2019-05-15T17:11:29-05:00 2018-06-30 562632458 PLEUS AND COMPANY LLC 14500 SOUTH OUTER 40 RD STE 201A CHESTERFIELD MO 63017 990 2017-07-01 463433074 MERCY HOSPITAL KINGFISHER INC MERC 4059365649 1000 HOSPITAL CIRCLE KINGFISHER OK 73750 JONATHAN VITIELLO SVP FINANCIAL OPERATIONS 3146283437 2019-05-15 1 DOUGLAS G PLEUS P00013488 3143179916 107.143.156.209 2019-05-15 10:32:37 CD P 2BE301797771FA56319AFE83B3D82A6B47BB15DE 5D794220C68C161820A811785299AFD302F4C684 2017 2019-02-21 02:37:17Z DIANA SMALLEY 1000 HOSPITAL CIRCLE KINGFISHER OK 73750 15002351 0 0928 X WWW.MERCY.NET/KINGFISHEROK X 2013 OK TO CARRY OUT THE HEALING MINISTRY OF JESUS BY PROMOTING HEALTH AND WELLNESS THROUGH OUR COMMUNITIES. TO PROVIDE QUALITY HEALTH SERVICES THROUGH A WISE USE OF RESOURCES AND EXCEPTIONAL MERCY SERVICE. 8 5 0 31 0 1224 31721 13105 13393078 14824308 -54 0 121815 164938 13546560 15002351 122613 163352 0 0 6727311 7089548 0 0 0 5351433 6212823 12201357 13465723 1345203 1536628 3274926 3635779 1808177 1883142 1466749 1752637 MERCY HOSPITAL KINGFISHER IS ROOTED IN THE MISSION OF JESUS AND THE HEALING MINISTRY OF THE CHURCH. THIS TRADITION IS MARKED BY VALUES OF JUSTICE, EXCELLENCE, STEWARDSHIP AND RESPECT FOR THE DIGNITY OF EACH PERSON. 0 0 10734980 163352 14892643 MERCY HOSPITAL KINGFISHER PROVIDES QUALITY MEDICAL HEALTH CARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. DURING FISCAL YEAR END JUNE 30, 2018, KINGFISHER PROVIDED SERVICES TO 317 INPATIENTS, 15,228 OTHER OUTPATIENTS, AND 4,247 EMERGENCY DEPARTMENT PATIENTS. THE AMOUNT OF UNCOMPENSATED CARE FOR FY 2018 WAS $467,726.MERCY HOSPITAL KINGFISHER'S EXEMPT PURPOSE ACHIEVEMENTS ARE EXPANDED UPON IN VARIOUS SECTIONS OF SCHEDULE H. 10734980 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 X 8 5 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 1 0 OK X LYNN PINAROC 4057523536 4300 WEST MEMORIAL ROAD OKLAHOMA CITY OK 73120 X CHEAP PAT BOARD MEMBER 1.00 0.00 X 0 0 0 DENTON BRIAN ADMINISTRATOR RURAL FACILITIES & BM 50.00 0.00 X 123718 0 20846 DIXSON MD JAMES D PHYSICIAN & BOARD MEMBER 1.00 59.00 X 0 450297 59627 HALLOCK DOROTHY BOARD MEMBER 1.00 0.00 X 0 0 0 PINAROC LYNN VP-FINANCE & BOARD MEMBER 1.00 59.00 X 0 213232 15375 VOTH JOE BOARD MEMBER 1.00 0.00 X 0 0 0 WALTA BRENDA BOARD MEMBER 1.00 0.00 X 0 0 0 SHEPHERD DEENA BOARD MEMBER 1.00 0.00 X 0 0 0 LEMON JIM BOARD MEMBER 1.00 0.00 X 0 0 0 VOTH JOE BOARD MEMBER 1.00 0.00 X 0 0 0 ENLOE TRACY CHIEF FINANCIAL OFFICER & BM 2.00 58.00 X 0 304562 38269 SMALLEY DIANA L PRESIDENT, WEST COMMUNITIES 1.00 59.00 X 0 1312329 21455 GEBHART JIM R PRESIDENT, MERCY HOSPITAL OKC 5.00 55.00 X 0 747932 89610 LE BICH-VI REGIONAL VP-GENERAL COUNSEL 1.00 59.00 X 0 319588 58019 TYSZKO SARAH L PHYSICIAN ASSISTANT 50.00 0.00 X 175662 0 15288 WILCOX DAVE M PHYSICIAN ASSISTANT 50.00 0.00 X 112379 0 6847 STEINLICHT MELVIN E REGISTERED NURSE II 50.00 0.00 X 108558 0 9388 DRAKOULAKIS VIORICA REGISTERED NURSE FLEX 50.00 0.00 X 106877 0 4207 RAJU GARY FORMER OFFICER 0.00 60.00 X 0 423193 40479 VITIELLO JONATHAN FORMER OFFICER 0.00 60.00 X 0 857053 108853 627194 4628186 488263 5 1 1 0 STAFF CARE PO BOX 281923 ATLANTA GA 30384 STAFFING SERVICES 187052 1 13105 13105 PATIENT SERVICE REVENUE 622110 14824308 14824308 14824308 63504 0 63504 63504 63504 CAFETERIA 722210 33099 33099 68335 68335 101434 15002351 14892643 0 96603 163352 163352 156350 156350 153930 153930 5499417 5146737 352680 257367 238689 18678 614744 562993 51751 407740 362970 44770 3600 3600 701516 396892 304624 8744 4947 3797 582448 329528 252920 7640 2090 5550 583477 330110 253367 19051 15235 3816 151501 5391 146110 82027 82027 BAD DEBTS 1853465 1853465 SHARED SERVICE FEE 1031446 536352 495094 DRUGS & MEDICAL EXPENSE 757451 737579 19872 REPAIRS & MAINTENANCE 376296 18008 358288 54161 30642 23519 13465723 10734980 2730743 0 1403742 1429430 1225937 1617164 184551 187581 10497 16238 1345681 973827 432991 371854 17208 13512 3274926 3635779 678962 391431 13917 1115298 1491711 1808177 1883142 X 1466749 1752637 1466749 1752637 3274926 3635779 X 1536628 -1250740 X X 0 1 X 1 1 1 X 0 0 0 0 0 1 4043 0 0 0 4043 0 PART II-B, LINE 1: THE FILING ORGANIZATION IS A MEMBER OF AND PAYS DUES TO THE CATHOLIC HOSPITAL ASSOCIATION (PAID BY PARENT ORGANIZATION), OKLAHOMA HOSPITAL ASSOCIATION, AND AMERICAN HOSPITAL ASSOCIATION. FOR THE YEAR ENDED JUNE 30, 2018, DUES WERE $12,981 AND $4,377, RESPECTIVELY. APPROXIMATELY 3.93% OF THE CATHOLIC HOSPITAL ASSOCIATION DUES, 23.40% OF OKLAHOMA HOSPITAL ASSOCIATION DUES, AND 22.98% OF AMERICAN HOSPITAL ASSOCIATION DUES WERE ATTRIBUTABLE TO LOBBYING ACTIVITIES PERFORMED. 106478 9834 96644 1239203 963993 275210 371854 DUE TO TAX-EXEMPT AFFILIATES 1491711 1491711 PART X, LINE 2 FEDERAL INCOME TAX PRIMARILY ALL OF THE MERCY HEALTH ENTITIES ARE RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(A) OF THE INTERNAL REVENUE CODE AS CHARITABLE ORGANIZATIONS QUALIFYING UNDER INTERNAL REVENUE CODE SECTION 501(C)(3), BY VIRTUE OF IRS DETERMINATION LETTERS OR INCLUSION IN THE OFFICIAL CATHOLIC DIRECTORY. MERCY COMPLETED AN ANALYSIS OF ITS TAX POSITIONS IN ACCORDANCE WITH APPLICABLE ACCOUNTING GUIDANCE AND DETERMINED THAT NO AMOUNTS WERE REQUIRED TO BE RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS AT JUNE 30, 2018 OR 2017. 1 1 X 1 X 1 X 1 1 1 0 1 1 368533 368533 0.03170 1199591 1100398 99193 0.00850 1568124 1100398 467726 0.04020 1568124 1100398 467726 0.04020 1 861657 0 6101243 6254035 -152792 X 1 1 1 1 MERCY HOSPITAL KINGFISHER INC 1000 KINGFISHER REGIONAL HOSPITAL DRIVE KINGFISHER OK 73750 WWW.MERCY.NET/ABOUT 2226 X X X X MERCY HOSPITAL KINGFISHER INC 1 0 0 1 X X X X X X X X X 15 1 0 1 1 X WWW.MERCY.NET/ABOUT/COMMUNITY-BENEFITS X 1 16 1 WWW.MERCY.NET/ABOUT/COMMUNITY-BENEFITS 0 1 X 100.000000000000 400.000000000000 X 1 1 X X X 1 X WWW.MERCY.NET/OPEN-PAGES/PAY-MY-BILL/#FINANCIAL-ASSISTANCE X WWW.MERCY.NET/OPEN-PAGES/PAY-MY-BILL/#FINANCIAL-ASSISTANCE X WWW.MERCY.NET/OPEN-PAGES/PAY-MY-BILL/#FINANCIAL-ASSISTANCE X X X X X X 1 X 0 X X X X X 1 X 0 0 MERCY HOSPITAL KINGFISHER, INC. PART V, SECTION B, LINE 5: WHEN CONDUCTING ITS MOST RECENT CHNA, MERCY HOSPITAL KINGFISHER WORKED CLOSELY WITH THE FOLLOWING:- SOONER SUCCESS - KINGFISHER COUNTY HEALTH DEPARTMENT REPRESENTATIVES- OSU COOPERATIVE EXTENSION SERVICE STAFF- DHS STAFF- CHISHOLM TRAIL TECHNOLOGY CENTER REPRESENTATIVES- FAMILY AND CHILDREN'S CONSULTANTS - OKLAHOMA STATE UNIVERSITY CENTER FOR RURAL HEALTH STAFF- MERCY HOSPITAL KINGFISHER LEADERSPLEASE REFER TO THE COMMUNITY HEALTH NEEDS ASSESSMENT WHICH CAN BE FOUND AT: WWW/MERCY.NET/COMMUNITY-BENEFITS MERCY HOSPITAL KINGFISHER, INC. PART V, SECTION B, LINE 6B: SEE PART V, SECTION B, LINE 5 RESPONSE MERCY HOSPITAL KINGFISHER, INC. PART V, SECTION B, LINE 11: BASED ON THE FINDINGS OF ITS MOST RECENTLY CONDUCTED CHNA, MERCY HOSPITAL, KINGFISHER HAS CHOSEN TO ADDRESS THE FOLLOWING THREE SIGNIFICANT HEALTH NEEDS. - ACCESS TO CARE- MENTAL HEALTH- HEALTHY LIFESTYLESSOME HIGHLIGHTS OF COMMUNITY PROGRAMS BEING ADDRESSED THROUGH THE COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) ARE:- HOSTED THE QUARTERLY MEETINGS OF THE KINGFISHER STUDENT GOVERNING BOARD- PARTICIPATION IN OBI BLOOD DRIVES- PARTICIPATED IN THE CHAPTER OF KINGFISHER ROTARY CLUB- PARTICIPATED IN AMBUCS/AMTRYKE LOCAL CHAPTER AND FUND RAISERS FOR BIKES, TRIKES, AND WHEELCHAIR RAMPS FOR THE DISABLED- CO-SPONSORED 8TH GRADE HEALTH FAIR, INCLUDING HEALTH SCREENING, WHICH WAS ATTENDED BY 350 PARTICIPANTS.- ACTIVE INVOLVEMENT IN KINGFISHER COUNTY COLLABORATIVE FOR YOUTH-RELATED ISSUES IMPACTING 165 YOUTH THIS YEAR.- LION'S CLUB PARTICIPATION AND PRESENTATIONS- KINGFISHER CHAMBER BOARD EXECUTIVE COMMITTEE MEMBER- RELAY FOR LIFE COMMITTEE MEMBER - KINGFISHER CHRISTMAS PARADE PARTICIPATION- COMPASSION CLINIC SUPPORT BY PROVIDING LAB AND MEDICAL SERVICES TO 170 PERSONS EACH QUARTER- CO-SPONSORED COLD TURKEY TROT 5K, TO HELP PROMOTE THE GREAT AMERICAN SMOKE-OUT AND BEING TOBACCO FREE- SPONSORED AND HOSTED A 5K NIGHTTIME GLOW RUN IN APRIL WITH 240 PARTICIPANTS. - SPONSORED TWO FAMILIES FOR THANKSGIVING MEALS- SPONSORED TWO FAMILIES FOR CHRISTMAS MEALS AND GIFTS MERCY HOSPITAL KINGFISHER, INC. PART V, SECTION B, LINE 20E: OTHER AREAS FROM A NOTICE PERSPECTIVE: FAP IS POSTED IN ALL REGISTRATION AREAS, FULL POLICY AND PLAIN LANGUAGE DOCUMENT POSTED ON WEBSITE, PLAIN LANGUAGE DOCUMENT IS AVAILABLE WHEN REQUESTED, THERE IS A NOTICE ON STATEMENT, AND ALL PATIENTS GET THREE STATEMENTS BEFORE THEY CAN GO TO A COLLECTION AGENCY. 1 1 - MHK OUTPATIENT REHAB 1000 HOSPITAL CIRCLE KINGFISHER OK 73750 REHABILITATION SERVICES PART I, LINE 7G: SUBSIDIZED HEALTH SERVICESTHE PHYSICIAN CLINICS ARE INCLUDED AS A NET AMOUNT (INCOME LESS EXPENSES) ALLOCATED BY THE CLINICAL SERVICE LINE IN THE INDIRECT COST. PART I, LN 7 COL(F): TOTAL EXPENSES FROM FORM 990, PART IX, LINE 25, COLUMN (A) ARE $13,419,596. INCLUDED IN THIS AMOUNT WAS BAD DEBT EXPENSE (CHARGES) OF $1,853,465. EXPENSES FOR THE PURPOSE OF CALCULATING LINE 7, COLUMN (F) ARE $861,657. PART I, LINE 6A COMMUNITY BENEFIT REPORTTHE ORGANIZATION'S COMMUNITY BENEFIT REPORT IS PREPARED BY ITS ULTIMATE PARENT ENTITY, MERCY HEALTH (EIN: 43-1423050). PART II, COMMUNITY BUILDING ACTIVITIES: COMMUNITY BUILDING ACTIVITIES ADDRESS THE ROOT CAUSES OF HEALTH-RELATED PROBLEMS. MULTIDISCIPLINARY COMMUNITY PARTNERSHIPS AND COLLABORATION ADDRESS THE SYSTEMIC MALFUNCTION AND THE ROOTS CAUSES OF ISSUES SUCH AS POVERTY, VIOLENCE, AND HOMELESSNESS. THEY STRENGTHEN THE COMMUNITY'S ABILITY TO PROMOTE HEALTH AND WELL-BEING. MERCY HOSPITAL KINGFISHER (MHK) COMMUNITY BUILDING ACTIVITIES PROMOTE THE HEALTH OF THE COMMUNITIES IN WHICH THEY SERVE. THROUGH PARTICIPATION IN NEIGHBORHOOD/COMMUNITY MEETINGS, COMMUNITY BOARDS, AND INVOLVEMENT IN COMMUNITY-BASED EVENTS, MHK DEMONSTRATES ITS ONGOING COMMITMENT TO THE COMMUNITY. COMMUNITY BUILDING ACTIVITIES SERVE AS A LINK TO ENGAGE MERCY COWORKERS TO LOOK BEYOND THE WALLS OF THE FACILITIES IN WHICH THEY SERVE.A FULL DESCRIPTION OF COMMUNITY BUILDING ACTIVITIES CAN BE FOUND AT: HTTPS://WWW.MERCY.NET/ABOUT/COMMUNITY-BENEFITS/ PART III, LINE 2: TO DETERMINE THE AMOUNT OF BAD DEBT EXPENSE, AT COST, BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENT ACCOUNTS WAS MULTIPLIED BY A RATIO OF COST TO CHARGES. THE RATIO OF COST TO CHARGES USED WAS BASED ON DETAILED COST ACCOUNT, WHERE AVAILABLE. WHERE COST ACCOUNTING IS NOT AVAILABLE, COST REPORT COST TO CHARGE RATIOS WERE UTILIZED. PART III, LINE 3: THE FILING ORGANIZATION DETERMINED THAT THE ESTIMATED AMOUNT OF BAD DEBT EXPENSE (AT COST) ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS $0. ALTHOUGH THE CHARITY CARE POLICY REQUIRES THE PARTICIPATION OF THE PATIENT REQUESTING ASSISTANCE, WE HAVE A PROCESS UNDER PRESUMPTIVE CHARITY TO ADDRESS ACCOUNTS FOR PATIENTS WHO DO NOT PROVIDE THE INFORMATION. WE BELIEVE THAT OUR CHARITY POLICY IS COMPREHENSIVE ENOUGH TO CAPTURE ALMOST ALL PATIENTS WHO QUALIFY FOR CHARITY CARE. PART III, LINE 4: THE TEXT OF THE FOOTNOTE THAT IS INCLUDED IN MERCY HEALTH AND SUBSIDIARIES AUDITED FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE IS AS FOLLOWS: "PATIENT ACCOUNTS RECEIVABLE THAT ARE DEEMED UNCOLLECTIBLE, INCLUDING THOSE PLACED WITH COLLECTION AGENCIES, ARE INITIALLY CHARGED AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IN ACCORDANCE WITH COLLECTION POLICIES OF THE HEALTH SYSTEM AND, IN CERTAIN CASES, ARE RECLASSIFIED TO CHARITY CARE IF DEEMED TO OTHERWISE MEET THE HEALTH SYSTEM'S CHARITY CARE POLICY. THE PROVISION FOR UNCOLLECTIBLE RECEIVABLES IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. PERIODICALLY THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES BASED UPON THE PAYOR COMPOSITION AND AGING OF RECEIVABLES WITH CONSIDERATION OF THE HISTORICAL PAYMENT AND WRITE-OFF EXPERIENCE BY PAYOR CATEGORY. THE RESULTS OF THESE REVIEWS ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR UNCOLLECTIBLE RECEIVABLES TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES. AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE, THE HEALTH SYSTEM FOLLOWS ESTABLISHED GUIDELINES FOR PLACING PAST-DUE PATIENT BALANCES WITH COLLECTION AGENCIES." PART III, LINE 8: IT IS THE POSITION OF MERCY HOSPITAL KINGFISHER THAT 100% OF ANY SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT. THIS AMOUNT REPRESENTS COST OF PROVIDING SERVICES THAT REMAIN UNCOMPENSATED TO THE PROVIDER. THE UNREIMBURSED COSTS OF MEDICARE IS CALCULATED BY THE GROSS CHARGES NET OF THE COST TO CHARGE RATIO LESS ANY PAYMENTS, DEDUCTIONS OR REIMBURSEMENTS USING THE ANNUAL MEDICARE COST REPORT (CMS FORM 2552-96). PART III, LINE 9B: MERCY'S COLLECTION POLICY PROVIDES THAT MERCY WILL PERFORM A REASONABLE COMMUNICATION AND/OR REVIEW OF PATIENT ACCOUNTS AS IT RELATES TO ANY SERVICE PROVIDED AT OUR FACILITIES BEFORE TURNING THE ACCOUNT TO BAD DEBT OR TAKING LEGAL ACTION FOR NONPAYMENT. MERCY ACTIVELY SCRUBS ACCOUNTS FOR PAYOR PLAN COVERAGE'S; INCLUDING MEDICAID. IN THE EVENT AN ACCOUNT IS TURNED TO COLLECTIONS, AND IS IDENTIFIED IN NEED OF FINANCIAL ASSISTANCE DUE TO CIRCUMSTANCE CHANGES, OR NOW REQUESTING ASSISTANCE, THE ACCOUNTS ARE RETURNED BY THE AGENCY AND CONSIDERED FOR CHARITY IF THE PATIENT PROVIDES THE REQUESTED INFORMATION. IF THE PATIENT FAILS TO RETURN THE INFORMATION, THE ACCOUNT WILL QUALIFY FOR COLLECTIONS.MERCY UTILIZES THE EXPERIAN TOOL TO ENHANCE THE ABILITY TO DETERMINE THE CHARITY QUALIFICATION PRIOR TO TURNING TO BAD DEBT, A PROCESS KNOWN AS PRESUMPTIVE CHARITY; USING HOUSEHOLD SIZE AND INCOME. MERCY WILL GRANT CHARITY IN SITUATIONS WHERE THERE HAS BEEN AN INABILITY TO OBTAIN INFORMATION FROM PATIENTS OR THE INFORMATION PROVIDED IS NOT COMPLETE ENOUGH TO MAKE A CHARITY DETERMINATION WHEN A PATIENT HAS SUBMITTED AN APPLICATION. IN ADDITION, MERCY UTILIZES THE SAME TOOL TO QUALIFY ACCOUNTS PER THE PRACTICE OF PRESUMPTIVE CHARITY PRIOR TO BAD DEBT PLACEMENT FOR BALANCES IN EXCESS OF $6500. ALL ACCOUNT BALANCES RELATING TO ACCOUNTS IDENTIFIED BY THE HIGHER BALANCES WILL BE CONSIDERED AND FLAGGED FOR CHARITY IF THERE IS AN INABILITY TO PAY AFTER A RETURN FROM THE COLLECTION AGENCY AT APPROXIMATELY 120 DAYS. MERCY WILL PURSUE APPROPRIATE MEANS IN THE COLLECTION OF DELINQUENT ACCOUNTS FROM PATIENTS WITH AN ESTABLISHED ABILITY TO PAY OR AN UNWILLINGNESS TO COOPERATE IN VALIDATING ELIGIBILITY FOR FINANCIAL ASSISTANCE. THESE APPROPRIATE MEANS MAY INCLUDE LEGAL ACTION CONSISTENT WITH MERCY MISSION AND VALUES AFTER A SENDING 3 MONTHLY STATEMENTS WITH THE FINAL INCLUDING NOTIFICATION; IF NO RESOLUTION THEY WILL BE TURNED TO COLLECTIONS. ADDITIONALLY, THEY MAY INCLUDE LIENS UPON REAL PROPERTY AND REASONABLE WAGE GARNISHMENTS. LEGAL ACTIONS WILL GENERALLY NOT INCLUDE BANK GARNISHMENTS, REPOSSESSION OF ASSETS OR FORECLOSURES TO ENSURE SATISFACTION OF A LIEN. MERCY HAS POLICIES AND PROCEDURES ESTABLISHED TO ADDRESS THE INITIATION OF LEGAL ACTION AND ANNUALLY REVIEW COMPLIANCE WITH POLICIES BUT ENSURE 120 DAYS OF BILLING AND COLLECTIONS OCCURS PRIOR TO ANY EXTRAORDINARY COLLECTIONS ARE PURSUED. PART VI, LINE 2: THE KINGFISHER COMMUNITY COLLABORATIVE CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT DURING 2014-2015 ALONG WITH A COMMUNITY HEALTH IMPROVEMENT PLAN DURING THE 4TH QUARTER 2015. THIS THROUGH ASSESSMENT IDENTIFIED CONCERNS IN THE COMMUNITY. THIS PROCESS AND FINDINGS WERE USED AS THE BASELINE DATA FOR THE CHNA FOR MERCY HOSPITAL, KINGFISHER. THE KINGFISHER COMMUNITY COLLABORATIVE IS A LOCAL HEALTH COALITION AND A CERTIFIED HEALTH IMPROVEMENT ORGANIZATION THAT MEETS QUARTERLY. THIS GROUP IS COMPOSED OF REPRESENTATIVES FROM SERVICE PROVIDERS, HEALTHCARE PROVIDERS, EDUCATION, SAFETY, FAITH BASED GROUPS, AND COMMUNITY MEMBERS WHO ALL HAVE THE SAME DESIRE TO IMPROVE THE QUALITY OF LIFE IN THE COMMUNITY. MERCY HOSPITAL, KINGFISHER IS AN ACTIVE AND ENGAGED MEMBER OF THE COALITION. A COMMUNITY MEETING FOR THE HOSPITAL'S CHNA WAS HOSTED BY THE KINGFISHER COMMUNITY COLLABORATIVE ON APRIL 11, 2016. STEPS TAKEN TO CONDUCT A CHNA FOR MERCY HOSPITAL, KINGFISHER BEGAN WITH A DESCRIPTION OF THE HOSPITAL'S MEDICAL SERVICE AREA, INCLUDING A DEMOGRAPHIC ANALYSIS AND A SUMMARY OF THE COMMUNITY MEETING. THE CHNA PROCESS IS FACILITATED BY STAFF OF THE OKLAHOMA OFFICE OF RURAL HEALTH AND MERCY HOSPITAL, KINGFISHER. COMMUNITY MEMBERS PRESENT REPRESENTED A CROSS SECTION OF THE COMMUNITY. THESE INDIVIDUALS WORK WITH DIVERSE, LOW-INCOME, AND UNDERSERVED POPULATIONS. THEY PROVIDE GREAT INSIGHT INTO THE NEEDS OF THE COMMUNITY. A SURVEY WAS DESIGNED TO GAUGE HOSPITAL USAGE, SATISFACTION, AND COMMUNITY HEALTH NEEDS FROM MARCH 1 THROUGH MARCH 25, 2016. A TOTAL OF 86 SURVEYS WERE COMPLETED. OF THOSE SURVEYS, 65 WERE ELECTRONIC RESPONSES. PART VI, LINE 3: MERCY 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 THROUGH SEVERAL MEANS. IF AT ANY TIME A PATIENT EXPRESSES HARDSHIP AND INABILITY TO PAY, THE ACCOUNTS IS PLACED FOR REVIEW. IN ADDITION, PATIENT HAVE SIGNAGE ABOUT THE POLICY AT THE ACCESS POINTS, AND ALL STAFF WORKING WITH THE PATIENT AT POINT OF SERVICE, SCHEDULING, CUSTOMER SERVICE, AND EVEN THROUGH THE MEDICAID ELIGIBILITY SCREENING, HAVE THE MEANS TO SEND THE ACCOUNT FOR REVIEW. THERE IS THE PLAIN LANGUAGE SUMMARY THAT IS BEING PROVIDED TO ALL WHOM EXPRESS HARDSHIPWHEN PRESENTING IN THE FACILITIES. IN ADDITION TO THE WEB ADDRESS PROVIDING THE APPLICATION, POLICIES, AND EVEN HOW UNINSURED ACCOUNTS ARE HANDLED. LASTLY, THE STATEMENTS (BILLING) MESSAGING TO THE PATIENT THAT MERCY DOES HAVE A FINANCIAL ASSISTANCE PROGRAM AND TO CALL TO SEE IF THEY ARE ELIGIBLE. MERCY STAFFS INTERNAL RESOURCES CERTIFIED TO ASSIST PATIENTS WITH MEDICAID APPLICATIONS AS WELL. PART VI, LINE 4: MERCY HOSPITAL KINGFISHER'S PRIMARY SERVICE AREA IS KINGFISHER COUNTY, OKLAHOMA. THE FOLLOWING INFORMATION IS DERIVED FROM 2018 IBM/WATSTON'S DEMOGRAPHICS AND FY2018 DECISION RESOURCE GROUP'S INSURANCE COVERAGE ESTIMATES. THE AREA'S POPULATION IS 17,493. 44% OF THE POPULATION'S AVERAGE HOUSEHOLD INCOME IS OVER $75,000. 41% OF THE POPULATION IS 45 AND OLDER. A PREVIOUS SURVEY INDICATED THAT 20% OF THE HOUSEHOLDS IS ON MEDICARE, 10% ON MEDICAID, AND 11% UNINSURED. PART VI, LINE 5: MERCY PROVIDES QUALITY MEDICAL HEALTH CARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY. MERCY IS A CATHOLIC HEALTH CARE CORPORATION THAT, PURSUANT TO THE ORGANIZATIONAL CORE BELIEF, THAT HEALTH CARE SERVICES ARE A VITAL AND INTEGRAL PART OF THE CHURCH'S HEALING MISSION, ENGAGES IN A MINISTRY WHICH PROVIDES GENERAL ACUTE CARE, AMBULATORY, LONG-TERM AND HOME CARE HEALTH SERVICES TO INDIVIDUALS AND FAMILIES IN ITS COMMUNITIES. MERCY OFFERS SERVICES AND PROGRAM WHICH FURTHER HEALTH PROMOTION, MAINTENANCE AND CARE TO THE COMMUNITY. PROGRAMS PROVIDED TO MEET THE COMMUNITY INCLUDE SUPPORT GROUPS, OUTREACH EVENTS, BLOOD DRIVES, AND CO-WORKER WORK DAYS.MERCY IS GOVERNED BY A BOARD OF DIRECTORS WHICH INCLUDES REPRESENTATION FROM COMMUNITY LEADERS FROM A VARIETY OF SECTORS. ALL BOARD MEMBERS ARE REQUIRED TO COMPLETE AN ANNUAL CONFLICT OF INTEREST SURVEY. ANY POTENTIAL CONFLICTS OF INTEREST DISCLOSED ARE REVIEWED AND RESOLVED. THIS PROCESS ENSURES THAT PUBLIC, RATHER THAN PRIVATE INTERESTS ARE SERVED.SURPLUS FUND AND UNRESTRICTED ASSETS HELD ARE REINVESTED IN PATIENT CARE, MEDICAL EDUCATION AND RESEARCH INITIATIVES WHICH SUPPORT THE ORGANIZATION'S MISSION TO DELIVER COMPASSIONATE CARE AND EXCEPTIONAL HEALTH CARE SERVICES TO THE COMMUNITIES IT SERVES. PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEM: THE FILING ORGANIZATION IS PART OF MERCY HEALTH ("MERCY"). MERCY IS A MISSOURI NON-PROFIT CORPORATION WITH ITS HEADQUARTERS ("MINISTRY OFFICE") IN ST. LOUIS, MISSOURI. MERCY PROVIDES HEALTH CARE SERVICES IN FOUR STATES - ARKANSAS, KANSAS, MISSOURI, AND OKLAHOMA - AND HAS OUTREACH MINISTRIES LOCATED IN LOUISIANA, MISSISSIPPI, AND TEXAS. MERCY'S MISSION IS "AS THE SISTERS OF MERCY BEFORE US, WE BRING TO LIFE THE HEALING MINISTRY OF JESUS THROUGH OUR COMPASSIONATE CARE AND EXCEPTIONAL SERVICE." AS OF JUNE 30, 2018, MERCY FACILITIES INCLUDED 30 ACUTE CARE HOSPITALS, 5 MANAGED HOSPITALS, 4 HEART HOSPITALS, 2 CHILDREN'S HOSPITALS, 2 ORTHOPEDIC HOSPITALS AND 3 REHAB HOSPITALS. FOR THE FISCAL YEAR ENDED JUNE 30, 2018, MERCY HAD MORE THAN 10.3 MILLION OUTPATIENT AND PHYSICIAN OFFICE VISITS, APPROXIMATELY 2,400 EMPLOYED PHYSICIANS, AND APPROXIMATELY 45,000 FULL-TIME EQUIVALENT EMPLOYEES. BASED ON NPSR, MERCY IS THE SIXTH LARGEST CATHOLIC HEALTH SYSTEM IN THE UNITED STATES. MERCY IS SPONSORED BY MERCY HEALTH MINISTRY, WHICH IS GOVERNED BY MEMBERS THAT INCLUDE SISTERS OF MERCY. MANY SERVICES THAT ARE ESSENTIAL TO FULFILLING MERCY'S MISSION ARE CENTRALIZED AT THE MINISTRY OFFICE. SUCH CENTRALIZED SERVICES INCLUDE: FINANCE (INCLUDING TREASURY, FINANCIAL ACCOUNTING AND REPORTING, REVENUE MANAGEMENT, INTERNAL AUDIT, ACCOUNTS PAYABLE AND PAYROLL OPERATIONS, ANALYTICS AND DECISION SUPPORT); ENVIRONMENTAL SERVICES SUPPORT; CLINICAL INTEGRATION; CARE MANAGEMENT; CLINICAL PERFORMANCE ACCELERATION; CLINICAL ENGINEERING; CLINICAL QUALITY MANAGEMENT; COMPLIANCE; GRANTS AND RESEARCH SERVICES; LEGAL AND COMPLIANCE COUNSEL; MARKETING AND COMMUNICATIONS; PLANNING, DESIGN AND CONSTRUCTION; PRODUCT DEVELOPMENT INFORMATICS; REAL ESTATE; SUPPLY CHAIN MANAGEMENT; MANAGED CARE STRATEGY SUPPORT; HUMAN RESOURCES (INCLUDING COMPENSATION, BENEFITS AND RECRUITING); MISSION SERVICES AND ETHICS; PHILANTHROPY SUPPORT; INFORMATION TECHNOLOGY; AND, COMMUNITY RELATIONS. THE CENTRALIZATION OF SUCH SUPPORT SERVICES ENABLES MERCY TO ENSURE THAT EACH OF ITS COMMUNITIES, WHETHER LARGE OR SMALL, HAS THE SERVICES IT NEEDS. 1 MERCY HEALTH FOUNDATION OF OKLAHOMA 4300 W MEMORIAL RD OKLAHOMA CITY OK 73120 454732301 501(C)(3) 8106 FMV GENERAL SUPPORT COMPASSION HEALTH CLINIC 1304 S 13TH KINGFISHER OK 73750 501(C)(3) 155246 FMV GENERAL SUPPORT 2 0 PART I, LINE 2: THE ORGANIZATION USES AN APPROVAL PROCESS TO DETERMINE WHICH ORGANIZATIONS WILL RECEIVE GRANTS DURING THE FISCAL YEAR. THE FUNDS ARE THEN GIVEN DIRECTLY TO THE NONPROFIT ORGANIZATION. 0 1 0 0 0 0 0 0 0 DIXSON MD JAMES D PHYSICIAN & BOARD MEMBER 0 277072 0 128432 0 44793 0 48108 0 11519 0 509924 0 38882 PINAROC LYNN VP-FINANCE & BOARD MEMBER 0 153760 0 26414 0 33058 0 9481 0 5894 0 228607 0 0 ENLOE TRACY CHIEF FINANCIAL OFFICER & BM 0 231276 0 54905 0 18381 0 22812 0 15457 0 342831 0 0 SMALLEY DIANA L PRESIDENT, WEST COMMUNITIES 0 584751 0 641552 0 86026 0 6968 0 14487 0 1333784 0 318363 GEBHART JIM R PRESIDENT, MERCY HOSPITAL OKC 0 457989 0 264738 0 25205 0 78239 0 11371 0 837542 0 0 LE BICH-VI REGIONAL VP-GENERAL COUNSEL 0 224149 0 67743 0 27696 0 42274 0 15745 0 377607 0 0 TYSZKO SARAH L PHYSICIAN ASSISTANT 165100 0 3135 0 7427 0 0 0 15288 0 190950 0 0 0 RAJU GARY FORMER OFFICER 0 282885 0 84973 0 55335 0 27365 0 13114 0 463672 0 0 VITIELLO JONATHAN FORMER OFFICER 0 511534 0 303796 0 41723 0 92348 0 16505 0 965906 0 0 PART I, LINE 1A CHARTER TRAVEL IS PROVIDED TO CERTAIN EMPLOYEES AS AND WHEN APPROPRIATE, AND AS DEEMED NECESSARY FOR BUSINESS TRAVEL. AFTER CHARTER TRAVEL APPROVAL HAS BEEN GRANTED IN ACCORDANCE WITH THE FINANCIAL JUSTIFICATION PROCESS, THE APPROVED CHARTER TRAVEL FOR BUSINESS IS A REIMBURSABLE EXPENSE WHICH IS NOT TAXABLE TO THE EMPLOYEES. IN ANY CIRCUMSTANCE IN WHICH CHARTER TRAVEL IS MADE AVAILABLE TO EMPLOYEES AND/OR SPOUSES/GUESTS FOR PERSONAL REASONS, MERCY POLICY REQUIRES TRACKING OF SUCH USE AND TAXATION OF THE EMPLOYEE(S) ACCORDINGLY. HOUSING BENEFITS ARE PROVIDED THROUGH A RELOCATION PROGRAM IN ACCORDANCE WITH COMPANY POLICY. SUCH BENEFITS ARE SUBJECT TO TAX TO AN EMPLOYEE OF A RELATED ORGANIZATION, GARY RAJU. PAYMENT BY THE COMPANY OF COSTS FOR TEMPORARY HOUSING BY EMPLOYEES FOR THE CONVENIENCE OF THE COMPANY IS MADE IN ACCORDANCE WITH THE CO-WORKER TRAVEL AND OTHER EXPENSE POLICY AND PROCEDURES. AS A REIMBURSABLE EXPENSE, THIS TYPE OF LODGING IS NOT TAXABLE TO THE EMPLOYEE. PART I, LINE 4B PART I, LINE 4B: MERCY HEALTH, THE ULTIMATE PARENT COMPANY, OFFERS A SUPPLEMENTAL RETIREMENT PLAN TO CERTAIN EXECUTIVES WHICH PROVIDE BENEFITS UPON VESTING DATE BASED ON COMPENSATION, AGE AT THE TIME OF BENEFIT COMMENCEMENT, LENGTH OF SERVICE WITH THE COMPANY AND/OR ITS AFFILIATES, AND LENGTH OF TENURE IN THE PLAN. THE FOLLOWING INDIVIDUALS PARTICIPATED IN THE PLAN. DIANA SMALLEY; JAMES DIXSON; JONATHAN VITIELLO; BICH-VI LE; JIM GEBHART; TRACY ENLOE THE AMOUNT OF ALL ACCRUED BENEFITS IS INCLUDED IN COMPENSATION AMOUNTS PROVIDED IN SCHEDULE J, PART II, COLUMN (C). DIANA SMALLEY AND JAMES DIXSON RECEIVED PAYMENTS FROM RETIREMENT PLAN(S) DURING THE YEAR FROM A RELATED ORGANIZATION. THE AMOUNT REPORTED FOR DIANA SMALLEY AND JAMES DIXSON IN COLUMN (F) IS INCLUDED IN COLUMN B (I) AS BASE COMPENSATION. THIS PAYOUT WAS INCLUDED IN COLUMN (C) OF PREVIOUSLY FILED FORMS 990. PART I, LINE 3 MERCY HEALTH (PARENT COMPANY) IS RESPONSIBLE FOR ESTABLISHING THE COMPENSATION OF THE ORGANIZATION'S CEO/EXECUTIVE DIRECTOR. THE FOLLOWING METHODS WERE USED BY MERCY HEALTH TO ESTABLISH COMPENSATION: -INDEPENDENT COMPENSATION CONSULTANT -COMPENSATION SURVEY OR STUDY -APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE KAYLA VOTH FAMILY MEMBER OF BOARD MEMBER (JOE VOTH) 64992 EMPLOYMENT 0 CARMEN MCALEXANDER FAMILY MEMBER OF BOARD MEMBER (BRENDA WALTA) 59763 EMPLOYMENT 0 FORM 990, PART VI, SECTION A, LINE 6 MERCY HEALTH OKLAHOMA COMMUNITIES IS THE SOLE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A MERCY HEALTH OKLAHOMA COMMUNITIES (THE MEMBER) MAY APPOINT OR REMOVE MEMBERS OF THE BOARD OF DIRECTORS AT ANY TIME AT THE MEMBER'S DISCRETION. FORM 990, PART VI, SECTION A, LINE 7B MERCY HEALTH OKLAHOMA COMMUNITIES HAS THE FOLLOWING POWERS AND RESPONSIBILITIES: -TO APPROVE AND ESTABLISH THE MISSION AND PHILOSOPHY ACCORDING TO WHICH THE CORPORATION AND ALL ORGANIZATIONS CONTROLLED BY THE CORPORATION SHALL OPERATE; -TO ADOPT OR AMEND THE ARTICLES OF INCORPORATION AND BYLAWS OF THE CORPORATION AND TO AMEND THE ORGANIZATIONAL DOCUMENTS OF ANY ORGANIZATION CONTROLLED BY THE CORPORATION; -TO APPOINT OR REMOVE, WITH OR WITHOUT CAUSE, ANY MEMBER OF THE BOARD OF DIRECTORS OF THE CORPORATION; -TO APPOINT OR REMOVE, WITH OR WITHOUT CAUSE, THE PRESIDENT/CEO OF THE CORPORATION OR ANY ORGANIZATION CONTROLLED BY THE CORPORATION AFTER CONSULTATION WITH THE SYSTEM; -TO APPROVE OR AMEND THE OVERALL STRATEGIC, LONG RANGE, BUSINESS PLANS, GOALS, AND OBJECTIVES OF THE CORPORATION OR ANY ORGANIZATION CONTROLLED BY THE CORPORATION; -TO APPROVE OR AMEND THE CONSOLIDATED OPERATING, CAPITAL AND CONSTRUCTION BUDGETS FOR THE CORPORATION OR ANY ORGANIZATION CONTROLLED BY THE CORPORATION AND CHANGES IN BUDGETS IN EXCESS OF AN AMOUNT ESTABLISHED FROM TIME TO TIME BY MERCY; -TO AUTHORIZE AND APPROVE THE LEASE OR SALE OF ANY OF THE ASSETS OF THE CORPORATION OR ANY ORGANIZATION CONTROLLED BY THE CORPORATION IN EXCESS OF ANY AMOUNT ESTABLISHED FROM TIME TO TIME BY MERCY; -TO AUTHORIZE AND APPROVE THE INCURRENCE OF DEBT BY THE CORPORATION OR ANY ORGANIZATION CONTROLLED BY THE CORPORATION (OTHER THAN DEBT INCURRED FOR THE ACQUISITION OF GOODS IN THE ORDINARY COURSE OF BUSINESS) AND TO GRANT ANY SECURITY INTERESTS, PLACE ANY ENCUMBRANCES, ENTER INTO ANY COVENANTS, AND EXECUTE ANY DOCUMENTS AND TAKE ANY ACTIONS NECESSARY OR APPROPRIATE IN CONNECTION WITH THE INCURRENCE OF SUCH DEBT; AND -TO MERGE, DISSOLVE, OR ABANDON THE CORPORATION OR ANY ORGANIZATION CONTROLLED BY THE CORPORATION, SUBJECT TO APPROVAL BY THE BOARD AS REQUIRED PURSUANT TO THE OKLAHOMA NONPROFIT CORPORATION ACT. -TO APPROVE THE CREATION, OWNERSHIP OR ACQUISITION OF, OR AFFILIATION WITH, ANY OTHER ORGANIZATION CONTROLLED BY THE CORPORATION; AND, -TO APPROVE CONTRACTS IN WHICH THE CORPORATION ASSUMES FINANCIAL RISK, INCLUDING BUT NOT LIMITED TO MANAGED CARE CONTRACTS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM, USING INFORMATION PROVIDED BY THE FILING ORGANIZATION. A DRAFT FORM 990 IS REVIEWED BY THE FILING ORGANIZATION'S FINANCE TEAM. THE DRAFT FORM 990 IS ALSO REVIEWED BY MERCY HEALTH'S TAX DEPARTMENT, TO ENSURE ACCURACY AND CONSISTENCY WITH OTHER RELATED ORGANIZATIONS' FORM 990S. AFTER QUESTIONS ARISING FROM THE VARIOUS REVIEWS ARE ADDRESSED AND INCORPORATED INTO THE FORM 990, A REVISED DRAFT IS PROVIDED TO THE FILING ORGANIZATION'S LEADERSHIP TEAM, INCLUDING THE CFO AND CEO, FOR REVIEW. ONCE REVIEWED AND APPROVED BY THE FILING ORGANIZATION'S LEADERSHIP TEAM, THE FORM 990 IS THEN SIGNED AND FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C OFFICERS, DIRECTORS, KEY EMPLOYEES AND OTHER DISQUALIFIED PERSONS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE ANNUALLY AND DID SO IN THE NORMAL COURSE FOR THE YEAR ENDED JUNE 30, 2018. THIS PROCESS IS ADMINISTERED AT THE MERCY HEALTH LEVEL BY MERCY'S CORPORATE COMPLIANCE DEPARTMENT. THE QUESTIONNAIRES ARE REVIEWED WITH LEADERSHIP AT THE LOCAL LEVEL AND POTENTIAL CONFLICTS DISCUSSED AND RESOLVED. THE CONFLICTS AND THEIR RESPECTIVE RESOLUTIONS ARE SHARED AT THE MERCY LEVEL WITH A TEAM INCLUDING MERCY'S CHIEF FINANCIAL OFFICER, CHIEF COMPLIANCE OFFICER AND OTHER MEMBERS OF FINANCE, LEGAL AND HR. SUMMARY RESULTS ARE REVIEWED WITH MERCY'S STEWARDSHIP COMMITTEE OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15B FOR THOSE CLASSIFIED AS OFFICERS (AND THUS DISQUALIFIED PERSONS), THE ORGANIZATION USES THE FOLLOWING TO ESTABLISH COMPENSATION: EXTERNAL MARKET SALARY SURVEYS, EXTERNAL MARKET SALARY STUDIES, ENGAGEMENT OF AN INDEPENDENT COMPENSATION CONSULTANT, AND REVIEW/APPROVAL OF COMPENSATION BY THE COMPENSATION COMMITTEE OF THE BOARD OF MERCY HEALTH. FOR THOSE CLASSIFIED AS KEY EMPLOYEES, THE ORGANIZATION USES THE FOLLOWING TO ESTABLISH THE COMPENSATION: EXTERNAL MARKET SALARY SURVEYS, EXTERNAL MARKET SALARY STUDIES, AND REVIEW/APPROVAL OF EXECUTIVE MANAGEMENT. COMPENSATION REVIEWS ARE COMPLETED ON AN ANNUAL BASIS, AND A REVIEW WAS COMPLETED DURING THE REPORTING YEAR. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE FROM TIME TO TIME BUT ARE NOT PUBLISHED PUBLICLY. FORM 990, PART VII, SECTION A, COLUMN B AVERAGE HOURS PER WEEK THE HOURS PER WEEK DISCLOSED IN PART VII IS THE AVERAGE HOURS THE LISTED PERSON WORKED OR DEVOTED PER WEEK WHILE EMPLOYED OR ASSOCIATED WITH THE FILING ORGANIZATION AND RELATED ORGANIZATIONS (IF APPLICABLE). FORM 990, PART XI, LINE 9: NET TRANSFERS TO/FROM AFFILIATES -1,251,056. CONTRIBUTION ADJUSTMENT 316. PART XII, LINE 2 AUDITED FINANCIAL STATEMENTS THE FILING ORGANIZATION'S FINANCIAL STATEMENTS WERE INCLUDED IN THE MERCY HEALTH AND SUBSIDIARIES ANNUAL FINANCIAL STATEMENT AUDIT. MERCY HEALTH AND SUBSIDIARIES RECEIVED AN UNQUALIFIED OPINION FROM THE EXTERNAL AUDITORS FOR FISCAL 2018 (THE TAX YEAR CURRENTLY BEING REPORTED). HOWEVER, NO SEPARATE AUDIT OPINION IS ISSUED ON THE FINANCIAL STATEMENTS OF THE FILING ORGANIZATION. THE ULTIMATE RESPONSIBILITY FOR OVERSIGHT OF THE FINANCIAL STATEMENT AUDIT AND SELECTION OF THE EXTERNAL AUDITOR LIES WITH THE STEWARDSHIP COMMITTEE OF THE MERCY HEALTH BOARD OF DIRECTORS. AUDIT RESULTS ARE COMMUNICATED TO THIS COMMITTEE. PART XII, LINE 3 SINGLE AUDIT ACT AND OMB CIRCULAR A-133 MERCY HEALTH UNDERGOES A CONSOLIDATED A-133 AUDIT EVERY YEAR AND DID SO FOR THE FISCAL YEAR ENDING JUNE 30, 2018. EACH ENTITY THAT RECEIVES FEDERAL FUNDS DURING THE YEAR IS INCLUDED ON THE SCHEDULE OF EXPENDITURES OF FEDERAL AWARDS (SEFA) AND IS ALSO INCLUDED IN THE POPULATION AVAILABLE FOR AUDIT. THE FILING ENTITY RECEIVED FEDERAL FUNDS DURING THE YEAR ENDED JUNE 30, 2018, WAS INCLUDED ON THE MERCY HEALTH CONSOLIDATED SEFA, AND THEREFORE, WAS ALSO INCLUDED IN THE POPULATION AVAILABLE FOR AUDIT. FORM 990, PART V, LINE 2A W-3 FILING SALARIES AND WAGES WITH LIMITED EXCEPTIONS, THE SALARIES AND WAGES REPORTED ON FORM 990, PART IX, LINE 7 REPRESENT AN ALLOCATION OF SALARIES AND WAGES FROM A RELATED ORGANIZATION. MOST EMPLOYEES ARE PAID BY A RELATED ORGANIZATION UNDER A COMMON PAYMASTER ARRANGEMENT. AS SUCH, ALL REQUIRED PAYROLL FILING FOR THESE EMPLOYEES (INCLUDING W-2 AND W-3'S) IS REPORTED UNDER THE RELATED ORGANIZATION, MHM SUPPORT SERVICES,EIN 20-2553101. FORM 990, SCHEDULE R, PART II MERCY HOSPITALS EAST COMMUNITIES MERCY HOSPITALS EAST COMMUNITIES CONSISTS OF MERCY HOSPITALS EAST COMMUNITIES ST. LOUIS, EIN 43-0653493, AND MERCY HOSPITALS EAST COMMUNITIES WASHINGTON, EIN 43-1066883. FORM 990, SCHEDULE R, PART V SYSTEM LIMITATIONS LAWSON ERP SOFTWARE IS THE PRIMARY ACCOUNTING SOFTWARE USED BY MERCY HEALTH SYSTEM, INC. AND SUBSIDIARIES. THE MAJORITY OF THE INTERCOMPANY/RELATED ORGANIZATION TRANSACTIONS ARE PROCESSED THROUGH LAWSON VIA INTERCOMPANY JOURNAL ENTRIES. WITH THE CURRENT DESIGN OF THE ERP SYSTEM, THERE ARE VARIOUS LIMITATIONS ON THE RELATED ORGANIZATION INFORMATION THAT CAN BE EXTRACTED FROM LAWSON. DUE TO THESE LIMITATIONS,MOST OF THE RELATED ORGANIZATION ACTIVITY FOR THE FILING ORGANIZATION HAS BEEN CLASSIFIED ON SCHEDULE R, PART V, IN LINES B AND C. FORM 990, PART V, LINE 1A INDEPENDENT CONTRACTORS INDEPENDENT CONTRACTORS FOR THE FILING ORGANIZATION ARE PAID BY MERCY HEALTH (EIN 43-1423050). AS SUCH, ALL REQUIRED FORM 1099 AND FORM 1096 REPORTING IS MADE FOR THE ENTIRE HEALTH SYSTEM (WITH LIMITED EXCEPTIONS) UNDER THE MERCY HEALTH EIN. CASA DE MISERICORDIA 1602 MCCLELLAND STREET LAREDO TX 78044 742912461 WOMEN'S DOMESTIC VIOLENCE SHELTER TX 501C3 7 MERCY MINISTRIES OF LAREDO 1 MCAULEY PORTFOLIO MGMT CO 14528 S OUTER FORTY ST 100 CHESTERFIELD MO 63017 261708048 PORTFOLIO MANAGEMENT MO 501C3 11-II MERCY HEALTH 1 MERCY ACO CLINICAL SERVICES INC 14528 S OUTER FORTY ST 100 CHESTERFIELD MO 63017 464504901 VIRTUAL CARE CENTER MO 501C3 3 MERCY HEALTH 1 MERCY CLINIC EAST COMMUNITIES 645 MARYVILLE CTR DR STE 100 ST LOUIS MO 63141 431771217 PHYSICIAN GROUP MO 501C3 9 MERCY HEALTH EAST COMMUNITIES 1 MERCY CLINIC FORT SMITH COMM 7301 ROGERS AVENUE FORT SMITH AR 72917 261318597 PHYSICIAN CLINIC AR 501C3 9 MERCY HEALTH FORT SMITH COMM 1 MERCY CLINIC OKLAHOMA COMM 4300 W MEMORIAL ROAD OKLAHOMA CITY OK 73120 270473057 PHYSICIAN GROUP OK 501C3 3 MERCY HEALTH OK COMMUNITIES 1 MERCY CLINIC SPRINGFIELD COMM 1965 FREMONT STREET SUITE 2950 SPRINGFIELD MO 65804 431560263 PHYSICIAN GROUP MO 501C3 3 MERCY HEALTH SPRINGFIELD COMM 1 MERCY FAMILY CENTER 14528 S OUTER FORTY ST 100 CHESTERFIELD MO 63017 721069468 FAMILY COUNSELING SERVICES MO 501C3 7 MERCY HEALTH 1 MERCY HEALTH 14528 S OUTER FORTY ST 100 CHESTERFIELD MO 63017 431423050 CORPORATE OFFICE MO 501C3 1 N/A 0 MERCY HEALTH EAST COMMUNITIES 645 MARYVILLE CTR DR STE 100 ST LOUIS MO 63141 431718408 HEALTH SYSTEM MO 501C3 11-II MERCY HEALTH 1 MERCY HEALTH EAST COMMUNITIES - SR 645 MARYVILLE CTR DR STE 100 ST LOUIS MO 63141 461412322 HEALTH SYSTEM MO 501C3 11-II MERCY HEALTH EAST COMMUNITIES 1 MERCY HEALTH FORT SMITH COMM 7301 ROGERS AVENUE FORT SMITH AR 72917 261318515 HOLDING COMPANY AR 501C3 11-II MERCY HEALTH 1 MERCY HEALTH FOUNDATION 14528 S OUTER FORTY ST 100 CHESTERFIELD MO 63017 200901499 FOUNDATION MO 501C3 11-II MERCY HEALTH 1 MERCY HEALTH FOUNDATION ADA 430 N MONTE VISTA STREET ADA OK 74820 463596274 FOUNDATION OK 501C3 11-I MERCY HOSPITAL ADA 1 MERCY HEALTH FOUNDATION ARDMORE 1011 14TH AVENUE NW ARDMORE OK 73401 710962525 FOUNDATION OK 501C3 11-I MERCY HOSPITAL ARDMORE 1 MERCY HEALTH FOUNDATION BERRYVILLE 214 CARTER STREET BERRYVILLE AR 72616 710759301 FOUNDATION AR 501C3 11-I MERCY HOSPITAL BERRYVILLE 1 MERCY HEALTH FOUNDATION FT SCOTT 401 WOODLAND HILLS BLVD FORT SCOTT KS 66701 481077073 FOUNDATION KS 501C3 11-III MERCY KANSAS COMMUNITIES INC 1 MERCY HEALTH FOUNDATION FORT SMITH 7301 ROGERS AVENUE FORT SMITH AR 72917 237330425 FOUNDATION AR 501C3 7 MERCY HOSPITAL FORT SMITH 1 MERCY HEALTH FOUNDATION HOT SPRINGS 300 WERNER STREET HOT SPRINGS AR 71913 710804718 FOUNDATION AR 501C3 11-II MISSION CLINICAL SERVICES 1 MERCY HEALTH FOUNDATION INDEPENDENCE 800 W MYRTLE INDEPENDENCE KS 67301 481079981 FOUNDATION; DISSOLVED 6/30/17 KS 501C3 11-I MERCY KANSAS COMMUNITIES INC 1 MERCY HEALTH FOUNDATION JEFFERSON 1400 US HIGHWAY 61 SOUTH FESTUS MO 63028 462797051 FOUNDATION MO 501C3 11-II MERCY HEALTH EAST COMMUNITIES - SR 1 MERCY HEALTH FOUNDATION JOPLIN 100 MERCY WAY JOPLIN MO 64804 270906136 FOUNDATION MO 501C3 11-I MERCY HEALTH SW MOKS COMM 1 MERCY HEALTH FOUNDATION LINCOLN 1000 EAST CHERRY STREET TROY MO 63379 811477159 FOUNDATION MO 501C3 11-II MERCY HEALTH EAST COMMUNITIES 1 MERCY HEALTH FOUNDATION NW ARK 2710 RIFE MEDICAL LN ROGERS AR 72858 710601687 FOUNDATION AR 501C3 11-III MERCY HOSPITAL ROGERS 1 MERCY HEALTH FOUNDATION OF OK 4300 W MEMORIAL ROAD OKLAHOMA CITY OK 73120 454732301 FOUNDATION OK 501C3 11-I MERCY HEALTH OK COMMUNITIES 1 MERCY HEALTH FOUNDATION OK CITY 4300 W MEMORIAL ROAD OKLAHOMA CITY OK 73120 463184231 FOUNDATION OK 501C3 11-I MERCY HEALTH OK COMMUNITIES 1 MERCY HEALTH FOUNDATION SPRINGFIELD 1235 E CHEROKEE STREET SPRINGFIELD MO 65804 320195818 FOUNDATION MO 501C3 11-II MERCY HEALTH SPRINGFIELD COMM 1 MERCY HEALTH FOUNDATION ST FRANCIS 100 W HIGHWAY 60 MOUNTAIN VIEW MO 65548 431873914 FOUNDATION MO 501C3 11-I MERCY ST FRANCIS HOSPITAL 1 MERCY HEALTH FOUNDATION STL 615 SOUTH NEW BALLAS ROAD ST LOUIS MO 63141 562410020 FOUNDATION MO 501C3 11-II MERCY HEALTH EAST COMMUNITIES 1 MERCY HEALTH FOUNDATION WASHINGTON 901 E FIFTH STREET WASHINGTON MO 63090 562410022 FOUNDATION MO 501C3 11-II MERCY HEALTH EAST COMMUNITIES 1 MERCY HEALTH NW ARK COMMUNITIES 2710 RIFE MEDICAL LN ROGERS AR 72758 621684203 PHYSICIAN GROUP AR 501C3 11-II MERCY HEALTH 1 MERCY HEALTH OK COMMUNITIES 4300 W MEMORIAL ROAD OKLAHOMA CITY OK 73120 731453048 HEALTH SYSTEM OK 501C3 11-II MERCY HEALTH 1 MERCY HEALTH PLANS OF MISSOURIINC 3265 S NATIONAL AVENUE SPRINGFIELD MO 65807 320481419 HMO MO 501C4 MERCY HEALTH 1 MERCY HEALTH PLANSINC 3265 S NATIONAL AVENUE SPRINGFIELD MO 65807 320486150 PPO MO 501C4 MERCY HEALTH PLANS OF MISSOURIINC 1 MERCY HEALTH SW MOKS COMM 100 MERCY WAY JOPLIN MO 64804 300584463 HEALTH SYSTEM MO 501C3 11-II MERCY HEALTH 1 MERCY HEALTH SPRINGFIELD COMM 1235 E CHEROKEE STREET SPRINGFIELD MO 65804 431856028 HEALTH SYSTEM MO 501C3 11-II MERCY HEALTH 1 MERCY HOME HEALTH BERRYVILLE 804 W FREEMAN SUITE 4 BERRYVILLE AR 72616 870781247 HOME HEALTH AND HOSPICE OPERATIONS AR 501C3 11-III MERCY HOSPITAL SPRINGFIELD 1 MERCY HOSPITAL ADA INC 430 N MONTE VISTA STREET ADA OK 74820 462288155 HOSPITAL OK 501C3 3 MERCY HEALTH OK COMMUNITIES 1 MERCY HOSPITAL ARDMORE 1011 14TH AVENUE NW ARDMORE OK 73401 731500629 HOSPITAL OK 501C3 3 MERCY HEALTH OK COMMUNITIES 1 MERCY HOSPITAL AURORA 500 PORTER AVENUE AURORA MO 65605 431936696 HOSPITAL MO 501C3 3 MERCY HEALTH SPRINGFIELD COMM 1 MERCY HOSPITAL BERRYVILLE 214 CARTER STREET BERRYVILLE AR 72616 710759299 HOSPITAL AR 501C3 3 MERCY HEALTH SPRINGFIELD COMM 1 MERCY HOSPITAL BOONEVILLE 880 WEST MAIN STREET BOONEVILLE AR 72927 463851119 HOSPITAL AR 501C3 3 MERCY HOSPITAL FORT SMITH 1 MERCY HOSPITAL CARTHAGE 3125 DR RUSSELL SMITH WAY CARTHAGE MO 64836 453808607 HOSPITAL MO 501C3 3 MERCY HEALTH SW MOKS COMM 1 MERCY HOSPITAL CASSVILLE 94 MAIN STREET CASSVILLE MO 65625 431936699 HOSPITAL MO 501C3 3 MERCY HEALTH SPRINGFIELD COMM 1 MERCY HOSPITAL COLUMBUS 220 PENNSYLVANIA AVENUE COLUMBUS KS 66725 270842031 HOSPITAL MO 501C3 3 MERCY HEALTH SW MOKS COMM 1 MERCY HOSPITAL EL RENO 2115 PARKVIEW DRIVE EL RENO OK 73036 272716065 HOSPITAL OK 501C3 3 MERCY HOSPITAL OKLAHOMA CITY 1 MERCY HOSPITAL FORT SMITH 7301 ROGERS AVENUE FORT SMITH AR 72917 710240352 HOSPITAL AR 501C3 3 MERCY HEALTH FORT SMITH COMM 1 MERCY HOSPITAL HEALDTON INC 3462 HOSPITAL RD HEALDTON OK 73438 263173902 HOSPITAL OK 501C3 3 MERCY HOSPITAL ARDMORE INC 1 MERCY HOSPITAL JEFFERSON 1400 HIGHWAY 61 SOUTH FESTUS MO 63028 430687077 HOSPITAL MO 501C3 3 MERCY HEALTH EAST COMMUNITIES - 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