TY 2019 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC)
(1) Mary M Hood...................................................................... Trustee/Ex Off	1.00 ................. 50.00	X	X	0	1,756,068	48,356
(2) John Wahlig...................................................................... Physician	50.00 ................. 0.00			1,024,319	0	37,703
(3) Timothy Dentry...................................................................... Trustee/Ex Off	1.00 ................. 50.00	X	X	0	730,643	137,680
(4) Anthony Filer...................................................................... Treasurer	1.00 ................. 50.00		X	0	745,697	54,010
(5) Nicolas F Arredondo...................................................................... Physician	50.00 ................. 0.00			740,650	0	39,260
(6) Lee Thibodeau...................................................................... Physician	50.00 ................. 0.00			697,445	0	39,185
(7) Glenn Martin...................................................................... Secretary	1.00 ................. 50.00		X	0	613,309	113,066
(8) Christopher Kleeman...................................................................... Medical Director	50.00 ................. 0.00			651,068	0	30,629
(9) Catherine McCrann...................................................................... Physician	50.00 ................. 0.00			579,029	0	39,562
(10) Charlie Therrien...................................................................... Pres/Ex Off	50.00 ................. 0.00	X	X	484,856	0	98,805
(11) Paul Bolin...................................................................... SVP & CHRO	1.00 ................. 50.00		X	0	435,162	96,820
(12) Benjamin Russell MD...................................................................... Trustee/Ex Off	50.00 ................. 0.00	X		399,733	0	27,773
(13) Colleen Hilton...................................................................... Former Officer	0.00 ................. 50.00			0	321,682	69,727
(14) Bruce Sandstrom...................................................................... VP, Fin/PT YR	50.00 ................. 0.00		X	346,482	0	34,622
(15) John Southall MD...................................................................... Trustee	50.00 ................. 0.00	X		334,911	0	34,610
(16) Michael Duffy MD...................................................................... VP Senior Phys	50.00 ................. 0.00		X	314,725	0	32,582
(17) Bette Neville...................................................................... VP CNO	50.00 ................. 0.00		X	259,653	0	34,923

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC)
(18) David Fernandez........................................................................ Former VP, Phys Practice	50.00 .......................0.00			240,963	15,530
(19) Melissa Skahan........................................................................ VP Mission Int	50.00 .......................0.00		X	207,472	28,347
(20) Wendy Napolitano........................................................................ VP Perf Oper	50.00 .......................0.00		X	163,979	36,214
(21) Chris Howard........................................................................ Trustee	1.00 .......................0.00	X		0	0
(22) Arthur Batson III........................................................................ Trustee	1.00 .......................0.00	X		0	0
(23) Daniel McGarvey........................................................................ Trustee	1.00 .......................0.00	X		0	0
(24) Sister Anne-Marie Bourque........................................................................ Trustee	1.00 .......................0.00	X		0	0
(25) Laura Blaisdell MD........................................................................ Trustee	1.00 .......................0.00	X		0	0
(26) Sister Mary Morey RSM........................................................................ Trustee	1.00 .......................0.00	X		0	0
(27) Mike Varney........................................................................ Trustee	1.00 .......................0.00	X		0	0
(28) Joseph Gray........................................................................ Trustee	1.00 .......................0.00	X		0	0
(29) Karen Pardue........................................................................ Trustee/PT YR	1.00 .......................0.00	X		0	0
(30) Margaret Hourigan........................................................................ Trustee/PT YR	1.00 .......................0.00	X		0	0
(31) Douglas McKeown........................................................................ Trustee	1.00 .......................0.00	X		0	0
(32) Paul Lones........................................................................ Trustee/Chair	2.00 .......................0.00	X	X	0	0
(33) William Schirmer MD........................................................................ Trustee	1.00 .......................0.00	X		0	0
(34) Debra D Taylor........................................................................ Trustee/Vice Ch	1.00 .......................0.00	X	X	0	0
(35) Sister Patricia Pora........................................................................ Trustee	1.00 .......................0.00	X		0	0
(36) Lisa Toner........................................................................ Trustee	1.00 .......................0.00	X		0	0
(37) David Kennedy........................................................................ VP, Fin/PT YR	50.00 .......................0.00		X	0	0

(A) Name and business address	(B) Description of services	(C) Compensation
CHEST MEDICINE ASSOCIATES 100 FODEN ROAD SUITE 103 SOUTH PORTLAND,ME04106	PHYSICIAN & DIRECTOR SERV	1,435,996
SIMPLIFI 5020 NORTHSHORE DRIVE SUITE 2 NORTH LITTLE ROCK,AR72118	TEMP STAFFING	878,985
COMPHEALTH PO BOX 972651 DALLAS,TX75397	TEMP STAFFING	747,715
HBCS 118 LUKENS DRIVE NEW CASTLE,DE19720	COLLECTION FEES	1,296,463
SOUTHERN MAINE ORTHOPAEDIC 16 NORTHBROOK DRIVE PORTLAND,ME04102	PHYSICIAN FEES	786,942
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 29

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
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Attach to Form 990 or Form 990-EZ.
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Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

Mercy Hospital

Employer identification number

01-0211534

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2019

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2018 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2019. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2018. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2019. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2018. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2019

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2018 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2019 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2018 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2019. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2018. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2019

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 12a or 12b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2019

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2019

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2019

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2019 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2019	(iii) Distributable Amount for 2019
1 Distributable amount for 2019 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2019:
a From 2014.......
b From 2015.......
c From 2016.......
d From 2017.......
e From 2018.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2019 distributable amount
i Carryover from 2014 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2019 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2019 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2020. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2015.....
b Excess from 2016.....
c Excess from 2017.....
d Excess from 2018.....
e Excess from 2019.....

Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2019

Additional Data

Software ID:	19009920
Software Version:	2019v5.0

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Name of the organization

Mercy Hospital

Employer identification number

01-0211534

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019) Page 2

Name of organization Mercy Hospital

Part I Contributors	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 3

Name of organization Mercy Hospital		Employer identification number 01-0211534

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 4


Name of organization Mercy Hospital			Employer identification number 01-0211534
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Additional Data

Software ID:	19009920
Software Version:	2019v5.0

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

Mercy Hospital

Employer identification number

01-0211534

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2019

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ........................
c	Total lobbying expenditures (add lines 1a and 1b) ............................................................
d	Other exempt purpose expenditures ...............................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ..................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ...................................................................................................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2016	(b) 2017	(c) 2018	(d) 2019	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2019

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes|No

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Yes

21,366

Total. Add lines 1c through 1i ....................................................................................................

21,366

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures (see instructions) .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
Part II-B, Line 1i - Other Activities Description	Non-deductible dues

Schedule C (Form 990 or 990EZ) 2019

Additional Data

Software ID:	19009920
Software Version:	2019v5.0

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

Mercy Hospital

Employer identification number

01-0211534

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2019

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....	3,506,492	3,492,269	1,997,798	1,926,568	1,857,178
b	Contributions ...	4,868	9,344	1,283,502	1,600	150
c	Net investment earnings, gains, and losses	144,504	67,892	273,034	69,630	69,240
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...	97,780	63,013	62,065
f	Administrative expenses ....
g	End of year balance ......	3,558,084	3,506,492	3,492,269	1,997,798	1,926,568

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

100.000 %

Term endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

Yes

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Yes

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	9,703,734		9,703,734
b	Buildings ....	62,180,950	12,565,249	49,615,701
c	Leasehold improvements	2,160,668	1,428,446	732,222
d	Equipment ....	49,791,143	39,628,374	10,162,769
e	Other .....	19,351,597	488,165	18,863,432
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				89,077,858

Schedule D (Form 990) 2019

Page 3

Part VII

InvestmentsOther Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3)Other
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1)A/R Workers Compensation Insurance				1,239,592
(2)Assets whose use is limited				195,279
(3)Beneficial Interest in Perpetual Trusts				921,930
(4)Board designated funds-Other				9,411
(5)Construction Fund				40,583,860
(6)Investment in Net Assets held @ EMHSF				9,435,174
(7)Self Insurance & Pension Plans				5,165,149
(8)Temporarily Donor Restricted Funds				209,164
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				57,759,559

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	14,365,120
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2019

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference

Explanation

Part V, Line 4: Intended uses of the endowment fund.

Endowment funds are designated for purposes that align within this organization's exempt purpose.

Part X : FIN48 Footnote

Northern Light Health, its hospitals, and certain other affiliates have been determined by the Internal Revenue Service to be tax-exempt charitable organizations as described in Section 501(c)(3) or 501(c)(2) of the Internal Revenue Code (the Code) and, accordingly, are exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. Accordingly, no provision for federal income taxes has been recorded in the accompanying consolidated financial statements for these organizations.Tax-exempt charitable organizations could be required to record an obligation for income taxes as the result of a tax position they have historically taken on various tax exposure items including unrelated business income or tax status. Under guidance issued by FASB, assets and liabilities are established for uncertain tax positions taken or positions expected to be taken in income tax returns when such positions are judged to not meet the more-likely-than-not threshold, based upon the technical merits of the position. Estimated interest and penalties, if applicable, related to uncertain tax positions are included as a component of income tax expense. The Northern Light Health has evaluated its tax position taken or expected to be taken on income tax returns and concluded the impact to be not material.Certain of the Northern Light Health's affiliates are taxable entities. Deferred taxes related to these entities are based on the difference between the financial statement and tax bases of assets and liabilities using enacted tax rates in effect in the years the differences are expected to reverse. The deferred tax assets and liabilities for these entities are not material.

Schedule D (Form 990) 2019

Additional Data

Software ID:	19009920
Software Version:	2019v5.0

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

Mercy Hospital

Employer identification number

01-0211534

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .		1,934	926,261		926,261	0.420 %
b	Medicaid (from Worksheet 3, column a) . . . . .		31,299	27,947,509	16,789,730	11,157,779	5.010 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .		33,233	28,873,770	16,789,730	12,084,040	5.430 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	14	751	1,050,734		1,050,734	0.470 %
f	Health professions education (from Worksheet 5) . . .
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	5		12,384		12,384	0.010 %
j	Total. Other Benefits . .	19	751	1,063,118		1,063,118	0.480 %
k	Total. Add lines 7d and 7j .	19	33,984	29,936,888	16,789,730	13,147,158	5.910 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2019

Schedule H (Form 990) 2019

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support	2	365,635	365,635	0.200 %
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building	1	560	560
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total	3	366,195	366,195	0.200 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

5,449,070

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

65,713,871

Enter Medicare allowable costs of care relating to payments on line 5.....

94,779,165

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-29,065,294

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2019

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	Northern Light Mercy Hospital 144 STATE STREET PORTLAND,ME04101 northernlighthealth.org/Mercy- 38065	X	X	X

Schedule H (Form 990) 2019

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	Northern Light Mercy Hospital
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 19

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): See Part V, Line 16j for URL

Other website (list url): See Part V, Line 16j for URL

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 19

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): See Part V, Line 16j for URL

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2019

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	Northern Light Mercy Hospital
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 150.0000%
and FPG family income limit for eligibility for discounted care of 250.0000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

See Part V, Line 16j for URL

The FAP application form was widely available on a website (list url):

See Part V, Line 16j for URL

A plain language summary of the FAP was widely available on a website (list url):
See Part V, Line 16j for URL

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 6

Part VFacility Information (continued)

Billing and Collections

	Northern Light Mercy Hospital
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	Northern Light Mercy Hospital
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2019

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
Facility: Northern Light Mercy Hospital - Part V, Section B, Line 5	The Maine Shared CHNA research team conducted a statewide qualitative assessment among stakeholders to identify and prioritize significant health issues in communities across the state. The assessment, coordinated with the Maine CDC, engaged public health expertise throughout the process. Community outreach was conducted between September 2018 and January 2019. Community forums with residents and service providers were held in the county. All forms of engagement included public forums and key informant interviews. The purpose of this outreach was to gather feedback on data and to identify health priorities, community assets, and gaps in resources to be used in health improvement planning. Local forums were conducted in partnership with the Maine CDC to solicit input from individuals representing populations with health disparities including medically underserved, low-income, or minority populations. The following organizations attended the October 4 and 11, 2018 Cumberland County Shared CHNA Community Engagement Forum and provided valuable feedback on the Maine Shared CHNA.Persons representing broad interests of the community who were consulted during the engagement process (the following list was extracted from the Cumberland County CHNA report, pages 28-30): Acadia Healthcare, Africans for Improved Access, Allons Health, Alzheimers Association, American Cancer Society, Birch Lane Strategies/ CDPHC, Bridgton Academy, Bridgton Community Center, Bridgton Hospital, Bridgton Hospital Physicians Group, Bridgton Lake Region Rotary Club, Bridgton Public Library, Cardiac activist, speaker, author of, An Arrow through the Heart, Catholic Charities Maine, Center for Grieving Children, Center for Tobacco Independence/MaineHealth, Central Maine HealthCare, System Director, Primary Care, Central Maine Medical Group, City of Portland Public Health Department, City of South Portland, Community Advocate, Community Health Educator, Community Dental, Community Members, Crooked River Counseling, Cross Cultural Consulting Group, Cumberland County Food Security Council, Cumberland Public Health District, Cutler Research Institute, USM Muskie School, Day One, First Congregational Church of Bridgton, Frannie Peabody Center, Gateway Community Services, Good Shepherd Food Bank, Greater Portland Health, Greater Portland Council of Governments, Hanley Leadership Center, Harry E. Davis Pediatric Center, Harpswell Dept. of Safety and Emergency Services, Homeless Health Partners, House of Languages, Lake Region Community Health Board, Lakes Environmental Association, Lakes Region Recovery Center, Lakes Region Substance Abuse Coalition, LearningWorks/Americorps, Lakes Region Substance Awareness Coalition Board Member - Key Bank Employee, Maine Access Immigrant Network (MAIN), Maine Behavioral Healthcare/Spring Harbor Hospital, Maine CDC, District Public Health Liaison, Maine Families, Maine Farmland Trust, Maine Immigrants Rights Coalition, MaineHealth, MaineHeath Care Partners, Maine Medical Center for Outcomes Research and Evaluation, Maine Medical Center, Maine Medical Partners, Martins Point HealthCare, MedAccess, Memorial Hospital, NH, Mid Coast Hospital, MSAD 61, National Alliance on Mental Illness (NAMI), Nautilus Public Health, Navigator Program, Bridgton Community Center, Northern Light Home Care & Hospice, Northern Light Mercy Hospital, Planned Parenthood of Northern New England, Portland Outright, Preble Street Learning Collaborative, Retired founding officer of Genzyme Corp., Cambridge, Retired M.D., Retired/ Community Member, Retired/Volunteer, Sam L. Cohen Foundation, SoPo Unite, Spring Harbor Hospital, Tai Chi Maine, The Bridgton News, The Opportunity Alliance, The Opportunity Alliance/Head Start, Town of Bridgton, Grant Writer, Town of Bridgton/Harrison, Local Health Officer, Town of Gray, Tri County Mental Health, United Way of Greater Portland, U.S. Centers for Disease Control & Prevention, U.S. Committee for Refugees and Immigrants, University of New England, University of Southern Maine, Westbrook Schools, Special Supplemental Nutrition Program for Women Infants, and Children (WIC).Key informant interview populations identified by the Maine Shared CHNA steering committee included medically underserved and vulnerable populations to ensure their input was heard and captured included:Veterans; Tribal communities; Adults ages 65 and older who are isolated or have multiple chronic conditions; Non-English speakers, undocumented individuals, immigrants, and refugees; Deaf individuals and those with other physical disabilities; Adolescents/youth; LGBTQ; People with mental health conditions and developmental disabilities; Rural individuals; Individuals in substance use disorder recovery/substance use disorder prevention and treatment professionals.Key informant interview populations identified by the Maine Shared CHNA steering committee included medically underserved and vulnerable populations to ensure their input was heard and captured included:Veterans; Tribal communities; Adults ages 65 and older who are isolated or have multiple chronic conditions; Non-English speakers, undocumented individuals, immigrants, and refugees; Deaf individuals and those with other physical disabilities; Adolescents/youth; LGBTQ; People with mental health conditions and developmental disabilities; Rural individuals; Individuals in substance use disorder recovery/substance use disorder prevention and treatment professionals.The following is a list of organizations who participated in Key Informant Interviews. No Tribal representatives were able to be interviewed. In the future we hope to include this important group of in the CHNA process:Alpha One, Androscoggin Home Healthcare + Hospice, Bingham Foundation, Cary Medical Center, Catholic Charities of Maine, Community Concepts, Community Caring Collaborative, Edmund Ervin Pediatric Center, MaineGeneral Health, Equality Maine, Family Medicine Institute, Frannie Peabody Center, Greater Portland Council of Governments, Healthy Acadia, Healthy Androscoggin, Healthy Communities of the Capitol Area, Kennebec Valley Council of Governments, Long Creek Youth Development Center, Maine Access Immigrant Network, Maine Alliance for Addiction and Recovery, Maine Alliance to Prevent Substance Abuse, Maine Chapter Multiple Sclerosis Society, Maine Council on Aging, Maine Migrant Health, Maine Seacoast Mission, Millinocket Chamber of Commerce, National Alliance on Mental Illness, Nautilus Public Health, Northern Light Maine Coast Hospital, Office of Aging and Disability Services, Penquis Community Action Agency, Portland Public Health, Seniors Plus, Sunrise Opportunities, Tri-County Mental Health Services, United Ambulance Service, Veterans Administration Maine Healthcare System, York County Community Action Corporation.
Facility: Northern Light Mercy Hospital - Part V, Section B, Line 6a	The Maine Shared CHNA was conducted through a collaborative effort among Maines four largest health-care systems Central Maine Healthcare, Northern Light Health (legal name Eastern Maine Healthcare Systems), MaineGeneral Health, MaineHealth and the Maine Center for Disease Control and Prevention, an office of the Maine Department of Health and Human Services (DHHS). Northern Light Health member organizations participating in the Shared CHNA included Acadia Hospital, Blue Hill Hospital, CA Dean Hospital, Eastern Maine Medical Center, Inland Hospital, Maine Coast Hospital, Mayo Hospital, Mercy Hospital, Sebasticook Valley Hospital, and AR Gould Hospital.
Facility: Northern Light Mercy Hospital - Part V, Section B, Line 11	The data gathered from the 2019 Shared Community Health Needs Assessment (Shared CHNA) informed Northern Light Mercy Hospitals Community Health Strategy (Implementation Strategy) developed with input from community stakeholders including those who serve priority populations, the local Public Health District Liaison, local business leaders, and community advocates. Priorities were selected after weighing the severity of each priority area, availability of known and effective interventions, determination that the priority area was un-addressed or under-addressed, and community collaborations underway with Mercy Hospital. A hospital task force considered the data and identified areas of significant need including priority concerns, intended actions to address the need, programs and resource allocation, planned collaborations, and population of focus. The implementation strategy was presented and adopted by the hospitals board of directors. Northern Light Mercy Hospital identified five priority areas of focus addressing the significant needs identified in its 2019 CHNA as follows:Social determinants of healthActions taken by Mercy Hospital to address this priority in FY20: Northern Light Mercy Hospital participated on a Northern Light Health systemwide Social Determinants of Health (SDOH) workgroup responsible for developing, implementing, and monitoring the effectiveness of a system approach to SDOH screening and intervention inclusive of food security and other social needs. To date, the workgroups focus has been on the identification of the SDOH screening and referral process, local resource development, provider training and education requirements for the screening tools implementation, quality review and management of these efforts. Northern Light Health defined SDOH screening and intervention as a strategic priority to improve the health of the patients it serves.Substance useActions taken by Mercy Hospital to address this priority in FY20: Northern Light Mercy Hospital continues to partner with Cumberland County Jail through the Bridges to Community effort, which has launched MAT with suboxone at the jail and continues to broaden the scope of services. Currently, the jails medical service provides Suboxone or Methadone to inmates with an existing prescription. The goal is to add nursing and counseling services to complement the existing services. Mercy Hospital allocates .5 FTE Recovery Coach to provide support and navigation to maintenance care, counseling, housing, recovery-oriented supports, and employment.Access to careActions taken by Mercy Hospital to address this priority in FY20: Northern Light Mercy Hospital provided health education, financial counseling, and outreach on October 17 to eight active participants, providing follow up outreach to residents and ongoing health care services. At the onset of COVID-19 community spread in Cumberland County, efforts to engage residents in Portland Public Housing increased markedly and Northern Light Mercy Hospital provided prevalence testing and education about infection prevention practices at three sites and provided universal testing at another location in response to an outbreak of COVID-19. Patients who tested positive for COVID-19 were followed by our Virtual COVID Clinic and the Nurse Triage Line to ensure they had continuous monitoring, access to care, and support. Northern Light Healths homecare nurses provided care in the home if patients required that level of support.Mental healthActions taken by Mercy Hospital to address this priority in FY20: Northern Light Mercy Hospitals Behavioral Health Team delivered training for clinical teams to raise awareness and foster improved patient retention and engagement in healthcare services. An additional Recovery Coach, who is also a Certified Intentional Peer Support Specialist, was added to serve patients in both the acute and outpatient environments. An additional Licensed Clinical Social Worker was also hired to ensure timely access to counseling for our patients.Older adult health/healthy agingActions taken by Mercy Hospital to address this priority in FY20: Northern Light Healths Director of Palliative Care, Robin Hirsh-Wright and Dr. James Van Kirk, MD Medical Director of Palliative delivered an education session for clinical teams at Mercy Hospital. Handouts were distributed to all primary care practices.Additional information related to actions taken by Northern Light Mercy Hospital on the above priorities can be found in their FY20 Progress Report to Our Community at https://northernlighthealth.org/2019-Community-Health-Strategy. Northern Light Mercy Hospital considered all priorities identified in the Shared CHNA, as well as other sources, through an extensive review process. Northern Light Mercy Hospital has opted to work on all top five priorities as identified in the Shared CHNA.
Facility: Northern Light Mercy Hospital - Part V, Section B, Line 16j	Response for 7a (list URL) is: https://northernlighthealth.org/Mercy-HospitalResponse for 7b (list URL) is: https://northernlighthealth.org/Community-Health-Needs-Assessment/2019-CHNA-ReportsResponse for 10a (list URL) is:https://northernlighthealth.org/2019-Community-Health-StrategyResponse for 16a, 16b, 16c (list URL) is https://northernlighthealth.org/Mercy-Hospital under "Bill Pay & Financial Assistance"

Schedule H (Form 990) 2019

Page 9

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?
Name and address		Type of Facility (describe)
1	Northern Light Womens Health 195 Fore River Parkway Suite 310 Portland,ME04102	Medical Office Building - Physician Svc
2	Northern Light Breast Care 195 Fore River Parkway Suite 250 Portland,ME04102	Medical Office Building - Physician Svc
3	Northern Light PrimaryUrgent Care 19 South Gorham Crossing Gorham,ME04038	Medical Office Building - Physician Svc
4	Northern Light Cancer Care 195 Fore River Parkway Suite 360 Portland,ME04102	Medical Office Building - Physician Svc
5	Northern Light Lymphedema Care 1364 Congress Street Suite 3 Portland,ME04102	Medical Office Building - Physician Svc
6	Northern Light Spine Surgery 195 Fore River Parkway Suite 440 Portland,ME04102	Medical Office Building - Physician Svc
7	Northern Light Endocrinology and Diabetes Care 144 State Street 4th Floor Portland,ME04101	Medical Office Building - Physician Svc
8	Northern Light Cardiovascular Care 144 State Street 5th Floor Portland,ME04101	Medical Office Building - Physician Svc
9	Northern Light Gastroenterology 25 Long Creek Drive South Portland,ME04106	Medical Office Building - Physician Svc
10	Northern Light Womens Imaging 195 Fore River Parkway Suite 260 Portland,ME04102	Medical Office Building - Mammography Svc
11	Northern Light Pain Management 144 State Street 1st Floor Portland,ME04101	Medical Office Building - Physician Svc
12	Northern Light Physicial Therapy 1364 Congress Street Suite 3 Portland,ME04102	Medical Office Building - Physical Therapy Svc
13	Northern Light Primary Care 778 Main Street Suite 1 South Portland,ME04106	Medical Office Building - Physician Svc
14	Northern Light Internal Medicine 43 Baxter Boulevard Portland,ME04101	Medical Office Building - Physician Svc
15	Northern Light Surgery 195 Fore River Parkway Suite 420 Portland,ME04102	Medical Office Building - Physician Svc
16	Northern Light Pulmonary 144 State Street 3rd Floor Portland,ME04101	Medical Office Building - Physician Svc
17	Northern Light Primary Care 75 Gray Road Falmouth,ME04105	Medical Office Building - Physician Svc
18	Northern Light Urgent Care 40 Park Road Westbrook,ME04092	Medical Office Building - Physician Svc
19	Northern Light PrimaryUrgent Care 409 Roosevelt Trail Windham,ME04062	Medical Office Building - Physician Svc
20	Northern Light Wound Care 144 State Street 4th Floor Portland,ME04101	Medical Office Building - Physician Svc
21	Northern Light PrimaryUrgent Care 385 Route One Yarmouth,ME04096	Medical Office Building - Physician Svc
22	Dr Harry E Davis Pediatrics 195 Fore River Parkway Suite 160 Portland,ME04102	Medical Office Building - Physician Svc
23	Dr Harry E Davis Pedatrics 385 Route One Yarmouth,ME04096	Medical Office Building - Physician Svc
24	Dr Harry E Davis Pediatrics 409 Roosevelt Trail Windham,ME04062	Medical Office Building - Physician Svc
25	Northern Light Ear Nose and Throat Care 195 Fore River Parkway Suite 420 Portland,ME04102	Medical Office Building - Physician Svc

Schedule H (Form 990) 2019

Page 10

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
Part I, Line 6a - Related Organization Community Benefit Report	The Northern Light Mercy Hospital community benefit report is contained in an annual community benefit report prepared by Northern Light Health which is the parent organization of all related organizations.
Part I, Line 7 - Explanation of Costing Methodology	Ratio of Patient Care Cost-to-Charges is used in calculations.
Part III, Line 2 - Methodology Used To Estimate Bad Debt Expense	The costing methology used to determine the amount is cost to charge ratio.
Part III, Line 4 - Bad Debt Expense	Patient and trade accounts receivable are stated at the amount management expects to collect from outstanding balances. See Footnote 2 of the attached financial statements, page 16 to 19 - Revenue Recognition and Patient Accounts Receivable section.
Part III, Line 8 - Explanation Of Shortfall As Community Benefit	Medicare losses should be treated as a community benefit because the losses are incurred in performing an important public service, and Maine hospitals experience one of the lowest Medicare reimbursement rates in the country.
Part III, Line 9b - Provisions On Collection Practices For Qualified Patients	All account guarantors who express an inability to pay inpatient and outpatient services will be screened for eligibility for charity care using an application and guidelines established by Northern Light Mercy Hospital. An account may be reconsidered for charity care at any time when new information is available about a patient's inability to pay.
Part VI, Line 3 - Patient Education of Eligibility for Assistance	Northern Light Mercys Financial Assistance policy describes how the organization informs and educates patients on Financial Assistance. Public Notice of the availability of assistance through this policy is made through each of the following means: 1. Posting notices in a visible manner in locations where there is a high volume of inpatient or outpatient admitting/registration, such as emergency departments, billing offices, admitting offices, and hospital outpatient service settings. 2. Posting notice of the availability of assistance and contact names and phone numbers on Northern Light Mercy Hospitals website. 3. Providing uninsured patients a matrix outlining the types of financial assistance available. Upon request, a full text copy of the Financial Assistance policy is made available. Northern Light Mercy Hospital has developed a professional model for financial counseling for all patients without insurance and has staff onsite to meet individually from 8am to 4pm on Monday through Friday. This includes comprehensive screens for potential resources such as governmental insurance and disability, enrollment on the Health Insurance Marketplace, and commercial insurance. Financial counselors have daily huddles, assigned work lists, and accountabilities to engage and develop an ongoing rapport with uninsured and vulnerable populations. They are available Monday through Friday from 8am-4pm and routinely meet with patients in the community to complete applications. With the advent of the ACA, the financial counselors have all been trained to act as Certified Application Counselors and helped to enroll both Mercy patients as well as to provide staffing and services for local community and municipal organizations.
Part VI, Line 4 - Community Information	Located in Portland, Maine, Northern Light Mercy Hospital has a service area comprised of both primary and secondary service areas, together referred to as the total service area. Total service areas (TSAs) are developed by the Northern Light Health Planning department based on neighboring zip codes from which a majority of a hospitals inpatient admissions originate. TSAs can sometimes overlap due to hospital locations or because of the specialty services provided by the hospitals.Towns representing Mercy Hospitals primary service area include: Buxton, Cape Elizabeth, Casco, Cornish, Cumberland, East Baldwin, Falmouth, Freeport, Gorham, Gray, Hollis, Limington, North Yarmouth, Old Orchard Beach, Portland, Pownal, Raymond, Saco, Scarborough, South Portland, Standish, Steep Falls, West Baldwin, Westbrook, Windham, and Yarmouth. Towns representing Mercy Hospitals secondary service area include: Acton, Alfred, Bath, Biddeford, Bridgton, Brownfield, Brunswick, Denmark, Durham, East Waterboro, Fryeburg, Harpswell, Harrison, Hiram, Kennebunk, Kennebunkport, Lebanon, Limerick, Lovell, Naples, New Gloucester, North Waterboro, Parsonsfield, Poland, Porter, Sanford, Sebago, Shapleigh, Springvale, Topsham, Waterboro, Waterford, and West Newfield.Cumberland Countys demographic and social determinants of health data are provided below for Mercy Hospital based on the hospitals physical location in Cumberland County.Cumberland County - Demographic Data: American Indian/Alaskan Native 0.2% (650), Asian 2.0% (5,899), Black/African American 2.7% (7,833), Hispanic 1.9% (5,538), Some other race 0.4% (1,132), Two or more races 2.3% (6,768), White 92.3% (265,918). Total county population 288,204.Cumberland County Social Determinants of Health Data: Median household income $61,902, Unemployment rate 2.9%, Individuals living in poverty 11.1%, Children living in poverty 13.3%, 65+ living alone 46.4%, People living in rural areas 36.1%, Food insecurity 14.0%.Other hospitals serving the Northern Light Mercy Hospital community: Based on the State of Maines definition of hospital service area, Northern Light Mercy Hospitals community is served by an additional two other hospitals, New England Rehabilitation Hospital and Maine Medical Center per Hospital Service Area (HSA) designation. Additionally, the Health Resources & Services Administration designated Mercys Hospitals service area as having a total of 4 medically underserved areas/populations.
Part VI, Line 4 - Community Building Activities	Northern Light Mercy Hospital's holds annual community health sessions and community building activities for the general public and vulnerable populations. In 2020, these activities included coordinating COVID 19 response by developing remote and universal COVID testing sites, supporting community response for COVID positive patients, education and messaging to promote vaccine confidence, and mass vaccination planning with Portlands Public Health, Public Housing Authority, non-profit community-based organizations, social service providers, and faith communities Health education sessions and health promotion clinics with preventive screening also occurred with partner organizations. Garys House, a department of Northern Light Mercy Hospital, is a safe, comfortable, and affordable home-away-from-home for families and individuals with loved ones receiving medical treatment in any greater Portland area hospital. Nine individual apartments and beautiful dining area and kitchen facilities provide respite for families. A donation of $15 per night is accepted for those able to pay for lodging. Several local organizations such as the United Way and UNUM volunteer regularly at Garys House. Northern Light Mercy Hospital operates McAuley Residence, a comprehensive two generational program for families affected by substance use disorder. The program provides intensive wrap-around services for both mother and child(ren) during a two-year length of stay. Northern Light Mercy Hospital offers Rapid Access Medication Assisted Treatment in the Emergency Department for persons with Opioid Use Disorders and partners with Amistad Peer Support and Recovery for Recovery Coaching Services. Northern Light Mercy Hospital facilitates a weekly meeting of providers and staff to advance the coordination of care, ensure vulnerable patients have access to a medical home, and address the social determinants of health such as housing, transportation, food, and medications for persons who use the Emergency Room frequently.
Part VI, Line 5 - Promotion of Community Health	Northern Light Mercy Hospital furthers its exempt purpose by promoting the health of the community through the following grant activity in FY20:Community Based Clinical Services: Medication Assisted Treatment - Mercy Medical Neighborhood & Improving Access to Quality CareSocial and Environmental Improvement Activities: McAuley Bangor Residence - Develop housing-based programs employing evidence-based strategies in a holistic approach to recovery for vulnerable families affected by substance abuse. Program must treat mother affected by substance abuse with at least one child under 10 years of age.; John T Gorman McAuley Residence Support - Bolster interventions and supports provided to the children and parents participating in the McAuley Residence program.The majority of Northern Light Mercy Hospitals Board of Directors reside in the primary service area and are not employees or independent contractors. Mercy also has an open medical staff. Northern Light Mercy Hospital donates food weekly as part of a food rescue program to local food pantries and soup kitchens. Northern Light Mercy Hospital also provides $32,117.47 to the City of Portlands Minority Health Department each year in support of the Community Health Outreach Workers, whose role is to provide health education, outreach, and patient navigation for vulnerable populations.
Part VI, Line 6 - Affilated Health Care System	The 2019 Maine Shared Community Health Needs Assessment (CHNA) was conducted by Northern Light Health in collaboration with several member/affiliated hospitals and the many public health and community organizations across the state. The Maine Shared CHNA informs initiatives to promote community health across the system as well as within each member hospitals local service area. Each member hospital adopted a local implementation strategy referred to as a Community Health Strategy and annual community health improvement plans, tailored to meet local needs.Northern Light Mercy Hospital participated two CHNA public forums to garner feedback and insights from local community members.
Part VI, Line 7 - States Filing of Community Benefit Report	N/A

Schedule H (Form 990) 2019

Additional Data

Software ID:	19009920
Software Version:	2019v5.0

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

Mercy Hospital

Employer identification number

01-0211534

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........

Yes

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ..

Yes

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Yes

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Yes

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2019

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1Anthony Filer Treasurer	(i) (ii)	------------- 547,066	------------- 183,558	------------- 15,073	------------- 22,400	------------- 31,610	------------- 799,707	-------------
2Benjamin Russell MD Trustee/Ex Off	(i) (ii)	288,133 -------------	105,646 -------------	5,954 -------------	6,284 -------------	21,489 -------------	427,506 -------------	-------------
3Bette Neville VP CNO	(i) (ii)	216,346 -------------	35,992 -------------	7,315 -------------	5,584 -------------	29,339 -------------	294,576 -------------	-------------
4Bruce Sandstrom VP, Fin/PT YR	(i) (ii)	259,523 -------------	44,522 -------------	42,437 -------------	22,916 -------------	11,706 -------------	381,104 -------------	-------------
5Catherine McCrann Physician	(i) (ii)	384,688 -------------	168,379 -------------	25,962 -------------	6,875 -------------	32,687 -------------	618,591 -------------	-------------
6Charlie Therrien Pres/Ex Off	(i) (ii)	377,211 -------------	81,796 -------------	25,849 -------------	78,097 -------------	20,708 -------------	583,661 -------------	-------------
7Christopher Kleeman Medical Director	(i) (ii)	418,525 -------------	229,071 -------------	3,472 -------------	-------------	30,629 -------------	681,697 -------------	-------------
8Colleen Hilton Former Officer	(i) (ii)	------------- 227,266	------------- 48,948	------------- 45,468	------------- 55,929	------------- 13,798	------------- 391,409	-------------
9David Fernandez Former VP, Phys Practice	(i) (ii)	150,461 -------------	3,677 -------------	86,825 -------------	-------------	15,530 -------------	256,493 -------------	-------------
10Glenn Martin Secretary	(i) (ii)	------------- 416,405	------------- 153,993	------------- 42,911	------------- 90,036	------------- 23,030	------------- 726,375	-------------
11John Southall MD Trustee	(i) (ii)	273,045 -------------	60,194 -------------	1,672 -------------	6,875 -------------	27,735 -------------	369,521 -------------	-------------
12John Wahlig Physician	(i) (ii)	831,723 -------------	170,390 -------------	22,206 -------------	6,875 -------------	30,828 -------------	1,062,022 -------------	-------------
13Lee Thibodeau Physician	(i) (ii)	639,835 -------------	23,920 -------------	33,690 -------------	6,875 -------------	32,310 -------------	736,630 -------------	-------------
14Mary M Hood Trustee/Ex Off	(i) (ii)	------------- 973,213	------------- 756,271	------------- 26,584	------------- 25,200	------------- 23,156	------------- 1,804,424	-------------
15Melissa Skahan VP Mission Int	(i) (ii)	175,009 -------------	29,922 -------------	2,541 -------------	4,938 -------------	23,409 -------------	235,819 -------------	-------------
16Michael Duffy MD VP Senior Phys	(i) (ii)	292,703 -------------	19,968 -------------	2,054 -------------	5,114 -------------	27,468 -------------	347,307 -------------	-------------
17Nicolas F Arredondo Physician	(i) (ii)	691,090 -------------	23,941 -------------	25,619 -------------	7,000 -------------	32,260 -------------	779,910 -------------	-------------
18Paul Bolin SVP & CHRO	(i) (ii)	------------- 320,588	------------- 52,165	------------- 62,409	------------- 64,214	------------- 32,606	------------- 531,982	-------------
19Timothy Dentry Trustee/Ex Off	(i) (ii)	------------- 604,626	------------- 112,673	------------- 13,344	------------- 104,720	------------- 32,960	------------- 868,323	-------------
20Wendy Napolitano VP Perf Oper	(i) (ii)	137,742 -------------	23,554 -------------	2,683 -------------	6,474 -------------	29,740 -------------	200,193 -------------	-------------

Schedule J (Form 990) 2019

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation
Part I, Line 1a: Relevant information in regards to selections on 1a.	The following received a wellness program incentive:Nicolas Arredondo, highest compensated employee $302Michael Duffy, officer 110 Bruce Sandstrom, officer 320 The benefit is available for all employees.
Part I, Line 7: Non-Fixed payments not listed above	Physician bonuses reported in Part II, column (ii) are based on worked RVUs.

Schedule J (Form 990) 2019

Additional Data

Software ID:	19009920
Software Version:	2019v5.0

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
Mercy Hospital

Employer identification number
01-0211534

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	Maine Health & Higher Edu	01-0314384	560425G61	04-04-2014	61,055,000	Refinance 2006H Bonds		X		X		X
B	Maine Health & Higher Edu	01-0314384		09-29-2020	45,400,000	Modernization of hospital camp		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	13,175,000
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	61,055,000		45,400,000
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............	47,399,888		45,000,000
7 Issuance costs from proceeds ...............	478,932		400,000
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............
11 Other spent proceeds .............	13,176,180
12 Other unspent proceeds .............
13 Year of substantial completion .............
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue of tax-exempt bonds (or, if issued prior to 2018, a current refunding issue)? ........		X		X
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2018, an advance refunding issue)? ........	X			X
16 Has the final allocation of proceeds been made? ..........	X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............		X		X

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2019

Page 2

Part Ⅲ

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?
c Are there any research agreements that may result in private business use of bond-financed property? .............		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........
6 Total of lines 4 and 5 .............
7 Does the bond issue meet the private security or payment test? ...
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X		X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......			X
b Exception to rebate? ........
c No rebate due? .........	X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X
b Name of provider ..........	NA		NA
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........

Schedule K (Form 990) 2019

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X
b Name of provider ..........	NA		NA
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X

Part Ⅴ

Procedures To Undertake Corrective Action

---------------------------------------------------------------------------------------------------------------	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X		X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).

Return Reference	Explanation
Part VI	Part IV, Line 2c, Column A, date the rebate computation was performed - 4/30/19.Part II, line 5, Column A, Proceeds in Refunding Escrows is held by MHHEFA.

Schedule K (Form 990) 2019

Additional Data

Software ID:	19009920
Software Version:	2019v5.0

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered "Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

Mercy Hospital

Employer identification number

01-0211534

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and section 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by the organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e) Original principal amount	(f) Balance due	(g) In default?		(h) Approved by board or committee?		(i) Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e) Original principal amount	(f) Balance due	Yes	No	Yes	No	Yes	No






Total ............... $

Part III

Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2019

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) Mary M Hood	officer=brd member	105,103	MHA membership dues		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference	Explanation
Schedule L, Part V Supplemental Information	Mary M. Hood board member/officer is a board member of Maine Hospital Association.

Schedule L (Form 990 or 990-EZ) 2019

Additional Data

Software ID:	19009920
Software Version:	2019v5.0

- TIN:

SCHEDULE M
(Form 990)

Department of the Treasury

Internal Revenue Service

Noncash Contributions

Complete if the organizations answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image

Attach to Form 990.
Right pointing arrow large image

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

Mercy Hospital

Employer identification number

01-0211534

Part I

Types of Property

	(a) Check if applicable	(b) Number of contributions or items contributed	(c) Noncash contribution amounts reported on Form 990, Part VIII, line 1g	(d) Method of determining noncash contribution amounts
1 Art—Works of art ....
2 Art—Historical treasures .
3 Art—Fractional interests ..
4 Books and publications ..
5 Clothing and household goods .......	X		3,852	FMV
6 Cars and other vehicles ..
7 Boats and planes ....
8 Intellectual property ...
9 Securities—Publicly traded .
10 Securities—Closely held stock .
11 Securities—Partnership, LLC, or trust interests ....
12 Securities—Miscellaneous ..	X	1	1,256	FMV
13 Qualified conservation contribution—Historic structures .....
14 Qualified conservation contribution—Other ...
15 Real estate—Residential .
16 Real estate—Commercial ..
17 Real estate—Other ...
18 Collectibles .....
19 Food inventory ...	X	81	36,096	FMV
20 Drugs and medical supplies .
21 Taxidermy ......
22 Historical artifacts ....
23 Scientific specimens ..
24 Archeological artifacts ...
25 Other ( Gift Certificates )	X	1	8,500	FMV
26 Other ( ELECTRONICS )	X	3	1,125	FMV
27 Other ( GIFT CERT )	X	8	6,000	FMV
28 Other ( JEWELRY )	X	1	3,400	FMV
Other ( MEDICAL SUPPLIE )	X	52	20,821	FMV

Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement

Yes

30a

During the year, did the organization receive by contribution any property reported in Part I, lines 1 through 28, that it must hold for at least three years from the date of the initial contribution, and which isn't required to be used for exempt purposes for the entire holding period? ...................

30a

If "Yes," describe the arrangement in Part II.

Does the organization have a gift acceptance policy that requires the review of any nonstandard contributions?

Yes

32a

Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash

contributions? ..........................

32a

If "Yes," describe in Part II.

If the organization didn't report an amount in column (c) for a type of property for which column (a) is checked,

describe in Part II.

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 51227J

Schedule M (Form 990) (2019)

Page 2

Part IISupplemental Information. Provide the information required by Part I, lines 30b, 32b, and 33, and whether the organization is reporting in Part I, column (b), the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.

Return Reference	Explanation

Schedule M (Form 990) (2019)

Additional Data

Software ID:	19009920
Software Version:	2019v5.0

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

Mercy Hospital

Employer identification number

01-0211534

Return Reference	Explanation
Form 990, Part III, Line 4d: Other Program Services Description	OTHER PROGRAM SERVICES 4: Charity care provided (at cost): 1,934 persons served OTHER PROGRAM SERVICES 5: Please see the following excerpt from the Northern Light Health Annual Report 2020 to the Community for details of community benefit projects at NLH members:HEROES AMONG US Healthcare Heroes As we reflect on 2020, people around the world would do well to remember these words by Nelson Mandela, Do not judge me by my successes, judge me by how many times I fell down and got back up again. We faced a global pandemic that took the lives of more than 500,000 of our fellow Americans and more than 2.5 million people worldwide and counting. We also faced deadly wildfires and hurricanes, racial unrest, and a country divided by politics. But during this turbulent time, we also saw the very best in people, including those whom we work alongside every day to deliver compassionate healthcare to the people of Maine. We saw our colleagues rise to the challenges of an unprecedented global pandemic, show courage in the face of adversity, and make selfless sacrifices to heal the sick and protect our communities. These people are heroes. They are the front line workers who provided direct patient care to those who became infected with coronavirus. They are also the people who worked behind the scenes to ensure our staff had the personal protective equipment and telehealth technology they needed to continue to provide care safely. They are the support staff that cleaned and disinfected rooms, prepared meals, and countless other tasks to support our direct care workers. In this years annual report, we celebrate these heroes. They may not have flashy costumes or superpowers like the comic book heroes or those in Hollywood films. But like those heroes, they must don masks as they face a genuine and dangerous enemy. In the pages of this years annual report, you will learn more about who they are and what they do. We will take you behind their masks to discover the true identity of the heroes among us. Timothy J. Dentry, MBA President & CEO Kathy Corey Northern Light Health, Board Chair HEROES ON THE FRONT LINES When it comes to caring for sick patients, Northern Light Healths front line staff put themselves at risk to provide exceptional care. We know they are brave and compassionate people, but COVID-19 has shown how far they are willing to go to help others. The following are a few of the many examples of courage and caring that we witnessed during this global pandemic. Cathy Bean, RNManager of Clinical and Community Health Services Northern Light Home Care & Hospice In late March, Portland saw a spike in the population of homeless people who were getting sick with COVID-19. To help protect the citys homeless residents, city leaders immediately opened the Portland Expo as an alternative shelter site that would allow them to maintain their shelter capacity while adhering to the Centers for Disease Controls (CDC) social distancing guidelines. But how would they separate the healthy population from those with the virus? Cathy Bean, RN stepped up to help. Donning protective gear, she and her staff went into the shelters daily to screen and test the residents. Northern Light Home Care & Hospice also equipped the city of Portland with a telehealth system so home care nurses could provide follow up appointments. As a result, they were able to help shelter residents with other medical conditions that may have been missed. Many of these people, due to COVID-19, were in quarantine, and meals brought outside their door with no one able to check on them. Now, we could get in there and take care of these people, and thats been very rewarding. Cathy Bean, RNElizabeth Bigler, RN Emergency Department Northern Light Blue Hill Hospital Elizabeth Bigler, RN thinks the most significant change to her job since COVID-19 is how much more physically exhausting it has become. She must often wear respirators, hoods, and other personal protective equipment, which can get quite hot and stuffy during a shift in the Emergency Department. Her biggest concern is making sure she doesnt bring this virus into her home. Its why she enters through a basement door, places her clothing directly into the wash, and showers before interacting with her family. My daughter who is eight is a sensitive, insightful soul. And shes had a lot of fears about me getting sick, not being able to see me if I did get sick, or me not coming home. Her daughter wrote her a touching letter one morning, telling her to be safe and that she loved her. Shes a really strong little girl. I had to tell her that this is a community effort. I cant not go because its scary. Some people still need help, and our job as community members is to help them. Elizabeth Bigler, RNJames Jarvis, MDSenior Physician ExecutiveIncident Command, Northern Light Health When Northern Light Health knew COVID-19 would arrive in Maine, James Jarvis, MD was chosen to coordinate the systems response among its member hospitals in addition to coordinating with state and local governments and the other major healthcare systems in Maine. Another unexpected role that Dr. Jarvis fulfilled during the pandemic was to be the primary spokesperson for Northern Light Health for weekly statewide news conferences via Zoom. Several times a week he would convey critical information to members of the media and our communities. One of the pleasant surprises Ive had during this time was somebody randomly driving by, lowering their window, and saying, Dr. Jarvis, how are you doing? You always ask how were doing through TV, we want to make sure youre okay. I teared up a little because, sure its neat to be recognized, but it was that sense of community that Mainers have to say, we need to make sure youre okay because we appreciate what youre doing. James Jarvis, MDCaroline Joyce, PACNorthern Light Primary Care Northern Light CA Dean Hospital Caroline Joyce loves the outdoors and dreams of retiring in a small rural community where hiking, fishing, and camping abound. She and her husband built their retirement home in Greenville, and she took a job at Northern Light CA Dean Hospital in September of 2019. Little did she realize how good her timing was to move to a rural community before the outbreak of COVID-19. As a primary and acute care provider, she willingly staffed the drive-up screening tent outside CA Dean. She endured wind and rain and snow to screen patients. And, she did all this while her mother, living in a nursing home in another state, was diagnosed with COVID-19. Luckily, my mom experienced mild symptoms, and while I wanted to see her, she was in an area of Massachusetts that was really hit hard by the coronavirus, and I was here seeing patients. I couldnt risk exposing them or my family. Caroline Joyce, PACSue-Anne Hammond, DOMedical Director of Primary CareNorthern Light Mercy Hospital For Dr. Hammond, COVID-19 became personal very quickly as one of her long-time patients, with whom shed experienced many ups and downs, was among the first in Maine to die of the deadly coronavirus. It was a curve ball, and it felt so unfair, she said. Dr. Hammond was instrumental in setting up the COVID-19 response plan for Northern Light Mercy Hospital, which became a model shared with other Northern Light Health hospitals across the state. The drive-up swab and go tent at Mercys Fore River campus allowed people to safely and easily get tested for the coronavirus. The plan also included a respiratory tent site in Westbrook to assess whether people with symptoms needed to be admitted to the emergency department or sent home with care instructions. And it included a virtual clinic to keep patients out of hospital and primary care settings through telehealth for follow-up appointments. She worked seven days a week while her children were being schooled at home. She and her husband, also a front line provider, tried to allay their familys fears and correct misinformation in their communities. On the hardest days I still love what I do. I dont feel like Im a hero; Im doing what was asked of me and what I chose to do as a doctor. This is a hard time, but I dont think I want to be anywhere else in the middle of all of this. Sue-Anne Hammond, DOJodi Kierstead, RNNurse Manager, Specialty ICU Northern Light AR Gould Hospital As a nurse manager, Jodis Kiersteads world radically changed when COVID-19 showed up in Maine. She went from managing budgets and staff training to suddenly responding to a pandemic. She enjoyed watching her staff pull together. Youre taking a bunch of people out of their comfort zone and putting them through huge changes and for them to do it with a smile it was amazing! And Jodi did her part to help too. As Northern Light Mercy Hospital in Portland was becoming inundated with patients, they put out a call for additional staff to help. Not only did Jodi travel to Portland and support her colleagues, despite having a 10-month-old baby at home, she and
Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder	Mercy Hospital d/b/a Northern Light Mercy Hospital (the Corporation) is a Maine nonprofit corporation. Eastern Maine Healthcare Systems, d/b/a Northern Light Health (NLH), also a Maine nonprofit corporation, is the sole voting corporate member of the Corporation.
Form 990, Part VI, Line 7a: How Members or Shareholders Elect Governing Body	Each year at their annual meeting, the directors elect replacements for those directors whose terms are expiring. Election of directors is subject to ratification by the NLH Board of Directors.
Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or Shareholders	The NLH President has authority to appoint and remove the SVP & President of the Corporation. NLH also has joint and superior authority to approve, disapprove or initiate action with respect to the following matters: I. amendments to the corporations Articles of Incorporation or Bylaws;II. changes in legal form of organization of the Corporation;III. election of the Directors/Trustees of the Corporation;IV. action concerning the Corporations operating budget and capital expenditures;V. the Corporations acquisition of assets or assumption of liabilities of an unaffiliated third party;VI. transfer of 5% or more of the assets of the Corporation;VII. financing transactions concerning the Corporation; VIII. merger, consolidation, sale, lease, mortgage, pledge or other disposition of all or substantially all assets of the Corporation; IX. add or revise a health care service of the Corporation;X. discontinue or close a health care service of the Corporation;XI. action concerning the Corporations role in the NLH Strategic Plan;XII. action concerning the Corporations participation in key strategic affiliations with third parties not affiliated with NLH; andXIII. dissolution of the Corporation.
Form 990, Part VI, Line 11b: Form 990 Review Process	Form 990 is reviewed by the VP of Finance of Northern Light Mercy Hospital. It is also provided to each board member either electronically or in hard copy with an opportunity to ask questions prior to filing with the IRS.
Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts	The organization requests updates of potential conflicts and relationships from the officers and Board members on an annual basis. The request requires disclosure of all business relationships, board memberships, and family relationships. A database is maintained that is compared to payroll records and the accounts payable vendor list to identify any potential conflicts of interest. Transactions are reviewed for reasonableness as an arm's length transaction.The first agenda item for board meetings and board committee meetings is for members to declare any conflict of interest with upcoming agenda items or deliberations. At any point when consideration is being given to purchase/contract with a party in interest, the member with the conflict is either excused from the discussion and consideration process or abstains from voting on the matter.All transactions identified with parties in interest are disclosed within the Form 990. All are deemed to be arm's length transactions.
Form 990, Part VI, Line 15a: Compensation Review & Approval Process - CEO, Top Management	The President of Northern Light Mercy Hospital and the system Chief Executive Officer (CEO) who serves on the board ex-officio are employed by the system parent, Eastern Maine Healthcare Systems d/b/a Northern Light Health (NLH).The NLH Executive Performance Management Committee (the Committee) is responsible to monitor and evaluate the performance of the NLH CEO. It shall have authority to set the compensation of the NLH CEO, and to review the recommendations of the NLH CEO with respect to the compensation of the Presidents of the Member Organizations and other key management personnel. The Committee is comprised entirely of independent Directors per NLH bylaws.Process:The Committee meets regularly throughout the fiscal year at the discretion of the Committee chair as well as on call of the Chair of the NLH board. In carrying out its duties pursuant to the Bylaws, the Committee:-Assures that the executive compensation program is administered in a manner consistent with the NLH executive compensation philosophy.-Reviews and updates the NLH executive compensation philosophy which serves as the foundation on which all current and future executive compensation decisions are made.-Assures that value of compensation provided by NLH does not exceed the value of services provided by the executive.-Reviews annual incentive compensation criteria for eligible executives, as defined by the NLH CEO.-Reviews periodic compensation survey information and provides expert input to proposed changes to the executive compensation program.-Assures that a formal and timely performance management system is in place for executives.-Reviews incentive compensation criteria scoring and associated pay schedules for officers and key employees.-Provides any public statements regarding executive compensation practices at NLH deemed appropriate.-Maintains minutes of the meeting and communicates actions to the NLH Board of Directors.To accomplish this, the committee uses an external consultant with access to comparative data from independent sources and include national as well as regional data points. The NLH CEO reviews all direct report compensation actions with the committee. In addition, the NLH CEO ensures that any subsidiary policies and practices governing executive compensation are consistent with the committee's philosophy and practices statement.Form 990, Part VI, Line 15b - Compensation Review & Approval Process - Officers & Key EmployeesCompensation of other officers and key employees of the organization is established by the Human Resources department who utilize external market research to establish compensation ranges for specific positions. On an annual basis, the compensation ranges are compared to the updated survey information.The hiring manager will determine where the employee will fall within the ranges established by the Human Resources department based on experience and credentials.
Form 990, Part VI, Line 19: Other Organization Documents Publicly Available	Northern Light Mercy Hospital makes its governing documents, conflict of interest policy and financial statements available to the public upon request.
Other Changes In Net Assets Or Fund Balances - Other Decreases	Change in net assets held @ EMHS Foundation = -$4904828
Other Changes In Net Assets Or Fund Balances - Other Increases	Transfer from exempt parent - Eastern Maine Healthcare Syste = $1003127

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2019

Additional Data

Software ID:	19009920
Software Version:	2019v5.0

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

Mercy Hospital

Employer identification number

01-0211534

Part I

Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)Eastern Maine Healthcare Systems EMHS 43 Whiting Hill Road Brewer,ME04412 01-0527066	Supporting org for healthcare affiliates	ME	501(c)(3)	12 Type II	N/A		No
(2)Acadia Hospital Corp AHC 43 Whiting Hill Road Brewer,ME04412 01-0459837	Provide healthcare services	ME	501(c)(3)	3	EMHS		No
(3)Acadia Healthcare Inc AHI 43 Whiting Hill Road Brewer,ME04412 22-3183888	Provide healthcare services	ME	501(c)(3)	10	AHC		No
(4)Eastern Maine Medical Center PO Box 404 489 State St Bangor,ME044020404 01-0211501	Provide healthcare services	ME	501(c)(3)	3	EMHS		No
(5)Eastern Maine Medical Center Auxiliary 43 Whiting Hill Road Brewer,ME04412 01-0377901	Fund raising for exempt EMMC	ME	501(c)(3)	10	EMMC		No
(6)EMHS Foundation 43 Whiting Hill Road Ste 400 Brewer,ME04412 22-2514163	Raise and manage funds for exempt orgs	ME	501(c)(3)	12 Type II	EMHS		No
(7)Rosscare 43 Whiting Hill Road Brewer,ME04412 01-0391038	Provide services to elderly	ME	501(c)(3)	PF	EMHS		No
(8)Inland Hospital 200 Kennedy Memorial Drive Waterville,ME04901 01-0217211	Provide healthcare services	ME	501(c)(3)	3	EMHS		No
(9)Lakewood 220 Kennedy Memorial Drive Waterville,ME04901 01-0421234	Provide skilled and long-term nursing ca	ME	501(c)(3)	3	Inland Hospital		No
(10)CA Dean Memorial Hospital Pritham Avenue PO Box 1129 Greenville,ME044411129 04-3341666	Provide healthcare services	ME	501(c)(3)	3	EMHS		No
(11)Blue Hill Memorial Hospital 57 Water Street Blue Hill,ME046145231 01-0227195	Provide healthcare services	ME	501(c)(3)	3	EMHS		No
(12)Sebasticook Valley Health SVH 447 North Main Street Pittsfield,ME04967 01-0263628	Provide healthcare services	ME	501(c)(3)	3	EMHS		No
(13)Sebasticook Valley Family Practice Assoc 447 North Main Street Pittsfield,ME04967 01-0357854	Provide patient care	ME	501(c)(3)	10	SVH		No
(14)The Aroostook Medical Center TAMC PO Box 151 140 Academy Street Presque Isle,ME047690151 01-0372148	Provide healthcare services	ME	501(c)(3)	3	EMHS		No
(15)VNA Home Health & Hospice 50 Foden Road South Portland,ME04106 01-0246804	Provide home health and hospice services	ME	501(c)(3)	10	EMHS		No
(16)Eastern Maine Healthcare Real Estate 43 Whiting Hill Road Brewer,ME04412 01-0391036	Leases of real estate	ME	501(c)(2)		EMHS		No
(17)WorkHealth LLC 43 Whiting Hill Road Brewer,ME04412 47-4315094	Provide healthcare services	ME	501(c)(3)	12 Type II	EMHS		No
(18)Maine Coast Regional Health Facilities 50 Union Street Ellsworth,ME04605 01-0198331	Provide healthcare services	ME	501(c)(3)	3	EMHS		No
(19)Maine Coast Medical Realty 50 Union Street Ellsworth,ME04605 01-0390918	Lease medical facilities	ME	501(c)(3)	12 Type I	MCH		No
(20)Beacon Health LLC 43 Whiting Hill Road Brewer,ME04412 45-2967056	Accountable care organization	ME	501(c)(3)	12 Type II	EMHS		No
(21)Beacon Rural Health LLC 43 Whiting Hill Road Brewer,ME04412 47-4483187	Accountable care organization	ME	501(c)(3)	12 Type II	EMHS		No
(22)Beacon Health ACO Holdings LLC 43 Whiting Hill Road Brewer,ME04412 36-4903784	Accountable care organization	ME	501(c)(3)	12 Type II	EMHS		No
(23)LTC LLC 43 Whiting Hill Road Brewer,ME04412 01-0211501	Operation of nursing homes	ME	501(c)(3)	3	EMMC		No
(24)Northern Light Medical Transport 43 Whiting Hill Rd Brewer,ME04412 83-0911574	Ambulance	ME	501(c)(3)	10	EMHS		No
(25)M Drug LLC 43 Whiting Hill Road Brewer,ME04412 27-2175482	Pharmacy	ME	501(c)(3)	3	EMMC		No
(26)MRH Corp dba NL Mayo Hospital 897 W Main Street DoverFoxcroft,ME04426 84-3689003	Provide healthcare services	ME	501(c)(3)	3	EMHS		No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2019

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) Meridian Mobile Health LLC 43 Whiting Hill Road Brewer,ME04412 01-0512673	Ambulance	ME	AHS				No			No
(2) Alliance Healthcare Documentation LLC 43 Whiting Hill Road Brewer,ME04412 46-2751855	Transcription	ME	AHS				No			No
(3) M Drug LLC 43 Whiting Hill Road Brewer,ME04412 27-2175482	Pharmacy	ME	AHS				No			No

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	Yes	No
(1) Affiliated Healthcare Systems AHS 43 Whiting Hill Road Brewer,ME04412 01-0385322	Holding co.	ME	EMHS	C				No
(2) Affiliated Laboratory Inc 43 Whiting Hill Road Brewer,ME04412 01-0381283	Clinical lab	ME	AHS	C				No
(3) Affiliated Healthcare Management 43 Whiting Hill Road Brewer,ME04412 01-0349339	Hlthcr mgmt	ME	AHS	C				No
(4) Beacon Direct 43 Whiting Hill Road Brewer,ME04412 37-1864965	Healthcare Self Funded TPA	ME	EMHS	C				No

Schedule R (Form 990) 2019

Page 3

Part V

Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

b Gift, grant, or capital contribution to related organization(s) ............................

c Gift, grant, or capital contribution from related organization(s) ............................

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

k Lease of facilities, equipment, or other assets from related organization(s) ......................

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

Yes

m Performance of services or membership or fundraising solicitations by related organization(s) .................

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

o Sharing of paid employees with related organization(s) ............................

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

r Other transfer of cash or property to related organization(s) ............................

s Other transfer of cash or property from related organization(s) ............................

Yes

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved

Schedule R (Form 990) 2019

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2019

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2019

Additional Data

Software ID:	19009920
Software Version:	2019v5.0

1	Briefly describe the organization’s mission or most significant activities: Mercy Hospital d/b/a Northern Light Mercy Hospital carries out the healing work of Christ by providing clinically excellent, compassionate healthcare for all, with special concern for the poor and disadvantaged.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	19
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	15
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	1,879
6	Total number of volunteers (estimate if necessary) .............	6	144
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	3,891,418	9,339,036
9	Program service revenue (Part VIII, line 2g) .........	231,861,107	209,752,641
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	181,137	281,649
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	414,437	296,261
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	236,348,099	219,669,587
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...		0
14	Benefits paid to or for members (Part IX, column (A), line 4).....		0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	124,615,958	123,962,729
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	97,769,793	98,555,803
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	222,385,751	222,518,532
19	Revenue less expenses. Subtract line 18 from line 12.......	13,962,348	-2,848,945
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	154,782,094	210,923,997
21	Total liabilities (Part X, line 26).............	102,299,960	165,125,331
22	Net assets or fund balances. Subtract line 21 from line 20.....	52,482,134	45,798,666

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 149,814,672 including grants of $ ) (Revenue $ 209,752,641 )
	Provide healthcare services regardless of ability to pay as well as education, research and promotion of health. Provided other uncompensated care (at cost) of $5,449,070

4b	(Code: ) (Expenses $ 29,065,294 including grants of $ ) (Revenue $ )
	Medicare shortfalls (at cost) 39,256 persons served

4c	(Code: ) (Expenses $ 11,157,779 including grants of $ ) (Revenue $ )
	Medicaid shortfalls (at cost) 31,299 persons served

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 926,261 including grants of $ ) (Revenue $ )
4e	Total program service expenses190,964,006

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	6,445,285	4,602,561	1,049,404

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	8,316,016
e	Government grants (contributions)		1e	218,483

f	All other contributions, gifts, grants, and similar amounts not included above		1f	804,537

g	Noncash contributions included in lines 1a - 1f:$		1g	81,050

h Total. Add lines 1a-1f.......		9,339,036

		Business Code
2a	Cafeteria	722514	676,926		676,926
b	Education	611710	10,730	10,730
c	Net Patient Care Service	621990	209,064,985	209,064,985
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		209,752,641

3 Investment income (including dividends, interest, and othersimilar amounts) ......			369,633			369,633
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents		345,573	6a
b	Less: rental expenses		31,995	6b
c	Rental income or (loss)		313,578	6c
d	Net rental income or (loss).......			313,578			313,578
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	11,545,217		7a
b	Less: cost or other basis and sales expenses	11,633,201		7b
c	Gain or (loss)	-87,984		7c
d	Net gain or (loss).........			-87,984			-87,984
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..			0
10a	Gross sales of inventory, less returns and allowances ..
			10a	50,367
b	Less: cost of goods sold ..		10b	67,684
c	Net income or (loss) from sales of inventory..			-17,317			-17,317
Business Code			Miscellaneous Revenue
11a
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			0
12	Total revenue. See instructions.....			219,669,587	209,075,715		1,254,836

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	0
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	0
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............	0
4	Benefits paid to or for members .......	0
5	Compensation of current officers, directors, trustees, and key employees ...........	2,839,687	1,874,922	964,765
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........	0
7	Other salaries and wages........	98,896,497	90,281,266	8,615,231
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	3,181,568	2,914,628	266,940
9	Other employee benefits .......	12,754,136	11,667,724	1,086,412
10	Payroll taxes ...........	6,290,841	5,763,027	527,814
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	11,843	10,376	1,467
c	Accounting ...........	27,595		27,595
d	Lobbying ...........	0
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	5,466	4,078	1,388
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	23,785,722	9,751,795	14,033,927
12	Advertising and promotion ....	769,518	769,518
13	Office expenses .......	4,887,258	3,405,962	1,481,296
14	Information technology ......	10,783,989	9,860,892	923,097
15	Royalties ..	0
16	Occupancy ...........	6,854,064	5,137,725	1,716,339
17	Travel ............	93,039	77,934	15,105
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	156,950	148,026	8,924
20	Interest ...........	2,053,780	1,532,336	521,444
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	5,507,115	4,788,967	718,148
23	Insurance ...	1,995,729	1,828,283	167,446
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	Medical Supplies Expense	32,446,728	32,446,728
b	Taxes & Licensing	5,030,098	5,286,949	-256,851
c	Repairs & Maintenance	3,595,152	3,013,181	581,971
d	Dues & Subscriptions	305,416	183,637	121,779
e	All other expenses	246,341	216,052	30,289
25	Total functional expenses. Add lines 1 through 24e	222,518,532	190,964,006	31,554,526	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			5,029	1	17,976,731
2	Savings and temporary cash investments .........			1,602,566	2	6,946,358
3	Pledges and grants receivable, net ......				3	0
4	Accounts receivable, net .............			32,361,051	4	30,247,859
5	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6	0
7	Notes and loans receivable, net ...........			51,225	7	32,350
8	Inventories for sale or use ............			4,542,560	8	4,680,246
9	Prepaid expenses and deferred charges ......			981,824	9	1,076,036
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	143,188,092
b	Less: accumulated depreciation	10b	54,110,234	91,165,203	10c	89,077,858
11	Investments—publicly traded securities .				11	0
12	Investments—other securities. See Part IV, line 11 .....				12	0
13	Investments—program-related. See Part IV, line 11 ..				13	0
14	Intangible assets ...............			3,127,000	14	3,127,000
15	Other assets. See Part IV, line 11 ...........			20,945,636	15	57,759,559
16	Total assets. Add lines 1 through 15 (must equal line 33)...			154,782,094	16	210,923,997

17	Accounts payable and accrued expenses .....	32,181,047	17	36,500,394
18	Grants payable ...		18
19	Deferred revenue .........	113,651	19	18,318,772
20	Tax-exempt bond liabilities .........	49,794,698	20	92,530,106
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..	4,287,594	23	3,410,939
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	15,922,970	25	14,365,120
26	Total liabilities. Add lines 17 through 25..	102,299,960	26	165,125,331

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	38,184,973	27	35,339,620
28	Net assets with donor restrictions ...........	14,297,161	28	10,459,046
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	52,482,134	32	45,798,666
33	Total liabilities and net assets/fund balances ........	154,782,094	33	210,923,997