2012-11-13T16:01:25-06:00 2011-12-31 440160260 BKD LLP 312 WALNUT STREET SUITE 300 CINCINNATI OH 45202 990 2011-01-01 311091597 MERCY HOSPITALS WEST MERC 5139815056 2446 Kipling Avenue Cincinnati OH 45239 DEBORAH BLOOMFIELD 2012-11-05 true P00961884 5136218300 2011 2016-02-24 21:20:13Z DEBORAH BLOOMFIELD 4600 mcauley place cincinnati OH 45242 189046269 false 0928 X WWW.E-MERCY.COM X 1999 OH MERCY HOSPITALS WEST CARES FOR ANYONE WHO COMES TO US, REGARDLESS OF ABILITY TO PAY, OFFERING FREE CARE TO ANYONE WITHOUT INSURANCE EARNING UP TO TWICE THE FEDERAL POVERTY GUIDELINES (FPG) & DISCOUNTS TO THOSE EARNING UP TO FOUR TIMES THE FPG. THOSE WITH INSURANCE WHO EARN MORE CAN ALSO QUALIFY FOR DISCOUNTS. 14 11 2013 575 4312173 0 698900 215825 184376083 187401484 167900 -133904 1296092 1408795 186538975 188892200 37600 52850 0 0 86138629 84576360 0 0 0 100682086 95246758 186858315 179875968 -319340 9016232 70021339 111974838 64254693 91143737 5766646 20831101 MERCY HOSPITALS WEST EXTENDS THE HEALING MINISTRY OF JESUS BY IMPROVING THE HEALTH OF OUR COMMUNITIES WITH EMPHASIS ON PEOPLE WHO ARE POOR AND UNDER-SERVED. false false 142798460 52850 187401484 THE PRIMARY EXEMPT PURPOSE OF MERCY HOSPITALS WEST 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 HOSPITALS WEST 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 IN 2011 WAS $5,578,185 SERVING 29,309 INDIVIDUALS. 142798460 true true false true false false false false false true false false false true true false true false false false false false false false false true true true false true false false false false false false false false false false false false false true false false false false true 0 0 2013 true true true false false false false false false false false false X 14 11 false false false false true true true true true false false true true true true true true false false false X DEBORAH BLOOMFIELD 5139815056 4600 MCAULEY PLACE CINCINNATI OH 45242 X DAVID J FREY 0.30 X X 0 0 0 GERMAINE BENNETT 0.30 X X 0 0 0 JAMES MAY 0.30 X X 0 1032294 197285 TODD GARDNER 0.30 X X 0 0 0 BEVERLY GRANT 0.30 X 0 0 0 DAVID C REED MD 0.30 X 0 0 0 DONALD WAYNE MD 0.30 X 0 690449 51947 GLORIA HAFFER 0.30 X 0 0 0 KIMBERLY MAUER 0.30 X 0 0 0 L RICHARD ROEDERSHEIMER MD 0.30 X 0 0 0 NEIL O'CONNOR 0.30 X 0 0 0 SR MARJORIE BOSSE RSM 0.30 X 0 0 0 SR MARY STANTON RSM 0.30 X 0 0 0 STEPHEN HEIS MD 0.30 X 0 0 0 STEVEN L MICKUS 0.30 X 0 1393505 322574 TIMOTHY INGRAM 0.30 X 0 0 0 DEBORAH BLOOMFIELD 0.30 X 0 461338 73008 MICHAEL STEPHENS 40.00 X 185211 0 18411 PATRICK KOWALSKI 40.00 X 458532 0 62086 PAUL HILTZ 40.00 X 293344 148766 81041 CLAIRE COMBS 1.00 X 0 413716 86427 DONALD ROHLING 1.00 X 0 208027 46993 JOYCE KEEGAN 40.00 X 179721 0 21128 LEE ANN LISKA 1.00 X 0 460233 73988 LEONARD M RANDOLPH JR MD 1.00 X 0 472625 67889 MAGGIE LUND 1.00 X 0 312901 47068 MICHAEL KRAMER 1.00 X 0 181410 28388 PATRICIA SCHROER 1.00 X 0 381041 78986 YOUSUF JAMAL AHMAD 1.00 X 0 394121 60284 CHRISTINE KIRBY 40.00 X 137906 0 25354 DAVID FINN 40.00 X 138452 0 26866 LARRY BAGBY 40.00 X 160560 0 25623 LOIS BOWMAN 40.00 X 149257 0 27739 MARK MAYHAUS 40.00 X 138230 0 35457 KEVIN COOK 0.00 X 0 538373 50813 THOMAS URBAN 0.00 X 0 496304 147273 1841213 7585103 1656628 32 true true false 0 93117 75010 47698 215825 NET PATIENT SERVICE REVENUE 621990 176620008 176620008 LABORATORY FEES 621500 7184084 4737939 2446145 RENTAL INCOME FROM AFFILIATES 531120 1731364 1731364 FITNESS CENTER 713940 1866028 1866028 0 0 0 0 187401484 18665 18665 0 0 0 0 0 1500 154069 0 -152569 -152569 -152569 0 0 0 CAFETERIA 722210 567754 567754 GIFT SHOP 900099 515603 515603 CHILDCARE 624410 206998 206998 118440 0 0 118440 1408795 188892200 183089311 4312173 1274891 52850 52850 0 0 0 1278213 958660 319553 0 66885695 50164271 16721424 2712892 2034669 678223 8890069 6667552 2222517 4809491 3607118 1202373 0 316 316 52198 52198 0 0 0 49207442 36905581 12301861 0 0 0 0 7011196 5258397 1752799 276193 207145 69048 0 0 1009765 757324 252441 0 3493246 2619935 873311 2024420 1518315 506105 MEMBERSHIP DUES 217114 162835 54279 OHIO FRANCHISE FEES 1685848 1685848 MEDICAL SUPPLIES 29984781 29984781 284239 213179 71060 0 179875968 142798460 37077508 0 0 706821 2272425 17965744 21063809 2567148 2802168 258079 192128 126715287 41912818 47975916 84802469 0 0 0 0 547631 841839 70021339 111974838 11817304 14339983 52437389 76803754 64254693 91143737 X 5766646 20831101 5766646 20831101 70021339 111974838 X 9016232 6048223 X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED true false false true 0 false true 3629 false false false 3629 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. 26080198 26080198 50824895 2769396 48055499 0 49810194 39143422 10666772 0 84802469 0 DEFERRED RENT 251455 DEFERRED INCOME 17121 FINANCIAL GUARANTEES-MOB LEASEBACK 1761092 OTHER LONG TERM LIABILITIES 4017363 NOTES PAYABLE TO AFFILIATE 70756723 76803754 188892200 179875968 9016232 0 0 9016232 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 29309 6839749 1261564 5578185 0.03100 36521 21953962 15021252 6932710 0.03850 0 0.00000 0 65830 28793711 16282816 12510895 0.06950 12 2651 277803 277803 0.00150 5 633 133249 133249 0.00070 1 373 2530308 2530308 0.01410 0 0.00000 15 3552 98993 98993 0.00060 33 7209 3040353 0 3040353 0.01690 33 73039 31834064 16282816 15551248 0.08640 0 0.00000 0 0.00000 1 42150 42150 0.00020 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 1 0 42150 0 42150 0.00020 false 17024480 0 55960476 48527036 7433440 X true true 2 1 MERCY HOSPITAL MT AIRY

2446 KIPLING AVENUE CINCINNATI OH 45239

X X X 2 MERCY HOSPITAL WESTERN HILLS

3131 QUEEN CITY AVENUE CINCINNATI OH 45238

X X X 1 HARRISON MEDICAL CENTER

10450 NEW HAVEN ROAD HARRISON OH 45030

24-HOUR EMERGENCY MEDICAL CARE, DIAGNOSTIC SERVICES AND PHYSICAL THERAPY Community benefit report prepared by related organization Schedule H, Part I, Line 6a MERCY HEALTH PARTNERS OF SOUTHWEST OHIO COMMUNITY BENEFIT REPORT PART I, LINE 6A THE ORGANIZATION'S COMMUNITY BENEFIT REPORT IS CONTAINED IN A REPORT PREPARED BY MERCY HEALTH PARTNERS - SOUTHWEST OHIO (MHP-SWO), A RELATED TAX EXEMPT ORGANIZATION. A COPY OF THE COMMUNITY BENEFIT REPORT CAN BE FOUND ON THE MHP-SWO WEBSITE AT E-MERCY.COM AND ON THE ORGANIZATION'S INTRANET. THE REPORT IS PUBLISHED IN THE GREATER CINCINNATI NEWSPAPERS AND MADE PUBLIC ON POSTER BOARDS THROUGHOUT THE ORGANIZATION. 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 DETERMINED 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 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 Community Building Activities Schedule H, Part II MERCY HOSPITALS WEST (MHW) PROVIDES COMMUNITY SUPPORT BY ASSISTING IN DISASTER PREPAREDNESS. PREPARING FOR DISASTER IS AN IMPORTANT ROLE FOR THE HOSPITAL TO ASSURE THE SAFETY AND HEALTH OF COMMUNITY RESIDENTS IN THE EVENT OF A NATURAL DISASTER, INDUSTRIAL ACCIDENT OR OTHER LARGE SCALE EMERGENCY. THE CHILDREN'S CENTER/DAY CARE SUBSIDIZED PROGRAM FOR THE POOR HELPS RESIDENTS MAINTAIN EMPLOYMENT BY PROVIDING LOW COST /HIGH QUALITY DAY CARE FOR THEIR CHILDREN. MHW SUPPORTS THE EVERY CHILD SUCCEEDS COMMUNITY PROGRAM BY PROVIDING SPACE TO OPERATE THE PROGRAM. MHW MAKES DONATIONS TO COMMUNITY GROUPS. 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 HOSPITAL MT. AIRY - 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.;(2) MERCY HOSPITAL WESTERN HILLS - 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 THE HOSPITAL USES EXISTING COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS SUCH AS THE 2011 UNITED WAY OF GREATER CINCINNATI REPORT (THE STATE OF THE COMMUNITY - A REPORT ON THE SOCIO-ECONOMIC HEALTH OF THE GREATER CINCINNATI REGION) AND THE GREATER CINCINNATI HEALTH COUNCIL REPORT (INDICATORS OF HEALTHY COMMUNITIES 2011). THE HOSPITAL USES 2011 DATA PROVIDED BY THE OHIO HOSPITAL ASSOCIATION. THE HOSPITAL ALSO UTILIZES HOSPITAL PERSONNEL AND PHYSICIANS WHO HAVE IDENTIFIED COMMUNITY NEEDS BASED ON ADMISSION/DISCHARGE AND OTHER HOSPITAL DATA. BASED ON THIS DATA AND INFORMATION, THE HOSPITAL ASSESSES AND CONTINUALLY RESPONDS TO CHANGING COMMUNITY NEEDS THROUGH THE SERVICES OFFERED. THE HOSPITAL 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. THE HOSPITAL INCORPORATES PLANNING FOR COMMUNITY BENEFITS AS PART OF ITS ANNUAL BUSINESS AND STRATEGIC PLANNING PROCESSES. TO HELP FACILITATE THIS PLANNING PROCESS, THE HOSPITAL UTILIZES QUANTITATIVE PRIMARY MARKET RESEARCH AND THE ANALYSIS OF HEALTH CARE UTILIZATION DATA BASES. IN ADDITION, SERVICE USE IS FORECAST UTILIZING LICENSED POPULATION BASED SOFTWARE. THE HOSPITAL HAS DEDICATED STAFF TO ASSIST IN THE COMMUNITY BENEFIT PLANNING, REPORTING, MONITORING AND IMPLEMENTATION OF COMMUNITY BENEFIT PROGRAMS AND SERVICES. THIS STAFF DEDICATED TO COMMUNITY BENEFIT EFFORTS OF THE HOSPITAL MEETS WITH THE REGIONAL COMMUNITY BENEFIT PLANNING COMMITTEE ON A MONTHLY BASIS AND WORKS CLOSELY WITH HEALTH AND HUMAN SERVICE ORGANIZATIONS IN THE AREA, PARTNERING WITH SOME TO PROVIDE SERVICES AND TO AVOID DUPLICATION. COMMUNITY BENEFIT ACTIVITIES AND PROGRAM EFFECTIVENESS ARE REPORTED TO THE REGIONAL BOARD BY THE HUMAN RESOURCE, MISSION AND COMMUNITY OUTREACH COMMITTEE OF THE REGIONAL BOARD. Patient education of eligibility for assistance. Schedule H, Part VI, Line 3 MERCY HOSPITALS WEST (MHW) 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. MHW 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. MHW 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 MHW. 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. MHW 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 MHW'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 BEEN THE HEART OF OUR MISSION. IN 2011 HELP, WITH THE ASSISTANCE OF AN OUTSIDE AGENCY, MANAGED 23,631 PATIENT REFERRALS. MHW IS PROUD TO MAKE OUR FINANCIAL ASSISTANCE INFORMATION AVAILABLE TO THE PUBLIC THROUGH OUR WEBSITE, WHICH CAN BE FOUND AT E-MERCY.COM. OTHER PATIENT EDUCATION INFORMATION THAT IS PROVIDED FOR ELIGIBILITY OF ASSISTANCE IS AS FOLLOWS: * A BILINGUAL REPRESENTATIVE IS AVAILABLE IN OUR OB CLINIC AT FAIRFIELD. TWO BILINGUAL REPRESENTATIVES ARE AVAILABLE IN OUR CUSTOMER SERVICE DEPARTMENT. * STAFF TRAINING ON HOSPITAL CARE ASSURANCE PROGRAM (HCAP) AND HOSPITAL FINANCIAL ASSISTANCE (HFA) WAS PROVIDED IN 2009 BY A PRIVATE AUDITING COMPANY. TRAINING INCLUDED A MANUAL AND IN-DEPTH INFORMATION REGARDING THE PREPARATION OF THE COST REPORT LOGS, ACCURATE COMPLETION OF THE HCAP APPLICATION AS WELL AS AN OVERVIEW OF THE FAQ'S PROVIDED BY THE OHIO HOSPITAL ASSOCIATION. * STAFF TRAINING PROVIDED BY SOCIAL SECURITY ADMINISTRATION TO ASSIST PATIENTS IN OBTAINING DISABILITY BENEFITS. * FINANCIAL ASSISTANCE COUNSELORS WORK WITH CASE MANAGERS TO EXPEDITE THE TRANSFER OF PATIENTS TO EXTENDED CARE FACILITIES. * FEDERAL POVERTY GUIDELINES ARE POSTED ON OUR WEBSITE AS WELL AS A COPY OF OUR CHARITY APPLICATION. * ALL THIRD PARTIES THAT WORK ON BEHALF OF THE ORGANIZATION TO COLLECT FEES (SUCH AS COLLECTION AGENCIES AND LAW FIRMS) ARE REQUIRED TO FOLLOW THE HOSPITAL'S POLICIES REGARDING PATIENT NOTIFICATION ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE. * CONSISTENT REVIEW OF SELF PAY PATIENTS FOR RETROACTIVE MEDICAID COVERAGE. * SERVICES PROVIDED BY VENDOR TO REACH OUT TO PATIENTS IN BAD DEBT TO SCREEN FOR HCAP ELIGIBILITY. Community information. Schedule H, Part VI, Line 4 MERCY HOSPITALS WEST (MHW) SERVES A ONE-COUNTY GEOGRAPHIC AREA FEATURING HAMILTON COUNTY. THE POPULATION OF MHW'S PRIMARY SERVICE AREA IS APPROXIMATELY 464,300. OUR COMMUNITY IS CHANGING AND WE ALSO SERVE A GROWING UNINSURED AND UNDERINSURED POPULATION. THERE ARE EIGHT HOSPITALS IN THE COMMUNITY OF WHICH ALL EIGHT ARE NOT-FOR-PROFIT HOSPITALS. MHW QUALIFIES FOR A DISPROPORTIONATE SHARE PAYMENT ON THEIR MEDICARE COST REPORT DUE TO THE LARGER THAN NORMAL SHARE OF MEDICAID PATIENT VOLUME SERVED BY THE HOSPITAL. THE DEMOGRAPHIC AREA SERVED BY MHW SERVES A POPULATION THAT INCLUDES 4.2% OF NON-ENGLISH SPEAKING PEOPLE. 8.0% OF RESIDENTS ARE IN HOUSEHOLDS BELOW THE FEDERAL POVERTY GUIDELINES. THE AVERAGE FAMILY HOUSEHOLD INCOME OF THE COMMUNITY SERVED BY THE HOSPITAL IS $58,939. THE LARGEST ETHNIC GROUP IN THE COMMUNITY SERVED BY THE HOSPITAL IS GERMAN. APPROXIMATELY 33% OF THE POPULATION IS OF GERMAN DESCENT. THE OCCUPATION CLASSIFICATION IN THE COMMUNITY CONSISTS OF 21% BLUE COLLAR, 61% WHITE COLLAR AND 18% SERVICE & FARM WORKERS. THE PERCENTAGE OF THE POPULATION IN THE COMMUNITY OVER 65 YEARS OLD IS 14%. IN THE COMMUNITY SERVED BY MHW CARDIAC ARREST, SEPTICEMIA AND ACUTE RESPIRATORY FAILURE 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. MHW WORKS CLOSELY WITH LOCAL COMMUNITY AGENCIES AND HEALTH DEPARTMENTS TO ADDRESS HEALTH PROBLEMS AND MINIMIZE THE EFFECTS ON THOSE WHO SUFFER. IN 2011, MHW HAD 13,672 ADMISSIONS, 113,594 OUTPATIENT VISITS, AND 96,680 EMERGENCY ROOM VISITS. Promotion of community health Schedule H, Part VI, Line 5 THE HOSPITAL OPERATES AN EMERGENCY ROOM OPEN TO ALL PERSONS REGARDLESS OF ABILITY TO PAY. IN ADDITION TO PROVIDING EMERGENCY SERVICES, THE HOSPITAL PROVIDES MINOR EMERGENCY AND URGENT CARE SERVICES TO ALL REGARDLESS OF ABILITY TO PAY. THE HOSPITAL PARTICIPATES IN MEDICAID, MEDICARE, CHAMPUS, AND/OR OTHER GOVERNMENT SPONSORED HEALTH PROGRAMS. THROUGH THE HEALTH PARTNERSHIP PROGRAM AND THE MERCY CLINIC, THE HOSPITAL CONNECTS POOR AND LOW INCOME RESIDENTS WITH PRIMARY CARE PHYSICIANS IN THE COMMUNITY WHO VOLUNTEER THEIR SERVICES TO PROVIDE PRIMARY AND URGENT CARE SERVICES. THE HOSPITAL ALSO PROVIDES PHARMACEUTICAL SUPPORT FOR THESE POOR AND LOW INCOME RESIDENTS. THE HOSPITAL ALSO COLLABORATES WITH LOCAL FEDERALLY QUALIFIED HEALTH CENTERS SUCH AS LINCOLN HEIGHTS HEALTH CENTER AND HEALTH SOURCE OF OHIO AS WELL AS COMMUNITY AGENCIES SUCH AS HEALTH CARE ACCESS NOW TO FURTHER ASSIST THE POOR AND MEDICALLY UNDERSERVED FIND A MEDICAL HOME IN THE COMMUNITY. MEDICAL SUPPLIES AND EQUIPMENT ARE DONATED TO LOCAL AGENCIES AS WELL AS TO AGENCIES WHICH SERVE OTHER COUNTRIES. THE HOSPITAL HAS AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED IN THE AREA. THE MAJORITY OF THE GOVERNING BODY CONSISTS OF INDEPENDENT PERSONS REPRESENTATIVE OF THE COMMUNITY SERVED BY THE HOSPITAL. THE HOSPITAL SERVES AS A CLINICAL EXPERIENCE SITE FOR SURGICAL RESIDENTS AS WELL AS OTHER HEALTH CARE PROFESSIONALS, SUCH AS NURSES, RESPIRATORY THERAPISTS, PHYSICAL THERAPISTS, OCCUPATIONAL THERAPISTS AND OTHERS. COMMUNITY GROUPS AND INDIVIDUALS ARE VERY SUPPORTIVE OF THE HOSPITAL AS IS EVIDENCED BY THE LARGE NUMBER OF VOLUNTEERS. THE HOSPITAL RECEIVES GUIDANCE AND INPUT FROM ITS COMMUNITY ADVISORY COUNCIL. Affiliated health care system Schedule H, Part VI, Line 6 THE HOSPITALS WHICH COMPRISE MHW (MERCY HOSPITAL MT. AIRY AND MERCY HOSPITAL WESTERN HILLS) ARE TWO OF THE SIX COMMUNITY HOSPITALS THAT ARE PART OF MERCY HEALTH PARTNERS OF SOUTHWEST OHIO (MHP-SWO). ALL ARE ACUTE CARE HOSPITALS AND OHIO NON-PROFIT CORPORATIONS. THE HOSPITALS ARE SPONSORED BY THE SISTERS OF MERCY AND THE FRANCISCAN SISTERS OF THE POOR AND HAVE BEEN PART OF THE COMMUNITY SINCE THEY WERE FOUNDED IN THE FOLLOWING YEARS: THE JEWISH HOSPITAL 1850 LICENSED BEDS: 209 MERCY HOSPITAL MT. AIRY 1971 LICENSED BEDS: 269 MERCY HOSPITAL CLERMONT 1973 LICENSED BEDS: 166 MERCY HOSPITAL FAIRFIELD 1978 LICENSED BEDS: 221 MERCY HOSPITAL WESTERN HILLS 1982 LICENSED BEDS: 261 MERCY HOSPITAL ANDERSON 1984 LICENSED BEDS: 193 EACH OF THE HOSPITALS WORKS INDIVIDUALLY AND COLLECTIVELY TO IDENTIFY AND ADDRESS COMMUNITY HEALTH NEEDS. IN ADDITION, MERCY FRANCISCAN AT ST. JOHN AND MERCY FRANCISCAN AT ST. RAPHAEL ARE TWO SOCIAL SERVICE AGENCIES THAT PROVIDE SHELTER, FOOD, EDUCATION, CLOTHES, AND HEALTH SERVICES TO CLIENTS IN ECONOMICALLY DEPRESSED NEIGHBORHOODS IN INNER CITY CINCINNATI AND HAMILTON. MHP-SWO IS THE SOLE SPONSOR FOR THESE AGENCIES. IN ADDITION, MHP-SWO INCLUDES A TOTAL OF 6 SENIOR HEALTH AND HOUSING COMMUNITIES IN CINCINNATI, OHIO, HAMILTON, OHIO, LOUISVILLE KENTUCKY AND NEW ALBANY, INDIANA. THESE SENIOR HEALTH AND HOUSING FACILITIES PROVIDE COMMUNITY BENEFIT SERVICES FOR THEIR RESIDENTS AND THE COMMUNITIES THEY SERVE. MERCY HEALTH PARTNERS OF SOUTHWEST OHIO COMMUNITY BENEFIT FOR 2011 PER THE AUDIT FOOTNOTE IS AS FOLLOWS: TOTAL 2011 COMMUNITY BENEFIT: $86.3 MILLION BENEFITS TO THE BROADER COMMUNITY: $10.7 MILLION UNREIMBURSED CARE FOR THOSE WHO ARE POOR AND QUALIFY FOR MEDICAID: $34.8 MILLION COST OF CARE FOR THOSE WHO COULD NOT AFFORD TO PAY: $33.0 MILLION SUPPORT FOR OTHER PROGRAMS FOR THOSE WHO ARE POOR: $7.7 MILLION COMMUNITY BENEFIT AS PERCENT OF TOTAL EXPENSE: 9.2 PERCENT MERCY HOSPITALS WEST 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 FOUR 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 ST IGNATIUS OF LOYOLA PARISH & SCHOOL 5222 NORTH BEND ROAD CINCINNATI OH 45247 530196617 501(C)(3) 40000 MISSION SUPPORT 1 0 Procedures for monitoring use of grant funds Schedule I, Part I, Line 2 ADMINISTRATION PERSONNEL REVIEW DOCUMENTATION SUBMITTED FOR THE INTENDED USE OF THE DONATIONS MADE. X true true false true false false false false false true false CHRISTINE KIRBY 128145 0 9072 0 689 0 9136 0 16218 0 163260 0 0 0 CLAIRE COMBS 0 328849 0 71153 0 13714 0 66310 0 20117 0 500143 0 0 DAVID FINN 137561 0 0 0 891 0 8926 0 17940 0 165318 0 0 0 DEBORAH BLOOMFIELD 0 369246 0 83127 0 8965 0 58066 0 14942 0 534346 0 0 DONALD ROHLING 0 164012 0 31528 0 12487 0 33515 0 13478 0 255020 0 0 DONALD WAYNE MD 0 568368 0 119337 0 2744 0 33184 0 18763 0 742396 0 0 JAMES MAY 0 597248 0 232123 0 202923 0 165366 0 31919 0 1229579 0 0 JOYCE KEEGAN 158741 0 17920 0 3060 0 13807 0 7321 0 200849 0 0 0 KEVIN COOK 0 510384 0 15000 0 12989 0 31670 0 19143 0 589186 0 0 LARRY BAGBY 159936 0 0 0 624 0 10516 0 15107 0 186183 0 0 0 LEE ANN LISKA 0 367989 0 77761 0 14483 0 47906 0 26082 0 534221 0 0 LEONARD M RANDOLPH JR MD 0 371985 0 81718 0 18922 0 46554 0 21335 0 540514 0 0 LOIS BOWMAN 148936 0 0 0 321 0 13871 0 13868 0 176996 0 0 0 MAGGIE LUND 0 246108 0 57067 0 9726 0 38581 0 8487 0 359969 0 0 MARK MAYHAUS 137701 0 300 0 229 0 15313 0 20144 0 173687 0 0 0 MICHAEL KRAMER 0 162517 0 18062 0 831 0 9520 0 18868 0 209798 0 0 MICHAEL STEPHENS 161656 0 15686 0 7869 0 8266 0 10145 0 203622 0 0 0 PATRICIA SCHROER 0 302479 0 66242 0 12320 0 62855 0 16131 0 460027 0 0 PATRICK KOWALSKI 266898 0 182016 0 9618 0 42452 0 19634 0 520618 0 0 0 PAUL HILTZ 114954 144824 171876 0 6514 3942 48006 14135 11774 7126 353124 170027 0 0 STEVEN L MICKUS 0 835062 0 338741 0 219702 0 296067 0 26507 0 1716079 0 0 THOMAS URBAN 0 386425 0 95940 0 13939 0 132334 0 14939 0 643577 0 0 YOUSUF JAMAL AHMAD 0 315656 0 69059 0 9406 0 40292 0 19992 0 454405 0 0 Health or social club dues or initiation fees Schedule J, Part I, Line 1a BECAUSE THE ORGANIZATION'S MISSION INCLUDES PROMOTING GOOD HEALTH FOR ALL, INCLUDING ITS OWN EMPLOYEES, THE ORGANIZATION PAYS PART OF THE MONTHLY DUES FOR MERCY HEALTHPLEX FACILITIES (RELATED ORGANIZATIONS), WHICH ARE HEALTH CLUBS. THE BENEFIT IS AVAILABLE TO ALL EMPLOYEES, NOT JUST EXECUTIVES. THE ENTIRE BENEFIT WAS TREATED AS TAXABLE COMPENSATION AND WAS PROVIDED FOR THE FOLLOWING LISTED INDIVIDUALS: JOYCE KEEGAN, CHRISTINE KIRBY, PATRICK KOWALSKI, DAVID FINN, AND MICHAEL STEPHENS. Arrangement used to establish the top management official's compensation Schedule J, Part I, Line 3 THE COMPENSATION OF PATRICK KOWALSKI, CEO WESTERN HILLS, AND PAUL HILTZ, CEO MT. AIRY, IS DETERMINED BY MERCY HEALTH PARTNERS OF SOUTHWEST OHIO (MHPSWO), A RELATED TAX-EXEMPT ORGANIZATION. MHPSWO UTILIZES A COMPENSATION COMMITTEE, A WRITTEN EMPLOYMENT CONTRACT, AN INDEPENDENT COMPENSATION CONSULTANT, AND APPROVAL BY BOARD OR COMPENSATION COMMITTEE WHEN DETERMINING MR. KOWALSKI'S AND MR. HILTZ'S COMPENSATION. Supplemental nonqualified retirement plan Schedule J, Part I, Line 4b THE MHP EXECUTIVE BENEFIT PLAN IS A DEFERRED COMPENSATION PLAN WHICH PROVIDES EMPLOYMENT CONTINUATION INCENTIVES TO ALL EXECUTIVE COUNCIL MEMBERS. IT PROVIDES ANNUAL CREDITS OF A SPECIFIED PERCENTAGE OF COMPENSATION. A BENEFIT IS CALCULATED FOR ANY INDIVIDUAL WHOSE COMPENSATION IS LIMITED IN THE QUALIFIED CASH BALANCE PLAN DUE TO INCOME WHICH EXCEEDS THE IRS MAXIMUM. THE BENEFIT IS BASED UPON FORM W-2 COMPENSATION AND IS EQUAL TO THE AMOUNT EXCLUDED FROM THE QUALIFIED PLAN. ADDITIONAL CONTRIBUTIONS ARE MADE ON AN ANNUAL BASIS WHICH ARE A PERCENTAGE OF BASE COMPENSATION. PARTICIPANTS MUST COMPLETE A TWO TIERED VESTING PROVISION. PARTICIPANTS MUST BE VESTED UNDER THE BASE QUALIFIED PLAN AND MUST COUNT 24 MONTHS AFTER TERMINATION DURING WHICH THEY DO NOT COMPETE WITH MERCY HEALTH PARTNERS OF SOUTHWEST OHIO. AMOUNTS INCLUDIBLE AS TAXABLE COMPENSATION FOR LISTED INDIVIDUALS DUE TO EXECUTIVE BENEFIT PLAN PARTICIPATION IN THE REPORTING YEAR WERE AS FOLLOWS: PATRICK KOWALSKI $0; PAUL HILTZ $0; MICHAEL STEPHENS $0; DEBORAH BLOOMFIELD $0; LEONARD M. RANDOLPH JR., MD $0; CLAIRE COMBS $0; YOUSUF JAMAL AHMAD $0; MAGGIE LUND $0; DONALD ROHLING $0; LEE ANN LISKA $0; PATRICIAN SCHROER $0; THOMAS URBAN $0. TERMS AND CONDITIONS OF CHP EXECUTIVE RETENTION PLAN 457(F) PART I, LINE 4B THE 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 DUES TO RETENTION PLAN PARTICIPATION IN THE REPORTING YEAR WERE AS FOLLOWS: JAMES MAY $0; STEVEN MICKUS $0. TERMS AND CONDITIONS OF THE CHP SERP PLAN PART I, LINE 4B THE 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 INCLUDABLE AS TAXABLE COMPENSATION FOR LISTED INDIVIDUALS DUE TO SERP PARTICIPATION IN THE REPORTING YEAR WERE AS FOLLOWS: JAMES MAY $129,591; THOMAS URBAN $164; STEVEN MICKUS $184,461. Non-fixed payments Schedule J, Part I, Line 7 SELECT OFFICERS, KEY EMPLOYEES AND HIGHEST COMPENSATED EMPLOYEES RECEIVE A BONUS PAYMENT BASED ON CERTAIN CRITERIA BEING MET IN THE PRIOR YEAR. THESE CRITERIA INCLUDE MEETING A CERTAIN NET EARNINGS AMOUNT AS WELL AS MEETING TARGETED PATIENT SATISFACTION SCORES AND PROVIDING A CERTAIN DOLLAR VALUE IN COMMUNITY BENEFIT SERVICES. 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 OF SOUTHWEST OHIO (MHP - SWO) IS THE SOLE MEMBER OF MERCY HOSPITALS WEST. 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 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 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 EACH YEAR TRUSTEES COMPLETE A CONFLICT OF INTEREST STATEMENT THAT IS SUBSEQUENTLY APPROVED BY THE AUDIT & CORPORATE RESPONSIBILITY COMMITTEE (ACRC) AT MHP - SWO AND THEN SENT TO CHP FOR THEIR ACRC TO APPROVE. ANY CONFLICTS OF INTEREST THAT OCCUR DURING THE YEAR ARE REQUIRED TO BE BROUGHT TO THE ATTENTION OF THE ACRC AT MHP - SWO. 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 PARTNERS WEBSITE. Average number of hours devoted per week to related organization Form 990, Part VII, Section A, Column B DAVID J. FREY - 2.1 GERMAINE BENNETT - 4.1 JAMES MAY - 44.9 TODD GARDNER - 2.1 BEVERLY GRANT - 2.1 DAVID C. REED, MD - 2.1 DONALD WAYNE, MD - 2.1 GLORIA HAFFER - 2.1 KIMBERLY MAUER - 2.1 L. RICHARD ROEDERSHEIMER, MD - 2.1 NEIL O'CONNOR - 2.1 SR MARJORIE BOSSE, RSM - 3.1 SR MARY STANTON, RSM - 2.1 STEPHEN HEIS, MD - 2.1 STEVEN L. MICKUS - 57.6 TIMOTHY INGRAM - 2.1 DEBORAH BLOOMFIELD - 42.7 CLAIRE COMBS - 44 DONALD ROHLING - 44 LEE ANN LISKA - 43 LEONARD M. RANDOLPH, JR, MD - 43 MAGGIE LUND - 43 MICHAEL KRAMER - 43 PATRICIA SCHROER - 43 YOUSUF JAMAL AHMAD - 43 KEVIN COOK - 51 THOMAS URBAN - 40 Other changes in net assets or fund balances Form 990, Part XI, Line 5 ELIMINATION OF I/C BALANCES - 6048223; 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 - Type III - FI CATHOLIC HEALTH PARTNERS false COMMUNITY MERCY HEALTH PARTNERS ONE S LIMESTONE ST SPRINGFIELD OH 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