2023-07-07T11:04:43-05:00 2022-09-30 FORVIS LLP 1551 N WATERFRONT PKWY STE 300 WICHITA KS 672066601 990 2021-10-01 480663711 MERCY HOSPITAL INC % AARON HERBEL MERC 6203456391 PO BOX 180 MOUNDRIDGE KS 67107 AARON J HERBEL ADMINISTRATOR 6203456391 2023-08-15 true AARON J HERBEL 999009999 SHAWNELL LINOT P01663908 3162652811 2 2021 2023-04-26 12:10:37Z AARON HERBEL 218 E PACK ST MOUNDRIDGE KS 67107 4389409 false 1971 X WWW.MERCYH.ORG X 1945 KS TO MEET THE HEALTHCARE NEEDS OF THOSE LIVING IN MOUNDRIDGE, KANSAS AND SURROUNDING RURAL AREAS REGARDLESS OF AGE, RACE, ETHNICITY, OR ECONOMIC STATUS. 12 11 70 18 0 2678767 1391110 3353222 2976696 -4738 1000 12706 16503 6039957 4385309 0 10000 0 0 2213586 2780700 0 0 0 2302220 2432866 4515806 5223566 1524151 -838257 3427687 4051682 158081 1620333 3269606 2431349 X TO PROVIDE HEALTH CARE SERVICES TO PERSONS IN MOUNDRIDGE, KANSAS AND THE SURROUNDING RURAL AREAS. WE, THE STAFF AT MERCY BELIEVE THAT PAUL'S INJUNCTION: BY LOVE SERVE ONE ANOTHER, SHOULD BE THE BASIS OF OUR SERVICE HERE. false false 4217832 10000 3125377 MERCY HOSPITAL, INC., HAS CONTINUED TO SERVE THE MOUNDRIDGE COMMUNITY SINCE 1944, WITH ACUTE CARE, SWING BED AND RESPITE SERVICES, LAB, RADIOLOGY, AND SURGERY, INPATIENT AND OUTPATIENT PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPY, AND 24-HOUR EMERGENCY ROOM. OUR MEDICAL STAFF CONSISTS OF SIX FAMILY-PRACTICE PHYSICIANS AND FOUR PHYSICIAN ASSISTANTS. SCHEDULE O FOR CONTINUATION. 4217832 true true false true false false false false false false true false false false false false false false false false false false false false false false true true false true false false false false false false false true false false false false false false true false false false true 6 0 true 70 true false false false false false false false false false false false false X 12 11 false false false false true true true true true false false true true true true true false true true false X AARON HERBEL 6203456391 218 E PACK ST MOUNDRIDGE KS 67107 X AARON HERBEL ADMINISTRATOR AND CFO 40.0 0.0 X 76295 0 5386 ARLIS RATZLAFF DIRECTOR 1.0 0.0 X 0 0 0 LAVERN NIKKEL DIRECTOR 1.0 0.0 X 0 0 0 KENDEL KOEHN DIRECTOR 1.0 0.0 X 0 0 0 WAYLAN WIGGERS DIRECTOR 1.0 0.0 X 0 0 0 LONNIE UNRUH DIRECTOR 1.0 0.0 X 0 0 0 VINCE KOEHN DIRECTOR 1.0 0.0 X 0 0 0 MICHAEL UNRUH CHAIRMAN/DIRECTOR 2.0 0.0 X X 0 0 0 DAVID LITWILLER ASSISTANT CHAIRMAN/DIRECTOR 2.0 0.0 X X 0 0 0 DOYLE WIEBE SECRETARY/TREASURER/DIRECTOR 2.0 0.0 X X 0 0 0 DONAVON LEE KOEHN DIRECTOR 1.0 0.0 X 0 0 0 DAVID BECKER DIRECTOR 1.0 0.0 X 0 0 0 CLIFFORD KOEHN DIRECTOR 1.0 0.0 X 0 0 0 MERLE ENSZ DIRECTOR 1.0 0.0 X 0 0 0 76295 0 5386 0 false false false FUQUA CONSTRUCTION INC PO BOX 335 INMAN KS 67546 GENERAL CONTRACTOR 651030 REHABVISIONS 11623 ARBOR STREET OMAHA NE 681442991 THERAPY 303672 GREAT PLAINS HEALTH ALLIANCE 250 NORTH ROCK ROAD WICHITA KS 67206 MEDICAL RECORDS 264492 BCBS EMPLOYEE HEALTH INS PO BOX 1402 TOPEKA KS 666010412 HEALTH INSURANCE 173680 CASCADE HEALTH SERVICES 1001 NW BARRY ROAD KANSAS CITY MO 64155 CONTRACTED NURSING 165318 7 632383 758727 1391110 NET PATIENT SERVICE REVENUE 621300 2976696 2976696 2976696 0 0 1142 1142 0 0 0 5100 4100 1000 1000 1000 0 0 0 0 0 0 0 0 0 EMPLOYEE/GUEST MEALS 722514 13685 13685 MEDICAL RECORD FEES 621300 1371 1371 All Other Misc Revenue 900099 305 12 293 305 12 293 15361 4385309 2978079 16120 0 10000 10000 0 0 86448 86448 10307 10307 2320149 2056932 263217 2792 2792 176000 156033 19967 185004 164016 20988 0 0 55605 55605 483 483 0 0 914214 910916 3298 0 9501 9501 520995 61804 459191 0 0 75614 60589 15025 11415 3232 8183 0 6646 6646 21069 19297 1772 0 269216 246570 22646 42755 39158 3597 MEDICAL SUPPLIES 362706 362706 EQUIPMENT RENTAL/MAINTENANCE 60175 59286 889 FOOD/DIETARY SUPPLIES 57716 57716 _ 0 24756 139 24617 5223566 4217832 1005734 0 556084 183437 0 0 0 0 540204 467231 0 0 0 0 0 0 200919 219980 36168 34243 6814651 3675803 2079330 3138848 0 0 0 0 14982 7943 0 0 0 0 3427687 4051682 132581 464833 0 0 0 0 0 0 0 0 0 0 0 0 25500 1155500 0 0 158081 1620333 X 2964137 2322770 305469 108579 3269606 2431349 3427687 4051682 -838257 X true X false true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 483 true false false 483 false SCHEDULE C, PART II-B, LINE 1F A PORTION OF THE DUES PAID TO KHA ARE DEDICATED TO LOBBYING. SCHEDULE C, PART II-B, LINE 1G DIRECT CONTACT WITH LEGISLATORS WAS DUE TO PRESENCE AT THE KHA-SPONSORED EVENTS. NO FUNDS WERE EXPENDED EXPRESSLY FOR THE PURPOSE OF INTERACTING WITH LEGISLATORS. 69011 69011 3677114 2066087 1611027 2503503 1575832 927771 564923 33884 531039 3138848 SCHEDULE D, PART X, LINE 2 MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. true true X true X false true true true false true true 1 32 84670 84670 0.01620 1 336 304314 87991 216323 0.04140 2 368 388984 87991 300993 0.05760 2 2278 4719 4719 0.00090 2 1108 1322275 638362 683913 0.13100 1 15 329 329 0.00010 5 3401 1327323 638362 688961 0.13200 7 3769 1716307 726353 989954 0.18960 false 147298 65874 992972 2147643 -1154671 X true true 1 1 MERCY HOSPITAL INC 218 E PACK STREET MOUNDRIDGE KS 67107 WWW.MERCYH.ORG H059003 X X X MERCY HOSPITAL INC 1 false false true X X X X X X X X X 21 true true true true X SEE SCHEDULE H, PART V, SECTION C X WWW.MCPHERSONHOSPITAL.ORG X true 21 true SEE SCHEDULE H, PART V, SECTION C false true X 150. 0. X X X X true true X X X true X SEE SCHEDULE H, PART V, SECTION C X SEE SCHEDULE H, PART V, SECTION C X SEE SCH H, PART V, SECTION C X X X X X X true X false X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 SURVEY FORMS WERE DISTRIBUTED TO THE GENERAL PUBLIC THROUGH AN ONLINE SURVEY PLATFORM, AND ALSO MADE AVAILABLE IN PAPER FORM AT PUBLIC LOCATIONS SUCH AS THE SENIOR CENTER, THE HOSPITAL, AND THE LOCAL CLINICS. SURVEYS WERE LINKED ON THE HOSPITAL WEBSITE FOR ANY MEMBER OF THE COMMUNITY TO ACCESS. FOLLOWING THE INITIAL COMMUNITY SURVEY, A FOLLOW-UP WORKGROUP WAS HELD, HOSTED BY THE MCPHERSON COUNTY HEALTH DEPARTMENT AND MCPHERSON HOSPITAL. PHYSICIANS FROM THE CONTRIBUTING HOSPITALS, AS WELL AS THE COUNTY HEALTH DIRECTOR WERE IN ATTENDENCE, AND PROVIDED THEIR INSIGHT AND EXPERTISE. MEMBERS OF THE COMMUNITY, INCLUDING REPRESENTATIVES FROM COUNTY EMERGENCY SERVICES, DIASABILITY SUPPORT AND SOCIAL PROGRAMS (INCLUDING THE COUNTY FOODBANK) AS WELL AS OTHER INDIVIDUALS WERE ALSO IN ATTENDENCE AND CONTRIBUTED THEIR INPUT. FOLLOWING THE COUNTY-WIDE MEETING, MERCY HOSPITAL HOSTED A MOUNDRIDGE-SPECIFIC TOWN-HALL MEEITNG WITH MEMBERS OF OUR COMMUNITY TO DRILL INTO COMMUNITY-SPECIFIC DATA AND NEEDS. THE RESULTS OF BOTH OF THESE EFFORTS WERE USED TO COMPILE THE CHNA REPORT. THOSE IN ATTENDANCE AT THE TOWN-HALL INCLUDED CITY LEADERSHIP, SCHOOL DISTRICT LEADERSHIP, CITY EMS, LOCAL LTC LEADERS, COMMUNITY MEMBERS AT LARGE, HOSPITAL BOARD MEMBERS, HOSPITAL EXECUTIVES, COMMUNITY FOUNDATION BOARD MEMBERS, MOUNDRIDGE POLICE CHIEF, REPRESENTATIVES FROM THE FAITH-BASED COMMUNITY AND LOCAL COMMUNITY MENTAL HEALTH CENTER REPRESENTATIVES. SCHEDULE H, PART V, SECTION B, LINE 6A MCPHERSON HOSPITAL, LINDSBORG COMMUNITY HOSPITAL SCHEDULE H, PART V, SECTION B, LINE 6B MCPHERSON COUNTY HEALTH DEPARTMENT SCHEDULE H, PART V, SECTION B, LINE 7A WWW.MERCYH.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ SCHEDULE H, PART V, SECTION B, LINE 10A WWW.MERCYH.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ SCHEDULE H, PART V, SECTION B, LINE 11 MERCY HOSPITAL IS PARTNERING WITH PIFC AND OTHER COMMUNITY ORGANIZATIONS TO INCREASE ACCESS TO HEALTHCARE SPECIALTY SERVICES. THIS WAS IDENTIFIED AS A NEED DURING THE CHNA. MERCY IS ACTIVELY DEVELOPING A WALK-IN CLINIC TO OPEN LATER IN 2023. ACCESS TO URGENT CARE SERVICES WAS A NEED IDNETIFIED DURING THE CHNA. HEALTH INSURANCE EDUCATION, AN IDENTIFIED NEED, WILL BE ADDRESSED AT A FREE INSURANCE WORKSHOP MERCY IS HOSTING IN OCTOBER 2023 WITH A LOCAL MEDICARE EXPERT. ALL COMMUNITY MEMBERS WILL BE INVITED. THE HOSPITAL CONTINUES TO GROW DISTIBUTION OF OUR FREE NEWSLETTER TO OUR COMMUNITY. THIS IS PUBLISHED QUARTERLY AND DISTRUBUTED BY MAIL AND DIRECT DELIVERY TO OVER 2,100 HOUSEHOLDS WITHIN OUR SERVICE AREA. THIS PUBLICATION OFFERS HEALTHY LIFESTYLE INFORMATION ON A RANGE OF ISSUES IDENTIFIED IN THE LAST CHNA INCLUDING OBESITY, MENTAL HEALTH AND SUBSTANCE ABUSE. WE ARE CONNECTING PATIENTS TO RESOURCES THAT WILL HELP THEM LIVE MORE WHOLESOME LIVES. MERCY CONTINUES PROVIDING FREE BLOOD PRESSURE CHECKS MONTHLY AT THE LOCAL SENIOR CENTER. MERCY IS WORKING ALONGSIDE PRAIRIE VIEW MENTAL HEALTH TO PROVIDE OPTIMAL EMERGENT MENTAL HEALTH SCREENINGS AND CRISIS INTERVENTION TREATMENT WHERE NEEDED. OBESITY TREATMENT AND HEALTHY LIVING TOPICS ARE ADDRESSED IN THE NEWSLETTER, BUT ARE NOT PART OF MERCY'S CORE TREATMENT SERVICES. WE PARTNER WITH LOCAL HEALTHCARE PROVIDERS TO CONNECT PATIENTS TO THESE SERVICES. MERCY HOSPITAL IS COMMITTED TO FOCUSING OUR RESOURCES AND EFFORTS ON ADDRESSING THESE PRIORITIES THOUGH 2023 AND BEYOND, TO MEET THE COMMUNITY'S HEALTH NEEDS. SCHEDULE H, PART V, SECTION B, LINES 16A, 16B, AND 16C WWW.MERCYH.ORG/FINANCIAL-ASSISTANCE/ SCHEDULE H, PART I, LINE 3C IN ADDITION TO FPG CONSIDERATIONS, THE HOSPITAL ALSO USES ASSET LEVEL, MEDICAL INDIGENCY, INSURANCE STATUS, AND UNDERINSURANCE STATUS TO DETERMINE WHETHER INDIVIDUALS ARE FAP ELIGIBLE. HOSPITAL ONLY PROVIDES 100% CHARITY CARE TO ELIGIBLE INDIVIDUALS. NO SLIDING SCALE IS USED TO DETERMINE DISCOUNTED CARE. ALL FAP ELIGIBLE INDIVIDUALS RECEIVE 100% FREE CARE. SCHEDULE H, PART I, LINE 7 THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS IN THE TABLE OF PART I, LINE 7, OF SCHEDULE H IS THE COST TO CHARGE RATIO FROM THE ORGANIZATION'S 9/30/2022 MEDICARE COST REPORT. SCHEDULE H, PART I, LINE 7, COLUMN F NOT APPLICABLE DUE TO ADOPTION OF ASC 606 REVENUE CONTRACTS WITH CUSTOMERS. SCHEDULE H, PART III, SECTION A, LINE 2 ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR UNCOLLECTIBLE ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND CO-PAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED OR PROVIDED BY POLICY) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED, IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE AMOUNT REPORTED IS THE INCREASE OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS, BASED ON THE EXPENSES INCURRED IN TAX YEAR 2022. SCHEDULE H, PART III, SECTION A, LINE 3 THE HOSPITAL'S BAD DEBT EXPENSE WAS MUCH HIGHER IN THIS TAX YEAR. THIS WAS DUE TO HIGH SELF-PAY ACCOUNTS-RECIEVABLE CARRYOVER FROM THE PREVIOUS YEAR. THERE WAS SOME CLEAN-UP OF OLD ACCOUNTS FROM THE PREVIOUS YEAR, WHICH RESULTED IN A HIGHER VOLUME. THERE IS A CERTAIN PERCENTAGE OF INDIVIDUALS EVERY YEAR WHO, DUE TO BEING IN THE HOSPITAL A SHORT TIME, ONLY INTERACTING WITH HOSPITAL STAFF IN THE ER SETTING (I.E. ONLY FOR SHORT PERIODS OF TIME WITH NO OPPORTUNITY TO COLLECT THE NECESSARY INFORMATION), OR DUE TO INSTABILITY IN THEIR LIVING ARRANGEMENTS, ARE UNABLE TO PROVIDE THE REQUIRED INFORMATION FOR A CHARITY CARE APPLICATION TO BE PROCESSED. WE SAW A DECREASE IN PATIENT PAYMENTS ON ACCOUNTS WHICH IS BELIEVED TO BE DUE TO LOWER PATIENT CASH-IN-HAND AND MEDICAL DEBTS NOT BEING FIRST PRIORITY. WE WERE SERVED SEVERAL BANKRUPTCY PAPERS DURING FY 2022 WHICH LED TO THOSE ACCOUNTS BEING DISCHARGED AS BAD DEBT. SCHEDULE H, PART III, SECTION A, LINE 4 NOT APPLICABLE DUE TO ADOPTION OF ASC 606 REVENUE CONTRACTS WITH CUSTOMERS. SCHEDULE H, PART III, SECTION B, LINE 8 WE PROVIDE OUTPATIENT SERVICES AS A BENEFIT TO OUR COMMUNITY, ALLOWING OUR LOCAL CITIZENS TO RECEIVE CARE CLOSE TO HOME AND WITHIN TIMEFRAMES WHEN THEIR CONDITION CAN BE TREATED. STATISTICS SHOW THAT WHEN AN EMERGENCY ROOM CLOSES IN A COMMUNITY, THE MORTALITY RATE INCREASES BY 6 PERCENTAGE POINTS DUE TO REDUCTION IN ACCESS TO CARE. THE OUTPATIENT CARE WE PROVIDE IS REIMBURSED AT WELL BELOW COST FROM BOTH MEDICARE AND MEDICAID. THE COST TO CHARGE RATIO FROM THE MOST-RECENTLY FILED MEDICARE COST REPORT WAS USED TO DETERMINE MEDICARE-ALLOWABLE COSTS FOR THE ASSOCIATED PAYMENTS, LESS AMOUNTS REPORTED AS COMMUNITY BENEFIT UNDER PART I SECTION 7. EXPENSES WERE UP SIGNIFICANTLY FOR MERCY HOSPITAL IN 2022 AND DUE TO LOWER PATIENT VOLUMES, THE CORRESPONDING REVENUE WAS NOT THERE TO OFSET THE COST INCREASES. SCHEDULE H, PART III, SECTION C, LINE 9B ANY SELF-PAY ACCOUNT THAT HAS BEEN SELF-PAY FOR 90 DAYS WITH NO ACTION SHALL BE CONSIDERED DELINQUENT. THESE ACCOUNTS WITH BALANCES OVER $50.00 ARE PASSED ON TO OUR INTERNAL COLLECTIONS DEPARTMENT, TO ATTEMPT CONTACT WITH THE GUARANTOR TO ESTABLISH A PAYMENT PLAN. THIS METHOD INCLUDES MAILINGS AND PHONE CALLS. BANKRUPTCIES WILL HAVE ALL COLLECTIONS EFFORTS STOPPED UPON RECEIPT OF BANKRUPTCY NOTICE. ALL ACCOUNTS BEING WORKED BY OUR INTERNAL COLLECTIONS DEPARTMENT ARE OFFERED THE HOSPITAL'S ESTABLISHED FINANCIAL ASSISTANCE POLICY AND APPLICATION. ANY PATIENT ACCOUNTS WHICH QUALIFY ARE HANDLED ACCORDING TO THAT POLICY. FUTURE ACCOUNTS FOR A GUARANTOR WHO IS KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE MAY BE AWARDED CHARITY CARE BASED ON ADMINISTRATIVE DECISION. ALL FINANCIAL ASSISTANCE APPLICATIONS ARE SUBJECT TO PERIODIC AND ANNUAL REVIEW TO ENSURE THE GUARANTOR'S CURRENT FINANCIAL SITUATION IS TAKEN INTO CONSIDERATION. SCHEDULE H, PART VI, LINE 2 IN 2022, A JOINT COMMUNITY HEALTH NEEDS ASSESSMENT WAS PERFORMED WITH TWO OTHER AREA HOSPITALS, IN CONJUNCTION WITH THE COUNTY HEALTH DEPARTMENT. RESIDENTS WERE ASKED TO COMPLETE ONLINE OR PAPER SURVEYS REGARDING HEALTH CONCERNS AND OPPORTUNITIES. AFTER INITIAL HEALTH ISSUES WERE IDENTIFIED, A WORKGROUP WAS FORMED REPRESENTING A CROSS SECTION OF SURVEY RESPONDENTS ALONG WITH COMMUNITY HEALTH EXPERTS AND RESOURCES. THIS WORKGROUP PRIORITIZED THE ISSUES AFFECTING THE COMMUNITY USING PUBLIC HEALTH DATA TO CONFIRM ADDITIONAL FACTORS. MERCY HOSPITAL HOSTED A TOWN-HALL MEETING WITH COMMUNITY RESIDENTS AND TOWN LEADERS TO FURTHER DRILL DOWN INTO NEEDS AND SURVEY THE POPULATION. ALL THIS INFORMATION WAS COMPILED INTO A REPORT WHICH HAS BEEN PUBLISHED ON OUR WEBSITE. MERCY HOSPITAL IDENTIFIED SOLUTIONS TO THESE IDENTIFIED HEALTH CONCERNS AND RELEASED A FACILITY-SPECIFIC IMPLEMENTATION PLAN, WHICH IS BEING CARRIED OUT STARTING IN 2023 THROUGH THE END OF 2025. ALL THESE DOCUMENTS ARE REVIEWED AND DISCUSSED WITH THE HOSPITAL'S PATIENT AND FAMILY ENGAGEMENT COMMITTEE CHOSEN FROM THE PATIENT POPULATION IN THE COMMUNITY. THESE INDIVIDUALS HELP TO DETERMINE THE WORTHINESS AND EFFICACY OF THE HOSPITAL'S EFFORTS. SCHEDULE H, PART VI, LINE 3 COMMUNICATION OF THE FINANCIAL ASSISTANCE AVAILABLE FROM MERCY HOSPITAL, INC. SHALL BE DISSEMINATED BY VARIOUS MEANS, WHICH MAY INCLUDE, BUT ARE NOT LIMITED TO, THE PUBLICATION OF NOTICES IN PATIENT BILLS AND BY POSTING NOTICES IN EMERGENCY ROOMS, REGISTRATION, PATIENT FINANCIAL SERVICES AND AT OTHER PUBLIC PLACES AS MERCY HOSPITAL, INC. MAY ELECT. INFORMATION SHALL ALSO BE INCLUDED ON THE FACILITY WEBSITE AND IN THE CONDITIONS OF ADMISSION FORM. REFERRAL OF PATIENTS FOR FINANCIAL ASSISTANCE MAY BE MADE BY ANY MEMBER OF THE MERCY HOSPITAL, INC. STAFF OR MEDICAL STAFF, INCLUDING PHYSICIANS, NURSES, FINANCIAL SERVICES STAFF, SOCIAL WORKER AND CASE MANAGER. A REQUEST FOR FINANCIAL ASSISTANCE MAY BE MADE BY THE PATIENT OR A FAMILY MEMBER, CLOSE FRIEND OR ASSOCIATE OF THE PATIENT, SUBJECT TO APPLICABLE PRIVACY LAWS. SCHEDULE H, PART VI, LINE 4 MERCY HOSPITAL IS LOCATED IN MOUNDRIDGE, KS AND SERVES AN DENSELY-SETTLED RURAL AREA THAT ALSO INCLUDES INDIVIDUALS FROM FOUR SURROUNDING COMMUNITIES. MOUNDRIDGE AND THE SURROUNDING RURAL SPACE HAS A POPULATION OF APPROXIMATELY 6,500 PEOPLE. BENEFICIARIES ARE FROM FARMING AND SOME MANUFACTURING ORGANIZATIONS IN THE APPROXIMATE 30-MILE RADIUS OF THE HOSPITAL. THERE ARE TWO OTHER HOSPITALS WITHIN A 20-MILE RADIUS ALSO SERVING THE AREA. SCHEDULE H, PART VI, LINE 5 THE HOSPITAL HAS AN ACTIVE PATIENT AND FAMILY ENGAGEMENT COMMITTEE THAT MEETS AT LEAST QUARTERLY. THIS GROUP IS COMPRISED OF VOLUNTEER COMMUNITY MEMBERS WHO HAVE BEEN PATIENTS IN THE HOSPITAL. THESE INDIVIDUALS SERVE AS ADVISORS FOR THE BOARD AND MEDICAL STAFF TO PROVIDE INSIGHT FROM THE COMMUNITY TO INFLUENCE HOSPITAL POLICY AND DECISIONS. MEDICAL STAFF IS COMPOSED OF COURTESY AND CONSULTING PHYSICIANS WHO MEET QUARTERLY. TOPICS RELATING TO COMMUNITY HEALTH MAY BE DISCUSSED IN MEDICAL STAFF MEETINGS. THE HOSPITAL'S BOARD IS COMPRISED OF 12 VOLUNTEER MEMBERS FROM VARIOUS REGIONS OF THE SERVICE AREA. SCHEDULE H, PART VI, LINE 6 N/A SCHEDULE H, PART VI, LINE 7 N/A true PHYSICIAN LOAN REPAYMENT ASSISTANCE 1 10000 SCHEDULE I, PART I, LINE 2 MERCY HOSPITAL IS NOT A FOUNDATION, AND THE GRANTS WE WOULD AWARD ARE ONLY TO INDIVIDUALS WHO MEET VERY SPECIFIC CRITERIA, SUCH AS A NEW PHYSICIAN PROVIDER WHO IS COMING TO TOWN. ALL GRANT TERMS MUST BE MET IN ADVANCE BEFORE THE FUNDS ARE DISBURSED. BRENDA KOEHN SPOUSE OF BOARD MEMBER 10307 SALARIES false FORM 990, PART III, LINE 4A THE FOLLOWING STATISTICS ARE OFFERED FOR THE FISCAL YEAR ENDING 9-30-2022: 194 MEDICARE, MEDICAID, AND MEDICARE ADVANTAGE ADMISSIONS AND 194 DISMISSALS; AGED PATIENTS SERVICES - 569 DAYS; PEDIATRICS SERVICES - 0 DAYS; SWING BED DAYS - 449; EKGS PERFORMED - 326; OUTPATIENT THERAPY - 4,211 INSTANCES OF SERVICE; ER VISITS - 1,074. FORM 990, PART VI, LINE 1A ALL MEMBERS OF THE BOARD OF DIRECTORS HAVE THE SAME VOTING PRIVILAGES. THE EXECUTIVE COMMITTEE DOES HAVE AUTHORITY TO ACT ON ANY MATTERS WHICH MAY ARISE BETWEEN REGULAR MEETINGS, SUJECT TO APPROVAL BY THE FULL BOARD AT THIER NEXT REGULAR MEETING. FORM 990, PART VI, SECTION A, LINE 6 MEMBERSHIP IN MERCY HOSPITAL, INC. IS LIMITED TO THE CONGREGATIONS OF THE VARIOUS CHURCHES OF THE CHURCH OF GOD IN CHRIST MENNONITE WITHIN THE AREA SERVED BY THE HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7A THE VARIOUS CONGREGATIONS, BEING THE MEMBERS OF MERCY HOSPITAL, INC., HAVE THE RIGHT TO ELECT, ADD, OR REMOVE BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B THE VARIOUS CONGREGATIONS, BEING THE MEMBERS OF MERCY HOSPITAL, INC., HAVE THE RIGHT TO APPROVE THE BYLAWS, ARTICLES OF INCORPORATION, AND APPROVE OR REMOVE BOARD MEMBERS. FORM 990, PART VI, SECTION B, LINE 11B AN INDEPENDENT ACCOUNTING FIRM PREPARES THE FORM 990. THE FORM 990 WITH ALL REQUIRED SCHEDULES IS THEN REVIEWED BY THE ORGANIZATION'S ADMINISTRATOR AND CFO. ANY QUESTIONS OR CONCERNS ARE ADDRESSED AND ANY NECESSARY CHANGES ARE MADE. THE FINAL FORM 990, WITH ALL REQUIRED SCHEDULES, IS PROVIDED TO ALL VOTING MEMBERS OF THE BOARD FOR THEIR REVIEW PRIOR TO FILING THE 990. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS AND THE ADMINISTRATOR REVIEW THE CONFLICT OF INTEREST POLICY ANNUALLY. EACH INDIVIDUAL IS RESPONSIBLE FOR DISCLOSING ANY POTENTIAL CONFLICTS. AN ADMINISTRATIVE BOARD DETERMINES WHETHER A CONFLICT IS PRESENT. IF A CONFLICT OF INTEREST IS PRESENT THE INTERESTED BOARD MEMBER IS EXCUSED FROM THE BOARDROOM DURING THE VOTE. THE ADMINISTRATIVE BOARD IS COMPOSED OF THREE INDIVIDUALS: AARON HERBEL, ADMINISTRATOR AND ACTING CFO; LORIE FRIESEN DON, AND VERLA FRIESEN, CORPORATE COMPLIANCE OFFICER. FORM 990, PART VI, SECTION B, LINES 15A & 15B AT THE TIME OF HIRE AND ANNUALLY THEREAFTER, THE KHA'S PUBLISHED WAGE SCALE AND AN INFORMAL SURVEY OF AREA COMPENSATION COMPARABLES ARE USED TO ESTABLISH REASONABLE COMPENSATION LEVELS. IN ADDITION, AN ANNUAL PERFORMANCE EVALUATION IS PERFORMED BY THE EXECUTIVE COMMITTEE OF THE HOSPITAL BOARD OF DIRECTORS. THE EVALUATIONS COMPLETED BY THE EXECUTIVE COMMITTEE ARE THEN PRESENTED TO THE BOARD OF DIRECTORS FOR APPROVAL. DOCUMENTATION OF THE APPROVED EVALUATIONS FOR COMPENSATION IS INCLUDED IN THE BOARD MINUTES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST TO THE HOSPITAL ADMINISTRATOR. FORM 990, PART XII, LINE 2C A BOARD MEMBER NOW OVERSEES OR REVIEWS THE FINANCIAL DOCUMENTS PREPARED BY THE CFO. FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED MEDICAL SERVICES TOTAL FEES:874953 FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED PLANT MAINT SERVICES TOTAL FEES:39201 FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED DIETARY SERVICES TOTAL FEES:60 CHURCH OF GOD IN CHRIST MENNONITE 100 AVE C MOUNDRIDGE KS 67107 237022612 CHURCH KS 501(C)(3) 1 false false false true false true false false false false false false false true true false false false false false