2011-11-10T16:00:29-06:00 2010-12-31 BKD LLP 312 WALNUT STREET SUITE 300 CINCINNATI OH 45202 990 2010-01-01 310537085 MERCY HOSPITAL ANDERSON MERC 5139815056 7500 State Road Cincinnati OH 45255 DEBORAH BLOOMFIELD 2011-11-03 true 5136218300 2010 2016-03-07 17:11:31Z DEBORAH BLOOMFIELD 4600 MCAULEY PLACE CINCINNATI OH 45242 180693856 false 0928 X WWW.E-MERCY.COM X 1970 OH MERCY HOSPITAL ANDERSON CARES FOR ANYONE WHO COMES TO US, REGARDLESS OF ABILITY TO PAY, OFFERING FREE CARE TO THOSE WITHOUT INSURANCE EARNING UP TO TWICE THE FEDERAL POVERTY GUIDELINES (FPG) & SUBSTANTIAL DISCOUNTS TO THOSE EARNING UP TO FOUR TIMES THE FPG. THOSE WITH INSURANCE WHO EARN MORE CAN ALSO QUALIFY FOR DISCOUNTS. 16 11 1262 457 0 0 721170 333955 174005538 176440026 1001271 2929922 1606013 989953 177333992 180693856 24741 45220 0 0 61259673 58441056 0 0 0 98386905 100509222 159671319 158995498 17662673 21698358 110746053 118814203 42208239 42501229 68537814 76312974 MERCY HOSPITAL ANDERSON EXTENDS THE HEALING MINISTRY OF JESUS BY IMPROVING THE HEALTH OF OUR COMMUNITIES WITH EMPHASIS ON PEOPLE WHO ARE POOR AND UNDER-SERVED. false 119256204 45220 177429979 MERCY HOSPITAL ANDERSON EXTENDS THE HEALING MINISTRY OF JESUS BY IMPROVING THE HEALTH OF OUR COMMUNITIES WITH EMPHASIS ON PEOPLE WHO ARE POOR AND UNDER-SERVED. MERCY HOSPITAL ANDERSON ACCOMPLISHES THIS BY DEMONSTRATING BEHAVIORS REFLECTING OUR CORE VALUES OF COMPASSION, EXCELLENCE, HUMAN DIGNITY, JUSTICE, SACREDNESS OF LIFE AND SERVICE. TOTAL CHARITY CARE PROVIDED IN 2010 WAS $6,580,698 SERVING 15,955 INDIVIDUALS. 119256204 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 false true true true false false false false false false false true false false false false false true false false false false true 0 0 1262 true false false false false false false false false false false X 16 11 false false false false true true true true true false false true true true true true true false false true true X DEBORAH BLOOMFIELD 5139815056 4600 MCAULEY PLACE CINCINNATI OH 45242 X THOMAS URBAN 0 X 0 506495 106603 PATRICIA SCHROER 40 X 378635 0 78206 JAMES E MAY 2 X X 0 937068 177170 DEBORAH BLOOMFIELD 2 X 0 440904 72297 DAVID C REED MD 2 X X 0 0 0 SR MARJORIE BOSSE RSM 2 X 0 0 0 GERMAINE BENNETT 2 X 0 0 0 TODD GARDNER 2 X 0 0 0 TIMOTHY INGRAM 2 X 0 0 0 KIMBERLY MAUER 2 X 0 0 0 NEIL O'CONNOR 2 X 0 0 0 GEORGE SHYBUT MD 2 X 0 0 0 L RICHARD ROEDERSHEIMER MD 2 X 0 0 0 SR MARY STANTON RSM 2 X 0 0 0 LEONARD M RANDOLPH JR MD 1 X 0 460284 66171 CLAIRE COMBS 1 X 0 410225 87564 LYNN FARRAR 1 X 0 271644 120412 YOUSUF JAMAL AHMAD 1 X 0 358459 60344 MAGGIE LUND 1 X 0 285756 40958 DONALD ROHLING 1 X 0 192781 40400 DANIEL ROTH MD 0 X 0 157263 21182 CRAIG WRIGHT 40 X 140831 0 34239 D TERRY BOYS 0 X 0 209496 11303 WILLIAM CARROLL 40 X 145695 0 33551 DAVID J FREY 2 X X 0 0 0 BEVERLY GRANT 2 X 0 0 0 GLORIA HAFFER 2 X 0 0 0 DONALD WAYNE MD 2 X 0 0 0 MICHAEL KRAMER 1 X 0 161163 27661 STEPHEN FEAGINS MD 40 X 255019 0 17786 JULIE HOLT 40 X 174997 0 22098 LEE ANN LISKA 1 X 0 164255 28991 STEVEN MICKUS 2 X 0 1473700 289519 RANDALL BOYD 40 X 140530 0 32981 LEAH NICOLE WHITENER 40 X 131495 0 10471 JASON NIEHAUS 40 X 71788 107883 37016 1438990 6137376 1416923 24 true true false 0 309151 21604 3200 333955 NET PATIENT SERVICE REVENUE 621990 174877566 174877566 PHARMACY (PATIENT) 446110 35535 35535 RENTAL INCOME FROM AFFILIATES 531120 559020 559020 INCOME FROM JV'S & PARTNERSHIPS 621990 967905 967905 0 0 0 0 176440026 693395 693395 0 0 0 0 0 2162878 73649 2162878 73649 2236527 2236527 0 0 0 CAFETERIA 722210 746433 746433 VENDING MACHINES 722210 29167 29167 OTHER OPERATIONAL 900099 214353 214353 0 0 0 0 989953 180693856 176440026 0 3919875 21200 21200 24020 24020 0 0 926741 695056 231685 0 46615877 34961908 11653969 1791881 1343911 447970 5960858 4470643 1490215 3145699 2359274 786425 0 0 0 2300 2300 0 0 0 44957979 33718484 11239495 0 37812957 28359718 9453239 0 0 4434483 3325862 1108621 106769 80077 26692 0 0 2518551 1888913 629638 0 7400733 5550550 1850183 1258181 943636 314545 MEMBERSHIP DUES 147941 110956 36985 MISCELLANEOUS 119607 89705 29902 OHIO FRANCHISE FEES 1749721 1312291 437430 0 0 0 0 158995498 119256204 39739294 0 0 13592 9962 15560458 17606342 1699396 2575941 201019 221361 155126155 99207745 53449175 55918410 34295827 38096221 0 0 5526586 4385966 110746053 118814203 10189636 10601642 32018603 31899587 42208239 42501229 X 68537814 76312974 68537814 76312974 110746053 118814203 X 21698358 -13923198 X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 true false false true false true 1508 false false false 1508 false 0 LOBBYING ACTIVITIES PART II-B, LINES 1A - 1I 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. 4677715 4677715 93350313 51920345 41429968 0 56567182 47287400 9279782 530945 530945 55918410 0 NOTE PAYABLE TO AFFILIATE 19899270 FINANCIAL GUARANTEES-MOB LEASEBACK 11962400 OTHER LONG TERM LIABILITIES 37917 31899587 180693856 158995498 21698358 0 0 21698358 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, 2010 AND 2009, AND DETERMINED THAT NO AMOUNTS WERE REQUIRED TO BE RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS AT DECEMBER 31, 2010 OR 2009. true true X true X true X true true true false true true 15955 6666811 86113 6580698 0.04140 17229 17800406 10769844 7030562 0.04420 0 0.00000 0 33184 24467217 10855957 13611260 0.08560 15 6372 425714 425714 0.00270 2 527 117791 6500 111291 0.00070 1 2026 798352 798352 0.00500 0 0.00000 11 596 26162 26162 0.00020 29 9521 1368019 6500 1361519 0.00860 29 42705 25835236 10862457 14972779 0.09420 0 0.00000 0 0.00000 2 54677 54677 0.00030 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 2 0 54677 0 54677 0.00030 false 1681640 771 33721820 32979972 741848 X true true SLEEP CENTER AT MERCY ANDERSON LLC SLEEP LAB SERVICES 0.49 0 0.51 RADIATION ONCOLOGY CNTR MERCY HOSP AND RADIATION THERAPY SERVICES 0.49 0 0.51 MERCY EASTSIDE CARDIOVASCULAR INSTIT HEART CATHERIZATION LABORATORY 0.49 0 0.51 1 1 MERCY HOSPITAL ANDERSON

7500 STATE ROAD CINCINNATI OH 45255

X X X MERCY HOSPITAL ANDERSON 1 3 SLEEP CENTER AT MERCY ANDERSON LLC

7500 STATE ROAD CINCINNATI OH 45255

SLEEP LAB SERVICES THE RADIATION ONCOLOGY CENTER

7500 STATE ROAD CINCINNATI OH 45255

RADIATION THERAPY SERVICES MERCY EASTSIDE CARDIOVASCULAR INSTITUTE

7500 STATE ROAD CINCINNATI OH 45255

HEART CATHERIZATION LABORATORY Community benefit report prepared by related organization Schedule H, Part I, Line 6a MERCY HEALTH PARTNERS OF SOUTHWEST OHIO Subsidized Health Services Schedule H, Part I, Line 7g THE AMOUNT OF SUBSIDIZED HEALTH SERVICE REPORTED ON LINE 7G INCLUDES $12,645 RELATED TO THE OB CLINIC. Bad Debt Expense excluded from financial assistance calculation Schedule H, Part I, Line 7, column(f) 0 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. Community Building Activities Schedule H, Part II MERCY HOSPITAL ANDERSON (MHA) 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. AT MHA DONATIONS ARE MADE TO COMMUNITY GROUPS. AN ONGOING COMMITMENT OF MHA IS TO SERVICE OF THE POOR AND UNDERSERVED OF THE EAST SIDE OF CINCINNATI IN HAMILTON COUNTY AND SOME SERVICE IN CLERMONT COUNTY AT THE CATHERINE MCAULEY HEALTH CENTER. Bad debt expense - financial statement footnote Schedule H, Part III, Line 4 THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. BAD DEBT IS CLASSIFIED AS AN OPERATING EXPENSE. THIS TREATMENT IS CONSISTENT WITH THE HFMA PRINCIPLES AND PRACTICES BOARD STATEMENT NO. 15 AND WITH THE AICPA AUDIT AND ACCOUNTING GUIDE FOR HEALTH CARE ORGANIZATIONS. AN AGGREGATE COST TO CHARGE RATIO WAS USED TO PROVIDE BAD DEBT AT COST FOR PART III, LINE 2. REMAINING BALANCES FOR PATIENTS THAT WE KNOW ARE ELIGIBLE FOR CHARITY CARE POLICIES ARE WRITTEN OFF TO CHARITY CARE. PATIENTS WHO MIGHT BE ELIGIBLE FOR CHARITY CARE BUT ARE UNKNOWN TO US ARE WRITTEN OFF TO BAD DEBT AND THEREFORE NOT INCLUDED IN CHARITY CARE. THE ESTIMATED AMOUNT OF THE HOSPITAL'S BAD DEBT EXPENSE (AT COST) ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE HOSPITAL'S CHARITY CARE POLICY REPORTED ON PART III, LINE 3 WAS DETERMINED AS FOLLOWS: REVIEWED DOLLAR AMOUNTS FOR TOTAL REFERRED FOR ASSISTANCE, APPROVED FOR ASSISTANCE AND APPLICATIONS DENIED BECAUSE OF INCOMPLETE INFORMATION; DEVELOPED THE PERCENTAGE OF APPROVED APPLICATIONS TO COMPLETED APPLICATIONS AND THEN APPLIED PERCENTAGE TO THOSE APPLICATIONS THAT WERE INCOMPLETE. THIS PROVIDED AN ESTIMATED AMOUNT OF THOSE APPLICATIONS THAT WERE INCOMPLETE THAT WOULD HAVE QUALIFIED FOR ASSISTANCE IF THE APPLICATION HAS BEEN COMPLETED. THE DOLLAR AMOUNT OF CHARITY CARE ACTUALLY WRITTEN-OFF REPRESENTS THOSE THAT WERE APPROVED. TO CALCULATE THE FULL ESTIMATED AMOUNT OF CHARITY CARE, A CALCULATION WAS DONE TO DETERMINE WHAT 100% OF CHARITY WOULD BE FOR THE TOTAL OF THE APPROVED APPLICATIONS AND THE ESTIMATED AMOUNT FOR THOSE APPLICATIONS THAT WERE INCOMPLETE BUT WOULD HAVE BEEN APPROVED IF COMPLETED. THE DIFFERENCE BETWEEN THIS ESTIMATED TOTAL AMOUNT AND THE ACTUAL WRITE-OFF AMOUNT FOR CHARITY CARE WAS THEN APPLIED TO THE RATIO COST-OF-CHARGES USED FOR CHARITY CARE AT COST. Community benefit & methodology for determining medicare costs Schedule H, Part III, Line 8 MEDICARE SHORTFALL IS NOT TREATED AS A COMMUNITY BENEFIT. THE AMOUNTS ON PART III, LINE 6 WERE GENERATED BY THE MEDICARE COST REPORT WHICH UTILIZES A DEPARTMENT COST TO CHARGE METHODOLOGY. 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. Needs assessment. Schedule H, Part VI, Line 2 THE HOSPITAL USES EXISTING COMMUNITY HEALTH NEEDS ASSESSMENT REPORTS SUCH AS THE 2008 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 HEALTH IMPROVEMENT COLLABORATIVE OF GREATER CINCINNATI REPORT (INDICATORS OF HEALTHY COMMUNITIES 2006). 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 HOSPITAL ANDERSON (MHA) 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. MHA 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. MHA 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 MHA. 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. MHA 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 MHA'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 2010, HELP MANAGED 14,592 PATIENT REFERRALS. MHA 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 HOSPITAL ANDERSON (MHA) SERVES A THREE-COUNTY GEOGRAPHIC AREA FEATURING THE FOLLOWING COUNTIES: HAMILTON, CLERMONT AND BROWN. THE POPULATION OF MHA'S PRIMARY SERVICE AREA IS APPROXIMATELY 295,500. OUR COMMUNITY IS CHANGING AND WE ALSO SERVE A GROWING UNINSURED AND UNDERINSURED POPULATION. THERE ARE TWO HOSPITALS IN THE COMMUNITY AND BOTH ARE NOT-FOR-PROFIT HOSPITALS. MHA 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 MHA SERVES A POPULATION THAT INCLUDES 3.5% OF NON-ENGLISH SPEAKING PEOPLE. 6.7% OF RESIDENTS ARE IN HOUSEHOLDS BELOW THE FEDERAL POVERTY GUIDELINES. THE AVERAGE FAMILY HOUSEHOLD INCOME OF THE COMMUNITY SERVED BY THE HOSPITAL IS $73,903. THE LARGEST ETHNIC GROUP IN THE COMMUNITY SERVED BY THE HOSPITAL IS GERMAN. APPROXIMATELY 26% OF THE POPULATION IS OF GERMAN DESCENT. THE OCCUPATION CLASSIFICATION IN THE COMMUNITY CONSISTS OF 23% BLUE COLLAR, 61% WHITE COLLAR AND 16% SERVICE & FARM WORKERS. THE PERCENTAGE OF THE POPULATION IN THE COMMUNITY OVER 65 YEARS OLD IS 12%. IN THE COMMUNITY SERVED BY MHA 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. MHA WORKS CLOSELY WITH LOCAL COMMUNITY AGENCIES AND HEALTH DEPARTMENTS TO ADDRESS HEALTH PROBLEMS AND MINIMIZE THE EFFECTS ON THOSE WHO SUFFER. IN 2010, MHA HAD 10,941 ADMISSIONS, 117,321 OUTPATIENT VISITS, AND 46,326 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 CATHERINE MCAULEY HEALTH CENTER, THE HEALTH PARTNERSHIP PROGRAM AND THE MERCY CARE 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 TO 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 HOSPITAL IS ONE OF 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 WORK 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 2010 PER THE AUDIT FOOTNOTE IS AS FOLLOWS: TOTAL 2010 COMMUNITY BENEFIT: $80.7 MILLION BENEFITS TO THE BROADER COMMUNITY: $6.3 MILLION UNREIMBURSED CARE FOR THOSE WHO ARE POOR AND QUALIFY FOR MEDICAID: $35.7 MILLION COST OF CARE FOR THOSE WHO COULD NOT AFFORD TO PAY: $33.2 MILLION SUPPORT FOR OTHER PROGRAMS FOR THOSE WHO ARE POOR: $5.5 MILLION COMMUNITY BENEFIT AS PERCENT OF TOTAL EXPENSE: 8.4 PERCENT MERCY HOSPITAL ANDERSON 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); THE MID-ATLANTIC COMMUNITY, MERION STATION, PA; 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, KENTUCKY, PENNSYLVANIA AND TENNESSEE. CHP IS FOCUSED ON IMPROVING THE HEALTH OF COMMUNITIES WE SERVE BY PROVIDING INTEGRATED HEALTH SERVICES THROUGH FACILITIES THAT INCLUDE ACUTE CARE HOSPITALS, LONG-TERM CARE RESIDENCES, HOUSING SITES FOR THE ELDERLY, 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 2010 PER THE AUDIT FOOTNOTE IS AS FOLLOWS: TOTAL 2010 COMMUNITY BENEFIT: $365.1 MILLION BENEFITS TO THE BROADER COMMUNITY: $77.1 MILLION UNREIMBURSED CARE FOR THOSE WHO ARE POOR AND QUALIFY FOR MEDICAID: $131.7 MILLION COST OF CARE FOR THOSE WHO COULD NOT AFFORD TO PAY: $123.2 MILLION SUPPORT FOR OTHER PROGRAMS FOR THOSE WHO ARE POOR: $33.1 MILLION COMMUNITY BENEFIT AS PERCENT OF TOTAL EXPENSE: 8.5 PERCENT 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. COMMUNITY BENEFIT REPORT PART VI, LINE 8 MERCY HOSPITAL ANDERSON IS NOT REQUIRED TO FILE A COMMUNITY BENEFIT REPORT IN ANY STATE. true WELLINGTON FOUNDATION 4701 CREEK ROAD SUITE 110 CINCINNATI OH 45242 311096263 501(C)(3) 20000 GENERAL PURPOSES 1 0 OUTREACH NURSE SERVICES 854 24020 Procedures for monitoring use of grant funds Schedule I, Part I, Line 2 MERCY HEALTH PARTNERS SOUTHWEST OHIO FOUNDATION PERSONNEL REVIEW THE DOCUMENTATION SUBMITTED FOR THE INTENDED USE OF THE WITHDRAWALS MADE. X true true true true false false false false false true false THOMAS URBAN 0 387059 0 42120 0 77316 0 82476 0 24127 0 613098 0 0 PATRICIA SCHROER 300532 0 65806 0 12297 0 61239 0 16967 0 456841 0 0 0 JAMES E MAY 0 539480 0 210106 0 187482 0 146085 0 31085 0 1114238 0 0 DEBORAH BLOOMFIELD 0 351691 0 79800 0 9413 0 57387 0 14910 0 513201 0 0 LEONARD M RANDOLPH JR MD 0 359042 0 82684 0 18558 0 45042 0 21129 0 526455 0 0 CLAIRE COMBS 0 327800 0 71047 0 11378 0 65463 0 22101 0 497789 0 0 LYNN FARRAR 0 112038 0 20000 0 139606 0 112766 0 7646 0 392056 0 0 YOUSUF JAMAL AHMAD 0 281628 0 67531 0 9300 0 41037 0 19307 0 418803 0 0 MAGGIE LUND 0 225561 0 50624 0 9571 0 32635 0 8323 0 326714 0 0 DONALD ROHLING 0 148287 0 32984 0 11510 0 27482 0 12918 0 233181 0 0 DANIEL ROTH MD 0 129636 0 27195 0 432 0 12478 0 8704 0 178445 0 0 CRAIG WRIGHT 140568 0 175 0 88 0 13108 0 21131 0 175070 0 0 0 D TERRY BOYS 0 165026 0 20859 0 23611 0 8357 0 2946 0 220799 0 0 WILLIAM CARROLL 135856 0 8695 0 1144 0 16402 0 17149 0 179246 0 0 0 MICHAEL KRAMER 0 151598 0 8928 0 637 0 10353 0 17308 0 188824 0 0 STEPHEN FEAGINS MD 232574 0 21669 0 776 0 0 0 17786 0 272805 0 0 0 JULIE HOLT 169163 0 5000 0 834 0 4198 0 17900 0 197095 0 0 0 LEE ANN LISKA 0 163188 0 0 0 1067 0 8653 0 20338 0 193246 0 0 STEVEN MICKUS 0 846286 0 253802 0 373612 0 267760 0 21759 0 1763219 0 0 RANDALL BOYD 139839 0 175 0 516 0 15288 0 17693 0 173511 0 0 0 JASON NIEHAUS 56706 104883 13082 0 2000 3000 7633 11451 7174 10758 86595 130092 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: RANDALL BOYD, MARK JOHNSON, LEAH NICOLE WHITENER, JULIE HOLT. 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 REPORTING YEAR TO LISTED INDIVIDUALS WERE AS FOLLOWS: LYNN FARRAR $132,360. 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. 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: DEBORAH BLOOMFIELD $0; PATRICIA SCHROER $0; YOUSEF JAMAL AHMAD $0; CLAIRE COMBS $0; LEONARD RANDOLPH, JR, MD $0; DONALD ROHLING $0; MAGGIE LUND $0, JASON NIEHAUS $0; LEE ANN LISKA $0. Non-fixed payments Schedule J, Part I, Line 7 SELECT OFFICERS, KEY EMPLOYEES AND HIGHEST COMPENSATED EMPLOYEES RECEIVED A BONUS PAYMENT BASED ON CERTAIN CRITERIA BEING MET IN THE YEAR 2009 AND PAYMENT WAS MADE IN 2010. THE CRITERIA INCLUDED MEETING A CERTAIN NET EARNINGS AMOUNT ALONG WITH MEETING TARGETED PATIENT SATISFACTION SCORES AND PROVIDING A CERTAIN LEVEL OF DOLLAR VALUE IN COMMUNITY BENEFIT SERVICES. TERMS AND CONDITIONS OF CHP SERP PLAN SCHEDULE J, 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 $132,881; THOMAS URBAN $65,043; STEVEN MICKUS $362,400. TERMS AND CONDITIONS OF CHP EXECUTIVE RETENTION PLAN 457(F) SCHEDULE J, PART I, LINE 4B THE CHP 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 SPECIFIC PROMOTION. PAYMENT OF THE VESTED ACCOUNT BALANCE IN A LUMP SUM OCCURS UPON VESTING. AMONTS INCLUDIBLE AS TAXABLE COMPENSATION FOR LISTED INDIVIDUALS DUE TO RETENTION PLAN PARTICIPATION IN THE REPORTING YEAR WERE AS FOLLOWS: JAMES MAY $0; STEVEN MICKUS $0. DETERMINATION OF COMPENSATION SCHEDULE J, PART I, LINE 3 THE COMPENSATION OF THE ORGANIZATION'S CEO, PATRICIA SCHROER, 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 MS. SCHROER'S COMPENSATION. TERMS AND CONDITIONS OF THE CMHP SERP SCHEDULE J, PART I, LINE 4B THE COMMUNITY MERCY HEALTH PARTNERS (CMHP) SERP PLAN IS A DEFERRED COMPENSATION PLAN WHICH PROVIDES SUPPLEMENTAL RETIREMENT BENEFITS TO PERSONS SELECTED BY THE CMHP COMMITTEE. IT PROVIDES ANNUAL CREDITS OF A SPECIFIED PERCENTAGE OF COMPENSATION AND ANNUAL INVESTMENT RETURNS AND/OR LOSSES. PARTICIPANTS VEST THE LATER OF FIVE YEARS OF ACTIVE SERVICE OR THE SECOND ANNIVERSARY OF HIS OR HER SEPARATION FROM SERVICE WITH THE EMPLOYER. VESTING OCCURS EARLIER FOR DEATH OR TOTAL DISABILITY. PAYMENTS DURING EMPLOYMENT ARE MADE FOR REQUIRED TAX WITHHOLDING. PAYMENT OF THE VESTED ACCOUNT BALANCE IN A LUMP SUM OCCURS AFTER TERMINATION OF EMPLOYMENT. AMOUNTS INCLUDABLE AS TAXABLE COMPENSATION FOR LISTED INDIVIDUALS DUE TO SERP PARTICIPATION IN THE REPORTING YEAR WERE AS FOLLOWS: D. TERRY BOYS $8,700. ANDERSON CATH LAB DAVID REED (BOARD MEMBER) HAS A REPORTABLE OWNERSHIP INTEREST 11028361 INDEPENDENT CONTRACTOR false Classes of members or stockholders Form 990, Part VI, Section A, Line 6 MERCY HEALTH PARTNERS OF SOUTHWEST OHIO IS THE SOLE MEMBER OF MERCY HOSPITAL OF ANDERSON. 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 CATHOLIC HEALTH PARTNERS CORPORATE MEMBER, CATHOLIC HEALTH PARTNERS GOVERNING BODY, OR CATHOLIC HEALTH PARTNERS CHIEF EXECUTIVE OFFICER APPROVAL. 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 MUST COMPLETE A CONFLICT OF INTEREST STATEMENT THAT IS SUBSEQUENTLY APPROVED BY THE AUDIT & CORPORATE RESPONSIBILITY COMMITTEE (ACRC) AT MHP AND THEN SENT TO CATHOLIC HEALTH PARTNERS 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. Public Disclosure 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 HOURS PER WEEK DEVOTED TO RELATED ORGANIZATIONS BY LISTED PERSONS FORM 990 PART VII SECTION A COLUMN (B) DAVID C. REED, M.D. 2 DAVID J. FREY 2 SISTER MARJORIE BOSSE, RSM 2 GERMAINE BENNETT 2 TODD GARDNER 2 TIMOTHY INGRAM 2 KIMBERLY MAUER 2 NEIL O'CONNOR 2 GEORGE SHYBUT, M.D. 2 L. RICHARD ROEDERSHEIMER, M.D. 2 SR. MARY STANTON, RSM 2 BEVERLY GRANT 2 GLORIA HAFFER 2 DONALD WAYNE, M.D. 2 JAMES E. MAY 47 DEBORAH BLOOMFIELD 50 LEONARD M. RANDOLPH JR., M.D. 44 CLAIRE COMBS 46 LYNN FARRAR 44 YOUSUF JAMAL AHMAD 44 MAGGIE LUND 44 DONALD ROHLING 46 LEE ANN LISKA 44 MICHAEL KRAMER 44 STEVEN MICKUS 50 THOMAS URBAN 40 DANIEL ROTH, M.D. 40 Other changes in net assets or fund balances Form 990, Part XI, Line 5 NET UNREALIZED GAINS (LOSSES) ON INVESTMENTS - 1162219; ELIMINATION OF I/C BALANCES - -15085417; CATHOLIC HEALTH PARTNERS 615 ELSINORE PLACE CINCINNATI OH 45202 311161086 HEALTHCARE SYSTEM PARENT OH 501(C)(3) 11 - Type III - FI NA CATHOLIC HEALTHCARE PARTNERS FOUNDATION 615 ELSINORE PLACE CINCINNATI OH 45202 201072726 FUNDRAISING OH 501(C)(3) 7 CATHOLIC HEALTH PARTNERS CATHOLIC HEALTHCARE PARTNERS HOUSING DEVELOPMENT 615 ELSINORE PLACE CINCINNATI OH 45202 208943658 HUD PARENT OH 501(C)(3) 9 CATHOLIC HEALTH PARTNERS CATHOLIC HEALTHCARE PARTNERS RETIREMENT TRUST 615 ELSINORE PLACE CINCINNATI OH 45202 316046304 RETIREMENT TRUST OH 501(C)(3) 8 CATHOLIC HEALTH PARTNERS SISTERS OF MERCY WORKERS COMPENSATION SELF-INSURANCE TRUST 615 ELSINORE PLACE CINCINNATI OH 45202 310990309 TRUST ADMINISTRATION OH 501(C)(3) 11 - Type I CATHOLIC HEALTH PARTNERS 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 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 ALLEN MEDICAL CENTER 200 WEST LORAIN ST OBERLIN OH 44074 340864230 HOSPITAL OH 501(C)(3) 3 COMMUNITY HEALTH PARTNERS REGIONAL HEALTH SYSTEM 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 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 ALLEN MEDICAL CENTER FOUNDATION 200 WEST LORAIN ST OBERLIN OH 44074 341675592 FOUNDATION OH 501(C)(3) 11 - Type I ALLEN MEDICAL CENTER 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 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 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 MERCY HOSPITALS WEST 2446 KIPLING AVENUE CINCINNATI OH 45239 311091597 HOSPITAL OH 501(C)(3) 3 MERCY HEALTH PARTNERS OF SOUTHWEST OHIO 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 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 CLERMONT MERCY FOUNDATION 3000 HOSPITAL DRIVE BATAVIA OH 45103 311514749 FOUNDATION OH 501(C)(3) 11 - Type III - FI THE SISTERS OF MERCY OF CLERMONT COUNTY OHIO 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 MERCY SACRED HEART INC 2120 PAYNE STREET LOUISVILLE KY 40206 611318326 RETIREMENT HOME KY 501(C)(3) 9 MERCY HEALTH PARTNERS OF SOUTHWEST OHIO 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 PROVIDENCE RETIREMENT HOME AUXILIARY 4915 CHARLESTOWN RD NEW ALBANY IN 47150 204664839 SUPPORTING ORG IN 501(C)(3) 11 - Type II MERCY LONG TERM CARE INITIATIVE 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 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 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 COMMUNITY MERCY HEALTH PARTNERS ONE S LIMESTONE ST SPRINGFIELD OH 45502 310785684 HOSPITAL OH 501(C)(3) 3 COMMUNITY MERCY HEALTH SYSTEM THE COMMUNITY MERCY FOUNDATION 1343 N FOUNTAIN BLVD SPRINGFIELD OH 45504 311443778 FOUNDATION OH 501(C)(3) 7 COMMUNITY MERCY HEALTH SYSTEM COMMUNITY HOSPITAL HEALTH SERVICES COMPANY ONE S LIMESTONE ST SPRINGFIELD OH 45502 311181984 HOSPITAL OH 501(C)(3) 3 COMMUNITY MERCY HEALTH SYSTEM CLARKE & CHAMPAIGN COUNTIES HEALTH INFORMATION EXCHANGE 1150 E HOME ROAD SPRINGFIELD OH 45503 260698515 MEDICAL INFORMATION EXCHANGE OH 501(C)(3) 9 COMMUNITY MERCY HEALTH SYSTEM THE WALLACE S MURRAY AND FRANCES RABBITTS MURRAY MEMORIAL TRUST ONE S LIMESTONE ST SPRINGFIELD OH 45502 346827136 INDIGENT MEDICAL CARE OH 501(C)(3) 11 - Type I NA MERCY HEALTH SYSTEM - NORTHERN REGION 2200 JEFFERSON AVENUE TOLEDO OH 43604 341344482 REGIONAL PARENT OH 501(C)(3) 11 - Type III - FI CATHOLIC HEALTH PARTNERS 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 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 RIVERSIDE MERCY HOSPITAL 3404 W SYLVANIA AVE TOLEDO OH 43623 311556401 HOSPITAL OH 501(C)(3) 3 MERCY HEALTH SYSTEM - NORTHERN REGION MERCY HOME CARE INC 2200 JEFFERSON AVENUE TOLEDO OH 43604 341587572 HOME HEALTHCARE OH 501(C)(3) 9 MERCY HEALTH SYSTEM - NORTHERN REGION MERCY COLLEGE OF NORTHWEST OHIO 2221 MADISON AVENUE TOLEDO OH 43604 341726619 MEDICAL COLLEGE OH 501(C)(3) 2 MERCY HEALTH SYSTEM - NORTHERN REGION MERCY COLLEGE OF NORTHWEST OHIO FOUNDATION INC 2221 MADISON AVENUE TOLEDO OH 43604 141963204 FOUNDATION OH 501(C)(3) 11 - Type I MERCY COLLEGE OF NORTHWEST OHIO MERCY HOSPITAL OF TIFFIN OHIO 45 ST LAWRENCE DRIVE TIFFIN OH 44883 344431174 HOSPITAL OH 501(C)(3) 3 MERCY HEALTH SYSTEM - NORTHERN REGION 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 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 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 ST VINCENT MERCY MEDICAL CENTER 2213 CHERRY STREET TOLEDO OH 43608 344428250 HOSPITAL OH 501(C)(3) 3 MERCY HEALTH SYSTEM - NORTHERN REGION 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 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