501(C)(3) 2 MERCY HEALTH SYSTEM - NORTHERN REGION false MERCY COLLEGE OF OHIO FOUNDATION INC 2221 MADISON AVENUE TOLEDO OH 43604 141963204 FOUNDATION OH 501(C)(3) 11 - Type I MERCY COLLEGE OF OHIO false MERCY HOSPITAL OF TIFFIN OHIO 45 ST LAWRENCE DRIVE TIFFIN OH 44883 344431174 HOSPITAL OH 501(C)(3) 3 MERCY HEALTH SYSTEM - NORTHERN REGION false MERCY TIFFIN HEALTH FOUNDATION 45 ST LAWRENCE DRIVE TIFFIN OH 44883 341499894 FOUNDATION OH 501(C)(3) 11 - Type III - FI MERCY HOSPITAL OF TIFFIN OHIO false THE SISTERS OF MERCY OF WILLARD OHIO 110 EAST HOWARD ST WILLARD OH 44890 341577110 HOSPITAL OH 501(C)(3) 3 MERCY HEALTH SYSTEM - NORTHERN REGION false MERCY HOSPITAL OF WILLARD FOUNDATION 110 EAST HOWARD ST WILLARD OH 44890 113742347 FOUNDATION OH 501(C)(3) 11 - Type III - FI THE SISTERS OF MERCY OF WILLARD OHIO false ST VINCENT MERCY MEDICAL CENTER 2213 CHERRY STREET TOLEDO OH 43608 344428250 HOSPITAL OH 501(C)(3) 3 MERCY HEALTH SYSTEM - NORTHERN REGION false ST VINCENT MERCY MEDICAL CENTER FOUNDATION 2213 CHERRY STREET TOLEDO OH 43608 237393213 FOUNDATION OH 501(C)(3) 11 - Type III - FI ST VINCENT MERCY MEDICAL CENTER false LIFESTAR AMBULANCE INC 2200 JEFFERSON AVENUE TOLEDO OH 43604 341354653 MEDICAL TRANSPORTATION OH 501(C)(3) 11 - Type II MERCY HEALTH SYSTEM - NORTHERN REGION false RSM MEDICAL FOUNDATION 2200 JEFFERSON AVENUE TOLEDO OH 43624 341693671 HOSPITAL OH 501(C)(3) 3 MERCY HEALTH SYSTEM - NORTHERN REGION false ST MARGUERITE D'YOUVILLE FOUNDATION II 2213 CHERRY STREET TOLEDO OH 43608 134350655 FOUNDATION OH 501(C)(3) 11 - Type II CATHOLIC HEALTH PARTNERS false SIMON OUTREACH SERVICES 2600 NAVARRE AVENUE OREGON OH 43616 341383325 MEDICAL OFFICE RENTAL OH 501(C)(3) 11 - Type II ST CHARLES MERCY HOSPITAL OF OREGON OHIO false FARLEY HEALTHCARE CORPORATION 2200 JEFFERSON AVENUE TOLEDO OH 43604 341363204 HEALTH SERVICES OH 501(C)(3) 9 MERCY HEALTH SYSTEM - NORTHERN REGION false ST RITA'S MEDICAL CENTER 730 W MARKET STREET LIMA OH 45801 341105619 HOSPITAL OH 501(C)(3) 3 CATHOLIC HEALTH PARTNERS false SRHC FOUNDATION 730 W MARKET STREET LIMA OH 45801 341368429 FOUNDATION OH 501(C)(3) 11 - Type III - FI ST RITA'S MEDICAL CENTER false NEW VISION MEDICAL LABORATORIES INC 750 W HIGH ST STE 400 LIMA OH 45801 341937267 MEDICAL LAB SERVICES OH 501(C)(3) 11 - Type III - FI ST RITA'S MEDICAL CENTER false HUMILITY OF MARY HEALTH PARTNERS 1044 BELMONT AVENUE YOUNGSTOWN OH 44501 340505560 HOSPITAL OH 501(C)(3) 3 CATHOLIC HEALTH PARTNERS false THE ASSUMPTION VILLAGE 9800 N MARKET STREET NORTH LIMA OH 44452 341013695 NURSING HOME OH 501(C)(3) 9 HUMILITY OF MARY HEALTH PARTNERS false HOSPICE OF THE VALLEY 5190 MARKET STREET YOUNGSTOWN OH 44512 341288745 HOSPICE SERVICES OH 501(C)(3) 9 HUMILITY OF MARY HEALTH PARTNERS false HUMILITY OF MARY DEVELOPMENT FOUNDATION 1044 BELMONT AVENUE YOUNGSTOWN OH 44501 341826978 FOUNDATION OH 501(C)(3) 11 - Type III - FI HUMILITY OF MARY HEALTH PARTNERS false HUMILITY HOUSE 755 OHLTOWN ROAD AUSTINTOWN OH 44515 341894783 NURSING HOME OH 501(C)(3) 9 HUMILITY OF MARY HEALTH PARTNERS false LAUREL LAKE RETIREMENT COMMUNITY INC 200 LAUREL LAKE DRIVE HUDSON OH 44236 341481142 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