2013-10-28T09:30:57-05:00 2012-06-30 135565207 KPMG LLP Two Central Park Plaza Suite 1501 Omaha NE 681021626 990 2011-07-01 440605373 The Children's Mercy Hospital CHIL 8162343000 2401 Gillham Road Kansas City MO 64108 Sandra AJ Lawrence 8162343000 2013-10-25 1 P00223617 4023481450 2011 2016-03-07 17:11:31Z X Sandra AJ Lawrence 2401 Gillham Road Kansas City MO 64108 873546821 0 X www.childrensmercy.org X 1901 MO Excellence in healthcare for children 14 9 6721 526 50566 -314046 26781980 28096636 772728245 831584151 1839740 938906 15480791 12617270 816830756 873236963 15992712 13089408 0 0 477094190 496964073 0 0 3077053 310580520 323354663 803667422 833408144 13163334 39828819 915564338 1038666908 396259169 372156824 519305169 666510084 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 681184693 13089408 831584151 All expenses for program services relate to providing healthcare. There were a total of 319 licensed beds and 76,829 patient days during the year from 13,397 admissions. Outpatient encounters were 661,332 from 189,399 individual patients.The Children's Mercy Hospital (the Hospital) consists of a 265-bed teaching hospital for children located in Kansas City, Missouri, and a 54-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. 681184693 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 1 0 0 0 1 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 0 0 1 382 0 6721 1 1 1 0 0 0 0 1 1 0 0 0 0 X 14 9 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 Page Branton Reed 1.00 X X 0 0 0 John Ovel 1.00 X X 0 0 0 Jon Zindel 1.00 X X 0 0 0 Peggy Dunn 1.00 X X 0 0 0 Edward M Connolly Jr 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 Johnathon Baum 1.00 X 0 0 0 Debbie Sosland-Edelman 1.00 X 0 0 0 Gerald Woods MD 40.00 X 305136 0 28986 Milton Fowler MD 40.00 X 325165 0 28986 Randall L O'Donnell PhD 40.00 X X 1372352 0 679105 Charles Roberts MD 40.00 X 611409 0 24882 Sandra AJ Lawrence 40.00 X 579504 0 28986 Karen S Cox RN PhD FAAN 40.00 X 509804 0 24654 Jo Stueve 40.00 X 493988 0 24654 Michael Artman 40.00 X 488011 0 14286 James O'Brien Jr MD 40.00 X 797211 0 28986 Walter S Andrews MD 40.00 X 781780 0 28986 Ronald J Sharp MD 40.00 X 736659 0 24654 Gary K Lofland MD 40.00 X 1217822 0 28986 Richard A Hopkins MD 40.00 X 801451 0 28986 9020292 0 995137 1265 0 1 0 JE Dunn Construction Company 1101 Locust Street Kansas City MO 64106 Construction 33558314 Anesthesia Associates 8717 West 110th Street Overland Park KS 66210 Anesthesiologists 23618265 Sodexho Marriott Services Inc 4880 Paysphere Circle Chicago IL 60674 Food Services 7273266 McCown Gordon Construction 422 Admiral Boulevard Kansas City MO 64106 Construction 6291056 Turner Construction 2345 Grand Boulevard Kansas City MO 64108 Construction 5015012 355 1053271 668589 9172296 11028695 6173785 190623 28096636 Net Patient Services 621110 831584151 831584151 831584151 946026 946026 6048 13168 -7120 -7120 -7120 205940 668589 296690 -90750 -90750 Cafeteria 722210 4517886 4517886 Transport 621910 2082040 2082040 Reinsurance 524298 1520185 1520185 4587909 4537343 50566 12708020 873236963 844234485 50566 855276 223035 223035 12866373 12866373 8396468 5228154 3168314 398440051 333698272 62539454 2202325 17834773 14857751 2880477 96545 44935413 34930447 9777660 227306 27357368 22790813 4418462 148093 1241425 1241425 305892 307 305585 78862930 60619738 18202693 40499 3171363 810315 2290706 70342 11826771 4717698 7072350 36723 4611445 3540290 1033358 37797 14744157 14744157 48712706 22902559 25699973 110174 8456232 6260975 2195257 Medical Supplies 85515231 81908661 3567032 39538 State Medicaid Taxes 33843131 33843131 0 0 Bad Debt 19207104 19207104 0 0 Food Services 5643450 5433986 198566 10898 7212826 2600927 4555086 56813 833408144 681184693 149146398 3077053 43246010 137629234 145554603 26663954 19704716 11119836 120868360 119523013 7239674 7962329 6690006 8737772 813165033 357974499 419306670 455190534 65113757 212035399 62611787 33118234 25228755 26686603 915564338 1038666908 106192809 109038981 245769062 201913263 366624 105071 43930674 61099509 396259169 372156824 X 473375598 624145095 45929571 42364989 519305169 666510084 915564338 1038666908 X 39828819 107376096 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 467864 467864 680716829 681184693 1000000 250000 0 0 1000000 1000000 1000000 1000000 4000000 6000000 290191 344415 405207 467864 1507677 250000 250000 250000 250000 1000000 1500000 3000 3000 41124198 755549 -1440270 1831768 38607709 35713462 695711 6607520 1892495 41124198 33889964 317605 3237589 1731696 35713462 42887302 416385 -7597819 1815904 33889964 0.00000 0.99310 0.00690 0 1 1 14212420 14212420 392081393 143066818 249014575 307804279 214907681 92896598 99066941 99066941 455190534 Reserve for Professional Liability Claims 36532903 Deferred Lease Incentive 2690566 Postretirement Medical Liability 21876040 61099509 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: 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, 2012 and 2011, there were no uncertain tax positions. North America 0 0 Program Services Travel for healthcare-related education and information sharing 45891 Central America & the Caribbean 0 0 Program Services Travel for healthcare-related education and information sharing 3987 Europe 0 0 Program Services Travel for healthcare-related education and information sharing 20542 East Asia & the Pacific 0 0 Program Services Travel for healthcare-related education and information sharing 38100 Middle East & North Africa 0 0 Program Services Travel for healthcare-related education and information sharing 1741 South Asia 0 0 Program Services Travel for healthcare-related education and information sharing 3672 Sub-Saharan Africa 0 0 Program Services Travel for healthcare-related education and information sharing 9836 0 0 0 0 0 0 123769 0 123769 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 874529 668589 205940 10722 154891 12000 119077 874529 668589 205940 10722 154891 12000 119077 296690 -90750 1 1 X 1 X 300.000000000000 1 X 500.000000000000 1 1 0 1 1 1 8879 12752973 1687394 11065579 0.01360 3 285372 459927610 353351240 106576370 0.13090 3 1777 9487928 6109746 3378182 0.00410 7 296028 482168511 361148380 121020131 0.14860 22 270178 3161937 210650 2951287 0.00360 61 5535 33500427 13240446 20259981 0.02490 5 138513 63524064 54413093 9110971 0.01120 187 910 10450689 0 10450689 0.01280 73 67011 328414 0 328414 0.00040 348 482147 110965531 67864189 43101342 0.05290 355 778175 593134042 429012569 164121473 0.20150 1 1245244 0 1245244 0.00150 1 180 97032 0 97032 0.00010 5 1158 222949 0 222949 0.00030 4 893 211290 0 211290 0.00030 54 144327 0 144327 0.00020 3 292 52062 0 52062 0.00010 68 2523 1972904 1972904 0.00250 0 19207104 0 2850253 2680883 169370 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 2 Children's Mercy South

5808 W 110th Overland Park KS 66211

X X X X X Specialty Clinics The Children's Mercy Hospital 1 1 1 300.000000000000 1 500.000000000000 1 X X X X X X X 1 1 X 1 0 1 X 0 0 Children's Mercy South 2 1 1 300.000000000000 1 500.000000000000 1 X X X X X X X 1 1 X 1 0 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

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 CMH Endocrinology - Springfield

1443 N Robberson Suite 308 Springfield MO 65802

Outreach Clinic 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 Gastroeneterolgy - Springfield

1965 S Fremont Ave Springfield MO 65804

Outreach Clinic CMH Endocrinology - Joplin

2203 W 32nd St Joplin MO 64804

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 - Pittsburg

1102 E Centennial Pittsburg KS 66762

Outreach Clinic CMH Endocrinology - Parsons

1902 S US Highway 59 Parsons KS 67357

Outreach Clinic CMH Endocrinology - Salina

400 S Santa Fe Ave Salina KS 67401

Outreach Clinic CMH Cardiology - Joplin

3020 S St Johns Blvd Suite A Joplin MO 64804

Outreach Clinic CMH Nephrology - Wichita

818 N Emporia Suite 310 Wichita KS 67214

Outreach Clinic CMH Cardiology - St Joseph

902 N Riverside Rd Suite 100 St Joseph MO 64506

Outreach Clinic CMH Orthopaedic Surgery - Wichita

2778 N Webb Rd Wichita KS 67226

Outreach Clinic CMH Gastroeneterolgy - Joplin

3333 McIntosh Dr Suite 6 Joplin MO 64804

Outreach Clinic CMH HematologyOncology - Wichita

9211 E 21st St N Wichita KS 67206

Outreach Clinic CMH Rheumatolgy - Springfield

1965 S Fremont Ave Springfield MO 65804

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 Gastroeneterolgy - Salina

400 S Santa Fe Ave Salina KS 67401

Outreach Clinic CMH Nephrology - Joplin

3333 McIntosh Dr Suite 6 Joplin MO 64804

Outreach Clinic CMH HematologyOncology - Springfield

1965 S Fremont Ave Springfield MO 65804

Outreach Clinic CMH Endocrinology - Hays

2214 Canterbury Dr Suite 204 Hays KS 67601

Outreach Clinic CMH Orthopaedic Surgery - Salina

520 S Santa Fe Ave Salina KS 67401

Outreach Clinic CMH Endocrinology - Great Bend

3515 Broadway Ave Great Bend KS 67530

Outreach Clinic CMH Orthopaedic Surgery - Springfield

3800 S National Ave Suite 200 Springfield MO 65807

Outreach Clinic CMH Oncology - Joplin

3333 McIntosh Dr Suite 6 Joplin MO 64804

Outreach Clinic CMH Endocrinology - St Joseph

902 N Riverside Rd Suite 100 St Joseph MO 64506

Outreach Clinic Children's Mercy Wichita

9825 Shannon Woods Wichita KS 67226

Temporary Outpatient Clinic CMH Urology - Wichita

6837 W 37th St North Bldg 1 Wichita KS 67205

Outreach Clinic CMH Genetics - Cillicothe

100 Central Ave Chillicothe MO 64061

Outreach Clinic CMH Hematology - Dodge City

2020 Central Dodge City KS 67801

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, home care, diagnostics, inpatient admissions and emergency services. The organization also operates a clinic within an inner city day care center serving 600 children daily, and a dedicated clinic named Children's Mercy West 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), but subtracted for purposes of calculating the percentage in this column is $ 19207104. Part I, Line 7, Column (f) The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $19,207,104. 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 health. 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 renovation of Hospital Hill Park, Community Supported Agriculture (CSA), Intensive Care Nursery Family Group, Hematology/Oncology Family Group 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. The Children's Mercy Hospital Part V, Section B, Line 13g: Flyers and business cards are available at all access points within the Hospital. All self pay patients and families are contacted by a financial counselor, 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. Children's Mercy South Part V, Section B, Line 13g: Flyers and business cards are available at all access points within the Hospital. All self pay patients and families are contacted by a financial counselor, 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. The Children's Mercy Hospital Part V, Section B, Line 19d: A blended rate from Commercial and Governmental payers is determined annually for our self-pay discount. Children's Mercy South Part V, Section B, Line 19d: A blended rate from Commercial and Governmental payers is determined annually for our self-pay discount. Part VI, Line 2: Children's Mercy has organized a dedicated Community Health Needs Assessment Advisory Committee that began meeting towards the end of 2011, which includes broad representation from the organization that spans across various clinical and administrative functions (27 current members). The sole purpose of this committee is to create the processes and infrastructure needed to regularly identify Community Health Needs and identify strategies to address them. As a result of the committee's work, Children's Mercy has partnered with Professional Research Consultants, Inc. to conduct the first pediatric-specific Community Health Needs Assessment and is currently in the process of finalizing the project and adopting said implementation strategies. Shortly after, the results of the year-long project will be communicated broadly. In addition, the Community Health Needs Assessment work is now directed by the Strategic Planning department to ensure ongoing alignment and incorporate Community Health Needs into the organizations regular planning processes. Part VI, Line 3: Flyers and business cards are available at all access points within the Hospital. All self pay patients and families are contacted by a financial counselor, 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. Approximately 74% of the total number of patients we encounter reside in these 4 counties alone. This is broken down by both encounters and percent of total as follows: Jackson County, MO (234,182 encounters and 37.2% of total); Clay County, MO (65,701 encounters and 10.4% of total); Johnson County, KS (103,696 encounters and 16.50% of total); and Wyandotte County, KS (59,693 encounters and 9.5% of total). 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 (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 VI, Line 7: The Children's Mercy Hospital did not file a community benefit report in any states. 1 Boys & Girls Club of Greater Kansas City 6301 Rockhill Road Kansas City MO 64131 436072065 501(c)3 9500 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 5300 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 7400 Support diabetes research and research-related education March of Dimes 4400 College Blvd Ste 180 Overland Park KS 66211 131846366 501(c)3 31300 Support programs that improve the health of mothers and babies Missouri Physicians Health 113 Madison Street Jefferson City MO 65102 431572458 501(c)3 7000 Provide quality continuing medical education for Missouri physicians 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 20200 Provide comfort and care for families seeking life-saving medical treatment for children 7 0 Medical Residency 37 113400 Patient Financial Assistance 8879 12752973 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 301729 0 0 0 3407 0 14700 0 14501 0 334337 0 0 0 Milton Fowler MD 322673 0 0 0 2492 0 14700 0 14487 0 354352 0 0 0 Randall L O'Donnell PhD 1039782 0 250000 0 82570 0 664819 0 14629 0 2051800 0 0 0 Charles Roberts MD 493908 0 93438 0 24063 0 14700 0 10525 0 636634 0 0 0 Sandra AJ Lawrence 466106 0 91657 0 21741 0 14700 0 14629 0 608833 0 0 0 Karen S Cox RN PhD FAAN 399532 0 73186 0 37086 0 14700 0 11306 0 535810 0 0 0 Jo Stueve 397345 0 73182 0 23461 0 14700 0 10247 0 518935 0 0 0 Michael Artman 483913 0 0 0 4098 0 0 0 14613 0 502624 0 0 0 James O'Brien Jr MD 778002 0 0 0 19209 0 14700 0 14629 0 826540 0 0 0 Walter S Andrews MD 760696 0 0 0 21084 0 14700 0 14629 0 811109 0 0 0 Ronald J Sharp MD 711402 0 0 0 25257 0 14700 0 10297 0 761656 0 0 0 Gary K Lofland MD 1196957 0 0 0 20865 0 14700 0 14629 0 1247151 0 0 0 Richard A Hopkins MD 780328 0 0 0 21123 0 14700 0 14629 0 830780 0 0 0 Part I, Line 4b A Supplemental Executive Retirement Plan (SERP) was made available to President & CEO, Randall O'Donnell, Ph.D. $423,402 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. Health and Educational Facilities Authority of the State of Missouri 431178966 60635RC62 2002-06-13 50000000 See Part VI 0 0 0 Health and Educational Facilities Authority of the State of Missouri 431178966 60635RC88 2003-06-05 27500000 Refund 1993 Bonds June 5, 2003 0 0 0 Health and Educational Facilities Authority of the State of Missouri 431178966 60635HH85 2009-11-15 178852416 See Part VI 0 0 0 44675000 46000000 1225608 2004 1 0 1 1 5225000 25550000 709028 1995 1 0 1 1 4465000 178852416 76208017 3940002 1 0 0 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 1 1 UBS AG 30.900000000000 0 0 0 0 0 0 1 1 UBS AG 20.900000000000 0 0 0 0 0 0 0 0 0 0 0 X Schedule K, Part I, Row A, Column (f) Bond Issue, Description of Purpose 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 I, Row C, 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. Construction is expected to begin on this facility in 2011 and proceeds of the Bonds are expected to be used to fund $15 million of the costs of this facility. 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. Peggy Dunn Secretary JE Dunn, More than 35% owned by family member 33558314 Construction 0 Margi Pence Director Hallmark Cards, More than 35% owned by family member 899289 Rental Property; Payments made to Kessington/Hunter Mgmt Co and Crown Center Parking 0 X 0 N/A X 0 N/A X 16 190623 FMV X 1 112548 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 Emergency Department at Children's Mercy South in Overland Park, Kansas In response to the growing number of patients we are serving from the State of Kansas, we opened the state's first pediatric emergency room program at our Overland Park hospital. The patient population being served by this program continues to grow, which means access to pediatric emergency room service has been substantially improved. Johnson County, Kansas, Urgent Care Also in pursuit of improved access, we moved our hospital-based urgent care program to a new facility on College Boulevard in Johnson County, Kansas. The program continues to be the community's only pediatric hospital-operated urgent care service, and cares for the health of a growing number of pediatric patients from Eastern Kansas and Western Missouri. Fetal Health Care Expansion The hospital expanded its capacity to manage the births of at-risk babies by moving to a newly constructed facility where larger numbers of at-risk births can be accommodated. The facility includes a newly constructed skywalk that connects our Fetal Health operating rooms and birthing centers directly to the operating rooms at Truman Medical Center. The skywalk permits Truman babies delivered during unexpected troubled births to be brought immediately for treatment at Children's Mercy. Conversely, if a well mother giving birth at our Fetal Health Center encounters unexpected challenges, that mom can be taken immediately to the operating room at Truman, where physicians trained in treating the body of an adult experiencing a health crisis are on duty 24 hours a day. Wichita, Kansas Outreach Greater access to nephrology and endocrinology pediatric programs occurred as we hired two full-time medical doctors and support staff to serve pediatric patients who reside in central and southwest Kansas. Negotiations got underway for the consolidation of outreach services in that part of the state by establishing a facility and a presence there, so a growing number of pediatric patients can be better served. Expanded Primary Care Greater access to primary care physicians, particularly for the Medicaid population, became the result of moving our Primary Care Clinic from the hospital's main campus at 24th and Gillham to a facility we purchased and renovated at 31st and Broadway in Kansas City, Missouri. As a result of this move, greater efficiencies were enabled on the campus itself so larger numbers of patients can gain access to vital programs. Patient Transport Technologies The hospital made a significant commitment to the purchase of additional transportation vehicles, including fixed-wing aircraft, thus improving the efficiency and safety for patients who are transported by the only pediatric-customized ambulances, helicopters, and aircraft available between Denver and St. Louis. 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 Form 990, Part XI, Line 5 Change in unrealized gains on investments: 2,761,567 Tax reversal of Friends of Children's Mercy 289,638 Change in benefit obligations (365,193) Tax reversal of unrealized loss (20,230,767) Intercompnay transfers 124,920,851 Total to Form 990, Part XI, Line 5 107,376,096 Description of Amendments Schedule H, Part I, Line 7f, Columns (a) through (f) The health professions education portion of the Other Benefits category was previously understated by $18,650,742 in net expenses due to a formula error in Community Benefit data. This understatement has been corrected, along with the understatement of columns (a) through (e) as well, and all corrections are reflected in Schedule H, Part I accordingly. CMH Insurance Company LLC 1000 Bank Street Suite 100 Burlington VT 05401 Insurance for The Children's Mercy Hospital VT 78991 8370648 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-FI 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 48846125 12513805 1.00000 0 1 1 0 1 0 0 0 1 0 1 0 1 1 1 1 1 1 Children's Mercy's Family Health Partners P 8402522 Book Children's Mercy's Family Health Partners I 227984 Book Children's Mercy's Family Health Partners K 2426853 Book Children's Mercy's Family Health Partners C 123904217 Book Children's Mercy Hospital Self-Insurance Trust Q 5550000 Cash Children's Mercy Pediatric Care Network P 3354586 Book Children's Mercy Pediatric Care Network I 93675 Book Children's Mercy Pediatric Care Network K 345866 Book Children's Mercy Pediatric Care Network B 1016638 Book Children's Mercy's Family Health Partners R 682589 Book Children's Mercy Pediatric Care Network R 146164 Book