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MERCY KANSAS COMMUNITIES INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
MERCY KANSAS COMMUNITIES INC (EIN 48-0956045)
Tax period
2011-07-01 to 2012-06-30
Filed
2013-05-23
IRS object ID
201321439349300627
Schema version
2011v1.5
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-05-23T15:19:26-05:00Timestamp
Tax Period End Date2012-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1ERNST & YOUNG US LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1190 CARONDELET PLAZA SUITE 1300AddressLine1
CityCLAYTONCity
StateMOState
ZIP Code63105ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN480956045EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1MERCY KANSAS COMMUNITIES INCBusinessNameLine1
FieldValueIRS element (for citing)
In Care Of Name% TERRI FLOYDInCareOfName
Name ControlMERCNameControl
Phone3145796100Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1401 Woodland Hills BlvdAddressLine1
CityFort ScottCity
StateKSState
ZIP Code66701ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameTerri FloydName
TitleVP FinanceTitle
Date Signed2013-05-13DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
Phone3142901000Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonTerri FloydNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1401 Woodland Hills BlvdAddressLine1
CityFort ScottCity
StateKSState
ZIP Code66701ZIPCode
FieldValueIRS element (for citing)
Gross Receipts75186631GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Group Exemption Number0928GroupExemptionNumber
Organization501c3XOrganization501c3
Web Sitewww.mercy.netWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1983YearFormation
State Legal DomicileKSStateLegalDomicile
Activity Or Mission DescriptionAS THE SISTERS OF MERCY BEFORE US, WE BRING TO LIFE THE HEALING MINISTRY OF JESUS THROUGH OUR COMPASSIONATE CARE AND EXCEPTIONAL SERVICE.ActivityOrMissionDescription
Nbr Voting Members Governing Body8NbrVotingMembersGoverningBody
Nbr Independent Voting Members3NbrIndependentVotingMembers
Total Nbr Employees787TotalNbrEmployees
Total Nbr Volunteers247TotalNbrVolunteers
Total Gross UBI460882TotalGrossUBI
Net Unrelated Business Txbl Income154853NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year102704ContributionsGrantsPriorYear
Contributions Grants Current Year103245ContributionsGrantsCurrentYear
Program Service Revenue Prior Year68225460ProgramServiceRevenuePriorYear
Program Service Revenue CY74019979ProgramServiceRevenueCY
Investment Income Prior Year200806InvestmentIncomePriorYear
Investment Income Current Year56432InvestmentIncomeCurrentYear
Other Revenue Prior Year2791805OtherRevenuePriorYear
Other Revenue Current Year1006975OtherRevenueCurrentYear
Total Revenue Prior Year71320775TotalRevenuePriorYear
Total Revenue Current Year75186631TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year45402GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY23240GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year36790572SalariesEtcPriorYear
Salaries Etc Current Year39063795SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year33142122OtherExpensePriorYear
Other Expenses Current Year33622095OtherExpensesCurrentYear
Total Expenses Prior Year69978096TotalExpensesPriorYear
Total Expenses Current Year72709130TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1342679RevenuesLessExpensesPriorYear
Revenues Less Expenses CY2477501RevenuesLessExpensesCY
Total Assets BOY69903945TotalAssetsBOY
Total Assets EOY71963658TotalAssetsEOY
Total Liabilities BOY12805173TotalLiabilitiesBOY
Total Liabilities EOY12387385TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY57098772NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY59576273NetAssetsOrFundBalancesEOY
Mission DescriptionAS THE SISTERS OF MERCY BEFORE US, WE BRING TO LIFE THE HEALING MINISTRY OF JESUS THROUGH OUR COMPASSIONATE CARE AND EXCEPTIONAL SERVICE.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense14600628Expense
Grants1550Grants
Revenue26270844Revenue
DescriptionMercy Hospital - Independence - Health care services provided are essential to the health and well-being of the individuals residing in the city of Independence and Montgomery county. The hospital provides basic primary care services which include: inpatient acute, swing bed, emergency room, general surgery, outpatient diagnostic, outpatient physical therapy and home health services. The community need is represented by the approximate 1072 discharges, 8867 emergency room visits, 1790 surgeries, 6964 home health visits and numerous outpatient procedures. Necessary tertiary care is transported out of the community to a larger hospital.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense19736776Expense
Grants12326Grants
Revenue36118437Revenue
DescriptionMercy Hospital - Fort Scott - Healthcare services provided are essential to the health and well-being of the individuals residing in the City of Fort Scott and Bourbon county. The hospital provides basic primary care services which include; inpatient acute, swing bed, inpatient rehab, emergency room, general surgery, outpatient diagnostic, outpatient physical therapy and home health services. The community need is represented by the approximate 1871 discharges, 6482 emergency room visits, 2169 surgeries, 8532 home health visits and numerous outpatient procedures. Necessary tertiary care is transported out of the community to a larger hospital.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense13875307Expense
Grants9364Grants
Revenue12056794Revenue
DescriptionMercy Physician Group - Fort Scott / Independence - Local physician services are essential to the health and well-being of the communities. The integrated physician group consists of the following mix of specialties: family practice, internal medicine, OB/GYN, general surgery, orthopedics and midlevel providers.Description
FieldValueIRS element (for citing)
Total Program Service Expense48212711TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredfalseScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MembertrueBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshptrueOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transaction Related EntitytrueTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Info In Schedule O Part VXInfoInScheduleOPartV
Number Forms Transmitted With10965NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees787NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncometrueUnrelatedBusinessIncome
Form990-T FiledtrueForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members8NbrVotingGoverningBodyMembers
Number Independent Voting Members3NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodyfalseForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOfalseCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonTERRI FLOYDNamePerson
Telephone Number6202237057TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1401 WOODLAND HILLS BLVDAddressLine1
CityFort ScottCity
StateKSState
ZIP Code66701ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (21 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
Sr Annrene Brau RSM
Board member1.0X000
Dottie Bringle
COO/Chief Nursing Officer60.0X028573743267
Patrick Callanan
VP- Patient Care Services60.0X154261011043
Sharon Campbell
Board member1.0X000
Terri Floyd
VP Finance60.0X022432941314
Jim Kelly
Board member1.0X000
Christopher Lewis
Physician60.0X324408023849
Robert Nichols MD
Physician60.0X273840042065
Gary Pulsipher
Chief executive officer60.00455036161622X
Carl Ammons
President-MH Independence60.0020795825808X
Reta Baker
Pres.-Mercy Hosp Fort Scott60.0028161064583X
Shelly Hunter
Chief financial officer60.0024251034525X
Bradley Kim Day
President, central communities60.00833159436266X
Michael Merrigan
Regional VP-General Counsel60.0032092365228X
Tanya Marion
Regional VP-Human Resources60.0016039116041X
William Hennessey III
Regional VP-Marketing/Comm60.0028054447347X
John Fox
Physician40.0452327024101X
Roger Parris
Physician40.0412177035626X
David Phelps
Physician40.0381486042599X
Larry Seals
Physician40.0476153024251X
Soheila Sohaei
Physician40.0476239017366X
FieldValueIRS element (for citing)
Total Reportable Comp From Org2950891TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs3292197TotalReportableCompFrmRltdOrgs
Total Other Compensation1156901TotalOtherCompensation
Number Individuals GT100 K36NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Acute Care Inc
1609 N Ankeny Blvd Ste 200ANKEYIA50023ER coverage1432489
SODEXO INC AND AFFILIATES
4880 PAYSPHERE CIRCHICAGOIL60674FOOD SERVICE LABOR967587
GENERAL ANESTHESIA SERVICE PA
PO BOX 263FORT SCOTTKS66701ANESTHETIC SERVICES768027
QUEST DIAGNOSTICS
PO BOX 740709ATLANTAGA30374LAB SERVICES256337
PATRICK J WOOD CONSTRUCTION
1254 240th StreetFORT SCOTTKS66701Construction251493
FieldValueIRS element (for citing)
Number Of Contractors GT100 K12NumberOfContractorsGT100K
Government Grants103245GovernmentGrants
Total Contributions103245TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
NET PATIENT SERVICE REVENUE-INDEPENDENCE6221101805838918058389
NET PATIENT SERVICE REVENUE-FORT SCOTT6221102402281224022812
NET PATIENT SERVICE REVENUE-MERCY CLINICS62211095772529577252
REFERENCE LAB6215002184472721599602245125
OTHER OPERATING REVENUE900099516799516799
FieldValueIRS element (for citing)
Total Program Service Revenue74019979TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column46614TotalRevenueColumn
Exclusion$46,614ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real365122Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real365122Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column365122TotalRevenueColumn
Exclusion$365,122ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other9818Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other9818Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column9818TotalRevenueColumn
Exclusion$9,818ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
CAFETERIA & VENDING722212586540586540
ALLOCATIONS/TRANSFERS AND FITNESS CENTER713940-2069-217826215757
MEDICAL TRANSCRIPTION FEES5614105738257382
FieldValueIRS element (for citing)
Total Other Revenue641853TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column75186631TotalRevenueColumn
Related Or Exempt Function Income74200950RelatedOrExemptFunctionIncome
Unrelated Business Revenue460882UnrelatedBusinessRevenue
Exclusion$421,554ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total23240Total
Program Services23240ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total859424Total
Program Services859424ProgramServices

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total182098Total
Program Services182098ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total30518792Total
Program Services25810632ProgramServices
Management And General4708160ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1350539Total
Program Services21172ProgramServices
Management And General1329367ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total4188990Total
Program Services610369ProgramServices
Management And General3578621ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1963952Total
Program Services324259ProgramServices
Management And General1639693ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total26257Total
Management And General26257ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total0Total

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total3317558Total
Program Services2671978ProgramServices
Management And General645580ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total386883Total
Program Services154378ProgramServices
Management And General232505ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total1688223Total
Program Services1162385ProgramServices
Management And General525838ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total16458Total
Program Services10058ProgramServices
Management And General6400ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1602858Total
Program Services442947ProgramServices
Management And General1159911ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total54748Total
Program Services38509ProgramServices
Management And General16239ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total19242Total
Program Services15029ProgramServices
Management And General4213ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total1394Total
Management And General1394ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total3618086Total
Program Services1707257ProgramServices
Management And General1910829ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total728844Total
Program Services394180ProgramServices
Management And General334664ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
BAD DEBT EXPENSE46509874650987
REPAIR & MAINTENANCE628212128247499965
SHARED SERVICE FEES1138825823490469039212
MEDICAL SUPPLIES53791305379130

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total114957Total
Program Services1277386ProgramServices
Management And General-1162429ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total72709130Total
Program Services48212711ProgramServices
Management And General24496419ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY24667034BOY
EOY24625465EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY3841828BOY
EOY4445428EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY740275BOY
EOY252144EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY1250401BOY
EOY1317498EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY619165BOY
EOY586647EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis107278988LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec68221913LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY38701379BOY
EOY39057075EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY177000EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY83863BOY
EOY1502401EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY69903945BOY
EOY71963658EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY12805173BOY
EOY10120463EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY2266922EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY12805173BOY
EOY12387385EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY56682384BOY
EOY59193221EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY416388BOY
EOY383052EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY57098772BOY
EOY59576273EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY69903945BOY
EOY71963658EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses2477501ReconcilationRevenueExpenses
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredtrueFederalGrantAuditRequired
Federal Grant Audit PerformedtrueFederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbying
Total Direct LobbyingTotalDirectLobbying
Total Lobbying ExpendituresTotalLobbyingExpenditures
Other Exempt Purpose ExpendituresOtherExemptPurposeExpenditures
Total Exempt Purpose ExpendituresTotalExemptPurposeExpenditures
Lobbying NontaxableLobbyingNontaxableAmount
Grassroots NontaxableGrassrootsNontaxableAmount
Tot Lobbying Grassroot Minus Non TxTotLobbyingGrassrootMinusNonTx
Tot Lobby Expend Mns Lobbying NontxTotLobbyExpendMnsLobbyingNontx
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationsfalseGrantsOtherOrganizations
Direct Contact LegislatorsfalseDirectContactLegislators
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiestrueOtherActivities
Other Activities$12,170OtherActivitiesAmount
Total Lobbying Expenditures IIB12170TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3
Form4720 Filed4912 TaxfalseForm4720Filed4912Tax

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierFORM 990, SCHEDULE C, PART II-B, LINE 1(I)Identifier
Return ReferenceSupplemental Lobbying InformationReturnReference
ExplanationTHE FILING ORGANIZATION IS A MEMBER OF AND PAYS DUES TO THE FOLLOWING HOSPITAL ASSOCIATIONS: AMERICAN HOSPITAL ASSOCIATION, KANSAS HOSPITAL ASSOCIATION, AND CATHOLIC HEALTH ASSOCIATION. FOR THE YEAR ENDED JUNE 30, 2012, DUES WERE $14,723, $53,090.52 AND $11,340.97, RESPECTIVELY. APPROXIMATELY 24.6% OF AMERICAN HOSPITAL ASSOCIATION DUES, 15% OF KANSAS HOSPITAL ASSOCIATION DUES, AND 5.15% OF CATHOLIC HEALTH ASSOCIATION DUES WERE ATTRIBUTABLE TO LOBBYING ACTIVITIES PERFORMED BY THESE ASSOCIATIONS.Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts
Current Year Minus3 YearsCurrentYearMinus3Years

Land Land

FieldValueIRS element (for citing)
Investment Cost Or Other Basis0InvestmentCostOrOtherBasis
Other Cost Or Other Basis1194518OtherCostOrOtherBasis
Book Value1194518BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Investment Cost Or Other Basis0InvestmentCostOrOtherBasis
Other Cost Or Other Basis59066095OtherCostOrOtherBasis
Depreciation29495290Depreciation
Book Value29570805BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Investment Cost Or Other Basis0InvestmentCostOrOtherBasis
Other Cost Or Other Basis974996OtherCostOrOtherBasis
Depreciation313193Depreciation
Book Value661803BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Investment Cost Or Other Basis0InvestmentCostOrOtherBasis
Other Cost Or Other Basis43777664OtherCostOrOtherBasis
Depreciation36987701Depreciation
Book Value6789963BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Investment Cost Or Other Basis0InvestmentCostOrOtherBasis
Other Cost Or Other Basis2265715OtherCostOrOtherBasis
Depreciation1425729Depreciation
Book Value839986BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings39057075TotalOfBookValueLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (6 entries)

DescriptionDescriptionAmountAmount
INVESTMENT IN MERCY COMMUNITY SERV$1,167,544
INVESTMENT IN ABANDON PROPERTIES$702,631
LT DISABILITY RESERVES$104,050
WORKERS COMPENSATION RESERVE$84,256
LT SMRP LIABILITY$81,282
EXEC SAVINGS PAYABLE$127,159
FieldValueIRS element (for citing)
Total Of Amounts2266922TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierFORM 990, SCHEDULE D, PART X, LINE 2Identifier
Return ReferenceASC 740 FOOTNOTEReturnReference
ExplanationTHE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF MERCY HEALTH AND AFFILIATES DO NOT INCLUDE A FOOTNOTE TO REPORT THE ORGANIZATION'S LIABILITY FOR UNCERTAIN TAX PROVISIONS UNDER ASC 740, AS THEY ARE DEEMED IMMATERIAL FOR DISCLOSURE.Explanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent100XPcent100
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare
Pcent400XPcent400
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgettrueExpensesExceededBudget
Unable To Provide CarefalseUnableToProvideCare
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense2651068TotalCommunityBenefitExpense
Net Community Benefit Expense2651068NetCommunityBenefitExpense
Percent Of Total Expense0.03890PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense2300356TotalCommunityBenefitExpense
Net Community Benefit Expense2300356NetCommunityBenefitExpense
Percent Of Total Expense0.03380PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense4951424TotalCommunityBenefitExpense
Net Community Benefit Expense4951424NetCommunityBenefitExpense
Percent Of Total Expense0.07270PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense179727TotalCommunityBenefitExpense
Direct Offsetting Revenue32318DirectOffsettingRevenue
Net Community Benefit Expense147409NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense78912TotalCommunityBenefitExpense
Net Community Benefit Expense78912NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense9675TotalCommunityBenefitExpense
Direct Offsetting Revenue1062DirectOffsettingRevenue
Net Community Benefit Expense8613NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense16480TotalCommunityBenefitExpense
Net Community Benefit Expense16480NetCommunityBenefitExpense
Percent Of Total Expense0.00020PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense284794TotalCommunityBenefitExpense
Direct Offsetting Revenue33380DirectOffsettingRevenue
Net Community Benefit Expense251414NetCommunityBenefitExpense
Percent Of Total Expense0.00020PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense5236218TotalCommunityBenefitExpense
Direct Offsetting Revenue33380DirectOffsettingRevenue
Net Community Benefit Expense5202838NetCommunityBenefitExpense
Percent Of Total Expense0.07290PercentOfTotalExpense

Economic Development EconomicDevelopment

FieldValueIRS element (for citing)
Total Community Building Expense575TotalCommunityBuildingExpense
Net Community Building Expense575NetCommunityBuildingExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Total Community Building Expense21209TotalCommunityBuildingExpense
Net Community Building Expense21209NetCommunityBuildingExpense
Percent Of Total Expense0.00030PercentOfTotalExpense

Leadership Development LeadershipDevelopment

FieldValueIRS element (for citing)
Total Community Building Expense138TotalCommunityBuildingExpense
Net Community Building Expense138NetCommunityBuildingExpense

Coalition Building CoalitionBuilding

FieldValueIRS element (for citing)
Total Community Building Expense1638TotalCommunityBuildingExpense
Net Community Building Expense1638NetCommunityBuildingExpense

Health Improvement Advocacy HealthImprovementAdvocacy

FieldValueIRS element (for citing)
Total Community Building Expense1002TotalCommunityBuildingExpense
Net Community Building Expense1002NetCommunityBuildingExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense24562TotalCommunityBuildingExpense
Net Community Building Expense24562NetCommunityBuildingExpense
Percent Of Total Expense0.00030PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$1,566,507BadDebtExpenseAmount
Amount Reimbursed By Medicare20858708AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare21498185CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-639477MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare
Number Of Hospital Facilities2NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA (2 entries)

Facility NumberFacilityNumberAddress Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeLicensed HospitalLicensedHospitalGeneral Medical And SurgicalGeneralMedicalAndSurgicalEr24 HoursEr24Hours
MERCY HOSPITAL FORT SCOTT
1401 Woodland Hills BlvdFort ScottKS66701XXX
MERCY HOSPITAL INDEPENDENCE
2800 W MyrtleIndependenceKS67301XXX

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB (2 entries)

Hospital Facility NumberHospitalFacilityNumberEligibility Criteria ExplainedEligibilityCriteriaExplainedUses FPG FreeUsesFPGFreeFPG Free PercentFPGFreePercentUses FPG DiscountedUsesFPGDiscountedFPG Discount PercentFPGDiscountPercentExplains BasisExplainsBasisIncome LevelIncomeLevelAsset LevelAssetLevelMedical IndigencyMedicalIndigencyExplains Application MethodExplainsApplicationMethodIncludes Publicity MeasuresIncludesPublicityMeasuresPosted On WebsitePostedOnWebsitePosted In Emergency RoomPostedInEmergencyRoomPosted In Admission OfficePostedInAdmissionOfficeAvailable On RequestAvailableOnRequestActions On NonpaymentActionsOnNonpaymentCollection ActivitiesCollectionActivitiesNondiscrim Emergency Care PolicyNondiscrimEmergencyCarePolicyUsed Other MethodUsedOtherMethodAmounts Generally BilledAmountsGenerallyBilledGross ChargesGrossCharges
MERCY HOSPITAL FORT SCOTT
1truetrue100true400.trueXXXtruetrueXXXXtruefalsetrueXfalsefalse
MERCY HOSPITAL INDEPENDENCE
2truetrue100true400.trueXXXtruetrueXXXXtruefalsetrueXfalsefalse

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities14NumberOfOtherFacilities

Other Facilities OtherFacilities (14 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
Mercy Arma
601 E WashingtonArmaKS66712Physician Clinic/Practice
Mercy Cherryvale
203 W Main StreetCherryvaleKS67335Primary Care Small
Mercy Columbus
101 W SycamoreColumbusKS66725Primary Care Small
Mercy Physician Building
403 Woodland Hills BoulevardFort ScottKS66701Physician Clinic/Practice
Mercy Hospital Fort Scott
401 Woodland Hills BoulevardFort ScottKS66701Hospital
Mercy Medical Plaza
902 S HortonFort ScottKS66701Physician Clinic/Practice
Mercy Health for Life Fort Scott
405 Woodland Hills BoulevardFort ScottKS66701Rehab/Fitness Center
Mercy Convenient Care Fort Scott
1624 S NationalFort ScottKS66701Urgent Care
Mercy Medical Plaza
800 W LaurelIndependenceKS67301Primary Care Medium
Mercy Medical Plaza West
900 W Myrtle Suite 103IndependenceKS67301Physician Clinic/Practice
Mercy Home Health and Hospice
422 W Main StreetIndependenceKS67301Home Care
Mercy Health for Life Independence
2011 N PennIndependenceKS67301Fitness Center
Mercy Oswego
805 Barker DriveOswegoKS67356Primary Care Small
Mercy Linn County
11155 Tucker RoadPleasantonKS66075Primary Care Small

Form990 Schedule H Part VI Form990ScheduleHPartVI

FieldValueIRS element (for citing)
IdentifierForm 990, Schedule H, PART I, LINE 7Identifier
ExplanationTOTAL EXPENSES FROM FORM 990, PART IX, LINE 25, COLUMN (A) ARE $72,709,130. INCLUDED IN THIS AMOUNT WAS BAD DEBT EXPENSE (CHARGES) OF $4,650,987. EXPENSES FOR THE PURPOSE OF CALCULATING LINE 7, COLUMN (F) ARE $68,058,143. Form 990, SCHEDULE H, PART III, LINE 2 TO DETERMINE THE AMOUNT OF BAD DEBT EXPENSE, AT COST, BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENT ACCOUNTS WAS MULTIPLIED BY A RATIO OF COST TO CHARGES. THE RATIO OF COST TO CHARGES USED WAS BASED ON DETAILED COST ACCOUNTING, WHERE AVAILABLE. WHERE COST ACCOUNTING IS NOT AVAILABLE, COST REPORT COST TO CHARGE RATIOS WERE UTILIZED. FORM 990, SCHEDULE H, PART III, LINE 3 THE FILING ORGANIZATION DETERMINED THAT THE ESTIMATED AMOUNT OF BAD DEBT EXPENSE (AT COST) ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS $0. ALTHOUGH THE CHARITY CARE POLICY REQUIRES THE PARTICIPATION OF THE PATIENT REQUESTING ASSISTANCE, WE HAVE A PROCESS UNDER PRESUMPTIVE CHARITY (REFER TO DISCLOSURE FOR PART III, #9B) TO ADDRESS ACCOUNTS FOR PATIENTS WHO DO NOT PROVIDE THE INFORMATION. WE BELIEVE THAT OUR CHARITY POLICY IS COMPREHENSIVE ENOUGH TO CAPTURE ALMOST ALL PATIENTS WHO QUALIFY FOR CHARITY CARE. FORM 990, SCHEDULE H, PART III, LINE 4 THE TEXT OF THE FOOTNOTE THAT IS INCLUDED IN MERCY HEALTH AND SUBSIDIARIES AUDITED FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE FOLLOWS: "PATIENT ACCOUNTS THAT ARE UNCOLLECTED, INCLUDING THOSE PLACED WITH COLLECTION AGENCIES, ARE INITIALLY CHARGED AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IN ACCORDANCE WITH COLLECTION POLICIES OF THE HEALTH SYSTEM AND, IN CERTAIN CASES, ARE RECLASSIFIED TO CHARITY CARE IF DEEMED TO OTHERWISE MEET THE HEALTH SYSTEM'S CHARITY CARE POLICY. THE PROVISION FOR UNCOLLECTIBLE RECEIVABLES IS BASED ON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS. PERIODICALLY THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES BASED UPON THE PAYOR COMPOSITION AND AGING OF RECEIVABLES AS OF THE REPORTING DATE WITH CONSIDERATION OF THE HISTORICAL PAYMENT AND WRITE-OFF EXPERIENCE BY PAYOR CATEGORY. THE RESULTS OF THESE REVIEWS ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR UNCOLLECTIBLE RECEIVABLES TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES. AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE, THE HEALTH SYSTEM FOLLOWS ESTABLISHED GUIDELINES FOR PLACING PAST-DUE BALANCES WITH COLLECTION AGENCIES." FORM 990, SCHEDULE H, PART III, LINE 8 IT IS THE POSITION OF MERCY KANSAS COMMIUNITIES THAT 100% OF ANY SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT. THIS AMOUNT REPRESENTS THE COST OF PROVIDING SERVICES THAT REMAIN UNCOMPENSATED TO THE PROVIDER. THE UNREIMBURSED COSTS OF MEDICARE ARE CALCULATED BY TAKING THE GROSS CHARGES NET OF THE COST TO CHARGE RATIO LESS ANY PAYMENTS, DEDUCTIONS OR REIMBURSEMENTS USING THE ANNUAL MEDICARE COST REPORT (CMS FORM 2552-96). FORM 990, SCHEDULE H, PART III, LINE 9B MERCY KANSAS COMMUNITIES' ("MERCY'S") DEBT COLLECTION POLICY PROVIDES THAT MERCY WILL PERFORM A REASONABLE REVIEW OF EACH INPATIENT ACCOUNT BEFORE TURNING AN ACCOUNT OVER TO A THIRD-PARTY COLLECTION AGENT AND PRIOR TO INSTITUTING ANY LEGAL ACTION FOR NON-PAYMENT, TO ASSURE THAT THE PATIENT AND PATIENT GUARANTOR ARE NOT ELIGIBLE FOR ANY ASSISTANCE PROGRAM (E.G., MEDICAID) AND DO NOT QUALIFY FOR COVERAGE THROUGH MERCY'S COMMUNITY ASSISTANCE POLICY. AFTER HAVING BEEN TURNED OVER TO A THIRD-PARTY COLLECTION AGENT, ANY PATIENT ACCOUNT THAT IS SUBSEQUENTLY DETERMINED TO HAVE MET THE MERCY COMMUNITY ASSISTANCE POLICY IS REQUIRED TO BE RETURNED IMMEDIATELY BY THE THIRD-PARTY COLLECTION AGENT TO MERCY FOR APPROPRIATE FOLLOW-UP. MERCY REQUIRES ITS THIRD-PARTY COLLECTION AGENTS TO INCLUDE A MESSAGE ON ALL STATEMENTS INDICATING THAT IF A PATIENT OR PATIENT GUARANTOR MEETS CERTAIN STIPULATED INCOME REQUIREMENTS, THE PATIENT OR PATIENT GUARANTOR MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE. MERCY UTILIZES THE "SEARCH AMERICA" TOOL TO ENHANCE THE ABILITY TO DETERMINE CHARITY QUALIFICATION. PRESUMPTIVE CHARITY WILL BE GRANTED IN SITUATIONS WHERE MERCY HAS BEEN UNABLE TO OBTAIN INFORMATION FROM PATIENTS OR THE INFORMATION PROVIDED IS NOT COMPLETE ENOUGH TO MAKE A CHARITY DETERMINATION. MERCY UTILIZES PRESUMPTIVE CHARITY PRIOR TO BAD DEBT PLACEMENT FOR CHARITY ADJUSTMENTS IN EXCESS OF $6,500. IN THESE CASES, MERCY UTILIZES THE SEARCH AMERICA REPORT STATUS OF "PROBABLE CHARITY" AS THE BASIS FOR ASSIGNING THE CHARITY LEVEL. MERCY WILL PURSUE APPROPRIATE MEANS IN THE COLLECTION OF DELINQUENT ACCOUNTS FROM PATIENTS WITH AN ESTABLISHED ABILITY TO PAY OR AN UNWILLINGNESS TO COOPERATE IN VALIDATING ELIGIBILITY FOR FINANCIAL ASSISTANCE. THESE APPROPRIATE MEANS MAY INCLUDE LEGAL ACTION CONSISTENT WITH MERCY MISSION AND VALUES. ADDITIONALLY THEY MAY INCLUDE LIENS UPON REAL PROPERTY AND REASONABLE WAGE GARNISHMENTS. LEGAL ACTIONS WILL GENERALLY NOT INCLUDE BANK GARNISHMENT, REPOSSESSION OF ASSETS OR FORECLOSURES TO ENFORCE SATISFACTION OF A LIEN. MERCY HAS POLICIES AND PROCEDURES ESTABLISHED TO ADDRESS THE INITIATION OF LEGAL ACTION AND ANNUALLY REVIEWS COMPLIANCE WITH ALL POLICIES. FORM 990, SCHEDULE H, PART V, LINE 19D EACH HOSPITAL FACILITY USED THE AVERAGE DISCOUNT OF THE HIGHEST (BEST PAYING) THREE COMMERCIAL MANAGED CARE PAYERS AS THE BASIS FOR ESTABLISHING UNINSURED DISCOUNT RATES FOR FAP ELIGIBLE INDIVIDUALS. UNDER NO CIRCUMSTANCES, WILL THIS UNINSURED DISCOUNT BE LESS THAN 15%. FORM 990, SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE MERCY KANSAS COMMUNITIES HAS PRINTED MATERIAL AVAILABLE AT EACH POINT OF REGISTRATION IN OUR FACILITIES, IN ADDITION TO ELECTRONIC AVAILABILITY AT OUR WEB SITE. FINANCIAL ASSISTANCE INFORMATION AS A PART OF OUR HEALING MINISTRY, MERCY KANSAS COMMUNITIES IS COMMITTED TO PROVIDING QUALITY HEALTHCARE SERVICES TO PATIENTS REGARDLESS OF THEIR FINANCIAL SITUATION. WE OFFER PAYMENT ASSISTANCE FOR THOSE WHO DO NOT HAVE INSURANCE OR WHO ARE IN FINANCIAL NEED. UNINSURED PATIENT DISCOUNTS A DISCOUNT FROM THE HOSPITAL'S REGULAR BILLED CHARGES WILL BE PROVIDED TO PATIENTS WHO DO NOT HAVE INSURANCE. THIS INCLUDES PATIENTS WHOSE FINANCIAL SITUATION NORMALLY WOULD NOT OTHERWISE QUALIFY THEM FOR CHARITY CARE DISCOUNTS. PATIENTS WITHOUT INSURANCE WHOSE FINANCIAL SITUATION QUALIFIES THEM FOR CHARITY CARE DISCOUNTS (SEE ELIGIBILITY GUIDELINES BELOW) MUST FIRST FIND OUT IF THEY ARE ELIGIBLE FOR MEDICAID BEFORE APPLYING FOR FINANCIAL ASSISTANCE. PATIENTS DENIED MEDICAID ELIGIBILITY THEN MUST PROVIDE CERTAIN INFORMATION TO SHOW FINANCIAL NEED. APPLICATIONS FOR CHARITY CARE DISCOUNTS WILL BE REVIEWED FOR ELIGIBILITY BASED ON THE APPLICANT'S INCOME, FAMILY SIZE, AMOUNT OF PAYMENT DUE AND AVAILABILITY OF OTHER ASSETS OR RESOURCES. PLEASE NOTE THAT CARE MUST BE MEDICALLY NECESSARY TO BE CONSIDERED ELIGIBLE FOR UNINSURED PATIENT DISCOUNTS. ELIGIBILITY GUIDELINES FOR CHARITY CARE DISCOUNTS THE FEDERAL POVERTY GUIDELINES FOR INCOME ARE THE BASIS FOR DETERMINING ELIGIBILITY FOR CHARITY CARE DISCOUNTS. FOR EXAMPLE, INDIVIDUALS WITH INCOMES BELOW 100% OF THE FEDERAL POVERTY GUIDELINES WILL BE ELIGIBLE FOR FREE CARE. INDIVIDUALS WITH INCOMES GREATER THAN 100% OF THE FEDERAL POVERTY GUIDELINES MAY BE ELIGIBLE FOR CARE AT DISCOUNTED RATES DEPENDING ON THEIR INCOME LEVEL AND/OR THE AMOUNT DUE TO THE HOSPITAL. ADDITIONAL FINANCIAL ASSISTANCE AFTER APPROPRIATE DISCOUNTS HAVE BEEN APPLIED, ARRANGEMENTS MAY BE MADE FOR AN INTEREST-FREE MONTHLY PAYMENT PLAN. GENERALLY, NO PATIENT'S FINANCIAL RESPONSIBILITY WILL BE GREATER THAN 20% OF ANNUAL HOUSEHOLD INCOME, ADJUSTED TO CONSIDER AVAILABILITY OF OTHER ASSETS THAT COULD BE USED TOWARD MAKING PAYMENTS. FORM 990, SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION MERCY KANSAS COMMUNITIES' PRIMARY SERVICE AREA INCLUDES THE FOLLOWING SEVEN COUNTIES IN SOUTHEAST KANSAS: LINN, BOURBON, CRAWFORD, WILSON, ELK, CHAUTAUQUA AND MONTGOMERY. THREE OF THE COUNTIES (LINN, BOURBON AND CRAWFORD) ARE IN THE FORT SCOTT AREA. BASED ON THOMSON REUTERS 2011 DATA, THE FORT SCOTT AREA'S POPULATION IS 64,521. THE AVERAGE HOUSEHOLD INCOME IS $46,191. 16% OF THE POPULATION IS AGE 65 AND OLDER. 18% OF THE POPULATION IS ON MEDICARE, 9% ON MEDICAID, AND 20% UNINSURED, BASED ON 2011 THOMSON REUTERS INSURANCE ESTIMATES. THE OTHER FOUR COUNTIES (WILSON, ELK, CHAUTAUQUA AND MONTGOMERY) ARE IN THE INDEPENDENCE, KANSAS AREA. BASED ON THOMSON REUTERS 2011 DATA, THE INDEPENDENCE AREA'S POPULATION IS 50,803. THE AVERAGE HOUSEHOLD INCOME IS $46,010. 19% OF THE POPULATION IS AGE 65 AND OLDER. 22% OF THE POPULATION IS ON MEDICARE, 9% ON MEDICAID, AND 15% UNINSURED, BASED ON 2011 THOMSON REUTERS INSURANCE ESTIMATES. FORM 990, SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH FORM 990, SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM: THE FILING ORGANIZATION IS PART OF MERCY HEALTH ("MERCY"). MERCY IExplanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
First Class Or Charter TravelXFirstClassOrCharterTravel
Travel For CompanionsXTravelForCompanions
Idemnification Gross Up PaymentsXIdemnificationGrossUpPayments
Written Policy Re T And E ExpensestrueWrittenPolicyReTAndEExpenses
Substantiation RequiredtrueSubstantiationRequired
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentstrueAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (18 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Dottie Bringle
021251804653002668903372909538032900400
Patrick Callanan
11972601662901790609821012220165304000
Terri Floyd
016331902291603809403485306461026564300
Christopher Lewis
29175100032657084950153540348257000
Robert Nichols MD
221259000525810298660121990315905000
Gary Pulsipher
03337680937090275590146910014712061665800
Carl Ammons
0153152022560032246014487011321023376600
Reta Baker
0212596029728039286052736011847034619300
Shelly Hunter
017881903856102513002524009285027703500
Bradley Kim Day
0598570020388703070204228390134270126942500
Michael Merrigan
0214349066366040208049457015771038615100
John Fox
423269000290580131380109630476428000
Roger Parris
36129200050885027989076370447803000
David Phelps
344804000366820299810126180424085000
Larry Seals
44079000035363084530157980500404000
Soheila Sohaei
4183890005785009380079860493605000
Tanya Marion
011156003003001880103958012083017643200
William Hennessey III
0132990095312052242032357014990032789100

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierFORM 990, SCHEDULE J, PART I, QUESTION 1Identifier
ExplanationCharter travel is provided to certain employees as and when appropriate, and as deemed necessary for business travel. After charter travel approval has been granted in accordance with the financial justification process, the approved charter travel for business is a reimbursable expense which is not taxable to the employees. Travel for companions is provided in rare instances and in accordance with the co-worker travel and other expense policy and procedures. Where companion travel has resulted in a taxable event, the employees are taxed for such travel. Limited instances of tax gross-ups may have occurred with respect to executives. FORM 990, SCHEDULE J, PART I, QUESTION 3 Mercy Kansas Communities, Inc. relies on a related organization; refer to Schedule O, Part VI, Question 15a and 15b for the process the related organization follows. FORM 990, SCHEDULE J, PART I, QUESTION 4B Mercy Kansas Communities, Inc. offers supplemental retirement plans to certain executives which provide benefits upon retirement based on compensation, age at the time of benefit commencement, length of service with the company and/or its affiliates, and length of tenure in the plan. The individuals reportable on this return who participate in the supplemental retirement plans include: Terri Floyd, Gary Pulsipher, Shelly Hunter, Reta Baker, Bradley Day, Michael Merrigan, Dottie Bringle, and William Hennessey. The amount of all accrued benefits is included in compensation amounts provided in Schedule J, Part II, Column (C). FORM 990, SCHEDULE J, PART I, QUESTION 7 Mercy Kansas Communities, Inc. provides a non-fixed bonus plan for which certain tiers of its employees are eligible. For fiscal year 2012 (July 1, 2011 - June 30, 2012), payment of all or part of the bonus was contingent upon attainment of certain financial targets. Payments are made annually in October following (I) the conclusion of the fiscal year and (II) determination of goal achievement. Bonus opportunities are tiered percentages and are dependent upon the leadership level and attainment percentage. Mercy's attainment of financial goals is reviewed by the Executive Compensation Committee of Mercy Health and is then taken into account when analyzing executive compensation for reasonableness.Explanation

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (5 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
Janice Baker
FAMILY MBR OF OFFICER40708Employmentfalse
Christina Chapman Young
FAMILY MBR OF OFFICER52723Employmentfalse
MICHELLE CALLANAN
FAMILY MBR OF TRUSTEE88667Employmentfalse
CHRIS AMMONS
FAMILY MBR OF OFFICER21279Independent Contractorfalse
CAMPBELL PRINT SOLUTIONS
TTEE IS OWNER11429PRINTING SERVICESfalse

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation

FieldValueIRS element (for citing)
IdentifierFORM 990, PART III, LINE 4DIdentifier
Return ReferenceOTHER PROGRAM SERVICE ACCOMPLISHMENTSReturnReference
ExplanationMERCY KANSAS COMMUNITIES, INC. PROVIDES QUALITY MEDICAL HEALTH CARE REGARDLESS OF RACE, CREED, GENDER, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. MERCY KANSAS COMMUNITIES, INC. PROVIDES INPATIENT DAY SERVICES, OUTPATIENT SERVICES, EMERGENCY SERVICES, HOME HEALTH VISITS AND OFFICE VISITS. HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY INCLUDE LOW COST PRENATAL CARE, BIRTHING CENTER FOR PATIENTS REQUIRING SPECIAL CARE AND, AT TIMES, OPERATIVE INTERVENTION FOR FETAL DISTRESS, CARE DESIGNED FOR MERCY EMPLOYEE'S SICK CHILDREN WHILE THE EMPLOYEE WORKS, GERIATRIC SITTER SERVICES, RURAL HEALTH CLINICS, EXPANDED TRANSPORTATION SERVICES, AMBULANCE SERVICE, SAFE KIDS PROGRAMS, MERCY 55 MATURE DRIVING CLASSES, MERCY COMPASSIONATE CARE PROGRAM, AND OTHER HEALTH PROGRAMS. FORM 990, PART V, QUESTION 1A FORM 1099/1096 FILING VENDORS FOR THE FILING ORGANIZATION ARE PAID BY MERCY HEALTH (EIN 43-1423050). AS SUCH, ALL REQUIRED FORM 1099 AND FORM 1096 REPORTING IS MADE FOR THE ENTIRE MERCY HEALTH SYSTEM (WITH LIMITED EXCEPTIONS) UNDER THE MERCY HEALTH EIN. THE NUMBER REPORTED IN PART V, QUESTION 1A FOR THE FILING ORGANIZATION ONLY INCLUDES THE FORM 1099S FILED TO REPORT PHYSICIAN DEBT FORGIVENESS. FORM 990, PART VI, QUESTIONS 6, 7A, 7B DESCRIPTIONS OF CLASSES OF MEMBERS OR STOCKHOLDERS THE FILING ORGANIZATION HAS A SOLE CORPORATE MEMBER, MERCY HEALTH SOUTHWEST MISSOURI/KANSAS COMMUNITIES. THE FOLLOWING CORPORATE POWERS AND RESPONSIBILITIES SHALL BE RESERVED SOLELY UNTO THE CORPORATE MEMBER: -TO APPROVE THE MISSION AND ESTABLISH THE PHILOSOPHY ACCORDING TO WHICH THE CORPORATION SHALL OPERATE; -TO AMEND THE ARTICLES OF INCORPORATION AND BYLAWS OF THE CORPORATION; -TO APPOINT MEMBERS OF THE BOARD; -TO APPOINT AND REMOVE THE CHIEF EXECUTIVE OFFICER OF THE CORPORATION; -TO APPROVE THE STRATEGIC PLAN, GOALS AND OBJECTIVES OF THE CORPORATION; -TO APPROVE THE OPERATING, CAPITAL, AND CONSTRUCTION BUDGETS FOR THE CORPORATION; -TO LEASE OR SELL ANY OF THE ASSETS OF THE CORPORATION OR ANY CORPORATION CONTROLLED BY THE CORPORATION; -TO ENCUMBER ANY OR ALL OF THE ASSETS OF THE CORPORATION OR ANY CORPORATION CONTROLLED BY THE CORPORATION; -TO AUTHORIZE AND APPROVE THE INCURRENCE OF DEBT BY THE CORPORATION OR ANY CORPORATION CONTROLLED BY THE CORPORATION (OTHER THAN DEBT INCURRED FOR THE ACQUISITION OF GOODS THAT ARE ACQUIRED IN THE ORDINARY COURSE OF BUSINESS) AND TO GRANT ANY SECURITY INTERESTS, PLACE ANY ENCUMBRANCES, ENTER INTO ANY COVENANTS, AND EXECUTE ANY DOCUMENTS AND TAKE ANY ACTIONS NECESSARY OR APPROPRIATE IN CONNECTION WITH THE INCURRENCE OF SUCH DEBT; -TO MERGE, DISSOLVE, OR ABANDON THE MERCY KANSAS COMMUNITIES CORPORATION; AND -TO APPROVE THE CREATION, OWNERSHIP OR ACQUISITION OF, OR AFFILIATION WITH, ANY OTHER ORGANIZATION BY THE CORPORATION. FORM 990, PART VI, LINE 11B REVIEW OF FORM 990 FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM, USING INFORMATION PROVIDED BY THE FILING ORGANIZATION. A DRAFT FORM 990 IS REVIEWED BY THE FILING ORGANIZATION'S FINANCE TEAM, INCLUDING THE DIRECTOR OF FINANCE AND THE VICE-PRESIDENT OF FINANCE. THE DRAFT FORM 990 IS ALSO REVIEWED BY MERCY HEALTH'S TAX DEPARTMENT, TO ENSURE ACCURACY AND CONSISTENCY WITH OTHER RELATED ORGANIZATIONS' FORM 990S. AFTER QUESTIONS ARISING FROM THE VARIOUS REVIEWS ARE ADDRESSED AND INCORPORATED INTO THE FORM 990, A REVISED DRAFT IS PROVIDED TO THE FILING ORGANIZATION'S LEADERSHIP TEAM, INCLUDING THE CFO, FOR REVIEW. IN ADDITION, THE FORM 990 IS MADE AVAILABLE TO THE MERCY HEALTH SOUTHWEST MISSOURI/KANSAS COMMUNITIES BOARD OF DIRECTORS FOR THEIR REVIEW, AS MERCY HEALTH SOUTHWEST MISSOURI/KANSAS COMMUNITIES IS THE SOLE CORPORATE MEMBER OF MERCY KANSAS COMMUNITIES AND HAS ULTIMATE RESPONSIBILITY TO APPOINT THE MERCY KANSAS COMMUNITIES BOARD (WHICH IS PRIMARILY ADVISORY IN NATURE) AND LEADERSHIP TEAM AND POWER TO APPROVE SIGNIFICANT FINANCIAL AND OPERATIONAL DECISIONS. ONCE REVIEWED AND APPROVED BY THE FILING ORGANIZATION'S LEADERSHIP TEAM, THE FORM 990 IS SIGNED AND FILED WITH THE IRS. FORM 990, PART VI, QUESTION 12C DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST OFFICERS, DIRECTORS, KEY EMPLOYEES AND OTHER DISQUALIFIED PERSONS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE ANNUALLY AND DID SO IN THE NORMAL COURSE FOR THE YEAR ENDED JUNE 30, 2012. THIS PROCESS IS ADMINISTERED AT THE MERCY HEALTH LEVEL BY MERCY'S BUSINESS RISK (INTERNAL AUDIT) DEPARTMENT. THE QUESTIONNAIRES ARE REVIEWED WITH LEADERSHIP AT THE LOCAL LEVEL AND POTENTIAL CONFLICTS DISCUSSED AND RESOLVED. THE CONFLICTS AND THEIR RESPECTIVE RESOLUTIONS ARE SHARED AT THE MERCY LEVEL WITH A TEAM INCLUDING MERCY'S CHIEF FINANCIAL OFFICER, CHIEF COMPLIANCE OFFICER AND OTHER MEMBERS OF FINANCE, LEGAL AND HR. SUMMARY RESULTS ARE REVIEWED WITH MERCY'S FINANCE, AUDIT AND COMPLIANCE COMMITTEE OF THE BOARD OF DIRECTORS. FORM 990, PART VI, QUESTION 15A AND 15B OFFICES & POSITIONS FOR WHICH PROCESS WAS USED, & YEAR PROCESS WAS BEGUN FOR THOSE CLASSIFIED AS OFFICERS (AND THUS DISQUALIFIED PERSONS), THE ORGANIZATION RELIES UPON MERCY HEALTH, WHICH USES THE FOLLOWING TO ESTABLISH COMPENSATION: EXTERNAL MARKET SALARY SURVEYS, EXTERNAL MARKET SALARY STUDIES, ENGAGEMENT OF AN INDEPENDENT COMPENSATION CONSULTANT, AND REVIEW/APPROVAL OF COMPENSATION BY THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF MERCY HEALTH. FOR THOSE CLASSIFIED AS KEY EMPLOYEES, THE ORGANIZATION USES THE FOLLOWING TO ESTABLISH THE COMPENSATION: EXTERNAL MARKET SALARY SURVEYS, EXTERNAL MARKET SALARY STUDIES, AND REVIEW/APPROVAL OF EXECUTIVE MANAGEMENT. COMPENSATION REVIEWS ARE COMPLETED ON AN ANNUAL BASIS AND A REVIEW WAS COMPLETED DURING THE REPORTING YEAR. FORM 990, PART VI, QUESTION 19 AVAIL OF GOV DOCS, CNFLCT OF INTEREST POLICY, & FIN STMTS TO GEN PUBLIC Governing documents, conflict of interest policy, and financial statements are made available upon request but are not published publicly. FORM 990, PART VII, SECTION A, COLUMN B AVERAGE HOURS PER WEEK SEVERAL INDIVIDUALS LISTED IN PART VII ARE DISCLOSED AS TRUSTEES, DIRECTORS, OFFICERS, AND KEY EMPLOYEES ON MULTIPLE FORM 990S OF ENTITIES INCLUDED WITHIN MERCY HEALTH. THE AVERAGE HOURS PER WEEK DISCLOSED IN PART VII IS AN ESTIMATE OF THE HOURS PER WEEK THAT THE LISTED INDIVIDUAL SPENDS ON BOTH THE FILING ORGANIZATION AND ALL RELATED ORGANIZATIONS. FORM 990, PART XII, QUESTION 2C AUDIT OF FINANCIAL STATEMENTS THE FILING ORGANIZATION'S FINANCIAL STATEMENTS WERE INCLUDED IN THE MERCY HEALTH ANNUAL FINANCIAL STATEMENT AUDIT. MERCY HEALTH RECEIVED AN UNQUALIFIED OPINION FROM THE EXTERNAL AUDITORS FOR FISCAL 2012 (THE TAX YEAR CURRENTLY BEING REPORTED). HOWEVER, NO SEPARATE AUDIT OPINION WAS ISSUED ON THE FINANCIAL STATEMENTS OF THE FILING ORGANIZATION. THE ULTIMATE RESPONSIBILITY FOR OVERSIGHT OF THE FINANCIAL STATEMENT AUDIT AND SELECTION OF THE EXTERNAL AUDITOR LIES WITH THE FINANCE, AUDIT, AND COMPLIANCE COMMITTEE OF THE MERCY HEALTH BOARD OF DIRECTORS. AUDIT RESULTS ARE COMMUNICATED TO THIS COMMITTEE.Explanation

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (67 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
Advance Care Hospital
300 Werner StreetHot SpringsAR71913710816634HospitalAR501(C)(3)3Mercy Healthtrue
Casa de Misericordia
1602 Mcclelland StreetLaredoTX78044742912461ShelterTX501(C)(3)7MM Laredotrue
Laredo Medical Group
14528 S Outer Forty Ste 100ChesterfieldMO63017742764726InactiveTX501(C)(3)9MHS-TXtrue
McAuley Portfolio Management Company
14528 S Outer Forty Ste 100ChesterfieldMO63017261708048Port MgmtMO501(C)(3)11bMercy Healthtrue
Mercy Clinic East Communites
14528 S Outer Forty Ste 100ChesterfieldMO63017431771217Phys GroupMO501(C)(3)9MHECtrue
Mercy Clinic Fort Smith Communitites
7301 Rogers AvenueFort SmithAR72917261318597Phys ClinicAR501(C)(3)9MHFSCtrue
Mercy Clinic Hot Springs Communitites
1 Mercy LaneHot SpringsAR71913261125131Phys ClinicAR501(C)(3)9MHHSCtrue
Mercy Clinic Oklahoma Communities
4300 W Memorial RoadOklahoma CityOK73120270473057Phys GroupOK501(C)(3)9MHOCtrue
Mercy Clinic Springfield Communities
1965 Fremont Street Ste 2950SpringfieldMO65804431560263Phys GroupMO501(C)(3)9MHSCtrue
Mercy Family Center
14528 S Outer Forty Ste 100ChesterfieldMO63017721069468counselingMO501(C)(3)7Mercy Healthtrue
Mercy Foundation for Health Innovation
14528 S Outer Forty Ste 100ChesterfieldMO63017200901499FoundationMO501(C)(3)11bMercy Healthtrue
Mercy Health
14528 S Outer Forty Ste 100ChesterfieldMO63017431423050Sup Hlth SysMO501(C)(3)1NAfalse
Mercy Health East Communities
14528 S Outer Forty Ste 100ChesterfieldMO63017431718408Hlth SystemMO501(C)(3)11bMercy Healthtrue
Mercy Health Fort Smith Communities
7301 Rogers AvenueFort SmithAR72917261318515Holding CoAR501(C)(3)11bMercy Healthtrue
Mercy Health Foundation Ardmore
1011 14th Avenue NWArdmoreOK73401710962525FoundationOK501(C)(3)11aMH Ardmoretrue
Mercy Health Foundation Berryville
214 Carter StreetBerryvilleAR72616710759301FoundationAR501(C)(3)11aMH Berryvilltrue
Mercy Health Foundation Fort Scott
401 Woodland Hills BlvdFort ScottKS66701481077073FoundationKS501(C)(3)11cMercy KS Comtrue
Mercy Health Foundation Hot Springs
300 Werner StreetHot SpringsAR71913710804718FoundationAR501(C)(3)11bMHHStrue
Mercy Health Foundation Independence
800 W MyrtleIndependenceKS67301481079981FoundationKS501(C)(3)11aMercy KS Comtrue
Mercy Health Foundation Joplin
2817 St Johns BlvdJoplinMO64804270906136FoundationMO501(C)(3)11aMHSMKCtrue
Mercy Health Foundation NW Arkansas
2710 Rife Medical LaneRogersAR72758710601687FoundationAR501(C)(3)11cMH Rogerstrue
Mercy Health Foundation OF Oklahoma
4300 W Memorial RoadOklahoma CityOK73120454732301FoundationOK501(C)(3)11aMHOCtrue
Mercy Health Foundation OK City
4300 W Memorial RoadOklahoma CityOK73120731593024FoundationOK501(C)(3)11aMHOCtrue
Mercy Health Foundation Springfield
1235 E Cherokee StreetSpringfieldMO65804320195818FoundationMO501(C)(3)11bMHSCtrue
Mercy Health Foundation St Louis
14528 S Outer Forty Ste 100ChesterfieldMO63017562410020FoundationMO501(C)(3)11bMHECtrue
Mercy Health Foundation Washington
901 E Fifth StreetWashingtonMO63090562410022FoundationMO501(C)(3)11bMHECtrue
Mercy Health Hot Springs Communities
300 Werner StreetHot SpringsAR71913261125064Holding CoAR501(C)(3)11bMercy Healthtrue
Mercy Health NW Arkansas Communities
2710 Rife Medical DriveRogersAR72758621684203Phys GroupAR501(C)(3)11bMercy Healthtrue
Mercy Health Oklahoma Communities
4300 W Memorial RoadOklahoma CityOK73120731453048Holding coOK501(C)(3)11bMercy Healthtrue
Mercy Health Springfield Communitites
1235 E Cherokee StreetSpringfieldMO65804431856028Holding CoMO501(C)(3)11bMercy Healthtrue
Mercy Health SW MOKS Communitites
2817 St Johns BlvdJoplinMO64804300584463Hlth SystemMO501(C)(3)11bMercy Healthfalse
Mercy Health System of Texas Inc
14528 S Outer Forty Ste 100ChesterfieldMO63017742764727InactiveTX501(C)(3)11bMercy Healthtrue
Mercy Home Health Berryville
804 W Freeman Suite 4BerryvilleAR72616870781247Home HealthAR501(C)(3)11cMH Sprngfldtrue
Mercy Hospital Ardmore
1011 14th Avenue NWArdmoreOK73401731500629HospitalOK501(C)(3)3MHOCtrue
Mercy Hospital Aurora
500 Porter AvenueAuroraMO65605431936696HospitalMO501(C)(3)3MHSCtrue
Mercy Hospital Berryville
214 Carter StreetBerryvilleAR72616710759299HospitalAR501(C)(3)3MHSCtrue
Mercy Hospital Carthage
3125 Dr Russell Smith WayCarthageMO64836453808607HospitalMO501(C)(3)3MHSMKCtrue
Mercy Hospital Cassville
94 Main StreetCassvilleMO65625431936699HospitalMO501(C)(3)3MHSCtrue
Mercy Hospital Columbus
220 Pennsylvania AvenueColumbusKS66725270842031HospitalMO501(C)(3)3MHSMKCtrue
Mercy Hospital El Reno
2115 Parkview DriveEl RenoOK73036272716065HospitalOK501(C)(3)3MHOCtrue
Mercy Hospital Fort Smith
7301 Rogers AvenueFort SmithAR72917710240352HospitalAR501(C)(3)3MHFSCtrue
Mercy Hospital Healdton
918 South 8th StreetHealdtonOK73438263173902HospitalOK501(C)(3)3MH Ardmoretrue
Mercy Hospital Hot Springs
300 Werner StreetHot SpringsAR71913710236913HospitalAR501(C)(3)3MHHSCtrue
Mercy Hospital Joplin
2817 St Johns BlvdJoplinMO64804270814858HospitalMO501(C)(3)3MHSMKCtrue
Mercy Hospital Lebanon
100 Hospital DriveLebanonMO65536431767432HospitalMO501(C)(3)3MHSCtrue
Mercy Hospital Logan County Inc
200 South AcademyGuthrieOK73044452998842HospitalOK501(C)(3)3MHOCtrue
Mercy Hospital of Laredo
14528 S Outer Forty Ste 100ChesterfieldMO63017741189682InactiveTX501(C)(3)3MHS-TXtrue
Mercy Hospital Oklahoma City
4300 W Memorial RoadOklahoma CityOK73120730579285HospitalOK501(C)(3)3MHOCtrue
Mercy Hospital Ozark
801 W River StreetOzarkAR72949710689680HospitalAR501(C)(3)3MHFStrue
Mercy Hospital Paris
500 E AcademyParisAR72855710655753HospitalAR501(C)(3)3MHFStrue
Mercy Hospital Rogers
2710 Rife Medical LaneRogersAR72758710294390HospitalAR501(C)(3)3MHNWACtrue
Mercy Hospital Springfield
1235 E Cherokee StreetSpringfieldMO65804440552485HospitalMO501(C)(3)3MHSCtrue
Mercy Hospital Tishomingo
1000 South ByrdTishomingoOK73460274433830HospitalOK501(C)(3)3MH Ardmoretrue
Mercy Hospital Waldron
1341 W 6th StreetWaldronAR72958710557895HospitalAR501(C)(3)3MHFStrue
Mercy Hospital Watonga Inc
500 Clarence Nash BlvdWatongaOK73772455199762HospitalOK501(C)(3)3MHOCtrue
Mercy Hospitals East Communities
14528 S Outer Forty Ste 100ChesterfieldMO63017430653493HospitalMO501(C)(3)3MHECtrue
Mercy Medical Research Institute
1235 E Cherokee StreetSpringfieldMO65804870796305ResearchMO501(C)(3)4MHSCtrue
Mercy Ministries of Laredo
2500 ZacatecasLaredoTX78046200198462outreachTX501(C)(3)7Mercy Healthtrue
Mercy St Francis Hospital
100 W Highway 60Mountain ViewMO65548440607149HospitalMO501(C)(3)3MHSCtrue
Mercy Support Services
14528 S OUTER FORTY STE 100CHESTERFIELDMO63017431677952InactiveMO501(C)(3)11cMHECtrue
MHM SUPPORT SERVICES
14528 S OUTER FORTY STE 100CHESTERFIELDMO63017202553101Hlth SystemMO501(C)(3)11BMERCY HEALTHtrue
Mission Clinical Services
300 Werner StreetHot SpringsAR71913134239691nursing homeAR501(C)(3)9MHHSCtrue
St Edward Mercy Foundation
PO Box 17000Fort SmithAR72917237330425FoundationAR501(C)(3)7MHFStrue
St John's Children's Hospital Inc
1235 E Cherokee StreetSpringfieldMO65804InactiveMO501(C)(3)3MHSCtrue
St Mary's Hospital of Enid Oklahoma
14528 S Outer Forty Ste 100ChesterfieldMO63017730614655InactiveOK501(C)(3)3MHOCtrue
The Sister M Cornelia Blasko Foundation
100 W Highway 60Mountain ViewMO65548431873914FoundationMO501(C)(3)11aMSFHtrue
Unity Ambulatory Care
14528 S OUTER FORTY STE 100CHESTERFIELDMO63017431861745InactiveMO501(C)(3)11cMHECtrue

Form990 Schedule R Part III Form990ScheduleRPartIII (5 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
Merc Ambu Surg CTR
7301 Rogers AvFort SmithAR72903710827721AMBUL SURG CENTERARNA
RES OPT & INNOV
645 Maryville Centre Dr 200St LouisMO63141460468368CENTRAL DIST.MONA
SO OK DIAG CTR
1011 14TH Ave NWArdmoreOK73401431971232MRI ServicesOKNA
Fort Smith EMS
1701 S GreenwoodFort SmithAR72901710416615Emergency MedARNA
St Ed Mer Med MOB
7301 Rogers AveFort SmithAR72903710554050Office BuildingARNA

Form990 Schedule R Part IV Form990ScheduleRPartIV (9 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntityShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsPercentage OwnershipPercentageOwnership
Frontenac Properties Inc
14528 S Outer Forty Suite 100ChesterfieldMO63017521914421HOLDING COMPDENAC-Corp
Inveno Health Inc
1235 E Cherokee StreetSpringfieldMO65804264509571IT SERVICESMONAC-Corp
Mercy Community Services Inc
401 Woodland Hills BlvdFort ScottKS66701481078101RETAIL PHARMACYKSMERCY KSC-Corp-4391311024251.00000
Mercy Health Center Condominium Inc
4300 W Memorial RdOklahoma CityOK73120680640970REAL ESTATEOKNAC-Corp
Mercy Health Network of the Southern Reg
1011 14th Avenue NWArdmoreOK73401731580607HEALTH CAREOKNAC-Corp
Mercy Health Network Inc
4300 W Memorial RoadOklahoma CityOK73120731381689HEALTH CAREOKNAC-Corp
Mercy Managed Care Corporation
4300 W Memorial RoadOklahoma CityOK73120731441665HOLDING COMPOKNAC-Corp
UH L Corp Inc
645 Maryville Centre Drive Suite 1St LouisMO63141742499535HOLDING COMPMONAC-Corp
Unity Support Services Inc
645 Maryville Centre Drive Suite 1St LouisMO63141431797042PRACTICE MGTMONAC-Corp
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (8 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
Mercy Community Services Inc
O2133198FMV
Mercy Health Foundation Fort Scott
p256070FMV
Mercy Health Foundation Independence
p64064FMV
MERCY HEALTH SPRINGFIELD COMMUNITIES
o94078FMV
MERCY HOSPITAL JOPLIN
O578649FMV
Mercy Hospital Rogers
o242158FMV
MHM Support Services
o24635145FMV
Resource Optimization & Innovation LLC
o1385269FMV

Form990 Schedule R Part VII Form990ScheduleRPartVII

FieldValueIRS element (for citing)
IdentifierFORM 990, SCHEDULE R, PART VIdentifier
ExplanationLAWSON ERP SOFTWARE IS THE PRIMARY ACCOUNTING SOFTWARE USED BY MERCY HEALTH. THE MAJORITY OF THE INTERCOMPANY/RELATED ORGANIZATION TRANSACTIONS ARE PROCESSED THROUGH LAWSON VIA INTERCOMPANY JOURNAL ENTRIES. WITH THE CURRENT DESIGN OF THE ERP SYSTEM, THERE ARE VARIOUS LIMITATIONS ON THE RELATED ORGANIZATION INFORMATION THAT CAN BE EXTRACTED FROM LAWSON. DUE TO THESE LIMITATIONS, MOST OF THE RELATED ORGANIZATION ACTIVITY FOR THE FILING ORGANIZATION HAS BEEN CLASSIFIED ON SCHEDULE R, PART V, IN LINES O AND P.Explanation