MERCY CRYSTAL LAKE HOSPITAL AND MEDICAL CENTER INC: Form 990, tax year 2024
View the entire original 990 at ProPublica ↗
- Organization
- MERCY CRYSTAL LAKE HOSPITAL AND MEDICAL CENTER INC (EIN 20-1673011)
- Tax period
- 2024-07-01 to 2025-06-30
- Filed
- 2026-05-15
- IRS object ID
- 202601359349310365
- Schema version
- 2024v5.5
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2026-05-15T17:05:34-05:00 | ReturnTs |
| Tax Period End | 2025-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390859910 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BAKER TILLY ADVISORY GROUP LP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 790 N WATER ST SUITE 2000 | AddressLine1Txt |
| City | MILWAUKEE | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53202 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2024-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 201673011 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MERCY CRYSTAL LAKE HOSPITAL | BusinessNameLine1Txt |
| Business Name Line2 | AND MEDICAL CENTER INC | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MERC | BusinessNameControlTxt |
| Phone | 7792205500 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 875 S ROUTE 31 | AddressLine1Txt |
| City | CRYSTAL LAKE | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60014 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JAVON BEA | PersonNm |
| Person Title | PRESIDENT/CEO | PersonTitleTxt |
| Phone | 7792205500 | PhoneNum |
| Signature | 2026-05-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | Yes (1) | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | SHELBY NETZ | PreparerPersonNm |
| PTIN | P01405265 | PTIN |
| Phone | 4147775500 | PhoneNum |
| Preparation | 2026-05-13 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2024 | TaxYr |
| Build TS | 2025-03-06 01:10:19Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MERCYHEALTH HOSP & PHYSICIAN CLINIC - | BusinessNameLine1Txt |
| Business Name Line2 | CRYSTAL LAKE | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JAVON BEA | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 5003 | AddressLine1Txt |
| City | JANESVILLE | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53547 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $50,907,607 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.MERCYHEALTHSYSTEM.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2014 | FormationYr |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Activity Or Mission | TO IMPROVE AND PROTECT THE HEALTH AND WELFARE OF THE COMMUNITY IN ACCORDANCE WITH OUR MISSION, THE MISSION OF MERCY CRYSTAL LAKE HOSPITAL AND MEDICAL CENTER, INC IS "EXCEPTIONAL HEALTH CARE SERVICES WITH A PASSION FOR MAKING LIVES BETTER". THE FOUNDATION OF THIS MISSION IS BASED ON A VISION OF QUALITY: EXCELLENCE IN PATIENT CARE; SERVICE: EXCEPTIONAL PATIENT AND CUSTOMER CARE; PARTNERING: BEST PLACE TO WORK; AND COST: COST-EFFECTIVE CARE ALONG WITH A COMMITMENT TO THE VALUES OF: HEALING IN THE BROADEST SENSE, PATIENTS COME FIRST, TREAT EACH OTHER LIKE FAMILY AND ALWAYS SEEK EXCELLENCE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 6 | VotingMembersIndependentCnt |
| Total Employee | 308 | TotalEmployeeCnt |
| Total Volunteers | 65 | TotalVolunteersCnt |
| Total Gross UBI | -$54,188 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $424 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $33,259,865 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $49,972,688 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $147,855 | PYOtherRevenueAmt |
| CY Other Revenue | $134,555 | CYOtherRevenueAmt |
| PY Total Revenue | $33,407,720 | PYTotalRevenueAmt |
| CY Total Revenue | $50,107,667 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $421,674 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $1,245,675 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $19,575,729 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $20,523,864 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $16,524,930 | PYOtherExpensesAmt |
| CY Other Expenses | $34,581,426 | CYOtherExpensesAmt |
| PY Total Expenses | $36,522,333 | PYTotalExpensesAmt |
| CY Total Expenses | $56,350,965 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$3,114,613 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$6,243,298 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $108,515,172 | TotalAssetsBOYAmt |
| Total Assets EOY | $105,588,582 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $111,629,785 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $114,946,493 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$3,114,613 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$9,357,911 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE MISSION OF MERCY CRYSTAL LAKE HOSPITAL AND MEDICAL CENTER, INC IS "EXCEPTIONAL HEALTH CARE SERVICES WITH A PASSION FOR MAKING LIVES BETTER". WITH A VISION OF QUALITY: EXCELLENCE IN PATIENT CARE; SERVICE: EXCEPTIONAL PATIENT AND CUSTOMER CARE; PARTNERING: BEST PLACE TO WORK; AND COST: COST-EFFECTIVE CARE ALONG WITH A COMMITMENT TO THE VALUES OF: HEALING IN THE BROADEST SENSE, PATIENTS COME FIRST, TREAT EACH OTHER LIKE FAMILY AND ALWAYS SEEK EXCELLENCE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $45,564,124 | ExpenseAmt |
| Grant | $1,245,675 | GrantAmt |
| Revenue | $49,987,568 | RevenueAmt |
| Desc | MERCY CRYSTAL LAKE HOSPITAL AND MEDICAL CENTER, INC (CLH) IS A NOT-FOR-PROFIT CHARITABLE HEALTHCARE INSTITUTION THAT FUNCTIONS IN ACCORDANCE WITH ALL APPLICABLE LAWS AND REGULATIONS. IN THE COURSE OF OPERATIONS, CLH IS COMMITTED TO PROVIDING SUPERIOR CARE EVERY DAY FOR ALL ITS PATIENTS. CLH FEATURES 13 INPATIENT BEDS AND TWO INTENSIVE CARE SUITES, SURGERY SUITES, EMERGENCY CARE AND DIAGNOSTIC SERVICES, AS WELL PRIMARY AND SPECIALTY CARE PHYSICIAN OFFICES.IN FISCAL YEAR 2025, PATIENT CARE WAS RENDERED TO 390 INDIVIDUALS WHO PRESENTED THEMSELVES FOR INPATIENT SERVICES, AND 174 INPATIENT SURGERIES ALONG WITH SUPPORTING 11,726 EMERGENCY ROOM VISITS.CLH HAS AN IN-HOUSE LABORATORY THAT PROVIDES TESTING FOR ALL WHO PRESENT THEMSELVES AT THE HOSPITAL FOR TREATMENT. CLH PROVIDED 78,727 LABORATORY TESTS. | Desc |
| Total Program Service Expenses | $45,564,124 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 19 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 308 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 6 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 0 | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | IL | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHANNON DUNPHY-ALEXANDER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6087573126 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8201 E RIVERSIDE BLVD | AddressLine1Txt |
| City | ROCKFORD | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61114 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| TODD ANDERSON | ||||||||
| VP/CFO (TERM 01/2025) | 1.00 | 62.00 | Yes (X) | $0 | $935,469 | $77,630 | ||
| KIMBERLY SCACCIA | ||||||||
| VP - REVENUE CYCLE (TERM 09/2025) | 1.00 | 62.00 | Yes (X) | $0 | $533,533 | $66,109 | ||
| MARK L GOELZER MD | ||||||||
| DIRECTOR/PHYSICIAN | 1.00 | 45.00 | $0 | $500,316 | $38,924 | Yes (X) | ||
| NICHOLAS VENTOCILLA | ||||||||
| ADVANCED PRACTICE CONTRACT PROVIDER | 40.00 | 0.00 | $289,906 | $0 | $46,567 | Yes (X) | ||
| GREGORY ZANKLE | ||||||||
| ADVANCED PRACTICE CONTRACT PROVIDER | 40.00 | 0.00 | $287,095 | $0 | $7,280 | Yes (X) | ||
| TYLER KILLPACK | ||||||||
| VICE-PRESIDENT | 1.00 | 55.00 | Yes (X) | $0 | $242,451 | $43,315 | ||
| THOMAS GARRITY | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $239,674 | $0 | $13,146 | Yes (X) | ||
| MANDY RUEFF | ||||||||
| ADVANCED PRACTICE CONTRACT PROVIDER | 32.00 | 0.00 | $237,396 | $0 | $2,602 | Yes (X) | ||
| BRENDA BOTE-CATACUTAN | ||||||||
| RN HOSPITAL ADVANCED | 44.00 | 0.00 | $160,849 | $0 | $34,860 | Yes (X) | ||
| JAVON R BEA | ||||||||
| PRESIDENT/CEO (SEE PAGES 46-47) | 1.00 | 67.00 | Yes (X) | $0 | $11,640,824 | $4,695,329 | Yes (X) | |
| ROWLAND J MCCLELLAN CHAIR | ||||||||
| & DIRECTOR (IN MEMORIAM 07/2025) | 1.00 | 7.00 | Yes (X) | $0 | $26,893 | $0 | Yes (X) | |
| DAVE L SYVERSON | ||||||||
| DIRECTOR | 1.00 | 7.00 | $0 | $15,753 | $0 | Yes (X) | ||
| KATHERINE A SCHACK | ||||||||
| VICE CHAIR & DIRECTOR | 1.00 | 7.00 | Yes (X) | $0 | $15,370 | $0 | Yes (X) | |
| WESLEY M JOST | ||||||||
| DIRECTOR | 1.00 | 7.00 | $0 | $15,290 | $0 | Yes (X) | ||
| THOMAS D BUDD | ||||||||
| SECRETARY & TREASURER | 1.00 | 7.00 | Yes (X) | $0 | $15,182 | $0 | Yes (X) | |
| THOMAS R POOL | ||||||||
| CHAIR & DIRECTOR | 1.00 | 7.00 | Yes (X) | $0 | $15,000 | $0 | Yes (X) | |
| CARLOS S AREVALO | ||||||||
| DIRECTOR (START 10/2024) | 1.00 | 7.00 | $0 | $1,500 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,214,920 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $13,957,581 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $5,025,762 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 27 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| WYNN ANESTHESIA GROUP LLC | |||||
| PO BOX 736097 | CHICAGO | IL | 606736097 | ANSTHESIA SERVICES | $1,367,595 |
| CASEY SHUPE | |||||
| 2283 EASTVIEW DRIVE | DES PLANIES | IL | 60018 | ANSTHESIA SERVICES | $739,955 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $424 | RelatedOrganizationsAmt |
| Total Contributions | $424 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT REVENUE | 621110 | $39,127,236 | $39,127,236 |
| MEDICARE | 621110 | $9,152,074 | $9,152,074 |
| MEDICAID | 621110 | $1,693,378 | $1,693,378 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $49,972,688 | TotalProgramServiceRevenueAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $5,680 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $46,028 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -$40,348 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$40,348 | TotalRevenueColumnAmt |
| Exclusion | -$40,348 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $714,604 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $753,912 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$39,308 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $14,880 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | -$54,188 | UnrelatedBusinessRevenueAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| CAFETERIA | 722210 | $161,242 | $161,242 |
| REBATES | 900099 | $50,420 | $50,420 |
| MISCELLANEOUS | 900099 | $2,549 | $2,549 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $214,211 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $50,107,667 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $49,987,568 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | -$54,188 | UnrelatedBusinessRevenueAmt |
| Exclusion | $173,863 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,095 | TotalAmt |
| Program Services | $23,095 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,222,580 | TotalAmt |
| Program Services | $1,222,580 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,535,680 | TotalAmt |
| Program Services | $11,631,646 | ProgramServicesAmt |
| Management And General | $4,904,034 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $701,688 | TotalAmt |
| Management And General | $701,688 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,778,924 | TotalAmt |
| Program Services | $97,450 | ProgramServicesAmt |
| Management And General | $1,681,474 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,507,572 | TotalAmt |
| Program Services | $1,158,574 | ProgramServicesAmt |
| Management And General | $348,998 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $44,431 | TotalAmt |
| Management And General | $44,431 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,455 | TotalAmt |
| Management And General | $11,455 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,295,607 | TotalAmt |
| Program Services | $1,664,965 | ProgramServicesAmt |
| Management And General | $630,642 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $108,607 | TotalAmt |
| Program Services | $25 | ProgramServicesAmt |
| Management And General | $108,582 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,074,910 | TotalAmt |
| Program Services | $6,901,731 | ProgramServicesAmt |
| Management And General | $173,179 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $466,553 | TotalAmt |
| Program Services | $60,280 | ProgramServicesAmt |
| Management And General | $406,273 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,122,191 | TotalAmt |
| Program Services | $2,416,758 | ProgramServicesAmt |
| Management And General | $705,433 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $95,217 | TotalAmt |
| Program Services | $57,651 | ProgramServicesAmt |
| Management And General | $37,566 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,661 | TotalAmt |
| Program Services | $5,296 | ProgramServicesAmt |
| Management And General | $6,365 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,375,668 | TotalAmt |
| Program Services | $3,500,534 | ProgramServicesAmt |
| Management And General | $875,134 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $171,082 | TotalAmt |
| Program Services | $136,866 | ProgramServicesAmt |
| Management And General | $34,216 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| BAD DEBT | $6,967,702 | $6,967,702 | |
| PHYSICIAN LOCUM FEES | $6,784,581 | $6,784,581 | |
| MEDICAID TAX | $2,820,251 | $2,820,251 | |
| MEMBERSHIP & DUES | $84,314 | $63,424 | $20,890 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $147,196 | TotalAmt |
| Program Services | $50,715 | ProgramServicesAmt |
| Management And General | $96,481 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $56,350,965 | TotalAmt |
| Program Services | $45,564,124 | ProgramServicesAmt |
| Management And General | $10,786,841 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,160,986 | BOYAmt |
| EOY | $5,732,132 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,955,258 | BOYAmt |
| EOY | $7,373,641 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,029,684 | BOYAmt |
| EOY | $2,259,132 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $20,975 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $96,276,146 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $6,533,129 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $93,404,696 | BOYAmt |
| EOY | $89,743,017 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $964,548 | BOYAmt |
| EOY | $459,685 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $108,515,172 | BOYAmt |
| EOY | $105,588,582 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,053,680 | BOYAmt |
| EOY | $1,750,656 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $109,576,105 | BOYAmt |
| EOY | $113,195,837 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $111,629,785 | BOYAmt |
| EOY | $114,946,493 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$3,114,613 | BOYAmt |
| EOY | -$9,357,911 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$3,114,613 | BOYAmt |
| EOY | -$9,357,911 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $108,515,172 | BOYAmt |
| EOY | $105,588,582 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$6,243,298 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,199,090 | OtherCostOrOtherBasisAmt |
| Book Value | $1,199,090 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $79,304,884 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,170,102 | DepreciationAmt |
| Book Value | $76,134,782 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $15,331,885 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,342,268 | DepreciationAmt |
| Book Value | $11,989,617 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $440,287 | OtherCostOrOtherBasisAmt |
| Depreciation | $20,759 | DepreciationAmt |
| Book Value | $419,528 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $89,743,017 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE FROM MERCY HEALTH SYSTEM CORP | $112,858,049 |
| DUE FROM MERCY ASSISTED CARE | $188,299 |
| DUE TO MERCY HAVARD HOSPITAL | $2,905 |
| THIRD PARTY PAYABLES | $146,584 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $113,195,837 | TotalLiabilityAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 250.000000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent350 | Yes (X) | Percent350Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $336,016 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $336,016 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00610 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,307,660 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,693,378 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,614,282 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06550 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $104,628 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $104,628 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00190 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,748,304 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,693,378 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,054,926 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07350 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $37,337 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $37,337 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00070 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,204,031 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,288,686 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $915,345 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01660 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $23,095 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $23,095 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,264,463 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,288,686 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $975,777 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01770 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $12,012,767 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,982,064 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,030,703 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09120 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,207,281 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $9,152,074 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $13,017,950 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$3,865,876 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MERCY CRYSTAL LAKE HOSPITAL AND MEDICAL CENTER INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 875 S ROUTE 31 | AddressLine1Txt |
| City | CRYSTAL LAKE | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60014 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | MERCYHEALTHSYSTEM.ORG | WebsiteAddressTxt |
| State License | 0006403 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MERCY CRYSTAL LAKE HOSPITAL AND MEDICAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | Yes (1) | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | 0 | CHNAConductedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 250.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 350.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SEE PART V, PAGE 8 | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE PART V, PAGE 8 | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE PART V, PAGE 8 | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Prospective Medicare Medicaid | Yes (X) | ProspectiveMedicareMedicaidInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| MERCY CRYSTAL LAKE HOSPITAL AND MEDICAL CENTER | PART V, SECTION B, LINE 5: A COMMUNITY NEEDS ASSESSMENT WAS DONE IN 2023 FOR THE HARVARD AREA AND MCHENRY COUNTY TO IDENTIFY OPPORTUNITIES TO IMPROVE THE HEALTH CARE SYSTEM AND IMPROVE PATIENT CARE AND PREVENTIVE SERVICE UTILIZATION AND THE OVERALL HEALTH AND QUALITY OF LIFE IN THE COMMUNITY. MERCY CRYSTAL LAKE HOSPITAL AND MEDICAL CENTER (MCL) IS LOCATED IN MCHENRY COUNTY TOO. MCL WILL INCLUDE ITS OWN COMMUNITY NEEDS ASSESSMENT IN 2026 WITH ALL THE OTHER MERCYHEALTH HOSPITALS. PARTICIPATION IN LOCAL HEALTH RELATED STRATEGY COALITIONS IN RELATION TO THE COMMUNITY HEALTH IMPROVEMENT PLAN ARE ONGOING.THE INFORMATION BELOW PERTAINS TO THE CHNA CONDUCTED BY MCL'S AFFILIATE, MERCY HARVARD HOSPITAL (MHH):TO GATHER PRIMARY DATA REGARDING HEALTH NEEDS IN MCHENRY COUNTY, MHH AND MHC AFFILIATES CREATED AN ONLINE COMMUNITY HEALTH SURVEY USING THE MACHFORM SURVEY TOOL. THE SURVEY WAS TRANSLATED INTO SPANISH, AND BOTH ENGLISH AND SPANISH VERSIONS WERE ACCESSIBLE VIA LINKS AND QR CODES. METHODS FOR SURVEY DISTRIBUTION INCLUDED SOCIAL MEDIA, MERCYHEALTH'S INTERNAL NEWSLETTER, MERCYHEALTH'S COMMUNITY NEWSLETTER, AND FLYER PLACEMENT AT KEY COMMUNITY LOCATIONS. THE SURVEY WAS DISTRIBUTED BETWEEN JANUARY 10, 2023, AND FEBRUARY 12, 2023. MHH RECEIVED 303 SURVEY RESPONSES. DATA WAS ALSO COLLECTED THROUGH VIRTUAL AND IN-PERSON INTERVIEWS WITH KEY STAKEHOLDERS WHO REPRESENT COMMUNITY ORGANIZATIONS AND, THROUGH THEIR ROLES AS COMMUNITY LEADERS AND ORGANIZERS, POSSESS VALUABLE INSIGHTS INTO HEALTH ISSUES EXPERIENCED BY THE POPULATIONS THEY SERVE. KEY INFORMANTS WERE SELECTED WITH THE GOAL OF GATHERING INFORMATION REFLECTIVE OF A BROAD CROSS-SECTION OF THE COMMUNITY, PARTICULARLY THOSE POPULATIONS UNLIKELY TO RESPOND TO THE SURVEY. SEVEN KEY INFORMANT INTERVIEWS WERE CONDUCTED BETWEEN JANUARY 2023 AND MARCH 2023.REPRESENTATIVES FROM MHH PARTICIPATED IN DEVELOPMENT OF THE MCHENRY COUNTY DEPARTMENT OF HEALTH'S 2022 COMMUNITY HEALTH IMPLEMENTATION PLAN (CHIP) PRIORITIES. MHH IS ALSO A MEMBER OF THE MCHENRY COUNTY DEPARTMENT OF HEALTH'S MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS (MAPP) CORE TEAM. MAPP WORKGROUPS ARE RESPONSIBLE FOR ADDRESSING PRIORITIES OUTLINED IN THE COUNTY'S CHIP. THROUGH THIS WORK, MHH HAS OBTAINED INPUT FROM CORE TEAM MEMBERS ABOUT RESOURCES AVAILABLE TO ADDRESS HEALTH ISSUES IN MCHENRY COUNTY. THE 2023 IMPLEMENTATION STRATEGY FOR THE 2023 COMMUNITY HEALTH NEEDS ASSESSMENT INCLUDE THE FOLLOWING PRIORITIES FOR CHRONIC DISEASE AND NUTRITION, PHYSICAL ACTIVITY, AND OBESITY. IN FY24, MHH INITIATED PATIENT OUTREACH FOR A1C CONTROL; CONTINUED EDUCATION FOR MERCYHEALTH STAFF ABOUT IMPORTANCE OF ACCURATE BLOOD PRESSURE SCREENINGS; STAFF FROM BOTH MCL AND MHH ATTENDED VARIOUS COMMUNITY EVENTS TO PROVIDE OUTREACH/EDUCATION ABOUT HEALTHY LIFESTYLE AND WEIGHT MANAGEMENT PROGRAMMING OFFERED AT MERCYHEALTH, AND CONDUCTED FREE BLOOD PRESSURE CHECKS. |
| MERCY CRYSTAL LAKE HOSPITAL AND MEDICAL CENTER | PART V, SECTION B, LINE 11: THE INFORMATION BELOW PERTAINS TO THE CHNA CONDUCTED BY MCL'S AFFILIATE, MERCY HARVARD HOSPITAL (MHH):WHEN RESPONDENTS WERE ASKED WHICH HEALTH BEHAVIORS SHOULD BE ADDRESSED IN MCHENRY COUNTY, MENTAL HEALTH, MENTAL CONDITIONS, AND SUICIDE WERE MOST FREQUENTLY IDENTIFIED. AMONG RESPONDENTS WHO REPORTED EXPERIENCING BARRIERS ACCESSING MENTAL HEALTH CARE IN THE PAST 12 MONTHS, THE MOST COMMONLY REPORTED BARRIERS WERE WAIT TIMES, AFFORDABILITY, AND INABILITY TO LOCATE A PROVIDER. ALCOHOL AND SUBSTANCE ABUSE WAS THE SECOND-MOST FREQUENTLY IDENTIFIED HEALTH BEHAVIOR THAT SURVEY RESPONDENTS FELT SHOULD BE ADDRESSED IN MCHENRY COUNTY. THE THIRD-MOST FREQUENTLY IDENTIFIED HEALTH NEEDS WAS NUTRITION, PHYSICAL ACTIVITY, AND OBESITY. THE ABOVE FINDINGS WERE PRESENTED IN APRIL 2023 TO THE MERCYHEALTH EXECUTIVE COUNCIL, COMPRISED OF MERCYHEALTH EXECUTIVE LEADERS. THE EXECUTIVE COUNCIL ACKNOWLEDGES THAT SOME OF THE NEEDS IDENTIFIED, - SUCH AS HOUSING, CHILDCARE, AND MENTAL HEALTH, - ARE SIGNIFICANT NEEDS; HOWEVER, MHH AS A HOSPITAL LACKS THE EXPERTISE NECESSARY TO APPROPRIATELY ADDRESS THESE NEEDS, AND OTHER COMMUNITY PROVIDERS WHO ALREADY OFFER RELATED SERVICES ARE BETTER POSITIONED TO MORE QUICKLY ADDRESS THEM. THE EXECUTIVE COUNCIL IDENTIFIED THE FOLLOWING AREAS AS PRIORITIES FOR MHH''S 2023 CHNA: 1. CHRONIC DISEASES 2. NUTRITION, PHYSICAL ACTIVITY, AND OBESITY THESE PRIORITY AREAS ADDRESS TWO SIGNIFICANT HEALTH NEEDS THAT HOSPITALS LIKE MHH MAY BE ABLE TO IMPACT, INCLUDING FOR POPULATIONS WHO EXPERIENCE BARRIERS TO ACCESSING HEALTH CARE. ACCORDINGLY, THE EXECUTIVE COUNCIL BELIEVES THAT THE ACTION ITEMS IDENTIFIED IN ITS ASSOCIATED IMPLEMENTATION STRATEGY WILL MAINTAIN OR IMPROVE THE COMMUNITY'S HEALTH STATUS.DURING THE COURSE OF THE FISCAL YEAR 2024, MERCYHEALTH CONTINUED TO PARTICIPATE IN NUMEROUS COMMUNITY HEALTH FAIRS, PROVIDED FREE SCREENINGS AT CLINICS AND IN CONJUNCTION WITH COMMUNITY-BASED ORGANIZATIONS/EVENTS OFFERED SCREENINGS AND EDUCATION. THESE EFFORTS WERE SUPPORTED THROUGH BROAD BASED MARKETING AND ADVERTISING PROGRAMS.FINALLY, IN THE AREA OF SCREENINGS, MERCYHEALTH PARTNERS ALONG WITH COMMUNITY AGENCIES AND MERCYHEALTH STAFF, OFFERED SCREENINGS AT HEALTH FAIRS, MERCYHEALTH SPONSORED EVENTS, AND THROUGH FREE AND SLIDING FEE SCALE PRIMARY CLINICS IN MCHENRY COUNTY.MERCYHEALTH PROVIDES EXTENSIVE TELEMEDICINE SERVICES TO INCREASE VIRTUAL ACCESS FOR OUR PATIENTS. MERCYHEALTH HAS PROVIDERS ON CALL THAT ARE AVAILABLE TO ASSIST EMS CREWS IN THE FIELD WITH TRAUMA-RELATED EMERGENCIES AND CRITICAL ILLNESSES.MCL AND MHH ADOPTED THE FOLLOWING IMPLEMENTATION STRATEGIES TO ADDRESS THE SIGNIFICANT HEALTH NEEDS IDENTIFIED IN ITS 2023 COMMUNITY HEALTH NEEDS ASSESSMENT:MAINTAIN PATIENT AND EMPLOYEE EDUCATION ABOUT ACCURATE BLOOD PRESSURE READINGS TO ENSURE ACCURATE DETECTION AND MANAGEMENT OF BLOOD PRESSURE ISSUES WHICH, WHEN UNCONTROLLED, CAN CONTRIBUTE TO CHRONIC DISEASES LIKE HEART AND KIDNEY DISEASE.IMPROVE PERFORMANCE ON QUALITY MEASURES RELATED TO DIABETES CARE MANAGEMENT, INCLUDING A1C COMPLETION, DIABETES EYE EXAM, AND KIDNEY FUNCTION THROUGH PATIENT OUTREACH AND EDUCATION TO EMPLOYEES ABOUT ADDRESSING ALL OUTSTANDING DIABETES CARE NEEDS DURING PATIENT VISITS.CONTINUE SHARING BEST PRACTICES FOR CHRONIC DISEASE MANAGEMENT WITH OTHER HEALTH SYSTEMS.PROVIDE FREE BLOOD PRESSURE CHECKS AND EDUCATION ABOUT HEALTHY LIFESTYLE CHOICES AT COMMUNITY EVENTS. EXPLORE COMMUNITY OUTREACH TO ADDRESS CHILD OBESITY. INCREASE NUMBER OF PATIENTS WHO RECEIVE SIT-TO-STAND FUNCTIONAL ABILITY SCREENINGS AND IF INDICATED PHYSICAL THERAPY REFERRALS AT MEDICARE ANNUAL WELLNESS VISITS THROUGH EMPLOYEE EDUCATION. CONTINUE ATHLETIC TRAINING PARTNERSHIPS TO IMPROVE HEALTH AND MAINTAIN SAFETY OF STUDENT ATHLETES THROUGH EDUCATION ON TOPICS INCLUDING PHYSICAL ACTIVITY, HYDRATION, NUTRITION, INJURY PREVENTION. |
| MERCY CRYSTAL LAKE HOSPITAL AND MEDICAL CENTER | PART V, SECTION B, LINE 13B: PRESUMPTIVE CHARITY CARE HOSPITAL BILLS FOR PATIENTS MEETING CERTAIN MERCYHEALTH REQUIREMENTS ARE CATEGORICALLY REDUCED BY 100% ON AN EPISODIC BASIS FOR ANY PATIENT LIABILITY. ALL THIRD-PARTY LIABILITY MUST BE EXHAUSTED. BASED ON INFORMATION RECEIVED FROM THIRD PARTY SOURCES, MERCYHEALTH MAY CATEGORIZE AN ACCOUNT AS PRESUMPTIVE CHARITY CARE AND REDUCE AMOUNTS UP TO 100%, IF MERCYHEALTH DETERMINES ONE OR MORE OF THE FOLLOWING CRITERIA APPLIES; NO OTHER PROOF OF INCOME WILL BE REQUESTED:I. PATIENT IS CURRENTLY ELIGIBLE FOR MEDICAID FOR OTHER DATES OF SERVICE OR SERVICES DEEMED NON-COVERED BY MEDICAID; OR, II. HOMELESSNESS;III. DECEASED WITH NO ESTATE; IV. MENTAL INCAPACITATION WITH NO ONE TO ACT ON THE PATIENT'S BEHALF;V. CONFIRMED BANKRUPTCY;VI. PATIENT IS ENROLLED IN OR ELIGIBLE FOR AN ASSISTANCE PROGRAM FOR LOW-INCOME INDIVIDUALS INCLUDING BUT NOT LIMITED TO:A. WOMEN, INFANT AND CHILDREN NUTRITION PROGRAM (WIC);B. SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP);C. ILLINOIS FREE LUNCH AND BREAKFAST PROGRAM;D. COMMUNITY BASED MEDICAL ASSISTANCE;E. TEMPORARY ASSISTANCE FOR NEEDY FAMILIES (TANF);F. LOW INCOME/SUBSIDIZED HOUSING IS PROVIDED AS A VALID ADDRESS;G. RECEIPT OF GRANT ASSISTANCE FOR MEDICAL SERVICES. |
| PART V, LINE 16A: | WWW.MERCYHEALTHSYSTEM.ORG/PATIENTSVISITORS/BILLING-INFORMATION/FINANCIAL-ASSISTANCE/ |
| PART V, LINE 16B: | WWW.MERCYHEALTHSYSTEM.ORG/PATIENTSVISITORS/BILLING-INFORMATION/FINANCIAL-ASSISTANCE/ |
| PART V, LINE 16C: | WWW.MERCYHEALTHSYSTEM.ORG/PATIENTSVISITORS/BILLING-INFORMATION/FINANCIAL-ASSISTANCE/ |
| PART V, LINE 22D: | MERCYHEALTH WILL NOT CHARGE PATIENTS WHO ARE ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THIS POLICY MORE THAN THE AMOUNTS GENERALLY BILLED (AGB) TO INSURED PATIENTS FOR EMERGENCY MEDICAL CARE OR MEDICALLY NECESSARY CARE. TO CALCULATE THE AGB, MERCYHEALTH USES THE "LOOK-BACK" METHOD DESCRIBED IN SECTION 4(B)(2) OF THE IRS AND TREASURY'S 501(R) FINAL RULE.IN THIS METHOD, MERCYHEALTH USES DATA BASED ON CLAIMS SENT TO MEDICARE'S FEE-FOR-SERVICE PROGRAM AND ALL PRIVATE COMMERCIAL INSURERS FOR EMERGENCY MEDICAL CARE AND MEDICALLY NECESSARY CARE OVER THE PAST YEAR TO DETERMINE THE PERCENTAGE OF GROSS CHARGES THAT IS TYPICALLY ALLOWED BY THESE INSURERS. MERCYHEALTH USES DATA FOR A 12-MONTH PERIOD BEGINNING APRIL 1 THROUGH MARCH 31 AND WILL ADJUST THE AGB PERCENTAGE YEARLY, EFFECTIVE EACH JULY 1. THE CURRENT AGB FOR EACH HOSPITAL IS LISTED IN THE FINANCIAL ASSISTANCE SUPPORTING INFORMATION ON OUR WEBSITE AT WWW.MERCYHEALTHSYSTEM.ORG OR AVAILABLE FREE OF CHARGE.MERCYHEALTH WILL NOT CHARGE PATIENTS WHO ARE ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THIS POLICY MORE THAN THE AMOUNTS GENERALLY BILLED (AGB) TO INSURED PATIENTS FOR EMERGENCY MEDICAL CARE OR MEDICALLY NECESSARY CARE. |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | THE HOSPITAL OFFERS A 25% SELF-PAY DISCOUNT TO ALL UNINSURED PATIENTS ON ALL MEDICALLY NECESSARY SERVICES, ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED ON THE FOLLOWING: INDIVIDUAL OR HOUSEHOLD INCOME, INDIVIDUAL OR HOUSEHOLD ASSETS, HOUSEHOLD SIZE, AND OTHER SOURCES OF PAYMENT FOR SERVICES. THE AMOUNT OF ASSISTANCE IS BASED ON THE PATIENT'S ABILITY TO PAY AND THE SIZE OF THEIR OUTSTANDING BALANCE. IF PATIENT INCOME AND HOUSEHOLD ASSETS ARE LESS THAN 250% IN FISCAL YEAR 2025 OF THE FEDERAL POVERTY GUIDELINES, THEN MERCYHEALTH WILL COVER 100% OF THEIR OUTSTANDING BALANCE. IF THE PATIENT'S INCOME AND HOUSEHOLD ASSETS FALL BETWEEN 251% AND 350% IN FISCAL YEAR 2025 OF THE FEDERAL POVERTY GUIDELINES, THEN A PATIENT'S REMAINING BALANCE CAN BE REDUCED AS MUCH AS 90% AND PAYMENT ARRANGEMENTS CAN BE EXTENDED FOR AS LONG AS TWENTY-FOUR MONTHS OR LONGER IF THERE ARE EXTENUATING CIRCUMSTANCES. FOR MEDICALLY NECESSARY PROCEDURES, UNDER HUBDA AN ILLINOIS LAW, A PATIENT RESIDING IN ILLINOIS MAY BE ELIGIBLE BASED ON 600% OF THE FEDERAL POVERTY GUIDELINES.MERCYHEALTH MAY CATEGORIZE AN ACCOUNT AS PRESUMPTIVE CHARITY CARE AND REDUCE AMOUNTS UP TO 100%, IF MERCYHEALTH DETERMINES CERTAIN CRITERIA APPLIES SUCH AS HOMELESSNESS OR DECEASED WITHOUT AN ESTATE. |
| PART I, LINE 6A: | MERCY HARVARD HOSPITAL, PREPARED A COMMUNITY BENEFIT REPORT WITH MCHENRY COUNTY. MERCY CRYSTAL LAKE HOSPITAL AND MEDICAL CENTER IS ALSO IN MCHENRY COUNTY. MCL DID NOT OPEN UNTIL FISCAL 2024 AND WILL ISSUE A COMMUNITY NEEDS ASSESSMENT IN 2026 WITH THE OTHER MERCY HEALTH CORPORATE ENTITIES. THE MCHENRY COUNTY COMMUNITY NEEDS ASSESSMENT CAN BE LOCATED ON THE WEBSITE WWW.MERCYHEALTHSYSTEM.ORG/ABOUT-US/COMMUNITY-NEEDS/. |
| PART I, LINE 7: | A COST-TO-CHARGE RATIO METHODOLOGY WAS USED TO DETERMINE COSTS ASSOCIATED WITH CHARITY CARE, UNREIMBURSED MEDICAID, AND OTHER MEANS TESTED GOVERNMENT PROGRAMS.THE COST-TO-CHARGE RATIO WAS DERIVED FROM IRS WORKSHEET 2: RATIO OF PATIENT CARE COST-TO CHARGE. THE COST OF THE OTHER BENEFITS REFERENCED IN THE TABLE OF LINE 7 (COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS; SUBSIDIZED HEALTH SERVICES; CASH AND IN-KIND CONTRIBUTIONS) WERE DETERMINED USING ACTUAL DEPARTMENT/SERVICE SPECIFIC DATA AND/OR COST ACCOUNTING DERIVED DATA. |
| PART I, LINES 5B AND 5C: | THE ORGANIZATION STILL PROVIDED CARE REGARDLESS OF ANY INDIVIDUAL'S ABILITY TO PAY. |
| PART III, LINE 3: | THE ESTIMATE OF BAD DEBT DOLLARS THAT MAY HAVE BEEN COVERED THROUGH MERCY HEALTH SYSTEM CORPORATION'S FINANCIAL ASSISTANCE POLICY (HAD THE PROPER PAPER WORK BEEN COMPLETED BY THE INDIVIDUAL NEEDING ASSISTANCE) IS ESTIMATED AT 16.31%. THIS FIGURE WAS BASED ON THE PERCENT OF BAD DEBT ACCOUNT DOLLARS THAT ARE RECLASSIFIED FOR CHARITY AND/OR BANKRUPTCY PURPOSES. |
| PART III, LINE 4: | BAD DEBT EXPENSE IS ACCOUNTED FOR AS DETAILED IN NOTE 1 OF THE AUDITED FINANCIAL STATEMENTS OF MERCY HEALTH CORPORATION. SEE BELOW: GENERALLY, PATIENTS WHO ARE COVERED BY THIRD-PARTY PAYORS ARE RESPONSIBLE FOR RELATED DEDUCTIBLES AND COINSURANCE, WHICH VARY IN AMOUNT. THE CORPORATION ALSO PROVIDES SERVICES TO UNINSURED PATIENTS, AND OFFERS THOSE UNINSURED PATIENTS A DISCOUNT, EITHER BY POLICY OR LAW, FROM STANDARD CHARGES. THE CORPORATION ESTIMATES THE TRANSACTION PRICE FOR PATIENTS WITH DEDUCTIBLES AND COINSURANCE AND FOR THOSE WHO ARE UNINSURED BASED ON HISTORICAL EXPERIENCE AND CURRENT MARKET CONDITIONS. THE INITIAL ESTIMATE OF THE TRANSACTION PRICE IS DETERMINED BY REDUCING THE STANDARD CHARGE BY ANY CONTRACTUAL ADJUSTMENTS, DISCOUNTS, AND IMPLICIT PRICE CONCESSIONS. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE GENERALLY RECORDED AS ADJUSTMENTS TO PATIENT SERVICE REVENUE IN THE PERIOD OF THE CHANGE. SUBSEQUENT CHANGES THAT ARE DETERMINED TO BE THE RESULT OF AN ADVERSE CHANGE IN THE PATIENT'S ABILITY TO PAY ARE RECORDED AS BAD DEBT EXPENSE. |
| PART III, LINE 8: | DATA FOR LINES 5 AND 6 OF PART III AND THE MEDICARE SHORTFALL IS BASED ON MERCY HEALTH SYSTEM CORPORATION'S MEDICARE COST REPORT. MEDICARE COSTS ARE ELIMINATED FROM THE SUBSIDIZED PROGRAMS ON PART 1, LN 7G AS CALCULATED BY OUR COST ACCOUNTING ANALYSIS. A COMBINATION OF COST ACCOUNTING AND THE MEDICARE COST TO CHARGE RATIO WAS USED FOR THE COMPUTATION OF SUBSIDIZED PROGRAMS. |
| PART III, LINE 9B: | MERCY HEALTH SYSTEM CORPORATION HAS A STRONG COMMITMENT TO PROVIDE QUALITY PATIENT CARE FOR ALL INDIVIDUALS. EMERGENCY STABILIZING SERVICES WILL NEVER BE DENIED NOR DELAYED ON THE PATIENT'S ABILITY TO PAY. AT MERCY HEALTH SYSTEM CORPORATION (MHS), ALL PATIENTS ARE TREATED WITH DIGNITY AND RESPECT REGARDLESS OF THEIR ABILITY TO PAY. MHS ASSISTS PATIENTS APPLYING FOR INSURANCE INCLUDING, AUTOMOBILE ACCIDENTS, CRIME VICTIMS, WORKERS COMPENSATION, MEDICAID, COBRA, LOCAL ASSISTANCE AND/OR HOSPITAL FINANCIAL ASSISTANCE, AND COPAY ASSISTANCE PROGRAMS. IF PATIENTS DO NOT QUALIFY FOR ANY OF THESE, MHS MAY EXTEND PAYMENT OPTIONS SUCH AS MONTHLY PAYMENTS, CREDIT CARD PAYMENTS OR FINANCIAL ASSISTANCE. PATIENTS WHO ARE SELF-PAY, REGARDLESS OF WHETHER THEY QUALIFY FOR MERCY HEALTH SYSTEM CORPORATION'S COMMUNITY CARE PROGRAM, RECEIVE A 25% DISCOUNT FROM MHS' STANDARD FEE SCHEDULE IN 2025. SELF-PAY PATIENTS MEET WITH PATIENT FINANCIAL COUNSELORS AND DISCUSS PAYMENT OPTIONS INCLUDING MHS' FINANCIAL ASSISTANCE PROGRAM. PATIENTS MUST APPLY FOR FINANCIAL ASSISTANCE AND SUPPLY MERCY WITH THE NECESSARY FINANCIAL AND OTHER INFORMATION REQUIRED. PATIENTS WHO QUALIFY FOR COMMUNITY CARE BENEFITS WILL RECEIVE A REDUCTION IN THE BALANCE OWED, EXTENDED PAYMENT TERMS, OR BOTH. THE AMOUNT OF THE FINANCIAL ASSISTANCE BENEFIT WILL BE BASED ON THE PATIENT'S ABILITY TO PAY AND THE SIZE OF THE OUTSTANDING BALANCE. |
| PART VI, LINE 2: | THE HOSPITALS OF MERCY HEALTH CORPORATION, INC. WORK IN CONJUNCTION WITH THE PUBLIC HEALTH DEPARTMENTS OF ROCK (WI), WALWORTH (WI), MCHENRY (IL) AND WINNEBAGO (IL) COUNTIES TO COMPLETE COMMUNITY HEALTH NEEDS ASSESSMENT SURVEYS FOR EACH REGION AND WORK TO ADDRESS THOSE NEEDS. COLLABORATION VARIED BY COUNTY AND INDEPENDENT REPORTS FOR EACH HOSPITAL WERE CREATED TO ENSURE IT MET IRS STANDARDS. COLLABORATIVE EXAMPLES OF MERCYHEALTH ORGANIZATIONS PROVIDING CARE TO THE COMMUNITY INCLUDE (BUT NOT LIMITED TO):RONALD MCDONALD CARE MOBILE: THE MOBILE UNIT PROVIDES FREE MEDICAL CARE TO UNINSURED AND UNDERINSURED CHILDREN IN FIVE NORTHERN ILLINOIS COUNTIES. SINCE ITS INCEPTION IN 2003, IT HAS PROVIDED $3.2 MILLION IN FREE CARE TO MORE THAN 10,380 CHILDREN. THE CARE MOBILE IS COMPLETELY FUNDED BY PHILANTHROPY FROM THE MERCYHEALTH DEVELOPMENT FOUNDATION, JAVON BEA HOSPITAL AUXILIARY, AND THE RONALD MCDONALD CHARITIES OF MADISON. HEALTHNET FREE CLINIC IN JANESVILLE, WISCONSIN; FAMILY HEALTH PARTNERSHIP CLINIC AND WELL CHILD CLINIC IN WOODSTOCK, IL; HARVARD FREE CLINIC IN MCHENRY COUNTY, ILLINOIS; AND THE BRIDGE CLINIC OF ROCKFORD, ILLINOIS, ARE SOME OF THE VENUES FOR UNINSURED OR UNDERINSURED INDIVIDUALS TO RECEIVE CARE. MANY MERCYHEALTH PHYSICIANS AND OTHER HEALTH CARE PROVIDERS VOLUNTEER THEIR SERVICES AT THESE CLINICS.ROCKFORD RESCUE MISSION: MERCYHEALTH RESIDENTS VOLUNTEER THEIR TIME TO PROVIDE CARE AT THE ROCKFORD RESCUE MISSION HOMELESS SHELTER.JAVON BEA HOSPITAL PARTNERS WITH A SILVER LINING FOUNDATION TO PROVIDE SCREENING MAMMOGRAMS AND OTHER BREAST RELATED SERVICES FOR UNINSURED OR UNDERINSURED WOMEN.RED CROSS: MERCYHEALTH HOSTS REGULAR BLOOD DRIVES AND PARTNERS IN COOPERATIVE VOLUNTEER EFFORTS.UNITED WAY: MERCYHEALTH HOSTS AN ANNUAL GIVING FUNDRAISING CAMPAIGN TO RAISE MONEY FOR UNITED WAY IN ALL ITS COUNTIES.AREA POLICE AND FIRE DEPARTMENTS: PROVIDE FREE OR REDUCED-COST PARAMEDIC/EMT EDUCATIONAL OPPORTUNITIES. EMPLOYEE PARTICIPATION ON COMMUNITY BOARDS. AN EXAMPLE: COMMUNITY ACTION, INC., A NOT-FOR-PROFIT ORGANIZATION OFFERING PROGRAMS TO FIGHT POVERTY IN ROCK AND WALWORTH COUNTIES. |
| PART VI, LINE 4: | MERCY CRYSTAL LAKE HOSPITAL AND MEDICAL CENTER, INC. IS LOCATED IN MCHENRY COUNTY, ILLINOIS. IT IS LICENSED FOR 15 ACUTE CARE BEDS. MCL IS A MICRO-HOSPITAL WITH 24/7 EMERGENCY SERVICES AND OUTPATIENT SURGERY. MCL BEGAN OPERATIONS IN 2024. APPROXIMATELY 16% OF MCHENRY COUNTY RESIDENTS LIVE IN HOUSEHOLDS WITH INCOME BELOW 200% OF THE FEDERAL POVERTY LEVEL. |
| PART VI, LINE 5: | MERCY CRYSTAL LAKE HOSPITAL AND MEDICAL CENTER HAS AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA. MERCY CRYSTAL LAKE HOSPITAL AND MEDICAL CENTER INC. HAS A GOVERNING BODY IN WHICH INDEPENDENT COMMUNITY MEMBERS COMPRISE A MAJORITY OF THE BOARD. |
| PART VI, LINE 6: | MERCY CRYSTAL LAKE HOSPITAL AND MEDICAL CENTER PROVIDES ACUTE CARE SERVICES IN MCHENRY COUNTY, ILLINOIS. IT IS PART OF A LARGER INTEGRATED HEALTH CARE SYSTEM AND IS AFFILIATED WITH OTHER SEPARATELY REPORTED ORGANIZATIONS KNOWN COLLECTIVELY AS "MERCYHEALTH". MERCY HEALTH CORPORATION IS THE PARENT COMPANY OF MERCY HEALTH SYSTEM CORPORATION, MERCY ASSISTED CARE INC., MERCY HARVARD HOSPITAL, INC., MERCY CRYSTAL LAKE HOSPITAL AND MEDICAL CENTER INC., JAVON BEA HOSPITAL, ROCKFORD HEALTH PHYSICIANS, AND MERCYHEALTH VISITING NURSES ASSOCIATION INC. MERCY HEALTH SYSTEM CORPORATION OPERATES TWO HOSPITALS AND HAS COMMUNITY CLINICS LOCATED THROUGHOUT SIX COUNTIES OF WISCONSIN AND ILLINOIS. MERCY ASSISTED CARE ALONG WITH MERCYHEALTH VISITING NURSES ASSOCIATION, INC. PROVIDES HOME HEALTH SERVICES, HOSPICE, AND DURABLE MEDICAL EQUIPMENT SERVICES; THUS, PROVIDING CONTINUATION OF CARE. JAVON BEA HOSPITAL PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES TO RESIDENTS OF ROCKFORD, ILLINOIS AND THE SURROUNDING COMMUNITIES. ROCKFORD HEALTH PHYSICIANS PROVIDES PHYSICIAN AND AMBULATORY CARE SERVICES AT SEVERAL ILLINOIS SITES. MERCYHEALTH WORKS WITH MERCYHEALTH DEVELOPMENT FOUNDATION, INC. TO OPERATE A HOMELESS SHELTER IN JANESVILLE, WISCONSIN. THE HOUSE OF MERCY HOMELESS CENTER PROVIDES SHELTER, SUPPORT, AND TRAINING TO WOMEN, CHILDREN, AND FAMILIES TO HELP FIGHT HOMELESSNESS. IT OPENED IN 1996 AND PROVIDED MORE THAN 10,000 SHELTER NIGHTS FOR 300 INDIVIDUALS IN FISCAL 2025. MERCY HOSPITAL ASSOCIATION OF VOLUNTEERS, INC. IS AN ENTITY WITH MERCYHEALTH'S VOLUNTEERS. THIS ORGANIZATION NOT ONLY SUPPORTS MERCYHEALTH'S SERVICES, BUT PROVIDES BENEFITS TO THE COMMUNITY AS A WHOLE. IN CONJUNCTION WITH MERCY HEALTH SYSTEM CORPORATION'S MEAL PREPARATION, THE VOLUNTEERS PARTICIPATE IN AND OVERSEE A MEALS -ON- WHEELS PROGRAM: PARTICIPANT/NUTRITION- SPECIFIC MEALS ARE PREPARED AND DELIVERED TO THE ELDERLY NEEDING ASSISTANCE IN JANESVILLE. THE VOLUNTEER ASSOCIATION RUNS A HOSPITALITY HOUSE IN WHICH FAMILY MEMBERS OF PATIENTS ARE OFFERED FREE HOUSING DURING THEIR LOVED ONES EXTENDED HOSPITAL STAY AND REHABILITATION. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCHENRY AREA CHAMBER OF COMMERCE | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1307 N GREEN STREET | AddressLine1Txt |
| City | MCHENRY | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60060 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 362992246 | RecipientEIN |
| IRC Section | 501(C)(6) | IRCSectionDesc |
| Cash Grant | $9,950 | CashGrantAmt |
| Non Cash Assistance | $0 | NonCashAssistanceAmt |
| Purpose Of Grant | PROGRAM SUPPORT | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 0 | Total501c3OrgCnt |
| Total Other Org | 1 | TotalOtherOrgCnt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | CHARITY CARE (GROSS CHARGES) - MERCY CRYSTAL LAKE HOSPITAL | GrantTypeTxt |
| Recipient | 740 | RecipientCnt |
| Cash Grant | $1,222,580 | CashGrantAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE HOSPITAL ASSISTS INDIVIDUALS WHO ARE UNINSURED OR UNDERINSURED BY PROVIDING CHARITY CARE. THIS IS APPLIED BY FOLLOWING THE HOSPITAL'S CHARITY CARE POLICY. THIS POLICY IS ADMINISTERED THROUGH THE PATIENT FINANCIAL SERVICE AND PATIENT ACCESS DEPARTMENTS OF THE HOSPITAL. GRANT APPLICATIONS ARE SUBMITTED TO THE HOSPITAL VERIFYING A NEED FOR FUNDS OR PRODUCTS (IE: AUTOMATIC ELECTRONIC DEFIBRILLATORS-AED'S). A DETERMINATION IS MADE THROUGH A PREDETERMINED SCORING METHOD AS TO WHAT ORGANIZATIONS WILL BE RECIPIENTS OF THE FUNDS OR PRODUCTS. CASH CONTRIBUTIONS ARE MADE ONLY TO RECOGNIZED CHARITIES FOR WHICH GOOD FAITH REGADING FUND USE HAS BEEN ESTABLISHED. THE CONTRIBUTION IS ONLY FOR THE AMOUNT OF THE APPEAL AND FOR A SPECIFIED NEED. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (10 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| TODD ANDERSON | ||||||||||||||
| VP/CFO (TERM 01/2025) | $0 | $586,511 | $0 | $312,052 | $0 | $36,906 | $0 | $54,422 | $0 | $23,208 | $0 | $1,013,099 | $0 | $0 |
| KIMBERLY SCACCIA | ||||||||||||||
| VP - REVENUE CYCLE (TERM 09/2025) | $0 | $322,371 | $0 | $183,768 | $0 | $27,394 | $0 | $32,410 | $0 | $33,699 | $0 | $599,642 | $0 | $0 |
| MARK L GOELZER MD | ||||||||||||||
| DIRECTOR/PHYSICIAN | $0 | $83,252 | $0 | $390,179 | $0 | $26,885 | $0 | $20,700 | $0 | $18,224 | $0 | $539,240 | $0 | $0 |
| NICHOLAS VENTOCILLA | ||||||||||||||
| ADVANCED PRACTICE CONTRACT PROVIDER | $257,443 | $0 | $32,355 | $0 | $108 | $0 | $9,137 | $0 | $37,430 | $0 | $336,473 | $0 | $0 | $0 |
| GREGORY ZANKLE | ||||||||||||||
| ADVANCED PRACTICE CONTRACT PROVIDER | $267,701 | $0 | $17,870 | $0 | $1,524 | $0 | $5,202 | $0 | $2,078 | $0 | $294,375 | $0 | $0 | $0 |
| TYLER KILLPACK | ||||||||||||||
| VICE-PRESIDENT | $0 | $172,826 | $0 | $67,500 | $0 | $2,125 | $0 | $11,064 | $0 | $32,251 | $0 | $285,766 | $0 | $0 |
| THOMAS GARRITY | ||||||||||||||
| PHYSICIAN | $208,655 | $0 | $18,500 | $0 | $12,519 | $0 | $9,586 | $0 | $3,560 | $0 | $252,820 | $0 | $0 | $0 |
| MANDY RUEFF | ||||||||||||||
| ADVANCED PRACTICE CONTRACT PROVIDER | $215,200 | $0 | $22,100 | $0 | $96 | $0 | $2,094 | $0 | $508 | $0 | $239,998 | $0 | $0 | $0 |
| BRENDA BOTE-CATACUTAN | ||||||||||||||
| RN HOSPITAL ADVANCED | $146,819 | $0 | $13,670 | $0 | $360 | $0 | $7,949 | $0 | $26,911 | $0 | $195,709 | $0 | $0 | $0 |
| JAVON R BEA | ||||||||||||||
| PRESIDENT/CEO (SEE PAGES 46-47) | $0 | $3,006,196 | $0 | $0 | $0 | $8,634,628 | $0 | $4,677,610 | $0 | $17,719 | $0 | $16,336,153 | $0 | $6,584,546 |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3 | THE MHSC COMPENSATION COMMITTEE IS COMPRISED OF THE BOARD CHAIRPERSON, VICE CHAIR, AND SECRETARY/TREASURER. THE COMPENSATION COMMITTEE IS ASSISTED BY INDEPENDENT NATIONAL COMPENSATION CONSULTANT AND INDEPENDENT TAX-EXEMPT EXPERT LEGAL COUNSEL. THE COMPENSATION COMMITTEE, LEGAL COUNSEL, AND THE COMPENSATION CONSULTANT MEET THROUGHOUT THE YEAR AND REPORT DIRECTLY TO THE BOARD OF DIRECTORS ANNUALLY. THIS PROCESS WAS COMPLETED FOR 2024. |
| PART I, LINE 4B | JAVON BEA AND TODD ANDERSON PARTICIPATED IN THE 457(F) PLAN DURING CALENDAR YEAR 2024. HOWEVER, NEITHER OF THESE INDIVIDUALS RECEIVED PAYOUTS DURING THE YEAR. |
| PART I, LINE 7 | BONUSES RECEIVED BY THE OFFICERS FOR MHSC ARE BASED UPON TWO CRITERIA: 1) FINANCIAL PERFORMANCE - UP TO 25% OF BASE SALARY WILL BE PAID BASED ON MEETING BUDGETARY GOALS. 2) LONG TERM INCENTIVE - BASED UPON STRATEGIC IMPLEMENTATION. EMPLOYEES CAN EARN UP TO ANOTHER 25% OF BASE SALARY TO BE PAID OUT OVER 3 YEARS AND IS BASED ON RETENTION AND LONG TERM GOALS. |
| PART II, LINE 1: | JAVON R. BEA - NO DEFERRED COMPENSATION PAYMENT MR. BEA HAS BEEN EMPLOYED BY MHSC AS PRESIDENT AND CEO OVER THE PAST 37 YEARS. DURING THIS TIME, MR. BEA HAS LED AN INCREDIBLE TRANSFORMATION TAKING A SMALL, SINGLE, STAND-ALONE COMMUNITY HOSPITAL AND CREATING A VERTICALLY INTEGRATED HEALTH SYSTEM WITH 85 FACILITIES IN 50 COMMUNITIES THROUGHOUT SOUTHERN WISCONSIN AND NORTHERN ILLINOIS, INCREASING GROSS REVENUE FROM $33 MILLION TO OVER $4.5 BILLION IN FY2025. THIS HAS ALLOWED THE HEALTH SYSTEM TO GO FROM SERVING 89,000 PATIENTS IN 1989 TO OVER 2.0 MILLION PATIENTS TODAY WORKING TOGETHER WITH OVER 7,500+ PARTNERS IN HEALTH CARE. IN ADDITION, MR. BEA OVERSEES OVER 800 EMPLOYED PHYSICIANS AND SERVES AS THE CEO OVER A WHOLLY OWNED & OPERATED MEDICAL INSURANCE COMPANY. TODAY, MHSC HAS BECOME THE LARGEST EMPLOYER IN SOUTHERN WISCONSIN AND NORTHERN ILLINOIS. THIS GROWTH CAN BE ATTRIBUTED TO MR. BEA'S VISIONARY LEADERSHIP. LEADERSHIP THAT OVER THE YEARS HAS LED TO MHSC RECEIVING NUMEROUS NATIONAL RECOGNIZED AWARDS INCLUDING BEING NAMED THE FIRST FULLY INTEGRATED HEALTH SYSTEM TO RECEIVE THE MALCOLM BALDRIGE NATIONAL QUALITY AWARD, THE MAGNET RECOGNITION AWARD, BEING RANKED #1 AND #2 ON AARP'S TOP 100 BEST PLACES TO WORK FOR WORKERS OVER 50, AND BEING RANKED IN THE TOP 25 ON THE TOP 100 INTEGRATED HEALTHCARE NETWORKS LIST BY MODERN HEALTHCARE. THE TURNAROUND OF MHSC IMPLEMENTED BY MR. BEA IS UNPARALLELED. BY PIONEERING A "PARTNERSHIP MODEL" OF COMPENSATION AND DESIGNING A CUSTOM CULTURE OF EXCELLENCE, MR. BEA IS VITAL TO THE DECADES-LONG AND CONTINUING GROWTH AT MHSC. THIS SUCCESS HAS MADE MR. BEA A HIGHLY SOUGHT AFTER SPEAKER AND CONSULTANT AS HE IS NOW WELL-RENOWNED FOR HIS INNOVATIONS IN THE AREAS OF INTEGRATED HEALTHCARE AND PHYSICIAN PARTNERSHIP MODELS. THE TREMENDOUS SUCCESS OF MHSC UNDER THE LEADERSHIP OF MR. BEA HAS ALLOWED HIM TO RECEIVE PAYOUTS FROM A DEFERRED COMPENSATION PACKAGE WHICH MHSC HAS BEEN PAYING INTO OVER MANY YEARS. THESE PAYMENTS ONLY BECAME PAYABLE IF MHSC ATTAINED CERTAIN DEFINED FINANCIAL AND STRATEGIC GOALS AND THE AMOUNTS ARE AT RISK EVERY SINGLE YEAR. AS INDICATED ABOVE, MANY OF THESE GOALS WERE ACHIEVED WITHIN THE PAST FEW YEARS RESULTING IN A RELEASE OF THESE DEFERRED PAYMENTS WHICH IMPACTED MR. BEA'S COMPENSATION REPORTING. THE SETTING OF THESE GOALS WERE LAID OUT BY THE BOARD OF DIRECTORS IN COOPERATION WITH NATIONALLY RECOGNIZED COMPENSATION ATTORNEYS AND CONSULTANTS TO MAKE SURE ALL FACTORS WERE TAKEN INTO CONSIDERATION. MR. BEA'S COMPENSATION HAS ALSO BEEN SCRUTINIZED BY NUMEROUS OUTSIDE ORGANIZATIONS AND MOST IMPORTANTLY, THE INTERNAL REVENUE SERVICE; AND HAS PASSED INSPECTION IN EACH CASE. TOTAL COMPENSATION IS APPROVED ANNUALLY BY THE BOARD OF DIRECTORS OF MHSC. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1A | THE VOTING MEMBERS OF THE EXECUTIVE COMMITTEE CONSISTS OF EIGHT INDIVIDUALS, EACH OF WHOM SHALL HAVE A VOTE, INCLUDING THE CEO, THE CHAIRMAN, VICE-CHAIRMAN, IMMEDIATE PAST CHAIRMAN, TREASURER, AND TWO ADDITIONAL DIRECTORS OF THE BOARD. AT LEAST ONE MEMBER OF THE EXECUTIVE COMMITTEE SHALL BE A PHYSICIAN. THE EXECUTIVE COMMITTEE SHALL IN ALL INSTANCES BE COMPRISED OF AT LEAST 51% COMMUNITY MEMBERS. IN THE EVENT THAT ONE OR MORE OF THE AFOREMENTIONED VOTING MEMBERS OF THE EXECUTIVE COMMITTEE IS UNABLE TO SERVE IN SUCH CAPACITY, THEN THE CHAIRMAN OF THE CORPORATION SHALL DESIGNATE A REPLACEMENT FROM AMONG THE BOARD MEMBERS. THE EXECUTIVE COMMITTEE SHALL MEET AS NEEDED. WHEN THE BOARD OF DIRECTORS IS NOT IN SESSION, THE EXECUTIVE COMMITTEE SHALL HAVE ALL THE POWERS, DUTIES, RESPONSIBILITIES AND AUTHORITY OF THE BOARD, EXCEPT AS PROHIBITED BY LAW. |
| FORM 990, PART VI, SECTION A, LINE 6 | MERCY HEALTH CORPORATION (MHC) IS THE SOLE CORPORATE MEMBER OF MERCY CRYSTAL LAKE HOSPITAL AND MEDICAL CENTER, INC. (CLH). THE SOLE MEMBER SHALL HAVE POWERS AND VOTING RIGHTS TO DO THE FOLLOWING: (A) APPOINT ALL THE DIRECTORS OF THE CORPORATION (B) NOMINATE TO THE CORPORATION'S BOARD OF DIRECTORS ALL CANDIDATES FOR SELECTION AS THE CORPORATION PRESIDENT (C) APPROVE EXPRESSLY ALL AMENDMENTS TO THE CORPORATION'S ARTICLES OF INCORPORATION AND BYLAWS (D) APPROVE ANNUAL BUDGETS, AND STRATEGIC, LONG-RANGE AND HEALTH MANPOWER DEVELOPMENT PLANS OF THE CORPORATION (E) REQUIRE THE CORPORATION'S BOARD OF DIRECTORS TO TAKE ANY ACTION (INCLUDING AUTHORIZING THE PLEDGE OR TRANSFER OF ASSETS TO MHC OR AS DIRECTED BY MHC, OR THE EXECUTION OF CONTRACTS) WHICH WOULD IMPROVE THE CREDIT WORTHINESS OR OTHERWISE RESULT IN FINANCIAL BENEFIT TO MHC AND ITS TAX-EXEMPT AFFILIATED CORPORATIONS (PROVIDED THAT UNDER NO CIRCUMSTANCES MAY MHC REQUIRE TRANSFER OF ASSETS IN VIOLATION OF LAW OR THE TERMS OF ANY CHARITABLE TRUST OR DONATION) (F) APPROVE ALL CONTRACTS OF INDEBTEDNESS EFFECTIVE FOR LONGER THAN EIGHTEEN MONTHS (G) APPROVE ALL PLANS OF MERGER OR CONSOLIDATION (H) APPROVE THE SALE, LEASE, EXCHANGE, MORTGAGE, PLEDGE OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL, THE PROPERTY AND ASSETS OF THE CORPORATION (I) APPROVE A VOLUNTARY DISSOLUTION OF THE CORPORATION (J) APPROVE MATERIAL AMENDMENTS TO THE CORPORATION'S STANDARD FORM OF PHYSICIAN EMPLOYMENT AGREEMENT, PROVIDED THE CORPORATION SHALL HAVE THE AUTHORITY TO NEGOTIATE THE TERMS AND CONDITIONS OF INDIVIDUAL PHYSICIAN EMPLOYMENT AGREEMENTS SO LONG AS THE NEGOTIATED TERMS AND CONDITIONS ARE CONSISTENT WITH THE REQUIREMENTS OF APPLICABLE LAW AND THE STRATEGIC, LONG-RANGE AND HEALTH MANPOWER DEVELOPMENT PLANS APPROVED BY MHC (K) APPROVE MATERIAL AMENDMENTS TO THE STANDARD COMPENSATION SYSTEM USED BY THE CORPORATION TO ESTABLISH INDIVIDUAL PHYSICIAN COMPENSATION (L) REQUIRE THE CORPORATION'S BOARD OF DIRECTORS TO TAKE ANY ACTION (INCLUDING AMENDING THE ARTICLES OF INCORPORATION OR BYLAWS), OR TO MODIFY OR RESCIND AN ACTION ALREADY TAKEN, IF MHC DETERMINES THAT FAILURE TO TAKE THE ACTION, OR TO MODIFY OR RESCIND AN ACTION ALREADY TAKEN, MAY RESULT IN THE CORPORATIONS FAILURE TO OBTAIN OR MAINTAIN ITS EXEMPTION AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3) OF THE CODE |
| FORM 990, PART VI, SECTION A, LINE 7A | SEE NARRATIVE FOR PART VI, LINE 6 |
| FORM 990, PART VI, SECTION A, LINE 7B | SEE NARRATIVE FOR PART VI, LINE 6 |
| FORM 990, PART VI, SECTION B, LINE 11B | MANAGEMENT REVIEWS THE FORM 990 BEFORE FILING AND IT IS AVAILABLE TO THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION B, LINE 12C | BY WRITTEN POLICY, MHC SENDS OUT, ON AN ANNUAL BASIS, THE CORPORATE CONFLICT AND DUALITY OF INTEREST POLICY TO ALL BOARD MEMBERS, CORPORATE OFFICERS AND OTHER KEY INDIVIDUALS (THOSE HAVING RESPONSIBILITY AND AUTHORITY TO MAKE FINAL DECISIONS REGARDING THE ACQUISITION OF PRODUCTS OR SERVICES). EACH RECIPIENT IS REQUIRED TO COMPLETE A FINANCIAL INTEREST DISCLOSURE STATEMENT, WHICH IS SUBMITTED TO THE MHC COMPLIANCE DEPARTMENT FOR REVIEW. WITH RESPECT TO PHYSICIANS AND MANAGERS WHO ARE KEY INDIVIDUALS, ANY POTENTIAL CONFLICT OF INTEREST IS REVIEWED WITH THE APPROPRIATE EXECUTIVE STAFF MEMBER FOR FOLLOW UP WITH THE DISCLOSING PARTY IN ORDER TO REVIEW THE MATTER IN MORE DETAIL. THIS INCLUDES EMPHASIZING THAT THE DISCLOSING PARTY IS NOT PERMITTED TO PARTICIPATE IN ANY NEGOTIATIONS FOR THE PURCHASE OF ANY PRODUCTS OR SERVICES WHERE THE CONFLICT IS DEEMED MATERIAL, OR AUTHORIZE THE SUBSEQUENT PURCHASE OF RELATED GOODS AND SERVICES. THE DISCLOSING PARTY IS ALSO REQUIRED TO IDENTIFY EACH AND EVERY INSTANCE OF A POTENTIAL CONFLICT AS THEY MAY ARISE IN THE ORDINARY COURSE OF BUSINESS. A SIMILAR PROCESS IS FOLLOWED FOR THE BOARD OF DIRECTORS, EXCEPT THAT ANY POTENTIAL CONFLICT IS REVIEWED BY THE BOARD'S GOVERNANCE COMMITTEE. BOARD MEMBERS MAY COMMENT ON TRANSACTIONS WHERE THERE IS A POTENTIAL CONFLICT, BUT CANNOT VOTE ON THE RELATED MATTER AND MAY BE REQUIRED TO LEAVE ANY MEETING WHERE THE POTENTIAL CONFLICT IS REVIEWED BY THE BOARD OR WHERE THE BOARD TAKES ACTION TO EITHER APPROVE OR NOT APPROVE THE PROPOSED TRANSACTION. A BOARD MEMBER ALSO HAS A CONTINUING DUTY TO REPORT ANY CONFLICTS AS THEY MAY ARISE IN THE ORDINARY COURSE OF BUSINESS. IN THE EVENT THAT A POTENTIAL CONFLICT OF INTEREST IS REPORTED OR DISCOVERED OUTSIDE THE ESTABLISHED PROCESS, APPROPRIATE REVIEW AND ACTION WOULD BE TAKEN. THIS PROCESS WAS LAST COMPLETED IN 2025, WHEN THE QUESTIONNAIRES WERE SENT TO ADDRESS ANY 2024 CONFLICTS IDENTIFIED. CLH AND MHC HAVE THE SAME BOARD, AND THEREFORE THE MHC QUESTIONNAIRE IS USED TO ALSO ADDRESS POTENTIAL AND ACTUAL CONFLICTS FOR THE FILING ORGANIZATION. THE MHC CONFLICT OF INTEREST POLICY IS AVAILABLE UPON REQUEST. |
| FORM 990, PART VI, SECTION C, LINE 19 | NO DOCUMENTS AVAILABLE TO THE PUBLIC |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (9 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| JAVON BEA HOSPITAL | |||||||||||
| 8201 E RIVERSIDE BLVD | ROCKFORD | IL | 61114 | 362167847 | HEALTHCARE | IL | 501(C)(3) | LINE 3 | MERCY HEALTH CORPORATION | 0 | |
| MERCYHEALTH DEVELOPMENT FOUNDATION | |||||||||||
| 8201 E RIVERSIDE BLVD | ROCKFORD | IL | 61114 | 363197918 | SUPPORT OF HEALTHCARE | IL | 501(C)(3) | LINE 12A, I | MERCY HEALTH CORPORATION | 0 | |
| ROCKFORD HEALTH PHYSICIANS | |||||||||||
| 8201 E RIVERSIDE BLVD | ROCKFORD | IL | 61114 | 363907436 | HEALTHCARE | IL | 501(C)(3) | LINE 3 | MERCY HEALTH CORPORATION | 0 | |
| MERCY HEALTH SYSTEM ASSOCIATION OF VOLUNTEERS | |||||||||||
| 1000 MINERAL POINT AVE | JANESVILLE | WI | 53548 | 390912682 | SUPPORT OF HEALTHCARE | WI | 501(C)(3) | LINE 12C, III-FI | MERCY HEALTH SYSTEM CORPORATION | 0 | |
| MERCY HEALTH SYSTEM CORPORATION | |||||||||||
| 1000 MINERAL POINT AVE | JANESVILLE | WI | 53548 | 390816848 | HEALTHCARE | WI | 501(C)(3) | LINE 3 | MERCY HEALTH CORPORATION | 0 | |
| MERCY ASSISTED CARE INC | |||||||||||
| 901 MINERAL POINT AVE | JANESVILLE | WI | 53548 | 391035110 | HEALTHCARE | WI | 501(C)(3) | LINE 10 | MERCY HEALTH CORPORATION | 0 | |
| MERCY HARVARD HOSPITAL INC | |||||||||||
| 901 GRANT STREET | HARVARD | IL | 60033 | 311551871 | HEALTHCARE | IL | 501(C)(3) | LINE 3 | MERCY HEALTH CORPORATION | 0 | |
| MERCYHEALTH VISITING NURSES ASSOCIATION INC | |||||||||||
| 8201 E RIVERSIDE BLVD | ROCKFORD | IL | 61114 | 362167945 | HEALTHCARE | IL | 501(C)(3) | LINE 10 | MERCY HEALTH CORPORATION | 0 | |
| MERCY HEALTH CORPORATION | |||||||||||
| 8201 E RIVERSIDE BLVD | ROCKFORD | IL | 61114 | 472158680 | SUPPORT OF HEALTHCARE | IL | 501(C)(3) | LINE 12B, II | 0 | N/A | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (4 entries)
| Address Line1ForeignAddress/AddressLine1Txt | CityForeignAddress/CityNm | CountryForeignAddress/CountryCd | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Legal Domicile StateLegalDomicileStateCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ROCKFORD HEALTH INSURANCE LTD | |||||||||||||
| WELLESLEY HOUSE SO 2ND FL | PEMBROKE HM | BD | INSURANCE | BD | N/A | C | 0 | ||||||
| JANESVILLE MEDICAL CENTER INC | |||||||||||||
| MANAGEMENT OF UNION EMPLOYEES | N/A | C | 0 | 1000 MINERAL POINT AVE | JANESVILLE | WI | 53548 | 391520130 | WI | ||||
| MERCYCARE INSURANCE COMPANY | |||||||||||||
| INSURANCE | N/A | C | 0 | 580 N WASHINGTON ST | JANESVILLE | WI | 53546 | 391768192 | WI | ||||
| MERCYCARE HMO INC - CONSOLIDATED WITH MERCYCARE INSURANCE CO | |||||||||||||
| INSURANCE | N/A | C | 0 | 580 N WASHINGTON ST | JANESVILLE | WI | 53546 | 201482553 | WI | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (1) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |