2014-05-14T15:40:48-05:00 2013-06-30 135565207 KPMG LLP 1212 North 96th Street Suite 300 Omaha NE 68114 990 2012-07-01 440605373 The Children's Mercy Hospital CHIL 8162343000 2401 Gillham Road Kansas City MO 64108 Sandra AJ Lawrence 8162343000 2014-05-13 1 Adam C Stark P01231721 4023481450 2012 2015-11-30 17:44:51Z Sandra AJ Lawrence 2401 Gillham Road Kansas City MO 64108 972736802 0 X www.childrensmercy.org X 1901 MO Excellence in healthcare for children 14 10 6974 708 54934 81771 28096636 28899955 831584151 918674257 938906 12188779 12617270 12193876 873236963 971956867 13089408 14245097 0 0 496964073 535022809 0 0 2626169 323354663 360510111 833408144 909778017 39828819 62178850 1038666908 1166481377 372156824 380227445 666510084 786253932 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 736683380 14245097 918674257 All expenses for program services relate to providing healthcare. There were a total of 354 licensed beds and 80,746 patient days during the year from 13,692 admissions. Interim stays totaled 8,436 and outpatient encounters were 695,421 from 195,971 individual patients. There were a total of 17,586 surgical procedures which includes 3,632 inpatient and 13,954 outpatient procedures. Diagnositc procedures, tests and treatments totaled 1,318,705 and outpatient prescriptions totaled 127,394. Children's Mercy critical care transports totaled 4,126 in fiscal year 2013.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. 736683380 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 541 0 0 6974 1 1 1 0 0 0 0 1 1 0 0 0 0 X 14 10 0 0 0 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 1.00 X X 0 0 0 Charlie Schellhorn 1.00 X X 0 0 0 Debbie Sosland-Edelman 1.00 X X 0 0 0 Elizabeth Braham 1.00 X 0 0 0 Mary Hunkeler 1.00 X 0 0 0 David Oliver 1.00 X 0 0 0 Robert Jackson MD 1.00 X 0 0 0 Margi Pence 1.00 X 0 0 0 Jonathan Baum 1.00 X 0 0 0 David Goebel 1.00 X 0 0 0 Tom Weir 1.00 X 0 0 0 John Sommerauer 1.00 X 0 0 0 Gerald Woods MD 40.00 X 309503 0 29628 Randall L O'Donnell PhD 40.00 X X 1466220 0 1948112 Charles Roberts MD 40.00 X 666965 0 21192 Sandra AJ Lawrence 40.00 X 668121 0 29628 Karen S Cox RN PhD FAAN 40.00 X 553540 0 25176 Jo Stueve 40.00 X 535898 0 25176 Michael Artman 40.00 X 501822 0 16250 Gary K Lofland MD 40.00 X 1218564 0 29628 James O'Brien Jr MD 40.00 X 953981 0 29628 Richard A Hopkins MD 40.00 X 800719 0 29628 Shawn David St Peter MD 40.00 X 740871 0 29628 Charles Snyder MD 40.00 X 740591 0 29628 Milton Fowler MD 40.00 X 387486 0 30236 9544281 0 2273538 1298 1 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 391 1017106 794713 7637300 10624146 8826690 178663 28899955 Net Patient Services 621110 918674257 918674257 918674257 12078241 12078241 599638 489100 110538 110538 110538 53073 794713 290835 -237762 -237762 Cafeteria 722210 4616992 4616992 Transport 621910 2781338 2781338 UMKC Contract for Residents 611310 820866 820866 4212442 4157508 54934 12431638 971956867 931161499 54934 11840479 238300 238300 14006797 14006797 11944911 5347036 6597875 426212104 356935817 67386832 1889455 18802315 15546382 3174852 81081 49235771 39481860 9547414 206497 28827708 23835712 4867683 124313 1110805 1110805 415430 130 415300 78953067 55611269 23309567 32231 3688448 765947 2848240 74261 13422207 5533580 7852165 36462 5759899 4450480 1306359 3060 10050663 10050663 52414812 25751196 26553306 110310 16232812 13834028 2398784 Medical Supplies 92425317 88726710 3690575 8032 State Medicaid Taxes 37526061 37526061 0 0 Bad Debt 22381410 22381410 0 0 Food Services 5890163 5667092 217488 5583 20239017 10992910 9191223 54884 909778017 736683380 170468468 2626169 137629234 165207961 26663954 50732367 11119836 7287792 119523013 138278603 7962329 8091799 8737772 9944058 885554688 409154194 455190534 476400494 212035399 223352150 33118234 24506454 26686603 62679699 1038666908 1166481377 109038981 112806750 201913263 197767869 105071 0 61099509 69652826 372156824 380227445 X 624145095 725844083 42364989 60409849 666510084 786253932 1038666908 1166481377 X 62178850 12809860 44755138 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 431136 431136 736252244 736683380 1000000 250000 0 0 1000000 1000000 1000000 1000000 4000000 6000000 344415 405207 467864 431136 1648622 250000 250000 250000 250000 1000000 1500000 38607709 961835 4052039 1624792 41996791 41124198 755549 -1440270 1831768 38607709 35713462 695711 6607520 1892495 41124198 33889964 317605 3237589 1731696 35713462 42887302 416385 -7597819 1815904 33889964 0.00000 0.99590 0.00410 0 1 1 15963738 15963738 486494134 159759624 326734510 348042486 249394570 98647916 35054330 35054330 476400494 Other Assets 26822928 Income Beneficiary and Charitable Remainder Trusts 35856771 62679699 Reserve for Professional Liability Claims 39386074 Deferred Lease Incentive 4422546 Postretirement Medical Liability 25844206 69652826 X Description of Intended Use of Endowment Funds: Part V, Line 4: Endowment funds are held by 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. Description of Uncertain Tax Positions Under FIN 48: 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, 2013 and 2012, there were no uncertain tax positions. North America 0 0 Program Services Travel for healthcare-related education and information sharing 40554 Central America & the Caribbean 0 0 Program Services Travel for healthcare-related education and information sharing 2208 Europe 0 0 Program Services Travel for healthcare-related education and information sharing 32768 East Asia & the Pacific 0 0 Program Services Travel for healthcare-related education and information sharing 17454 Middle East & North Africa 0 0 Program Services Travel for healthcare-related education and information sharing 4674 South Asia 0 0 Program Services Travel for healthcare-related education and information sharing 6444 Sub-Saharan Africa 0 0 Program Services Travel for healthcare-related education and information sharing 9487 South America 0 0 Program Services Travel for healthcare-related education and information sharing 4490 0 0 0 0 0 0 118079 0 118079 0 0 0 0 0 0 Method Used to Acccount for Expenditures: Schedule F, Part I, Line 3: Method Used to Account for Expenditures: Actual expenses for international travel Gala/Auction 847786 794713 53073 7236 152873 15778 114948 847786 794713 53073 7236 152873 15778 114948 290835 -237762 1 1 X 1 X 300.000000000000 1 X 500.000000000000 1 1 0 1 1 1 7920 14003798 1669762 12334036 0.01390 3 303979 509498779 397629033 111869746 0.12610 3 14774 33382062 22454275 10927787 0.01230 7 326673 556884639 421753070 135131569 0.15230 28 114995 3707890 136916 3570974 0.00400 47 9345 35806846 15198121 20608725 0.02320 5 138549 64166804 58236187 5930617 0.00670 162 646 9815738 0 9815738 0.01110 63 51663 250311 0 250311 0.00030 305 315198 113747589 73571224 40176365 0.04530 312 641871 670632228 495324294 175307934 0.19760 1 32372 0 32372 0.00000 4 1728 75982 0 75982 0.00010 1 371 37378 39921 -2543 0.00000 1 101 3407 0 3407 0.00000 2 565 266094 0 266094 0.00030 1 375650 0 375650 0.00040 2 700 70952 0 70952 0.00010 12 3465 861835 39921 821914 0.00090 0 22381410 0 3112962 3730493 -617531 X 1 1 2 1 The Children's Mercy Hospital

2401 Gillham Road Kansas City MO 64108

X X X X X X Specialty Clinics; Primary Care Clinics A 2 Children's Mercy South

5808 W 110th Overland Park KS 66211

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 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 1 1 X X 1 0 X 1 X 0 0 37 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 College Boulevard Urgen

5520 College Boulevard Suite 130 Overland Park KS 66211

Urgent Care Children's Mercy College Boulevard

5520 College Boulevard Overland Park KS 66211

Outpatient Clinics 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 Endocrinology - Springfield

1443 N Robberson Suite 308 Springfield MO 65804

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 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 - Parsons

1902 S US Highway 59 Parsons KS 67357

Outreach Clinic CMH Cardiology - Joplin

3020 S St Johns Blvd Suite A Joplin MO 64804

Outreach Clinic CMH Endocrinology - Great Bend

3515 Broadway Ave Great Bend KS 67530

Outreach Clinic CMH Orthopaedic Surgery - Wichita

2778 N Webb Rd Wichita KS 67226

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 Gastroeneterolgy - Salina

400 S Santa Fe Ave Salina KS 67401

Outreach Clinic CMH Orthopaedic Surgery - Salina

520 S Santa Fe Ave Salina KS 67401

Outreach Clinic CMH Cardiology - Junction City

1106 St Marys Rd Junction City KS 66441

Outreach Clinic CMH HematologyOncology - Wichita

9211 E 21st St N Wichita KS 67206

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 Speech & Language

1330 E Linwood Blvd Kansas City MO 64109

Specialty Clinic CMH HematologyOncology - Springfield

1965 S Fremont Ave Springfield MO 65804

Outreach Clinic CMH Orthopaedic Surgery - Springfield

3800 S National Ave Suite 200 Springfield MO 65807

Outreach Clinic CMH Endocrinology - St Joseph

902 N Riverside Rd Suite 100 St Joseph MO 64506

Outreach Clinic CMH Endocrinology - Pittsburg

1102 E Centennial Pittsburg KS 66762

Outreach Clinic CMH Cardiology - St Joseph

902 N Riverside Rd Suite 100 St Joseph MO 64506

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 CMH Hematology - Dodge City

2020 Central Dodge City KS 67801

Outreach Clinic CMH Genetics - Cillicothe

100 Central Ave Chillicothe MO 64061

Outreach Clinic CMH Endocrinology - Hays

2214 Canterbury Dr Suite 204 Hays KS 67601

Outreach Clinic Pediatric Eye Care PA

4820 College Blvd Overland Park KS 66211

Pratice Use 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, Line 7, Column (f) The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), is subtracted for purposes of calculating the percentage in this column is $22,381,410. Part II: 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, Intensive Care Nursery Family Group, Hematology/Oncology Family Group, Violence Prevention Councils, and numerous advocacy efforts. Part III, Line 4: There is no financial statement footnote on bad debt. The amount of bad debt reported represents cost of charges. The primary basis of bad debt is the sum of adjustments made to patient accounts that represent non-collectible amounts. The allowance for uncollectible accounts is adjusted to equal the sum of all accounts whose balances are in excess of 365 days and self pay account balances. If the prior period's allowance balance is less than the current month's calculated balance, the allowance is credited and bad debt is increased. If the balance requires a decrease, then bad debt is also decreased by the same amount.Discounts (Gross Charges less Ratio of Cost to Charge applied) and any other adjustments on patient accounts are applied to account balances prior to any bad debt expense determination. 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 V, Section B, Line 5c 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/ 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. Part V, Line 8 Facility Reporting Group A See below 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 5c: Facility 1 -- The Children's Mercy Hospital Part V, Section B, line 14g: 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 14g: 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. 1 American Heart Association 6800 W 93rd Street Overland Park KS 66212 135613797 501(c)3 42015 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 14250 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 8250 Initiatives in Aging in Community, addressing undertreatment of chronic pain, certificate program in clinical ethics and health policy. Juvenile Diabetes Research Foundation 920 Main Street Ste 280 Kansas City MO 64105 231907729 501(c)3 7620 Support diabetes research and research-related education Leukemia & Lymphoma Society 6811 Shawnee Mission Parkway Ste 202 Shawnee Mission KS 66202 135644916 501(c)3 7900 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 Blvd Ste 180 Overland Park KS 66211 131846366 501(c)3 15000 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 45600 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 Street Kansas City MO 64108 431190760 501(c)3 13785 Provide comfort and care for families seeking life-saving medical treatment for children 8 0 Medical Residency 10 3000 Patient Financial Assistance 7920 14003797 Cost Charity Care Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, 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. Grants are also provided to the Medical Residents of The Children's Mercy Hospital. X X X X X 0 1 0 0 0 1 0 0 0 Gerald Woods MD 305522 0 0 0 3981 0 15000 0 14868 0 339371 0 0 0 Randall L O'Donnell PhD 1054205 0 373595 0 38420 0 1932876 0 15597 0 3414693 0 0 0 Charles Roberts MD 507632 0 136870 0 22463 0 15000 0 6553 0 688518 0 0 0 Sandra AJ Lawrence 512995 0 134670 0 20456 0 15000 0 14989 0 698110 0 0 0 Karen S Cox RN PhD FAAN 409847 0 107692 0 36001 0 15000 0 11554 0 580094 0 0 0 Jo Stueve 406262 0 107687 0 21949 0 15000 0 10495 0 561393 0 0 0 Michael Artman 496288 0 0 0 5534 0 4316 0 12289 0 518427 0 0 0 Gary K Lofland MD 1196940 0 0 0 21624 0 15000 0 14989 0 1248553 0 0 0 James O'Brien Jr MD 934272 0 0 0 19709 0 15000 0 14989 0 983970 0 0 0 Richard A Hopkins MD 779096 0 0 0 21623 0 15000 0 14989 0 830708 0 0 0 Shawn David St Peter MD 722282 0 0 0 18589 0 15000 0 14989 0 770860 0 0 0 Charles Snyder MD 720874 0 0 0 19717 0 15000 0 16048 0 771639 0 0 0 Milton Fowler MD 374946 0 10000 0 2540 0 15000 0 15463 0 417949 0 0 0 Part I, Line 4b A Supplemental Executive Retirement Plan (SERP) was made available to President & CEO, Randall O'Donnell, Ph.D. $1,628,167 was deferred into the plan during the year. 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. 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 6940000 179112696 80262696 98850000 2013 1 0 1 1 B 45750000 71550000 71550000 1 0 1 1 A 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 1 1 0 0.00000 0.00000 0.00000 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) Bond Issue, Description of Purpose $100,000,000: Refinance of Commerce Bank debt which refinanced Series 2007 bonds. $80,002,416: A portion of the proceeds of the Bonds loaned to the Corporation will be used to construct and equip a new six-story bed tower on the Corporation's Main Campus. The tower will provide an additional 42 medical/surgical beds, a maternal fetal medicine unit with four observation beds and a labor and delivery suite, 14 additional pediatric intensive care beds, expansion of radiology and infusion services, expansion of the cafeteria, dock, and storage space and expanded gift shop. The Corporation plans to establish a presence in Independence, Missouri in eastern Jackson County to be known as Children's Mercy East, which will include outpatient pediatric services. The Corporation has purchased the 8.9 acre site and has received a grant for $1 million to pay for the architectural and engineering costs associated with this project. The Corporation will also use a portion of the proceeds of the Bonds for other capital expenditures at its facilities that are part of its ongoing capital improvement plan. Schedule K, Part I, Row B, Column (f) Bond Issue, Description of Purpose 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. A portion of the proceeds of the Bonds will be used to finance and reimburse the Corporation for a portion of the costs of the Project, which consists of (1) the following improvements at the Corporation's Main Campus in Kansas City, Missouri: (a) construction of four new operating rooms designed for cardiac surgery, together with related support facilities and space over the emergency room parking area at the southeast corner of the Main Campus, (b) construction of a fifth floor addition to the existing Henson Tower to house a new 27-bed inpatient unit, (c) construction of a new heliport with two landing surfaces on the roof of the existing Sutherland Tower and (d) construction of a four-story 72,000 square foot clinic and research building over the existing parking garage; and (2) construction of the following improvements at the Corporation's South Campus in Overland Park, Kansas: (a) a new 120,000 square foot building, connected to the existing approximately 50,000 square foot building, to be used to house an urgent care center, new patient beds and additional general support space and (b) the development of 400 new surface parking spaces. Schedule K, Part II, Line 11, Column A Proceeds, Other Spent Proceeds $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 Proceeds, Other Spent Proceeds $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 Proceeds, Date of Substantial Completion 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 1030330 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 24447044 Medical 0 X 4 1120 FMV X N/A X 3600 FMV X 10 115189 FMV X 9 8401 FMV X Trips & Experiences 9 13275 FMV X Sporting or Performance Event 14 29238 FMV X Gift Cards 14 3276 FMV X Miscellanous Auction Items 22 4564 FMV 0 0 1 0 Non Reporting of Revenue: Part I, Line 33: Books and clothing were received and utilized by patients and families; not resold. New Program Services Form 990, Part III, line 2 Pediatric Refractive Surgery Pediatric ophthalmology patients at risk of losing their eyesight benefit from experiencing this innovative surgical procedure. Using unique laser technology enabling beams of light to replace blades of steel, one of our specially-trained ophthalmologic surgeons performs this procedure on patients who see their sight saved without even having been required to remain in the hospital for an overnight stay. Wichita, Kansas Outreach In our previous fiscal year, we employed new physicians in endocrinology and nephrology to serve a growing number of patients from central and southwest Kansas. In this most recent fiscal year, we enlarged our commitment to that community by moving into a fully dedicated facility in Wichita enabling us to provide services to patients residing in the region with allergies and asthma. Metro Kansas City expansion of Allergy, Asthma, and Endocrinology We continued expanding into the unused capacity of our new facility at 3101 Broadway by opening up more space and offering more support to enlarge our clinical programs in allergy, immunology, asthma, endocrinology, and ophthalmology. Expansion to St. Joseph, Missouri Through special arrangements made with Heartland Health in St. Joseph, Missouri, Children's Mercy established a hospital-based clinical presence in St. Joseph and started regular clinics in service to patients requiring support from providers in pediatric cardiology and endocrinology. Opening and Dedication of Lisa Barth Interfaith Chapel and Garden Families experiencing extraordinary health challenges, prolonged hospital stays, or both, find solace and comfort from spiritual reflection enabled by the dedication of our new Lisa Barth Chapel and the fountain-garden on a hospital balcony just outside it. Families gain the opportunity to use the Chapel's nearly 3,500 square feet of quiet and still space for reflection, ecumenical spiritual comfort, and support. Neonatology Outreach for Truman Medical Center/Lakewood Campus In our ongoing effort to serve the Neonatal Intensive Care Unit needs of community-based hospitals, Children's Mercy now sends representatives of our neonatology provider team to bring specialist support for patients in the NICU at Truman Medical Center/Lakewood. Form 990, Part V, Line 1c: As part of ongoing due diligence around processes and procedures, the Children's Mercy Hospital recently discovered instances of non-compliance with backup withholding rules for reportable payments. We are working to correct all such matters. 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. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Change in benefit obligation -594,530. Intercompany transfer 21,917. Tax reversal of unrealized gain 10,355,609. Tax reversal of Friends of Children's Mercy 442,142. Transfer of income beneficiary and charitable remainder trusts 34,530,000. CMH Insurance Company LLC 1000 Bank Street Suite 100 Burlington VT 05401 Insurance for The Children's Mercy Hospital VT 76674 8162104 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 MI Trust Co NA PO Box 2977 Milwaukee WI 53201 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 Pediatric Care Network Inc 2401 Gillham Road Kansas City MO 64108 453741386 Coordinates medical care of pediatric patients KS The Children's Mercy Hospital C 89499796 12881829 1.00000 1 Income Beneficiary Trusts (6) Trust MO N/A T 0 Thomas R Bailey Trust Carroll County Courthouse 8 S Main Carrollton MO 64633 436160940 Trust MO N/A T 29556 1.00000 0 0 1 1 0 1 0 0 0 0 1 0 1 0 1 1 1 1 1 1 Children's Mercy's Family Health Partners C 19008394 Book Children's Mercy Pediatric Care Network P 6305467 Book Children's Mercy Pediatric Care Network J 187351 Book Children's Mercy Pediatric Care Network L 822601 Book Children's Mercy Pediatric Care Network S 98903 Book Children's Mercy Pediatric Care Network B 18986475 Book