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MERCY HEALTH NORTHWEST ARKANSAS COMMUNITIES: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
MERCY HEALTH NORTHWEST ARKANSAS COMMUNITIES (EIN 62-1684203)
Tax period
2011-07-01 to 2012-06-30
Filed
2013-05-14
IRS object ID
201341349349306024
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)
Timestamp2013-05-14T15:28:47-04:00Timestamp
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)
EIN621684203EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1MERCY HEALTH NORTHWEST ARKANSAS COMMUNITIESBusinessNameLine1
FieldValueIRS element (for citing)
In Care Of Name% Benny J Stover CPAInCareOfName
Name ControlMERCNameControl
Phone3145796100Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12710 Rife Medical LaneAddressLine1
CityRogersCity
StateARState
ZIP Code72758ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameBenny StoverName
TitleVP-FinanceTitle
Date Signed2013-05-10DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
Phone3142901000Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonScott StreetNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line12710 Rife Medical LaneAddressLine1
CityRogersCity
StateARState
ZIP Code72758ZIPCode
FieldValueIRS element (for citing)
Gross Receipts62285423GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Group Exemption Number0928GroupExemptionNumber
Organization501c3XOrganization501c3
Web Sitewww.mercy.netWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1997YearFormation
State Legal DomicileARStateLegalDomicile
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 Body11NbrVotingMembersGoverningBody
Nbr Independent Voting Members8NbrIndependentVotingMembers
Total Nbr Employees712TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year58695633ProgramServiceRevenuePriorYear
Program Service Revenue CY62087740ProgramServiceRevenueCY
Investment Income Prior Year-50792InvestmentIncomePriorYear
Investment Income Current Year15342InvestmentIncomeCurrentYear
Other Revenue Prior Year417373OtherRevenuePriorYear
Other Revenue Current Year182341OtherRevenueCurrentYear
Total Revenue Prior Year59062214TotalRevenuePriorYear
Total Revenue Current Year62285423TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY500GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year54614704SalariesEtcPriorYear
Salaries Etc Current Year58414319SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year18000387OtherExpensePriorYear
Other Expenses Current Year20486652OtherExpensesCurrentYear
Total Expenses Prior Year72615091TotalExpensesPriorYear
Total Expenses Current Year78901471TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-13552877RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-16616048RevenuesLessExpensesCY
Total Assets BOY10751653TotalAssetsBOY
Total Assets EOY12569127TotalAssetsEOY
Total Liabilities BOY60049053TotalLiabilitiesBOY
Total Liabilities EOY78478829TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY-49297400NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY-65909702NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
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
Expense25411896Expense
Grants0Grants
Revenue23335630Revenue
DescriptionFAMILY MEDICINE PHYSICIAN SERVICES: MERCY HEALTH NORTHWEST ARKANSAS COMMUNITIES FAMILY MEDICINE PHYSICIAN SERVICES ARE COMPRISED OF 33 BOARD CERTIFIED FAMILY MEDICINE PHYSICIANS AND 8 MID-LEVELS, WHO PROVIDE PRIMARY MEDICINE SERVICES TO PATIENTS RANGING FROM ONE YEAR OLD THROUGH ADULTHOOD. THESE SERVICES ARE OFFERED IN APPROXIMATELY 10 LOCATIONS THROUGHOUT BENTON COUNTY ARKANSAS, AND THE SURROUNDING SERVICE AREA. DURING THE YEAR, 180,235 OFFICE VISITS WERE PROVIDED TO PATIENTS.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense11979703Expense
Grants0Grants
Revenue7088001Revenue
DescriptionCARDIOVASCULAR PHYSICIAN SERVICES: MERCY HEALTH NORTHWEST ARKANSAS COMMUNITIES CARDIOVASCULAR PHYSICIAN SERVICES ARE COMPRISED OF 6 CARDIOLOGISTS, 2 CARDIOVASCULAR SURGIONS, AND 7 MID-LEVEL PROVIDERS. THESE PROVIDERS SERVE PATIENTS THROUGHOUT BENTON COUNTY ARKANSAS AND THE SURROUNDING SERVICE AREA, WHO HAVE HEART RELATED MEDICAL NEEDS. DURING THE YEAR, 20,331 OFFICE VISITS WERE PROVIDED TO PATIENTS.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense4954742Expense
Grants0Grants
Revenue4486435Revenue
DescriptionPEDIATRIC PHYSICIAN SERVICES: MERCY HEALTH NORTHWEST ARKANSAS COMMUNITIES PEDIATRIC PHYSICIAN SERVICES ARE COMPRISED OF 6 BOARD CERTIFIED PEDIATRICIANS AND 2 MID-LEVELS, WHO PROVIDED PRIMARY MEDICINE SERVICES TO PATIENTS RANGING IN AGE FROM INFANTS THROUGH EIGHTEEN YEARS. SERVICES ARE PROVIDED TO PATIENTS THROUGHOUT BENTON COUNTY ARKANSAS AND THE SURROUNDING SERVICE AREA. DURING THE YEAR, 35,342 OFFICE VISITS WERE PROVIDED TO PATIENTS.Description
FieldValueIRS element (for citing)
Total Of Other Program Service Exp27268595TotalOfOtherProgramServiceExp
Total Of Other Program Service Grnt500TotalOfOtherProgramServiceGrnt
Total Of Other Program Service Rev27360015TotalOfOtherProgramServiceRev
Total Program Service Expense69614936TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredfalseScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
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
HospitalfalseHospital
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 MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
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 With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees712NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
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 Members11NbrVotingGoverningBodyMembers
Number Independent Voting Members8NumberIndependentVotingMembers
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 BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonBenny J Stover CPANamePerson
Telephone Number4793382903TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12710 Rife Medical LaneAddressLine1
CityRogersCity
StateARState
ZIP Code72758ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (32 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
Paul Bergant
Board member1.0X000
Wayne Callahan
Board member1.0X000
Hugh Donnell
PHYSICIAN & Board member60.0X324687037798
Sr Gayle Evans RSM
Board member1.0X000
Sr Chabanel Finnegan RSM
Board member1.0X000
Dr Donna Johnson
Physician/Board member-1/1/1260.0X504423033074
Rollin Ford
Board member1.0X000
Sr Teresa Kelone RSM
Board member1.0X000
Tabitha Lipscomb
Board member1.0X000
Paul Mahan
Board member1.0X000
Miguel Rivera
Board member-through 08/01/111.0X000
Steve Stewart
Board member-through 12/01/111.0X000
Robert Stuppy
physician & Board member60.0X744102029565
Scott Street
Chief executive officer60.0X0547813113902X
Jonathan Vitiello
Chief financial officer60.0043976761898X
Bradley Kim Day
President-central comm60.00833159436266X
Stephen Goss
Physician executive60.0350072073751X
Steven Hughes
Chief administrative officer60.0213163017363X
Tanya Marion
Regional VP-Human resources60.0016039116041X
Michael Merrigan
Regional VP-General Counsel60.0032092365228X
Benny Stover
VP-Finance60.0171481019523X
Amr El-Shafei
Physician40.01293110013237X
Philip Riley
Physician40.0763134015616X
Christopher Simpson
Physician40.0763410025427X
Kuntal Thaker
Physician40.0939446029575X
Larry Weathers
Physician40.0741643023662X
Susan Barrett
Former president40.003000000X
George Flynn
SR VP & FORMER CEO60.00571155192126X
Karen Little-Smith
Accountable executive40.0122416011553X
Jerri L Lynne Mitchell
Former chief financial officer01067570X
Richard Barclay
VP HR & Former Key Employee60.0200796014609X
Michele Stewart
COO & Former Key Employee60.0291030067596X
FieldValueIRS element (for citing)
Total Reportable Comp From Org7422913TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs3279965TotalReportableCompFrmRltdOrgs
Total Other Compensation1297810TotalOtherCompensation
Number Individuals GT100 K101NumberIndividualsGT100K
Formers ListedtrueFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (4 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
QUEST DIAGNOSTICS
PO BOX 740709ATLANTAGA30374LAB DIAGNOSTICS290050
BERLIN WHEELER INC
PO BOX 463JEFFERSON CITYMO65102COLLECTIONS173401
TIMELINE RECRUITING LLC
13841 COLLECTIONS CENTER DRIVECHICAGOIL60693RECRUITING147730
EMDEON
PO Box 572490MURRAYUT84127Claims processing134609
FieldValueIRS element (for citing)
Number Of Contractors GT100 K4NumberOfContractorsGT100K
Total Contributions0TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NET PATIENT SERVICE REVENUE6211116151788161517881
RENTAL INCOME FROM RELATED ORGS531120178321178321
OTHER OPERATING REVENUE900099391538391538
FieldValueIRS element (for citing)
Total Program Service Revenue62087740TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column15342TotalRevenueColumn
Exclusion$15,342ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

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 (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
HOSPITAL SUPPORT REVENUE621111181530181530
CAFETERIA & VENDING900099811811
FieldValueIRS element (for citing)
Total Other Revenue182341TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column62285423TotalRevenueColumn
Related Or Exempt Function Income62270081RelatedOrExemptFunctionIncome
Exclusion$15,342ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total500Total
Program Services500ProgramServices

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)
Total2546459Total
Program Services2546459ProgramServices

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total46004350Total
Program Services40060793ProgramServices
Management And General5943557ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1816815Total
Program Services1577128ProgramServices
Management And General239687ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total5434653Total
Program Services4752688ProgramServices
Management And General681965ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total2612042Total
Program Services2290689ProgramServices
Management And General321353ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total177467Total
Management And General177467ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total159Total
Management And General159ManagementAndGeneral

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)
Total1953944Total
Program Services1713555ProgramServices
Management And General240389ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total64944Total
Program Services37788ProgramServices
Management And General27156ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total881068Total
Program Services447304ProgramServices
Management And General433764ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total802573Total
Program Services703835ProgramServices
Management And General98738ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total4341057Total
Program Services3652887ProgramServices
Management And General688170ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total230487Total
Program Services137741ProgramServices
Management And General92746ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total622Total
Program Services119ProgramServices
Management And General503ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total38651Total
Program Services33896ProgramServices
Management And General4755ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total758215Total
Program Services664934ProgramServices
Management And General93281ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total1439197Total
Program Services1317176ProgramServices
Management And General122021ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
REPAIRS & MAINTENANCE16596112860237359
SHARED SERVICES67841459494983465
BAD DEBT EXPENSES32641743264174
MEDICAL SUPPLIES56897195689719

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total78901471Total
Program Services69614936ProgramServices
Management And General9286535ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY687001BOY
EOY481493EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY5410088BOY
EOY6027356EOY

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)
BOY630789BOY
EOY1236480EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY428120BOY
EOY453516EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY111222BOY
EOY13086EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis10981878LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec6624682LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY3484433BOY
EOY4357196EOY

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
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY10751653BOY
EOY12569127EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY7672388BOY
EOY9496494EOY

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)
BOY2484565BOY
EOY1998906EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY49892100BOY
EOY66983429EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY60049053BOY
EOY78478829EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY-49297400BOY
EOY-65909702EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY-49297400BOY
EOY-65909702EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY10751653BOY
EOY12569127EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-16616048ReconcilationRevenueExpenses
Reconcilation Other Changes3746ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years58003CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years0CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years0CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year0CurrentTaxYearMinus1Year
Current Tax Year0CurrentTaxYear
Total58003Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years86990336CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years95352882CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years54103144CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year58695633CurrentTaxYearMinus1Year
Current Tax Year61696202CurrentTaxYear
Total356838197Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years87048339CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years95352882CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years54103144CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year58695633CurrentTaxYearMinus1Year
Current Tax Year61696202CurrentTaxYear
Total356896200Total
FieldValueIRS element (for citing)
Public Support Total509356896200PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years874009CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years41511CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years27879CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year-18223CurrentTaxYearMinus1Year
Current Tax Year15342CurrentTaxYear
Total940518Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years874009CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years41511CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years27879CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year-18223CurrentTaxYearMinus1Year
Current Tax Year15342CurrentTaxYear
Total940518Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1765506CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1237480CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years533693CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year417373CurrentTaxYearMinus1Year
Current Tax Year573879CurrentTaxYear
Total4527931Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years89687854CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years96631873CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years54664716CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year59094783CurrentTaxYearMinus1Year
Current Tax Year62285423CurrentTaxYear
Total362364649Total
FieldValueIRS element (for citing)
Public Support Percentage5090.98491PublicSupportPercentage509
Prior Year Support Percentage0.98084PriorYearSupportPercentage
Investment Income Percentage0.00260InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00501PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509
General ExplanationOTHER INCOME INCLUDED SERVICES PROVIDED TO SUPPORT THE HOSPITAL, SUCH AS CAFETERIA INCOME AND OTHER SERVICE REVENUE.GeneralExplanation

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)
Other Cost Or Other Basis125000OtherCostOrOtherBasis
Book Value125000BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1453944OtherCostOrOtherBasis
Depreciation1040021Depreciation
Book Value413923BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis4005650OtherCostOrOtherBasis
Depreciation2120675Depreciation
Book Value1884975BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis4911483OtherCostOrOtherBasis
Depreciation3452337Depreciation
Book Value1459146BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis485801OtherCostOrOtherBasis
Depreciation11649Depreciation
Book Value474152BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings4357196TotalOfBookValueLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
DEPOSITORY ACCOUNTS-BOA$23,313,854
DUE TO AFFILIATES$43,223,509
MISCELLANEOUS RESERVES$446,066
FieldValueIRS element (for citing)
Total Of Amounts66983429TotalOfAmounts

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 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 PaymenttrueSeverancePayment
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 (22 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus 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 OrgsCompReportPrior990RelatedOrgsBonus Filing OrgBonusFilingOrg
Hugh Donnell
29617200285150176390201590362485000
Dr Donna Johnson
43644600679770126060204680537497000
Robert Stuppy
5832940060808082240213410773667000100000
Scott Street
03734341540520203270978480160540661715000
Jonathan Vitiello
0278936693000915310464750154230501665000
Bradley Kim Day
0598570203887030702042283901342701269425000
Stephen Goss
2359600053462053444020307042382300060650
Steven Hughes
164286002490505803011560023052600023972
Tanya Marion
011156030030018801039580120830176432000
Michael Merrigan
0214349663660402080494570157710386151000
Benny Stover
132505001172004751014772019100400027256
Amr El-Shafei
125415000389600332009917013063470000
Philip Riley
7166880046446058720974407787500000
Christopher Simpson
71679000466200406102136607888370000
Kuntal Thaker
90428100866508134021441096902100026500
Larry Weathers
621687001199560692101674107653050000
Susan Barrett
030000000000000300000000
George Flynn
041052013386002677501763390157870763281000
Karen Little-Smith
920530022589056130594001339690007774
Jerri L Lynne Mitchell
000010675700000106757000
Richard Barclay
13883500319300821306396021540500030031
Michele Stewart
2059160020076052390015206035862600065038

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 Health Northwest Arkansas Communities 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 4a The following individual received a severance payment during calendar 2011: Jerri (Lynne) Mitchell, $106,757. FORM 990, Schedule J, Part I, Question 4b Mercy Health Northwest Arkansas Communities 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: Scott Street, Jonathan Vitiello, Bradley Day, Stephen Goss, Michael Merrigan, and George Flynn. 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 Health Northwest Arkansas Communities 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 O IRS990ScheduleO

General Explanation GeneralExplanation

FieldValueIRS element (for citing)
IdentifierFORM 990, PART III, LINE 4DIdentifier
Return ReferenceOTHER PROGRAM SERVICESReturnReference
ExplanationMERCY HEALTH NORTHWEST ARKANSAS COMMUNITIES (MHNWAC) AND ITS MEMBER HEALTH CARE FACILITIES PROVIDE QUALITY CARE REGARDLESS OF RACE, CREED, GENDER, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. IN ACTIVE PURSUIT OF THE ABOVE STATED MISSION, MHNWAC PROVIDED 31,651 INPATIENT SERVICE DAYS OF ACUTE OR SUB-ACUTE CARE. MHNWAC HAD ACUTE NEWBORN DISCHARGES OF 1,250, NEWBORN PATIENT DATS DAYS WERE 2,154, RESPONDED TO APPROXIMATELY 39,611 EMERGENCY ROOM ENCOUNTERS, MADE OVER 22,500 HOME HEALTH CARE VISITS AND COMPLETED 68,183 OUTPATIENT VISITS. COMMUNITY OUTREACH/BENEFIT PROGRAMS INCLUDE SUPPORT GROUPS FOR CURRENT AND PAST PATIENTS (DIABETIC, CARDIAC, ETC.), EXPECTING/NEW PARENTS (CHILD BIRTH CLASSES, VARIOUS SUPPORT GROUPS, ETC.), AND EMPLOYEES (EDUCATIONAL ASSISTANCE PROGRAMS, ETC.), LOCAL/SURROUNDING COMMUNITY (WELLNESS PROGRAMS, HEALTH FAIRS, HOME HEALTH PROGRAMS, ETC.) RELIEF FROM FINANCIAL BURDEN OF HEALTH CARE SERVICES TO THE INDIGENT CONSISTS OF CHARGES OF $12,792,362 FOR CHARITY CARE PROVIDED WITH A COST OF RELATED SERVICES. EXPENSES $ 27,268,595 INCLUDING GRANTS OF $500 REVENUE $ 27,360,015 FORM 990, PART V, QUESTION 1A FORMS 1099 AND FORM 1096 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 HEALTH SYSTEM (WITH LIMITED EXCEPTIONS) UNDER THE MERCY HEALTH EIN. FORM 990, PART VI, QUESTION 6, 7A, AND 7B DESCRIPTION OF CLASSES OF MEMBERS OR STOCKHOLDERS THE FILING ORGANIZATION HAS A SOLE CORPORATE MEMBER, MERCY HEALTH. THE FOLLOWING CORPORATE POWERS AND RESPONSIBILITIES SHALL BE RESERVED SOLELY UNTO THE CORPORATE MEMBER: -TO APPROVE AND ESTABLISH THE MISSION AND PHILOSOPHY ACCORDING TO WHICH THE CORPORATION AND ALL CORPORATIONS CONTROLLED BY THE CORPORATION SHALL OPERATE; -TO ADOPT OR AMEND THE ARTICLES OF INCORPORATION AND BYLAWS OF MERCY HOSPITAL ROGERS; -TO ADOPT OR AMEND THE ARTICLES OF INCORPORATION AND BYLAWS OF THE CORPORATION, EXCEPT THAT: -ANY AND ALL AMENDMENTS TO THE BYLAWS OF THE CORPORATION THAT MATERIALLY AFFECT THE EXISTENCE OR OPERATIONS OF THE MEDICAL GROUP BOARD, AS PROVIDED IN SECTION 8.2, MUST BE APPROVED BY THE MEDICAL GROUP BOARD, AND II. ANY AND ALL AMENDMENTS TO THE BYLAWS OF THE CORPORATION THAT MATERIALLY AFFECT THOSE POWERS RESERVED SOLELY TO THE MEDICAL GROUP, AS DESCRIBED IN SECTION 8.3, MUST BE APPROVED BY THE MEDICAL GROUP BOARD; -TO APPROVE AND APPOINT THE THREE (3) MEDICAL GROUP PHYSICIAN DIRECTORS AND ALL COMMUNITY REPRESENTATIVE DIRECTORS ON THE BOARD FROM NOMINATIONS SUBMITTED BY THE NOMINATING COMMITTEE; -TO APPOINT THE (2) MERCY HEALTH DIRECTORS ON THE BOARD; -TO APPOINT THE PRESIDENT/CEO OF THE CORPORATION, WHO SHALL SERVE AS AN EX-OFFICIO DIRECTOR ON THE BOARD WITH VOTE; -TO REMOVE ALL DIRECTORS ON THE BOARD WITH OR WITHOUT CAUSE; -TO APPROVE OR AMEND THE OVERALL STRATEGIC, LONG RANGE, AND HEALTH MANPOWER DEVELOPMENT PLANS, GOALS, AND OBJECTIVES OF THE CORPORATION OR ANY CORPORATION CONTROLLED BY THE CORPORATION; -TO APPROVE THE CONSOLIDATED OPERATING, CAPITAL, AND CONSTRUCTION BUDGETS (INCLUDING AGGREGATE PHYSICIAN COMPENSATION LEVELS) FOR THE CORPORATION OR ANY CORPORATION CONTROLLED BY THE CORPORATION AND CHANGES IN THE BUDGETS IN EXCESS OF AN AMOUNT ESTABLISHED FROM TIME TO TIME BY THE CORPORATE MEMBER; -TO LEASE OR SELL ANY OF THE ASSETS OF THE CORPORATION OR ANY CORPORATION CONTROLLED BY THE CORPORATION IN EXCESS OF AN AMOUNT ESTABLISHED FROM TIME TO TIME BY THE CORPORATE MEMBER; -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 CORPORATION OR ANY CORPORATION CONTROLLED BY THE CORPORATION; AND, -TO APPROVE THE CREATION, OWNERSHIP OR ACQUISITION OF, OR AFFILIATION WITH, ANY OTHER ORGANIZATION BY THE CORPORATION. FORM 990, PART VI, QUESTION 11B DSCR PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990 THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM, USING INFORMATION PROVIDED BY THE FILING ORGANIZATION. A DRAFT FORM 990 IS REVIEWED BY THE FILING ORGANIZATION'S FINANCE TEAM, INCLUDING THE MANAGER OF ACCOUNTING 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 AND CEO, FOR REVIEW. ONCE REVIEWED AND APPROVED BY THE FILING ORGANIZATION'S LEADERSHIP TEAM, THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS FOR REVIEW; IT IS THEN 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 THE 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, MERCY HEALTH 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 GOV DOCS, CONFLICT 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 XI, LINE 5 RECONCILIATION OF NET ASSETS PRIOR PERIOD ADJUSTMENT = $3,746 TOTAL OTHER CHANGES IN NET ASSETS = $3,746 FORM 990, PART XII, QUESTION 2C THE FILING ORGANIZATION'S FINANCIAL STATEMENTS WERE INCLUDED IN MERCY HEALTH AND SUBSIDIARIES ANNUAL FINANCIAL STATEMENT AUDIT. MERCY HEALTH AND SUBSIDIARIES RECEIVED AN UNQUALIFIED OPINION FROM THE EXTERNAL AUDITORS FOR FISCAL 2012 (THE TAX YEAR CURRENTLY BEING REPORTED). HOWEVER, NO SEPARATE AUDIT OPINION IS ISSUED ON THE FINANCIAL STATEMENTS OF THE FILING ORGANIZATION. THE ULTIMATE RESPONSIBILITY FOR OVERSIGHT OF THE FINANCIAL STATEMENT AUDIT AND SELECTION OF THE EXTERNAL AUDITOR LIES WITH THE FINANCE, AUDIT, AND COMPLIANCE COMMITTEE OF 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 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 Healthtrue
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 Kansas Communities Inc
401 Woodland Hills BlvdFt ScottKS66701480956045HospitalKS501(C)(3)3MHSMKCtrue
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 EntityTypeOfEntity
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 PHARMACYKSNAC-Corp
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 EmployeestrueSharingOfPaidEmployees
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 (6 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
Mercy Hospital Fort Smith
o65270FMV
Mercy Hospital Rogers
n90121FMV
Mercy Hospital Rogers
o106768FMV
Mercy Hospital Rogers
p7008611FMV
MHM Support Services
o21685626FMV
Resource Optimization & Innovation LLC
o517140FMV

Form990 Schedule R Part VII Form990ScheduleRPartVII

FieldValueIRS element (for citing)
IdentifierFORM 990, SCHEDULE R, PART VIIdentifier
Return ReferenceSUPPLEMENTAL INFORMATION FOR SCHEDULE RReturnReference
ExplanationLAWSON ERP SOFTWARE IS THE PRIMARY ACCOUNTING SOFTWARE USED BY MERCY HEALTH AND AFFILIATES. 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 ORGANIZATIONS ACTIVITY FOR THE FILING ORGANIZATION HAS BEEN CLASSIFIED ON SCHEDULE R, PART V, IN LINES O AND P.Explanation