2015-05-12T15:37:17-05:00 2014-06-30 135565207 KPMG LLP 1212 North 96th Street Suite 300 Omaha NE 68114 990 2013-07-01 440605373 The Children's Mercy Hospital CHIL 8162343000 2401 Gillham Road Kansas City MO 64108 Sandra AJ Lawrence Executive VP & CFO 8162343000 2015-05-12 1 Donald Neal Jr P00798244 4023481450 2013 2016-03-07 17:11:31Z Sandra AJ Lawrence 2401 Gillham Road Kansas City MO 64108 1057908303 0 X www.childrensmercy.org X 1901 MO Excellence in healthcare for children 13 9 7342 685 1008031 121035 28899955 25724237 918674257 1002116827 12188779 17499723 12193876 12030516 971956867 1057371303 14245097 17371584 0 0 535022809 578436336 0 0 2490896 360510111 394700729 909778017 990508649 62178850 66862654 1166481377 1291671043 380227445 413064742 786253932 878606301 X To improve the health and well being of children by providing comprehensive, family-centered health care and committing to the highest level of clinical and psychosocial care, and to research, academic and service excellence. 1 0 812551911 17371584 1002116827 All expenses for program services relate to providing healthcare. There were a total of 354 licensed beds and 82,688 patient days during the year from 13,649 admissions. Interim stays totaled 9,142 and outpatient encounters were 682,666 from 205,876 individual patients. There were a total of 18,353 surgical procedures which includes 3,873 inpatient and 14,480 outpatient procedures. Diagnositc procedures, tests and treatments totaled 1,309,233 and outpatient prescriptions totaled 135,697. Children's Mercy critical care transports totaled 4,986 in fiscal year 2014.The Children's Mercy Hospital (the Hospital) consists of a 301-bed teaching hospital for children located in Kansas City, Missouri, and a 53-bed hospital for children located in Overland Park, Kansas. The Children's Mercy Hospital provides the highest level of medical care, technology, services, equipment, and facilities promoting the health and well-being of children in the region, from birth through adolescence. Patients and their families are treated with compassion in a family-centered environment that recognizes their physical, emotional, financial, social, and spiritual needs. The comprehensive healthcare environment provided by the Hospital includes clinical services, research, and teaching efforts, which are designed to serve today's and tomorrow's children, and the community in which they live.The Hospital's services are available to all regardless of ability to pay. 812551911 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 1 0 0 0 1 0 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 0 0 1 X 686 0 0 7342 1 1 1 0 0 0 0 1 1 0 0 0 0 X 13 9 0 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 X Sandra AJ Lawrence EVP & CFO 8162343000 2401 Gillham Road Kansas City MO 64108 John Ovel Chairman 1.00 X X 0 0 0 Charlie Schellhorn Vice Chairman/Treasurer 1.00 X X 0 0 0 Debbie Sosland-Edelman Secretary 1.00 X X 0 0 0 Elizabeth Braham Director 1.00 X 0 0 0 Dr Carolyn Davis Director 1.00 X 0 0 0 Paul McLaughlin Director 1.00 X 0 0 0 Margi Pence Director 1.00 X 0 0 0 Jonathan Baum Director 1.00 X 0 0 0 David Goebel Director 1.00 X 0 0 0 Tom Weir Director 1.00 X 0 0 0 John Sommerauer Director 1.00 X 0 0 0 Gerald Woods MD Director 40.00 X 317207 0 30468 Randall L O'Donnell PhD Director; President & CEO 40.00 X X 4540496 0 353535 Charles Roberts MD EVP & Exec.Medical Director 40.00 X 667085 0 21666 Sandra AJ Lawrence Executive VP & CFO 40.00 X 668386 0 30468 Karen S Cox RN PhD FAAN Executive VP & Co-COO 40.00 X 550123 0 25848 Jo Stueve Executive VP & Co-COO 40.00 X 535052 0 25848 Michael Artman Chairman- Dept of Pediatrics 40.00 X 515276 0 25930 James O'Brien Jr MD Physician 40.00 X 1096111 0 30468 Walter S Andrews MD Physician 40.00 X 740256 0 30468 Shawn David St Peter MD Physician 40.00 X 740210 0 30468 Charles Snyder MD Physician 40.00 X 739970 0 30468 George Whit Holcomb MD Physician 40.00 X 739084 0 30468 11849256 0 666103 1373 0 1 0 Anesthesia Associates 8717 West 110th Street Overland Park KS 66210 Anesthesiologists 24194992 Sodexho Marriott Services Inc 4880 Paysphere Circle Chicago IL 80674 Food Services 7467696 Lytle Construction Inc 1100 SW Hamblen Rd Lees Summit MO 64081 Construction 4678626 JE Dunn Construction Company 1101 Locust Street Kansas City MO 64106 Construction 3549800 University Physician Associate 2310 Holmes Street Kansas City MO 64108 Physicians 3398744 386 897771 1943196 7767386 9909465 5206419 812128 25724237 Net Patient Services 621110 1002116827 1002116827 1002116827 17493348 17493348 7000 625 6375 6375 6375 398662 1943196 536375 -137713 -137713 Cafeteria 722210 4428544 4428544 Transport 621910 1528439 1528439 UMKC Contract for Residents 611310 789326 789326 5421920 4413889 1008031 12168229 1057371303 1013283400 1008031 17355635 349931 349931 17021653 17021653 8236996 4899122 3337874 465377573 405366328 58301022 1710223 22468544 19463226 2924184 81134 51083310 44250575 6648273 184462 31269913 27087353 4069644 112916 1748393 1748393 352348 352348 84970505 56717103 28252730 672 4473137 898854 3504473 69810 14608042 5745935 8823798 38309 6078636 4735034 1330595 13007 13667207 13667207 52943546 28745902 24078257 119387 16307856 4496323 11811533 Medical Supplies 102911988 98032799 4777557 101632 State Medicaid Taxes 39029090 39029090 Bad Debt 26993070 26993070 Food Services 5117838 4834780 276333 6725 25499073 10217626 15228828 52619 990508649 812551911 175465842 2490896 165207961 136890547 50732367 25046295 7287792 5559033 138278603 154079066 8091799 8907139 9944058 10576338 949249538 461363325 476400494 487886213 223352150 368202828 24506454 19889908 62679699 74633676 1166481377 1291671043 112806750 136567159 197767869 194030088 69652826 82467495 380227445 413064742 X 725844083 812371001 60409849 66235300 786253932 878606301 1166481377 1291671043 X 66862654 19278271 6211444 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 615259 615259 811936652 812551911 1000000 250000 0 0 1000000 1000000 1000000 1000000 4000000 6000000 405207 467864 431136 615259 1919466 250000 250000 250000 250000 1000000 1500000 41996791 1926665 5685649 1590688 48018417 38607709 961835 4052039 1624792 41996791 41124198 755549 -1440270 1831768 38607709 35713462 695711 6607520 1892495 41124198 33889964 317605 3237589 1731696 35713462 0.99350 0.00650 0 1 1 18548699 18548699 530478964 179413507 351065457 372830067 281949818 90880249 27391808 27391808 487886213 Other Assets 35105406 Income Beneficiary and Charitable Remainder Trusts 39528270 74633676 Reserve for Prof. Liability Claims 47488141 Deferred Lease Incentive 4090743 Postretirement Medical Liability 30888611 82467495 X Part V, Line 4: Endowment funds are held by The Children's Mercy Hospital and The Children's Mercy Hospital Foundation, a supporting organization of The Children's Mercy Hospital. The endowment funds are intended to provide a permanent source of funding for designated activities carried out by The Children's Mercy Hospital, the funds for which are provided from the earnings and principal of these endowment funds. Part X, Line 2: FIN 48 Footnote: The Hospital and its affiliates follow ASC Subtopic 740-10, Income Taxes - Overall. ASC Subtopic 740-10 provides specific guidance on how to address uncertainty in accounting for income tax assets and liabilities, prescribing recognition thresholds and measurement attributes. At June 30, 2014 and 2013, there were no uncertain tax positions. North America Program Services Travel for healthcare-related education and information sharing 195738 Central America & the Caribbean Program Services Travel for healthcare-related education and information sharing 39420 Europe Program Services Travel for healthcare-related education and information sharing 58311 East Asia & the Pacific Program Services Travel for healthcare-related education and information sharing 14118 Middle East & North Africa Program Services Travel for healthcare-related education and information sharing 2415 South Asia Program Services Travel for healthcare-related education and information sharing 1530 Sub-Saharan Africa Program Services Travel for healthcare-related education and information sharing 2742 0 0 0 0 0 0 314274 0 314274 0 0 0 0 0 0 Part I, line 3: Method Used to Account for Expenditures: Actual expenses for international travel Gala/Auction 1260186 1080202 179984 64882 158207 9020 84017 Event/Auction 698409 532109 166300 63200 17682 89857 30744 1 383263 330885 52378 5000 10500 0 3266 2341858 1943196 398662 133082 186389 98877 118027 536375 -137713 1 1 X 1 X 300.000000000000 1 X 500.000000000000 1 1 0 1 1 1 9168 17021653 1330847 15690806 0.01630 3 312208 543397471 421394583 122002888 0.12660 3 15591 36622738 20028028 16594710 0.01720 7 336967 597041862 442753458 154288404 0.16010 25 138123 4479882 328423 4151459 0.00430 49 8793 37030085 14032331 22997754 0.02390 5 149192 76732193 71389740 5342453 0.00550 235 0 8640753 8017872 622881 0.00060 61 67196 338168 0 338168 0.00040 375 363304 127221081 93768366 33452715 0.03470 382 700271 724262943 536521824 187741119 0.19480 1 0 40167 0 40167 0.00000 0 0 0 0 0.00000 3 1407 71183 0 71183 0.00010 1 175 33771 26381 7390 0.00000 2 500 5499 0 5499 0.00000 3 671 144421 30000 114421 0.00010 1 0 377212 0 377212 0.00040 4 1116 81291 6240 75051 0.00010 0 0 0 0.00000 15 3869 753544 62621 690923 0.00070 0 26993070 0 4361984 6051305 -1689321 X 1 1 2 1 The Children's Mercy Hospital 2401 Gillham Road Kansas City MO 64108 http://www.childrensmercy.org/ 39-54 X X X X X X Specialty Clinics; Primary Care Clinics A 2 Children's Mercy South 5808 W 110th Overland Park KS 66211 http://www.childrensmercy.org/ H-046-008 X X X X X Specialty Clinics A Facility Reporting Group - A 1 X X X X X X X X X 12 1 0 1 X See Supplemental Information X http://www.childrensmercy.healthforecast.net/ X X X X X X X X X 1 0 1 1 300.000000000000 1 500.000000000000 1 X X X X X X X X 1 1 X X 1 0 X 1 X 0 0 Part V, Section B Facility Reporting Group A Facility Reporting Group A consists of: - Facility 1: The Children's Mercy Hospital, - Facility 2: Children's Mercy South Facility 1 -- The Children's Mercy Hospital Part V, Section B, line 3: As part of this CHNA, there were five focus groups with 57 key informants including physicians, other health professionals, social service providers, business leaders, and other community leaders. Potential participants were chosen because of their ability to identify primary concerns of the populations with whom they work as well as the community overall. Healthcare providers from the following organizations are: Carousel Pediatric Care/KC Hospice, Hickman Mills C-1 School District, Independence School District, Lee's Summit School District, Mother & Child Health Coalition, Olathe USD 233, Shawnee Mission Public School USD 512, TMC Lakewood, TriCounty Mental Health, Turn House Children's Clinic, Unified Government of Wyandotte County Public Health Department, United Healthcare, University Academy School Board Clinic, University of Missouri-Kansas City School of Nursing. Representatives from Children's Mercy facilities included: Children's Mercy Hospital, Children's Mercy South, Family Advisory Board, and Teen Advisory Board. Health/Public Health Professionals from the following organizations were included: Baby and Child Association, Cass County Pediatrics and Associates, Clay County Health Department, Cockerell and McIntosh Pediatrics, Johnson County (KS) Health Department, Pediatric Partners. Social services representatives from the following organizations: Bureau of Genetics and Healthy Childhood Missouri Department of Health and Human Services, Greater Kansas City Boys and Girls Club, Kansas Children's Service League, KC Hospice, Kids TLC, Mid America Headstart, Weighing-In Community Collaborative. Community leaders from the following organizations were included: Aetna, Brush Creek Community Schools, Catholic Charities of Kansas City - St. Joseph, Inc., Commerce Bank of Kansas City, GreenEarth Cleaning, Hall Family Foundation, Lathrop & Gage Foundation, MARC, Poisinelli Shughart, and Sprint. Facility 1 -- The Children's Mercy Hospital Part V, Section B, line 5d: The CHNA reports for both facilities in Facility Reporting Group A are located on the Hospital website: https://www.childrensmercy.org/About_Us/About_Childrens_Mercy/Community_Health_Needs_Assessment/Community_Health_Needs_Assessment/ Facility 1 -- The Children's Mercy Hospital Part V, Section B, line 7: As required by the final Section 501(r) Regulations, please find the Children's Mercy Hospital Implementation Startegy Plan, Year 1 Status Updates, located on our website at: http://www.childrensmercy.org/About_Us/About_Childrens_Mercy/Community_Health_Needs_Assessment/Year_1_Progress_Updates/ Facility 1 -- The Children's Mercy Hospital Part V, Section B, line 20d: The hospital calculates the cost to charge ratio from the most recently audited financial statements to determine discounts for patients receiving financial assistance and the self pay discount. Facility 2 -- Children's Mercy South Part V, Section B, line 3: As part of this CHNA, there were five focus groups with 57 key informants including physicians, other health professionals, social service providers, business leaders, and other community leaders. Potential participants were chosen because of their ability to identify primary concerns of the populations with whom they work as well as the community overall. Healthcare providers from the following organizations are: Carousel Pediatric Care/KC Hospice, Hickman Mills C-1 School District, Independence School District, Lee's Summit School District, Mother & Child Health Coalition, Olathe USD 233, Shawnee Mission Public School USD 512, TMC Lakewood, TriCounty Mental Health, Turn House Children's Clinic, Unified Government of Wyandotte County Public Health Department, United Healthcare, University Academy School Board Clinic, University of Missouri-Kansas City School of Nursing. Representatives from Children's Mercy facilities included: Children's Mercy Hospital, Children's Mercy South, Family Advisory Board, and Teen Advisory Board. Health/Public Health Professionals from the following organizations were included: Baby and Child Association, Cass County Pediatrics and Associates, Clay County Health Department, Cockerell and McIntosh Pediatrics, Johnson County (KS) Health Department, Pediatric Partners. Social services representatives from the following organizations: Bureau of Genetics and Healthy Childhood Missouri Department of Health and Human Services, Greater Kansas City Boys and Girls Club, Kansas Children's Service League, KC Hospice, Kids TLC, Mid America Headstart, Weighing-In Community Collaborative. Community leaders from the following organizations were included: Aetna, Brush Creek Community Schools, Catholic Charities of Kansas City - St. Joseph, Inc., Commerce Bank of Kansas City, GreenEarth Cleaning, Hall Family Foundation, Lathrop & Gage Foundation, MARC, Poisinelli Shughart, and Sprint. Facility 2 -- Children's Mercy South Part V, Section B, line 5d: The CHNA reports for both facilities in Facility Reporting Group A are located on the Hospital website: https://www.childrensmercy.org/About_Us/About_Childrens_Mercy/Community_Health_Needs_Assessment/Community_Health_Needs_Assessment/ Facility 2 -- Children's Mercy South Part V, Section B, line 7: As required by the final Section 501(r) Regulations, please find the Children's Mercy Hospital Implementation Startegy Plan, Year 1 Status Updates, located on our website at: http://www.childrensmercy.org/About_Us/About_Childrens_Mercy/Community_Health_Needs_Assessment/Year_1_Progress_Updates/ Facility 2 -- Children's Mercy South Part V, Section B, line 20d: The hospital calculates the cost to charge ratio from the most recently audited financial statements to determine discounts for patients receiving financial assistance and the self pay discount. 43 Children's Mercy Northland 501 NW Barry Rd Kansas City MO 64155 Outpatient Clinics Children's Mercy Clinics on Broadway 3101 Broadway Kansas City MO 64111 Outpatient Clinics Children's Mercy East 20300 East Valley View Parkway Independence MO 66102 Outpatient Clinics Children's Mercy Blue Valley 6750 West 135th Street Overland park KS 66223 Outpatient Clinics Children's Mercy College Boulevard 5520 College Boulevard Overland Park KS 66211 Outpatient Clinics Children's Mercy College Boulevard Urgen 5520 College Boulevard Suite 130 Overland Park KS 66211 Urgent Care Children's Mercy West 4313 State Ave Kansas City KS 66201 Outpatient Clinics Children's Mercy Wichita 3243 E Murdock Wichita KS 67208 Outpatient Clinics Children's Mercy St Joseph 802 North Riverside Road Suite 105 St Joseph MO 64501 Outpatient Clinics CMH- Joplin Freeman Health System 3333 McIntosh Circle Dr Suite 6 Joplin MO 64804 Outpatient Clinics CMH Endocrinology - Springfield 1443 N Robberson Suite 308 Springfield MO 65804 Outreach Clinic CMH Gastroeneterolgy - Wichita 6837 W 37th St North Bldg 1 Wichita KS 67205 Outreach Clinic CMH Endocrinology - Junction City 1106 St Marys Rd Junction City KS 66441 Outreach Clinic CMH Endocrinology - Great Bend 3515 Broadway Ave Great Bend KS 67530 Outreach Clinic CMH Endocrinology - Parsons 1902 S US Highway 59 Parsons KS 67357 Outreach Clinic CMH Endocrinology - Pittsburg KS 3011 N Michigan Pittsburg KS 66762 Outreach Clinic CMH Speech & Language 1330 E Linwood Blvd Kansas City MO 64109 Specialty Clinic CMH Cardiology - Junction City 1106 St Marys Rd Junction City KS 66441 Outreach Clinic CMH Orthopaedic Surgery - Salina 520 S Santa Fe Ave Salina KS 67401 Outreach Clinic CMH Endocrinology - Salina 737 W Crawford Salina KS 67401 Outreach Clinic CMH Gastroeneterolgy - Salina 400 S Santa Fe Ave Salina KS 67401 Outreach Clinic CMH Orthopaedic Surgery - Wichita 2778 N Webb Rd Wichita KS 67226 Outreach Clinic CMH HematologyOncology - Springfield 1965 S Fremont Ave Springfield MO 65804 Outreach Clinic CMH Hematology - Dodge City 2020 Central Dodge City KS 67801 Outreach Clinic CMH HematologyOncology - Wichita 9211 E 21st St N Wichita KS 67206 Outreach Clinic CMH Urology - Wichita 6837 W 37th St North Bldg 1 Wichita KS 67205 Outreach Clinic CMH Nephrology - Wichita 818 N Emporia Suite 310 Wichita KS 67214 Outreach Clinic Pediatric Eye Care PA 4820 College Blvd Overland Park KS 66211 Pratice Use CMH- DevelopmentalBehavioral Medicine 211 Cherry Ave Oakley KS 67748 Outreach Clinic CMH Endocrinology - Pittsburg 1102 E Centennial Pittsburg KS 66762 Outreach Clinic CMH Endocrinology - Hays 2214 Canterbury Dr Suite 204 Hays KS 67601 Outreach Clinic CMH Genetics - Cillicothe 100 Central Ave Chillicothe MO 64061 Outreach Clinic CMH Endocrinology - St Joseph 902 N Riverside Rd Suite 100 St Joseph MO 64506 Outreach Clinic CMH Cardiology - St Joseph 902 N Riverside Rd Suite 100 St Joseph MO 64506 Outreach Clinic CMH Orthopaedic Surgery - Springfield 3800 S National Ave Suite 200 Springfield MO 65807 Outreach Clinic CMH Nephrology - Joplin 3333 McIntosh Dr Suite 3 Joplin MO 64804 Outreach Clinic CMH Oncology - Joplin 3333 McIntosh Dr Suite 3 Joplin MO 64804 Outreach Clinic CMH Gastroeneterolgy - Joplin 3333 McIntosh Dr Suite 3 Joplin MO 64804 Outreach Clinic CMH Rheumatolgy - Springfield 1965 S Fremont Ave Springfield MO 65804 Outreach Clinic CMH Endocrinology - Salina 400 S Santa Fe Ave Salina KS 67401 Outreach Clinic CMH Endocrinology - Joplin 2203 W 32nd St Joplin MO 64804 Outreach Clinic CMH Gastroeneterolgy - Springfield 1965 S Fremont Ave Springfield MO 65804 Outreach Clinic CMH Cardiology - Joplin 3020 S St Johns Blvd Suite A Joplin MO 64804 Outreach Clinic Part I, Line 7: Cost-to-charge ratios were calculated as appropriate and applied to charges. Part I, Line 7g: The Children's Mercy Hospital operates subsidized health services that span across primary care clinics, specialty care clinics, and emergency services. The organization also operates a clinic within an inner city day care center serving 400 children daily, and a dedicated clinic named Children's Mercy West, The Cordell Meeks Jr. Clinic in the underserved community of Kansas City, KS. Additionally, our physicians and nurses provide outreach specialty clinics in communities throughout our region, making this specialized care more easily accessible to families so they don't have to travel long distances to receive care in Kansas City. In an attempt to further improve access, Children's Mercy has invested in a telemedicine/telehealth infrastructure that will allow the organization to reach a broader patient population. Part I, Ln 7 Col(f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), which is subtracted for purposes of calculating the percentage in this column, is $26,993,070. Part I, Line 7h The current year Net Community Benefit Expense and persons served for Research decreased from the prior year due to the inclusion of restricted grants in direct offsetting revenue, as required per the 2013 Schedule H instructions. Many individuals in our community benefit from the publications, presentations and general knowledge from our research activities. The persons served do not reflect these individuals. The number listed ($622,881) also does not include the majority of internally funded research expenses. We are working to determine an improved process to best capture the full impact to the community of these numbers moving forward. Part II, Community Building Activities: The Children's Mercy Hospital has developed a variety of community building activities that allow the organization to connect with the community we serve and promote healthly living. In addition to several longstanding programs such as Weighing In, Children's Mercy also offers community oriented programs and/or resources intended to make physical improvements, provide community support, build coalitions, advocate for community health improvements and address community-wide workforce issues. Some examples include, the maintenance of our Hospital Hill Park, Council on Violence Preventions, Environmental Health Community Trainings, Equity and Diversity programs, and numerous advocacy activities. Part III, Line 2: The provision for bad debt is based upon management's assessment of expected net collections of contractually due amounts considering its historical experience and trends for each of its major payor sources of revenue. For receivables associated with services provided to patients who have third party coverage, the Hospital provides a provision for bad debt for balances greater than 365 days or those otherwise deemed uncollectible. For receivables associated with self-pay patients, the Hospital records a provision for bad debt in the period of service on the basis of its past experience at an amount that approximates cost. Part III, Line 4: While there is not specific footnote on bad debt expense, please refer to footnote '(o) Net Patient Service Revenue and Other Revenue' on page 10 of the attached audited financial statements. This footnote discusses both bad debt expense as well as the allowance for doubtful accounts. Part III, Line 8: The Children's Mercy Hospital follows the regulations governing the preparation of the Medicare Cost Report. In doing so, the Medicare allowable costs are based on the Hospital's audited financial statement amounts adjusted for those costs not allowable, such as costs related to physician and nurse practitioner services, marketing, and physician referrals. Other revenue sources such as for the cafeteria, vending machines, medical records fees, and various miscellaneous operating revenues are offset from total costs to determine allowable costs. Total costs per functional area, or Cost Report line/category, are divided by charges to determine cost-to-charge ratios for each area. Part III, Line 9b: Collection attempts are discontinued once charges are determined to be eligible for charity care or financial assistance; insurance collection attempts continue as appropriate. Part VI, Line 2: In fiscal year 2013, Children's Mercy embarked on the first comprehensive and scientific child and adolescent Community Health Needs Assessment. Several needs were identified, but the following three needs were prioritized based on their significance related to magnitude (e.g. # of persons affected) and impact (e.g. quality of life): 1.) Access, Including the Importance of a Medical Home, 2.) Injury and Safety, and 3.) Nutrition, Physical Activity and Weight Status. In addition to the prioritized needs, Children's Mercy remains committed to maintaining our extensive investments and clinical services, and also intends to facilitate the development of strategies to be carried out by community groups to have a positive impact on the additional needs identified in this research. The goal of this was to understand the needs and act to care for the children and adolescents in the defined community. The assessment was directed by Children's Mercy with research support from Professional Research Consultants, Inc. based in Omaha, NE. This assessment incorporates data from both quantitative and qualitative sources. Quantitative data input includes primary research (the 2013 PRC Child and Adolescent Health Survey) and secondary research (vital statistics and other existing health-related data); these quantitative components allow for trending and comparison to benchmark data at the state and national levels. Qualitative data input includes primary research gathered through a series of 5 Key Informant Focus Groups, which included representatives from community health care providers, public health professionals, social service representatives, and community leaders. Part VI, Line 3: Flyers and business cards are available at all access points within the Hospital. Efforts are made by the financial counselors to contact self pay patients and families, either in person, or through phone call or letters. Self pay or underinsured patients can also be referred to a financial counselor by an Access Representative, Patient Care Services, Social Work, Patient Financial Services, or other staff members for screening and assistance. Part VI, Line 4: The Children's Mercy Hospital service area is comprised of counties located in both Missouri and Kansas. Our Primary Service Area is defined as the 18 counties immediately surrounding the Kansas City MSA, while our Secondary Service Area is comprised of the 50 surrounding counties. Children's Mercy Hospital is the only pediatric hospital within the tertiary service area and we provide a number of unique services not available anywhere within a 200-mile radius of Kansas City. In addition, a minority of the pediatric primary care providers in our service area accept Medicaid, so our primary care and dental services see a disproportionate share of uninsured and underinsured patients. The hospital is located in an area designated by HRSA as medically underserved and as a primary care and dental health provider. For purposes of the Community Health Needs Assessment, Children's Mercy Hospital has defined a 4 county "community" based on patient utilization data. This is comprised of 2 counties in Missouri (Jackson and Clay) and 2 counties in Kansas (Johnson and Wyandotte). These counties serve as both the location of our physical facilities (e.g. Main Campus, Children's Mercy South, Children's Mercy West, Children's Mercy Northland, Children's Mercy Broadway Clinics and Children's Mercy East) and the source of a majority of our patient encounters. During the fiscal year in which Children's Mercy initiated the Community Health Needs Assessment, approximately 74% of the total number of patients we encounter reside in these 4 counties alone. Part VI, Line 5: The Children's Mercy Hospital is a nonprofit hospital operated to serve a public rather than a private interest and meeting the requirements of Revenue Ruling 69-545. Control of the Hospital rests with its Board, which is primarily composed of members of the community, in addition to a few select employees of the Hospital. The Hospital accepts patients paying with Medicaid and Medicare, and operates an active and generally accessible emergency room open to all children without regard to ability to pay. The Hospital uses any surplus funds to improve the quality of patient care, expand its facilities, and advance its medical training, education, and research programs.Children's Mercy promotes pediatric health in the Kansas City region in numerous ways. In addition to providing the community with access to a top-tier tertiary care center and training future pediatric healthcare providers, we provide many community-oriented programs. Highlights of these programs include supporting the clinical care of at-risk children (i.e. Operation Breakthrough, providing free vaccinations to all family members and caregivers of Children's Mercy patients (i.e. Family and Friends Flu Vaccination Clinic), providing direct funding support to community organizations with like missions (i.e. Rose Brooks Bridge Program, Civic Engagement), training community members on assessing and managing child abuse (i.e. SCAN Outreach Services) and providing training and education for families with children at-risk for obesity or diabetes (i.e. Weighing In, Zoom to Health, PHIT Kids, etc.). Part VI, Line 6: The Children's Mercy Hospital is not part of an affiliated health care system. 1 American Heart Association 6800 W 93rd Street Overland Park KS 66212 135613797 501(c)3 7398 Mission is to foster appropriate cardiac care in an effort to reduce disability and deaths caused by cardiovascular disease and stroke. Boys & Girls Club of Greater Kansas City 6301 Rockhill Road Kansas City MO 64131 436072065 501(c)3 19000 Promote development of self-esteem, values, and skills for boys and girls, ages 5-18 Center for Practical Bioethics 1111 Main St Ste 500 Kansas City MO 64105 480985815 501(c)3 10000 Initiatives in Aging in Community, addressing undertreatment of chronic pain, certificate program in clinical ethics and health policy. Cystic Fibrosis Foundation 6950 Squibb Road Ste 310 Mission KS 66202 131930701 501(c)3 7500 Mission is to cure cystic fibrosis and to provide all people with the disease the opportunity to lead full, productive lives by funding research and drug development, promoting individualized treatment, and ensuring access to high-quality, specialized care. Jewish Community Relations BureauAmerican Jewish Committee 5801 W 115th St Ste 503 Overland Park KS 66211 440545913 501(c)3 9250 Advocate for justice, protecting and preserving equal rights for all members of Greater Kansas City community. Builds Bridges of understanding and nurtures guiding principles that all people of goodwill embrace-working to prevent discrimination, reduce prejudice, strenghten democracy, and expand freedom. JDRF- Juvenile Diabetes Research Foundation 920 Main St Ste 280 Kansas City MO 64105 231907729 501(c)3 8800 Support diabetes research and research-related eduction. Leukemia and Lymphoma Society 6811 Shawnee Mission Pkwy Ste 202 Shawnee Mission KS 66202 131846366 501(c)3 5200 Mission is to cure leukemia, lymphoma, Hodgkin's disease and myeloma, and improve the quality of life of patients and their families. March of Dimes 4400 College Ste 180 Overland Park KS 66211 131846366 501(c)3 12750 Support programs that improve the health of mothers and babies. Reach Out and Read Kansas City 3901 Rainbow Blvd MS 1051 Kansas City KS 66106 480547734 501(c)3 46000 Prepares Kansas City's youngest children to succeed in school by partnering with doctors and nurses to prescribe books and encourage families to read together. Ronald McDonald House Charities 2502 Cherry St Kansas City MO 64108 510231573 501(c)3 89120 Provide comfort and care for families seeking life-saving medical treatment for their children. Rose Brooks Center PO Box 320599 Kansas City MO 64132 510231573 501(c)3 15750 Provides emergency shelter to women and children escaping life-threatening abuse. 11 Patient Financial Assistance 9168 17021653 Cost Charity Care Part I, Line 2: Grants generally go to nonprofit organizations and agencies with which The Children's Mercy Hospital shares a common mission. These are agencies that generally support the health and well-being of children and families. The Children's Mercy Hospital documents the appropriate use of our funds by attending annual events to collaborate with agency board members and their executive leaders about issues related to the achievement of the agency's mission; reviewing web-based annual reports; and requesting and receiving a report from the agency grant recipient confirming the portion of grant dollars that go directly to the agency's mission-critical enterprise. X X X X X 0 1 0 0 0 1 0 0 0 Gerald Woods MD Director 311057 0 2169 0 3981 0 15300 0 15407 0 347914 0 0 0 Randall L O'Donnell PhD Director; President & CEO 1088035 0 327079 0 3125382 0 337759 0 16137 0 4894392 0 3089680 0 Charles Roberts MD EVP & Exec.Medical Director 528197 0 115002 0 23886 0 15300 0 6765 0 689150 0 0 0 Sandra AJ Lawrence Executive VP & CFO 524081 0 122629 0 21676 0 15300 0 15523 0 699209 0 0 0 Karen S Cox RN PhD FAAN Executive VP & Co-COO 417682 0 96136 0 36305 0 15300 0 11926 0 577349 0 0 0 Jo Stueve Executive VP & Co-COO 415932 0 96663 0 22457 0 15300 0 10867 0 561219 0 0 0 Michael Artman Chairman- Dept of Pediatrics 492914 0 0 0 22362 0 15300 0 11514 0 542090 0 0 0 James O'Brien Jr MD Physician 1075692 0 0 0 20419 0 15300 0 15523 0 1126934 0 0 0 Walter S Andrews MD Physician 717361 0 0 0 22895 0 15300 0 15523 0 771079 0 0 0 Shawn David St Peter MD Physician 721121 0 0 0 19089 0 15300 0 15523 0 771033 0 0 0 Charles Snyder MD Physician 719663 0 0 0 20307 0 15300 0 16582 0 771852 0 0 0 George Whit Holcomb MD Physician 718180 0 0 0 20904 0 15300 0 16582 0 770966 0 0 0 Part I, Line 4b Included in the compensation of Randall O'Donnell, President & CEO, is $3,089,680 in SERP payout. This amount is a payment from the Plan representing the value no longer subject to a substantial risk of forfeiture. Part I, Line 6 A portion of the total cash compensation paid to the President/CEO and all Executive Vice Presidents is determined by a performance based plan approved by the Compensation Committee of the Board of Directors. The plan includes Hospital and individual performance goals, one component of which is based in part on net earnings. Part II, Line 2, Column (C) $322,459 of deferred severance compensation was accrued for Randall O'Donnell that may or may not be paid in the future. A Health and Educational Facilities Authority of the State of Missouri 431178966 60635HH85 2009-11-15 178852416 See Part VI 0 0 0 B Health and Educational Facilities Authority of the State of Missouri 431178966 2010-12-21 71550000 See Part VI 0 0 0 A 9375000 179112696 80262696 98850000 2013 1 0 1 1 B 47550000 71550000 71550000 1 0 1 1 A 0 0 1 1 0 0 0 1 B 0 0 1 1 0 0 0 1 A 0 1 0 0 0 0 0 1 1 B 0 0 1 0 1 1 UBS AG 30.900000000000 0 0 0 0 1 A 1 B 1 Schedule K, Part I, Row A, Column (f) The Series 2009 Bonds were issued for the following purposes: (i) refinance a bank loan, which was incurred to refinance the Series 2007AB Bonds (issued June 26, 2007) and (ii) finance hospital facilities (new tower on Main Campus and new hospital location). Schedule K, Part I, Row B, Column (f) In 2008, the Organization restructed some of its existing debt. The Series 2002 Bonds (June 19, 2002) were remarketed as the Series 2008A Bonds, and the Series 2003 Bonds (June 5, 2003) were remarketed as the Series 2008B Bonds. Then, in 2010, the Series 2008A/B Bonds were modified in a manner that resulted in a "reissuance" for tax purposes. Schedule K, Part II, Line 11, Column A $98,850,000 of Bond proceeds were used to pay off the bank loan that was incurred to refinance the Series 2007AB Bonds. Schedule K, Part II, Line 11, Column B $71,550,000 of Bond proceeds were treated as used to refinance the Series 2008AB Bonds as a result of the "reissuance" of the Series 2008AB Bonds. Schedule K, Part II, Line 13, Column B The Series 2008AB Bonds were treated as "reissued" on December 21, 2010, and therefore, there were no "new-money" projects financed by the Series 2008AB Bonds. Margi Pence Director Hallmark Cards, More than 35% owned by family member 1165054 Rental Property; Payments made to Kessington/Hunter Mgmt Co and Crown Center Parking 0 John Sommerauer Director Anesthesia Associates of Kansas City, Member for the organization 27873166 Medical 0 X 7 4005 FMV X 33340 FMV X 109087 FMV X 1 10070 FMV X 15 82303 FMV X 24 8210 FMV X 29 45316 FMV X 29 44855 FMV X Toys 510 258138 FMV X Trips & Exper 44 120403 FMV X Sporting or P 47 54070 FMV X Miscellaneous 77 42331 FMV 3 0 1 0 Part I, Line 33: Books and clothing were received and utilized by patients and families; not resold. Form 990, Part III, line 2 Urgent Care - Children's Mercy Blue Valley In December 2013, Children's Mercy Blue Valley Urgent Care opened its doors replacing the previous Urgent Care Center in Johnson County and doubling its size. The Urgent Care Center provides much-needed, specialized pediatric services to a fast-growing community. Patients and families now have access to Children's Mercy urgent care services closer to their homes. Urgent care services are for children with minor injuries or illnesses that are not considered life-threatening, but require prompt attention. Sports Medicine Clinic and Physical Therapy Gym - Blue Valley In December 2013, a state-of-the-art, 3,500 square foot, pediatric sports medicine gym was opened in Johnson County. The region's only pediatric focused gym includes a track lane, small basketball court and specialized exercise equipment for sports physical therapy. In addition to the sports medicine gym, a sports medicine clinic is also conveniently offered at the same location. The Sports Medicine Clinic and Physical Therapy Gym are for young athletes with acute or chronic sports-related injuries, dislocations, concussions or fractures. Joplin Regional Center In affiliation with Freeman Health System, Children's Mercy opened a permanent specialty center in Joplin, Missouri on January 14, 2014. The new regional center offers seven pediatric specialty clinics including Cardiology, Endocrinology, Gastroenterology, Hematology/Oncology, Nephrology, and Rheumatology. The permanent location and specialists allows patients and families access to specialized pediatric services right in their very own community. Telemedicine Expansion With an expanding regional footprint and an increasing desire for access to Children's Mercy pediatric services, expansion of telemedicine offerings is a priority ensuring patients receive the care they need in a more accessible location. Children's Mercy now offers 21 telemedicine clinics, in 17 different specialty areas, at seven regional locations and one international location. Single Day Surgery Program The Single-Visit Surgery program enhances the patient experience by allowing patients from outside the KC metro to have their clinical evaluation and surgery completed in one trip. Previously, this process required three trips: one for evaluation; the second for surgery; the third for follow-up. Patients who qualify for the Single-Visit Surgery program are children with no significant co-morbidities and the following conditions: -Umbilical hernia (patients 3 years and older); -Inguinal hernia (patients 12 months and older); -Hydrocele (patients 12 months and older); -Epigastric hernia (any age). Safe and Healthy Families Trauma Prevention & Treatment Center The Safe and Healthy Families Trauma Prevention & Treatment Clinic consists of a multidisciplinary team of health care professionals who assess and treat traumatized children and their families. Children who are seen through this clinic include those who suffer from PTSD or experience symptoms of traumatic stress after being exposed to a traumatic event(s), which include witnessing or experiencing life threatening accidents, disasters, child maltreatment, assault, and family and community violence. Research confirms these children are at high-risk for lifelong impairments in learning, behavior, and both mental and physical health. Through improved recognition of the short-term and long-term effects of trauma on the developing mind and body there has been an increase in awareness of children needing a comprehensive assessment and treatment to improve their health and well-being. Fetal Surgery The Fetal Surgery Program, which is part of The Ferrell Family Fetal Health Center, provides prenatal consultation to advise families on the role of fetal surgery for specific conditions. Initially, the program is focused on two main procedures: the first and the most common, fetoscopic laser ablation for twin-to-twin transfusion syndrome; the second is repair of myelomeningocele, the most serious form of spina bifida. Form 990, Part V, Line 1c: As of the date of this return, The Children's Mercy Hospital is in compliance to the best of our knowledge. The Children's Mercy Hospital is working to resolve previously discovered instances of non-compliance with backup withholding rules for reportable payments. Form 990, Part VI, Section A, line 4 The bylaws of The Children's Mercy Hospital were updated to add a Quality and Safety Committee to the list of Standing Committees. The duties and activities of the Quality and Safety Committee were also added to the bylaws. Form 990, Part VI, Section B, line 11 The final Form 990, including all required schedules, was provided to each voting member of the Board of Directors prior to its filing with the IRS. Form 990, Part VI, Section B, line 12c Each employee is required to complete an Outside Professional and Commercial Interests Form (Conflict of Interest Form) at the time of employment, at the time of their annual evaluation, and any time their financial interests change. Board members are required to complete a Conflict of Interest Questionnaire at the time of their appointment, at least one time annually, and are required to update their information any time their financial interests change. All Outside Professional and Commercial Interests Forms and Conflict of Interest Questionnaires are reviewed by the Corporate Compliance Manager. Form 990, Part VI, Section B, line 15 The Compensation Committee of the Board of Directors is responsible for approving the compensation of the CEO, which they document in an Employment Agreement between the Board of Directors and the CEO. The Compensation Committee also approves the compensation of the EVP/CFO, the EVP/Chief Medical Officer, two persons with the title EVP/co-Chief Operating Officer, all officers of the Hospital, and the Chair of the Department of Pediatrics, who is a key employee. The Compensation Committee is composed of independent outside directors who receive no compensation for their participation on the Board. The Compensation Committee engages an outside consulting firm, whose practice includes the analysis of compensation for not-for-profit hospitals, to advise the Committee with regard to market data and analysis, which was used to establish compensation. A letter from the compensation consultant opining on the reasonableness of the compensation was provided to the Committee and documentation of the Committee's deliberations and decision are in existence. Form 990, Part VI, Section C, line 19 The organization's governing documents, conflict of interest policy, and audited financial statements are available upon request. Form 990, Part XI, line 9: Change in benefit obligation 136,768. Tax reversal of unrealized gain 2,267,678. Tax reversal of Friends of Children's Mercy 135,998. Transfer of income beneficiary and charitable remainder trusts 3,671,000. CMH Insurance Company LLC 1000 Bank Street Suite 100 Burlington VT 05401 Insurance for The Children's Mercy Hospital VT 79912 10657485 The Children's Mercy Hospital Children's Mercy Health Network 2401 Gillham Road Kansas City MO 64108 Physician network for education and purchasing MO 0 0 The Children's Mercy Hospital Children's Mercy Hospital Foundation 2401 Gillham Road Kansas City MO 64108 431564302 Investment management to benefit Children's Mercy Hospital MO 501(C)(3) line 11, III-NFI N/A 0 Friends of Children's Mercy 2401 Gillham Road Kansas City MO 64108 430961097 Support of Children's Mercy Hospital MO 501(c)(3) line 11, III-FI N/A 0 Children's Mercy's Family Health Partners Inc 2420 Pershing Kansas City MO 64108 431726517 Integrated health insurance benefits care system MO 501(C)(3) line 9 The Children's Mercy Hospital 1 Children's Mercy Hospital Self-Insurance Trust Commerce Trust Co PO Box 419248 Kansas City MO 64141 436231807 Providing funds for malpractice claims against CMH & employees MO 501(C)(3) line 11, I The Children's Mercy Hospital 1 Children's Mercy Integrated Care Solutions Inc 2401 Gillham Road Kansas City MO 64108 453741386 Coordinates medical care of pediatric patients KS The Children's Mercy Hospital C 94987948 12526290 1.00000 1 Income Beneficiary Trusts (6) Trust MO N/A T 0 0 0 1 0 1 0 0 0 0 1 0 1 0 1 1 0 1 0 1 Children's Mercy Integrated Care Solutions O 4967589 Book Children's Mercy Integrated Care Solutions J 187351 Book Children's Mercy Integrated Care Solutions L 953291 Book Children's Mercy Integrated Care Solutions S 57922 Book