2012-05-11T08:10:40-05:00 2011-06-30 PLEUS AND COMPANY LLC 14323 S OUTER FORTY STE 310N CHESTERFIELD MO 63017 990 2010-07-01 730579285 MERCY HEALTH CENTER INC MERC 4057523655 4300 WEST MEMORIAL ROAD OKLAHOMA CITY OK 73120 JON VITIELLO 4057523724 2012-05-11 1 3143179916 2010 2016-02-24 21:20:13Z DIANA SMALLEY 4300 WEST MEMORIAL ROAD OKLAHOMA CITY OK 73120 338656984 0 0928 X WWW.MERCY.NET/OKLAHOMACITYOK X 1992 OK TO CARRY OUT THE HEALING MINISTRY OF JESUS BY PROMOTING HEALTH AND WELLNESS THROUGH OUR COMMUNITIES, TO PROVIDE QUALITY HEALTH SERVICES THROUGH A WISE USE OF RESOURCES AND EXCEPTIONAL MERCY SERVICE. 9 8 3497 313 12904975 0 627287 2431152 286482348 307737621 166746 267464 25666162 26834790 312942543 337271027 433938 937121 0 0 132422711 132623808 0 0 0 163961721 181243899 296818370 314804828 16124173 22466199 165291354 207020771 27573380 22988954 137717974 184031817 X MERCY HOSPITAL OKLAHOMA CITY IS ROOTED IN THE MISSION OF JESUS AND THE HEALING MINISTRY OF THE CHURCH. THIS TRADITION IS MARKED BY VALUES OF JUSTICE, EXCELLENCE, STEWARDSHIP AND RESPECT FOR THE DIGNITY OF EACH PERSON.MERCY HOSPITAL OKLAHOMA CITY IMPLEMENTS AND ADVOCATES FOR INNOVATIVE HEALTH AND SOCIAL SERVICES TO IMPROVE THE HEALTH AND QUALITY OF LIFE OF COMMUNITIES SERVED, WITH PARTICULAR CONCERN FOR PEOPLE WHO ARE ECONOMICALLY POOR.IN SERVING OTHERS WE MAKE A DIFFERENCE BY TOUCHING THEIR LIVES WITH COMPASSION AND EXCEPTIONAL MERCY SERVICE. 0 0 223529081 937121 316536623 MERCY HOSPITAL OKLAHOMA CITY ("MERCY") PROVIDES QUALITY MEDICAL HEALTH CARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. DURING FY2011, MERCY PROVIDED SERVICES TO 19,335 INPATIENTS, 48,378 EMERGENCY DEPARTMENT PATIENTS, AND 273,544 OUTPATIENTS. SERVICES ARE PROVIDED THROUGH A COMMUNITY-BASED, ACUTE CARE HOSPITAL, AND A REHABILITATION CENTER. OUR OUTPATIENT SERVICES INCLUDE A HOME HEALTH AGENCY, OUTPATIENT SURGERY AND DIAGNOSTICS AND VARIOUS PRIMARY PHYSICIAN CLINICS/SERVICES. THE INSTITUTION CONTINUES TO FOCUS ON THE PROVISION OF PRIMARY HEALTH SERVICES THROUGH THE PURCHASE OF PRIMARY CLINICS AND EDUCATION TO THE COMMUNITY, REGARDLESS OF THEIR MEANS TO PAY FOR THESE SERVICES. MERCY RECOGNIZES THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES AND, FURTHER, THAT PART OF OUR MISSION IS TO PROVIDE HEALTH CARE SERVICES AND HEALTH CARE EDUCATION TO THE COMMUNITIES IN WHICH OUR FACILITIES ARE LOCATED. IN KEEPING WITH MERCY'S COMMITMENT TO SERVE ALL MEMBERS OF THE COMMUNITY, MERCY PROVIDES; (I) FREE CARE AND/OR SUBSIDIZED CARE, (II) CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST, (III) HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY, (IV) HEALTH EDUCATION PROGRAMS, AND (V) A VARIETY OF BROAD COMMUNITY SUPPORT ACTIVITIES. AMONG THE COMMUNITY SUPPORT ACTIVITIES OFFERED BY MERCY ARE THE FOLLOWING:1) COMMUNITY EDUCATION AND WELLNESS PROGRAMS 2) SUPPORT GROUP MEETINGS3) HEALTH FAIRS, SCREENINGS, AND FREE CLINICS 4) SUBSIDIZED HEALTH SERVICES INCLUDING HOSPICE, HOME HEALTH SERVICES, AND DISASTER READINESS, AND COMMUNITY HEALTH RESEARCH5) CASH AND IN-KIND DONATIONS FOR EVENTS AND FUND-RAISING6) COMMUNITY BUILDING ACTIVITIES, IN PARTNERSHIP WITH OTHER COMMUNITY ORGANIZATIONS7) PRE-NATAL AND WELL BABY CARE TO THE POOR MERCY PROVIDES CARE TO PATIENTS WHO LACK FINANCIAL RESOURCES AND ARE DEEMED TO BE MEDICALLY INDIGENT AND DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE. IN ADDITION, MERCY PROVIDES SERVICES TO OTHER PATIENTS UNDER THE MEDICARE PROGRAM AND VARIOUS STATE MEDICAID PROGRAMS. SUCH PROGRAMS PAY PROVIDERS AMOUNTS THAT ARE LESS THAN BILLED CHARGES OF THE SERVICES PROVIDED TO THE RECIPIENTS. CARE IS PROVIDED TO THOSE WITH LIMITED OR NO ABILITY TO PAY. RELIEF FOR THE FINANCIAL BURDEN OF HEALTH CARE SERVICES RENDERED TO THE INDIGENT TOTALED $18,698,895 IN FY2011.MERCY CONTINUES TO BE A STRONG LEADER AND PARTNER IN COMMUNITY COLLABORATIONS IN OKLAHOMA. THESE INCLUDE HEALTH EDUCATION PROGRAMS/CLASSES, SUPPORT GROUPS, CLINICAL SERVICES, IN-KIND DONATIONS, CONFERENCES, AND MANY COMMUNITY BUILDING ACTIVITIES. SOME OF THE HIGHLIGHTS INCLUDE "PROJECT EARLY DETECTION" WHICH PROVIDES BREAST HEALTH SERVICES FOR UNINSURED WOMEN AND "DIABETES WELLNESS PROJECT" WHICH SERVES DIABETIC CLIENTS WHO ATTEND A FREE CLINIC. THIS PROJECT OFFERS DIABETES EDUCATION, FOOT CARE, BLOOD GLUCOSE MONITORING SKILLS AND SUPPLIES, HEALTHY LUNCHES, GROCERY SHOPPING TIPS, EXERCISE ACTIVITIES, AND JOURNALING. MERCY HAS ALSO ADOPTED A LOW-INCOME ELEMENTARY SCHOOL AND PROVIDES WEEKLY TUTORS, AN ANNUAL HEALTH FAIR, AND OTHER SUPPORT. A WIDE VARIETY OF SUPPORT GROUPS IS OFFERED EACH MONTH. LAB SERVICES ARE PROVIDED FOR THREE FREE CLINICS IN THE COMMUNITY. 223529081 1 1 0 1 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 1 0 0 1 3 0 1 3497 1 1 1 0 0 0 0 0 0 0 0 0 X 9 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 1 1 OK X JON VITIELLO 4057523724 4300 WEST MEMORIAL ROAD OKLAHOMA CITY OK 73120 DIANA SMALLEY 40.00 X X 0 600864 183577 LINDA P LAMBERT 1.00 X 0 0 0 SISTER MARY JEANETTE NOONAN RSM 1.00 X 0 0 0 DONALD K RAHHAL MD 1.00 X 0 0 0 BROOK D SCOTT MD 1.00 X 0 0 0 SISTER CABRINI KOELSCH RSM 1.00 X 0 0 0 SISTER ROSEMARY WELSH RSM 1.00 X 0 0 0 JANE JAYROE GAMBLE 1.00 X 0 0 0 MIKE E O'NEAL 1.00 X 0 0 0 JONATHAN VITIELLO 40.00 X 0 375238 49437 JAMES NEWMAN 40.00 X 0 468970 86659 MARK JOHNSON 40.00 X 416698 0 97363 GABRIEL PARDO 40.00 X 0 315672 26476 KEITH MADISON 40.00 X 151121 0 14058 LINDA FANNING 40.00 X 192250 0 25926 BECKY PAYTON 40.00 X 257460 0 36940 JERRY BAUMEISTER 40.00 X 187414 0 42031 JAMES DIXSON 40.00 X 386701 25140 82598 THOMAS EDELSTEIN 40.00 X 152645 0 31850 JIM GEBHART 40.00 X 0 409214 29445 AARON STEFFENS 40.00 X 201328 0 20753 PAUL FOSTER 40.00 X 203963 0 21565 CINDY CARMICHAEL 40.00 X 220510 0 12398 RALPH C THOMAS 40.00 X 461591 0 16108 BOB G THOMPSON 40.00 X 333547 0 30679 DUSTAN P BUCKLEY 40.00 X 198800 100040 7196 JEFF JOHNSTON 40.00 X 0 513656 154704 JULIA AKINS 40.00 X 0 361561 50600 LOREN FJONE 40.00 X 0 242324 6428 3364028 3412679 1026791 80 1 1 0 FASTAFF INC DEPT 1452 DENVER CO 80291 NURSING 3305457 JE DUNN CONSTRUCTION 10900 HEFNER POINTE DR SUITE 305 OKLAHOMA CITY OK 73120 CONSTRUCTION 2575279 CYMETRIX 2875 MICHELLE DR STE 250 IRVINE CA 92606 ACCOUNTS RECEIVABLE OUTSOURCE 1498145 GK FINANCING 4 EMBARDCADERO CTR STE 3700 SAN FRANCISCO CA 94111 MEDICAL AND FINANCING SVCS 1157088 AFFILIATED ANESTHESIOLOGISTS 4200 W MEMORIAL RD STE 703 OKLAHOMA CITY OK 73120 MEDICAL SERVICES 792311 79 2431152 2431152 PATIENT SERVICE REVENU 621300 307737621 307737621 307737621 267610 267610 4788126 1385811 3402315 3402315 3402315 146 -146 -146 -146 MDT LABORATORY SVC 621500 10294549 10294549 PHARMACY 446110 7660224 5857794 1802430 CAFETERIA 722210 1694999 1694999 3782703 2941208 807996 33499 23432475 337271027 316536623 12904975 5398277 831221 831221 105900 105900 1896480 1896480 106748857 86728161 20020696 3777445 3015912 761533 13200707 8737066 4463641 7000319 5585492 1414827 35693484 759735 34933749 17482 6000 11482 37536 37536 183 183 15916876 9644988 6271888 57252 32492 24760 973095 709990 263105 122748 97180 25568 5593904 1813788 3780116 400970 255823 145147 11528221 5693572 5834649 1386183 1386183 MEDICAL SUPPLIES 47506785 47506785 BAD DEBT 25348749 25348749 PHARMACEUTICALS 21549517 21549517 EQUIPMENT RENTAL & MAIN 3367917 2378830 989087 DUES 1098851 106978 991873 10644146 2620902 8023244 314804828 223529081 91275747 0 12956047 22798744 44055396 44489256 179982 29973 4755247 5261129 549621 81186 320167147 225634332 101680023 94532815 72476 73876 1949360 1042562 37804432 165291354 207020771 26897146 22664372 226176 450058 324582 27573380 22988954 X 137717974 184031817 137717974 184031817 165291354 207020771 X 22466199 23847644 X X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 10582 0 0 0 10582 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: THE FILING ORGANIZATION IS A MEMBER OF AND PAYS DUES TO THE OKLAHOMA HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION. FOR THE YEAR ENDED JUNE 30, 2011, DUES WERE $74,594 AND $24,692, RESPECTIVELY. APPROXIMATELY 8.79% OF OKLAHOMA HOSPITAL ASSOCIATION DUES AND 16.3% OF AMERICAN HOSPITAL ASSOCIATION DUES WERE ATTRIBUTABLE TO LOBBYING ACTIVITIES PERFORMED. 1602629 11170270 12772899 77484688 42957297 34527391 425639 177298 248341 222765333 178043316 44722017 6718588 4456421 2262167 94532815 OTHER ASSETS 180000 DUE FROM TAX EXEMPT AFFILIATES 37624432 37804432 MEDICARE SETTLEMENTS 324582 324582 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF MERCY HEALTH AND SUBSIDIARIES DO NOT INCLUDE A FOOTNOTE TO REPORT THE ORGANIZATION'S LIABILITY FOR UNCERTAIN TAX PROVISIONS UNDER FIN 48, AS THEY ARE DEEMED IMMATERIAL FOR DISCLOSURE. 1 1 X 1 X 1 X 1 1 1 0 1 1 6567356 6567356 0.02270 12131539 12131539 0.04190 18698895 18698895 0.06460 890401 890401 0.00310 192163 192163 0.00070 723758 723758 0.00250 194588 194588 0.00070 2000910 2000910 0.00700 20699805 20699805 0.07160 174356 174356 0.00060 36071 36071 0.00010 13090 13090 0.00000 223517 223517 0.00070 1 8274740 0 80686067 94953127 -14267060 X 1 1 1 1 MERCY HOSPITAL OKLAHOMA CITY

4300 WEST MEMORIAL ROAD OKLAHOMA CITY OK 73120

X X X NOT REQUIRED 1 PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 25348749. PART II: MERCY HOSPITAL OKLAHOMA CITY (MHOC) COMMUNITY BUILDING ACTIVITIES PROMOTE THE HEALTH OF THE COMMUNITIES IN WHICH THEY SERVE. THROUGH ACTIVE PARTICIPATION IN COMMUNITY BOARDS, NEIGHBORHOOD/COMMUNITY MEETINGS AND INVOLVEMENT IN COMMUNITY-BASED EVENTS, MHOC DEMONSTRATES ITS ONGOING COMMITMENT TO THE COMMUNITY. COMMUNITY BUILDING ACTIVITIES SERVE AS A LINK TO ENGAGE MERCY COWORKERS TO LOOK BEYOND THE WALLS OF THE FACILITIES IN WHICH THEY SERVE. SOME OF THE COMMUNITY BUILDING ACTIVITIES IN WHICH MHOC SERVES ARE:- MHOC WAS A FOUNDING PARTNER OF THE HEALTH ALLIANCE FOR THE UNINSURED (HAU), WHICH WAS FORMED TO IMPROVE ACCESS OF HEALTHCARE FOR THE UNINSURED. THERE ARE 16 CLINICS AFFILIATED WITH THE HAU. THE RN CHRONIC DISEASE COORDINATOR FROM MHOC IS ASSIGNED TO THE HAU.- DIABETES WELLNESS PROJECT (DWP) PROVIDES DIABETES EDUCATION, FOOT CARE, BLOOD GLUCOSE MONITORING SKILLS AND SUPPLIES TO UNINSURED DIABETICS. A TRAIN-THE-TRAINER SESSION WAS HELD IN ATOKA, OKLAHOMA IN ORDER TO BEGIN EXPANSION TO THE RURAL AREA.- MERCY MENTORS PROVIDE WEEKLY TUTORING TO LINWOOD ELEMENTARY, AN INNER-CITY, LOW- INCOME ELEMENTARY SCHOOL.- PROJECT EARLY DETECTION (PED) PROVIDES BREAST CARE SERVICES FOR UNINSURED WOMEN IN OKLAHOMA.- HEALTHTEACHER, A COMPREHENSIVE K-12 CURRICULUM THAT PROMOTES LIFELONG HEALTH WAS PRESENTED TO EACH SCHOOL DISTRICT IN THE MERCY SERVICE AREA.- ACTIVE PARTICIPATION ON COMMUNITY BOARDS, COMMUNITY EVENTS: ELDER LAW DAY, CAREGIVER SURVIVAL SKILLS CONFERENCE, OKLAHOMA TURNING POINT COUNCIL, LINWOOD NEIGHBORHOOD HEALTH FAIR, ANNUAL FLU SHOTS FOR THE UNDERSERVED, - ONGOING COLLABORATION WITH COMMUNITY PARTNERS/AGENCIES TO MEET THE NEEDS OF THE POOR AND UNINSURED. 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 FORUNCOLLECTIBLE ACCOUNTS IN ACCORDANCE WITH COLLECTIONS POLICIES OF THEHEALTH SYSTEMS AND, IN CERTAIN CASES, ARE RECLASSIFIED TO CHARITY CAREIF DEEMED TO OTHERWISE MEET THE HEALTH SYSTEM'S CHARITY CARE POLICY.THE PROVISION FOR UNCOLLECTIBLE RECEIVABLES IS BASED ON MANAGEMENT'SASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERINGBUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTHCARE COVERAGE, ANDOTHER COLLECTION INDICATORS. PERIODICALLY THROUGHOUT THE YEAR,MANAGEMENT ASSESS THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLERECEIVABLES BASED UPON THE PAYOR COMPOSITION AND AGING OF RECEIVABLESAS OF THE REPORTING DATE WITH CONSIDERATION OF THE HISTORICAL PAYMENTAND WRITE-OFF EXPERIENCE BY PAYOR CATEGORY. THE RESULTS OF THESEREVIEWS ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FORUNCOLLECTIBLE RECEIVABLES TO ESTABLISH AN APPROPRIATE ALLOWANCE FORUNCOLLECTIBLE RECEIVABLES. AFTER SATISFACTION OF AMOUNTS DUE FROMINSURANCE, THE HEALTH SYSTEM FOLLOWS ESTABLISHED GUIDELINES FORPLACING PAST-DUE BALANCES WITH COLLECTION AGENCIES." 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. THE FILING ORGANIZATION DETERMINED THAT THE ESTIMATED AMOUNT OF BAD DEBT EXPENSE (AT COST) ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THEORGANIZATION'S CHARITY CARE POLICY IS $0. ALTHOUGH THE CHARITY CAREPOLICY REQUIRES THE PARTICIPATION OF THE PATIENT REQUESTING ASSISTANCE, WE HAVE A PROCESS UNDER PRESUMPTIVE CHARITY (REFER TODISCLOSURE FOR PART III, #9B) TO ADDRESS ACCOUNTS FOR PATIENTS WHO DONOT PROVIDE THE INFORMATION. WE BELIEVE THAT OUR CHARITY POLICY ISCOMPREHENSIVE ENOUGH TO CAPTURE ALMOST ALL PATIENTS WHO QUALIFY FORCHARITY CARE. PART III, LINE 8: IT IS THE POSITION OF MERCY HOSPITAL OKLAHOMA CITY THAT 100% OF ANY SHORT FALL SHOULD BE TREATED AS COMMUNITY BENEFIT. THIS AMOUNT REPRESENTS COST OF PROVIDING SERVICES THAT REMAIN UNCOMPENSATED TO THE PROVIDER.THE UNREIMBURSED COSTS OF MEDICARE IS CALCULATED BY THE GROSS CHARGESNET OF THE COST TO CHARGE RATIO LESS ANY PAYMENTS, DEDUCTIONS ORREIMBURSMENTS USING THE ANNUAL MEDICARE COST REPORT (CMS FORM 2552-96) PART III, LINE 9B: MERCY HOSPITAL OKLAHOMA CITY ("MERCY") DEBT COLLECTION POLICY PROVIDES THAT MERCY WILL PERFORM A REASONABLE REVIEW OF EACH INPATIENT ACCOUNT BEFORE TURNING AN ACCOUNT 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 MET THE MERCY HOSPITAL COMMUNITY ASSISTANCE POLICY IS REQUIRED TO BE RETURNED IMMEDIATELY BY THE THIRD-PARTY COLLECTION AGENT TO MERCY FOR APROPRIATE 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 HOSPITAL HAS BEEN UNABLE TO OBTAIN INFORMATION FROM PATIENTS OR THE INFORMATION PROVIDED IS NOT COMPLETE ENOUGH TO MAKE A CHARITY DETERMINATION. MERCY UTILITIZES PRESUMPTIVE CHARITY PRIOR TO BAD DEBT PLACEMENT FOR CHARITY ADJUSTMENTS IN EXCESS OF $10,000. 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 CONSISTENTWITH MERCY MISSION AND VALUES. ADDITIONALLY THEY MAY INCLUDE LIENS UPONREAL PROPERTY AND REASONABLE WAGE GARNISHMENTS. LEGAL ACTIONS WILLGENERALLY NOT INCLUDE BANK GARNISHMENT, REPOSSESSION OF ASSETS ORFORECLOSURES TO ENFORCE SATISFACTION OF A LIEN. MERCY HAS POLICIES ANDPROCEDURES ESTABLISHED TO ADDRESS THE INITIATION OF LEGAL ACTION ANDANNUALLY REVIEWS COMPLIANCE WITH ALL POLICIES. PART VI, LINE 2: COMMUNITY ROUNDTABLES #2 MEETINGS WERE HELD IN OKLAHOMA CITY, WHICH IS LOCATED IN THE MERCY HOSPITAL OKLAHOMA CITY SERVICE AREA. PARTICIPANTS PROVIDED FEEDBACK CONCERNING CHANGES THEY HAVE OBSERVED FROM LAST YEAR'S MEETINGS.- OKLAHOMA HEALTH IMPROVEMENT PLAN (OHIP). THIS IS A COMPREHENSIVE PLAN OF THE OKLAHOMA STATE HEALTH DEPARTMENT AND ITS PARTNERS TO IDENTIFY HEALTH PROBLEMS IN THE STATE AND PROVIDE NEW UPDATES.- CITY/COUNTY HEALTH DEPARTMENT WELLNESS SCORES- COMMUNITY HEALTH STATUS REPORT 2010 PART VI, LINE 3: THE FILING ORGANIZATION HAS PRINTED MATERIAL AVAILABLE AT EACH POINT OF REGISTRATION IN OUR FACILITY, IN ADDITION TO ELECTRONICALLY AVAILABILITY AT OUR WEB SITE. SPECIFIC INFORMATION PROVIDED: FINANCIAL ASSISTANCE INFORMATION AS A PART OF OUR HEALING MINISTRY, THE FILING ORGANIZATION 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 10% OF ANNUAL HOUSEHOLD INCOME, ADJUSTED TO CONSIDER AVAILABILITY OF OTHER ASSETS THAT COULD BE USED TOWARD MAKING PAYMENTS. PART VI, LINE 4: MERCY HOSPITAL OKLAHOMA CITY IS LOCATED IN NORTHWEST OKLAHOMA CITY. MERCY HOSPITAL OKLAHOMA CITY PRIMARILY SERVES THOSE IN URBAN/SUBURBAN OKLAHOMA CITY AND A SIX-COUNTY AREA WITH A 1.09 MILLION POPULATION; OKLAHOMA, CANADIAN, CLEVELAND, KINGFISHER, LINCOLN AND LOGAN COUNTIES.- OKC SUMMARY: 16% OF POPULATION ARE UNINSURED, 16% MEDICAID, AND 14% MEDICARE- HIGHER DEATH RATE THAN THE US RATE- OKLAHOMA COUNTY COMPARES UNFAVORABLY TO COUNTIES OF SIMILAR POPULATION COMPOSITION AND DEMOGRAPHIC MAKE-UP ON 16 OF 22 COMMUNITY HEALTH INDICATORS.- LEADING CAUSE OF DEATH ATTRIBUTED TO INJURIES FOR RESIDENTS UNDER AGE 45 WITH CANCER AND HEART DISEASE FOR THOSE AGE 45+.- RISK FACTORS THAT CONTRIBUTE TO PREMATURE DEATH ARE HIGH BLOOD PRESSURE, SMOKING, AND ADULT OBESITY.- IDENTIFIED HEALTH NEEDS: SCHOOL HEALTH INITIATIVE, ACCESS TO HEALTH SERVICES, PREVENTION, TOBACCO, OBESITY PART VI, LINE 6: MERCY HOSPITAL OKLAHOMA CITY (MHOC) IS A CATHOLIC HEALTH CARE CORPORATION THAT, PURSUANT TO THE ORGANIZATIONAL CORE BELIEF THAT HEALTH CARE SERVICES ARE A VITAL AND INTEGRAL PART OF THE CHURCH'S HEALING MISSION, ENGAGES IN A MINISTRY WHICH PROVIDES GENERAL ACUTE CARE, AMBULATORY, LONG-TERM AND HOME CARE HEALTH SERVICES TO INDIVIDUALS AND FAMILIES IN ITS SERVICE COMMUNITIES. IN KEEPING WITH MHOC'S COMMITMENT TO SERVE ALL MEMBERS OF THE COMMUNITIES IT SERVES, MHOC PROVIDES CARE TO PATIENTS REGARDLESS OF ABILITY TO PAY. AS DEFINED BY THE INSTITUTION'S CHARITY POLICY, MHOC DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY FOR CHARITY CARE. IN ADDITION, MHOC PROVIDES SERVICES TO OTHER PATIENTS UNDER THE MEDICARE PROGRAM AND VARIOUS STATE MEDICAID PROGRAMS. SUCH PROGRAMS PAY PROVIDERS AMOUNTS THAT ARE SUBSTANTIALLY LESS THAN BILLED CHARGES, AND FREQUENTLY LESS THAN THE COST, OF THE SERVICES PROVIDED TO THE RECIPIENTS.MHOC IS GOVERNED BY A BOARD OF DIRECTORS WHICH INCLUDES REPRESENTATION FROM COMMUNITY LEADERS IN THE ORGANIZATION'S PRIMARY SERVICE AREAS. ALL BOARD MEMBERS ARE REQUIRED TO COMPLETE AN ANNUAL CONFLICT OF INTEREST SURVEY. ANY POTENTIAL CONFLICTS OF INTEREST DISCLOSED BY BOARD MEMBERS ARE SCREENED BY GENERAL COUNSEL AND REVIEWED BY THE BOARD CHAIRPERSON AND CEO. THIS PROCESS ENSURES THAT PUBLIC, RATHER THAN PRIVATE, INTERESTS ARESERVED BY MHOC.SURPLUS FUNDS AND UNRESTRICTED ASSETS HELD BY MHOC ARE REINVESTED IN PATIENT CARE, MEDICAL EDUCATION AND RESEARCH INITIATIVES WHICH SUPPORT THE ORGANIZATION'S MISSION TO DELIVER COMPASSIONATE CARE AND EXCEPTIONAL HEALTH CARE SERVICES TO THE COMMUNITIES IT SERVES. EXAMPLES INCLUDE THE FOLLOWING: - PURCHASE AND INSTALLATION OF KEY DIAGNOSTIC IMAGING EQUIPMENT TO AID IN THE ACCURATE AND TIMELY DIAGNOSIS OF DISEASE.- PURCHASE AND INSTALLATION OF CANCER TREATMENT INFUSION THERAPY SERVICES AND STATE-OF-THE-ART RADIATION TREATMENT (LINEAR ACCELERATOR.)- EXPANSION OF EMERGENCY ROOM FACILITIES AT MERCY HOSPITAL OKLAHOMA CITY TO FURTHER MEET THE HEALTH CARE NEEDS OF THIS COMMUNITY. - RENOVATION AND UPGRADE OF THE INTENSIVE CARE UNIT AT MERCY HOSPITAL OKLAHOMA CITY TO PROVIDE THE HIGHEST QUALITY CARE OF THIS COMMUNITY.- CONVERSION TO THE EPIC ELECTRONIC HEALTH RECORD SYSTEM. THIS PLATFORM ALLOWS CONTINUITY OF PATIENT MEDICAL RECORD ACCESS BY PROVIDERS THROUGHOUT THE MERCY SYSTEM (ONE PATIENT, ONE RECORD) AND ALSO ALLOWS THE PATIENT TO ACCESS INFORMATION FROM THEIR OWN RECORDS, ALLOWING MORE COMPLETE AND MEANINGFUL COMMUNICATION, INFORMATION AND HEALTH EDUCATION FOR THE COMMUNITY. - RENOVATION AND UPGRADES TO THE OPERATING ROOM SUITES TO MEET THE TECHNOLOGICAL AND CLINICAL ADVANCES, CONTINUING TO PROVIDE THE HIGHEST QUALITY OF CARE TO SUPPORT THE NEEDS OF THE POPULATION SERVED MY MHOC AND ITS STAFF PHYSICIANS. PART VI, LINE 7: THE FILING ORGANIZATION IS PART OF MERCY HEALTH ("MERCY"). MERCY IS A MISSOURI NON-PROFIT CORPORATION WITH ITS HEADQUARTERS ("MINISTRY OFFICE") IN ST. LOUIS, MISSOURI. MERCY PROVIDES HEALTH CARE SERVICES IN FOUR STATES - ARKANSAS, KANSAS, MISSOURI, AND OKLAHOMA - AND HAS OUTREACH MINISTRIES LOCATED IN LOUISIANA, MISSISSIPPI, AND TEXAS. MERCY'S MISSION IS "AS THE SISTERS OF MERCY BEFORE US, WE BRING LIFE TO THE HEALING MINISTRY OF JESUS THROUGH OUR COMPASSIONATE CARE AND EXCEPTIONAL SERVICE." AS OF JUNE 30, 2011, MERCY FACILITIES INCLUDED 31 HOSPITALS WITH 3,822 ACUTE LICENSED BEDS (3,393 ACUTE AVAILABLE BEDS). FOR THE FISCAL YEAR ENDED JUNE 30, 2011, MERCY HAD 4.4 MILLION PROVIDER VISITS AND 2.4 MILLION OUTPATIENT VISITS, MORE THAN 1,300 EMPLOYED PHYSICIANS, AND APPROXIMATELY 29,000 FULL-TIME EQUIVALENT EMPLOYEES, MAKING MERCY THE EIGHTH LARGEST CATHOLIC HEALTH SYSTEM IN THE UNITED STATES BASED ON NET PATIENT SERVICE REVENUE. MERCY IS SPONSORED BY MERCY HEALTH MINISTRY, WHICH IS GOVERNED BY MEMBERS THAT INCLUDE SISTERS OF MERCY.MANY SERVICES THAT ARE ESSENTIAL TO FULFILLING MERCY'S MISSION ARE CENTRALIZED AT THE MINISTRY OFFICE. SUCH CENTRALIZED SERVICES INCLUDE TREASURY, INFORMATION TECHNOLOGY, CLINICAL QUALITY MANAGEMENT, LEGAL AND COMPLIANCE COUNSEL, COMPENSATION AND BENEFITS, CONSULTING, PERFORMANCE MANAGEMENT, REVENUE MANAGEMENT, CAPITAL MANAGEMENT, CLINICAL ENGINEERING, AND CLINICAL SAFETY. THE CENTRALIZATION OF SUCH SUPPORT SERVICES ENABLES MERCY TO ENSURE THAT EACH OF ITS COMMUNITIES, WHETHER LARGE OR SMALL, HAS THE SERVICES IT NEEDS. 1 ALLIED ARTS ONE N HUDSON STE 140 OKLAHOMA CITY OK 73102 730804291 501(C)(3) 15000 COMMUNITY ENRICHMENT EDMUND AREA CHAMBER OF COMMERCE 825 E 2ND ST SUITE 100 EDMUND OK 73034 730544087 501(C)(6) 15574 ECONOMIC DEVELOPMENT MARCH OF DIMES 5100 BROOKLINE STE 270 OKLAHOMA CITY OK 73102 131846366 501(C)(3) 67000 NICU FAMILY SUPPORT GREATER OKLAHOMA CITY CHAMBER OF COMMERCE 123 PARK AVE OKLAHOMA CITY OK 73102 730381180 501(C)(6) 15000 EDUCATIONAL ENDOWMENT UNITED WAY OF CENTRAL OKLAHOMA PO BOX 837 OKLAHOMA CITY OK 73105 730589829 501(C)(3) 43000 COMMUNITY CAMPAIGN OKLAHOMA COUNTY MEDICAL SOCIETY ALLIANCE 1901 PRESTON PLACE EDMUND OK 73013 731205746 501(C)(3) 5000 CHARITABLE DONATION WORLD NEIGHBORS INC 4127 MW 122ND STREET OKLAHOMA CITY OK 73120 730707328 501(C)(3) 5000 SPONSORSHIP DONATION OKLAHOMA MEDICAL RESEARCH FOUNDATION 825 NE 13TH STREET OKLAHOMA CITY OK 73104 730580274 501(C)(3) 398476 RESEARCH OKLAHOMA HOSP EDUCATION RSCH FDTN TRUST 4000 LINCOLN BOULEVARD OKLAHOMA CITY OK 73105 736111625 501(C)(3) 10000 RESEARCH 7 2 TUITION SCHOLARSHIPS 35 105900 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE ORGANIZATION USES AN APPROVAL PROCESS TO DETERMINE WHICH ORGANIZATIONS WILL RECEIVE GRANTS DURING THE FISCAL YEAR. THE FUNDS ARE THEN GIVEN DIRECTLY TO THE NONPROFIT ORGANIZATION. X X 0 0 1 1 0 0 0 0 0 1 0 DIANA SMALLEY 0 411753 0 180335 0 8776 0 169434 0 14143 0 784441 0 0 JONATHAN VITIELLO 0 260553 0 108343 0 6342 0 35784 0 13653 0 424675 0 0 JAMES NEWMAN 0 167633 0 114755 0 186582 0 77196 0 9463 0 555629 0 0 MARK JOHNSON 309894 0 73862 0 32942 0 86487 0 10876 0 514061 0 0 0 GABRIEL PARDO 0 266386 0 0 0 49286 0 12138 0 14338 0 342148 0 0 KEITH MADISON 117414 0 9499 0 24208 0 8178 0 5880 0 165179 0 0 0 LINDA FANNING 147446 0 24718 0 20086 0 24351 0 1575 0 218176 0 0 0 BECKY PAYTON 180048 0 52065 0 25347 0 26479 0 10461 0 294400 0 0 0 JERRY BAUMEISTER 117329 0 23411 0 46674 0 36005 0 6026 0 229445 0 0 0 JAMES DIXSON 296058 24106 69188 0 21455 1034 71704 0 10021 873 468426 26013 0 0 THOMAS EDELSTEIN 120231 0 20112 0 12302 0 19116 0 12734 0 184495 0 0 0 JIM GEBHART 0 310534 0 95943 0 2737 0 16123 0 13322 0 438659 0 0 AARON STEFFENS 159784 0 31652 0 9892 0 7552 0 13201 0 222081 0 0 0 PAUL FOSTER 152275 0 25477 0 26211 0 8315 0 13250 0 225528 0 0 0 CINDY CARMICHAEL 183774 0 28141 0 8595 0 6081 0 6317 0 232908 0 0 0 RALPH C THOMAS 391663 0 60286 0 9642 0 5140 0 10968 0 477699 0 0 0 BOB G THOMPSON 237028 0 67329 0 29190 0 24094 0 6585 0 364226 0 0 0 DUSTAN P BUCKLEY 38300 100000 160500 0 0 40 7196 0 0 0 205996 100040 0 0 JEFF JOHNSTON 0 325561 0 166734 0 21361 0 138924 0 15780 0 668360 0 0 JULIA AKINS 0 187864 0 119350 0 54347 0 40067 0 10533 0 412161 0 0 LOREN FJONE 0 175358 0 39682 0 27284 0 0 0 6428 0 248752 0 0 PART I, LINE 1A CHARTER TRAVEL IS PROVIDED TO ALL EMPLOYEES AS DEEMED NECESSARY FOR BUSINESS TRAVEL AND PURSUANT TO THE APPROVAL BY THE FINANCE DEPARTMENT. 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 UNDER LIMITED CIRCUMSTANCES 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. HOUSING BENEFITS ARE PROVIDED THROUGH A RELOCATION PROGRAM IN ACCORDANCE WITH COMPANY POLICY. SUCH BENEFITS ARE SUBJECT TO TAX TO THE EMPLOYEE. PAYMENT BY THE COMPANY OF COSTS FOR TEMPORARY HOUSING BY EMPLOYEES FOR THE CONVENIENCE OF THE COMPANY IS MADE IN ACCORDANCE WITH THE CO-WORKER TRAVEL AND OTHER EXPENSE POLICY AND PROCEDURES. AS A REIMBURSABLE EXPENSE, THIS TYPE OF LODGING IS NOT TAXABLE TO THE EMPLOYEE. PART I, LINES 4A-B JAMES NEWMAN RECEIVED $95,142 OF SEVERANCE COMPENSATION FROM MERCY HEALTH. SCHEDULE J, PART I, QUESTION 4B MERCY HEALTH, THE PARENT COMPANY, 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 EXECUTIVE RETIREMENT PLANS INCLUDE: DIANA SMALLEY; JEFFREY JOHNSTON THE FOLLOWING INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL MANAGEMENT RETIREMENT PLAN: JAMES DIXSON; LINDA FANNING; MARK JOHNSON; JEFFREY JOHNSTON; JAMES NEWMAN; BECKY PAYTON; JONATHAN VITIELLO; RALPH THOMAS; JIM GEBHART THE AMOUNT OF ALL ACCRUED BENEFITS IS INCLUDED IN COMPENSATION AMOUNTS PROVIDED IN SCHEDULE J, PART II, COLUMN (C). NO PERSONS LISTED ON THIS RETURN RECEIVED PAYMENT UNDER THE PLANS DURING THE TAX YEAR. PART I, LINE 7 THE RELATED ORGANIZATION WHICH EMPLOYS THOSE INDIVIDUALS LISTED ON PART VII, AND THE FILING ORGANIZATION WHEN APPLICABLE, PROVIDES A NON-FIXED BONUS PLAN FOR WHICH CERTAIN TIERS OF ITS EMPLOYEES ARE ELIGIBLE. FOR FISCAL YEAR 2011 (JULY 1, 2010 - JULY 30, 2011) 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 ARE REVIEWED BY THE EXECUTIVE COMPENSATION COMMITTEE OF MERCY HEALTH AND ARE THEN TAKEN INTO ACCOUNT WHEN ANALYZING EXECUTIVE COMPENSATION FOR REASONABLENESS. SUPPLEMENTAL INFORMATION PART III PART I, LINE 3: THE FILING ORGANIZATION RELIES ON A RELATED ORGANIZATION; REFER TO SCHEDULE O, PART VI, QUESTION 15A AND 15B FOR THE PROCESS THE RELATED ORGANIZATION FOLLOWS. OKLAHOMA HEART HOSPITAL LLC SEE SCHEDULE O 644280 INDEPENDENT CONTRACTOR 0 OKLAHOMA CARDIO VASCULAR ASSOCIATION SEE SCHEDULE O 35781 INDEPENDENT CONTRACTOR 0 FORM 990, PART VI, SECTION A, LINE 6 MERCY HOSPITAL OKLAHOMA CITY HAS A SOLE CORPORATE MEMBER, MERCY HEALTH OKLAHOMA COMMUNITIES. FORM 990, PART VI, SECTION A, LINE 7A MERCY HEALTH OKLAHOMA COMMUNITIES MAY APPOINT AND REMOVE MEMBERS OF THE BOARD. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING CORPORATE POWERS AND RESPONSIBILITIES SHALL BE RESERVED SOLELY UNTO MERCY HEALTH OKLAHOMA COMMUNITIES: - ADOPT OR AMEND THE MISSION AND PHILOSOPHY OF THE CORPORATION AND ANY ORGANIZATION CONTROLLED BY THE CORPORATION; - ADOPT OR AMEND THE STRATEGIC PLANS, GOALS, AND OBJECTIVES OF THE CORPORATION AND ANY ORGANIZATION CONTROLLED BY THE CORPORATION; - ADOPT OR AMEND THE OPERATING AND CAPITAL BUDGETS OF THE CORPORATION AND ANY ORGANIZATION CONTROLLED BY THE CORPORATION AND ANY CHANGES IN SUCH BUDGETS IN EXCESS OF AN AMOUNT ESTABLISHED FROM TIME TO TIME BY THE MEMBER; - REVIEW AND APPROVE ANY CAPITAL EXPENDITURES OR RECOMMENDATIONS NOT PREVIOUSLY APPROVED AS PART OF THE CORPORATION'S BUDGETS; - AUTHORIZE OR APPROVE THE ASSIGNMENT, TRANSFER, SALE OR LEASE OF ANY OF THE ASSETS OF THE CORPORATION OR ANY ORGANIZATION CONTROLLED BY THE CORPORATION OR INTEREST THEREIN IN EXCESS OF AN AMOUNT ESTABLISHED FROM TIME TO TIME BY THE MEMBER; - AUTHORIZE OR APPROVE THE GRANT OF ANY PLEDGE, LIEN, ENCUMBRANCE, MORTGAGE, DEED OF TRUST OR OTHER SECURITY INTEREST IN ANY OR ALL OF THE ASSETS OF THE CORPORATION AND ANY ORGANIZATION CONTROLLED BY THE CORPORATION; - AUTHORIZE OR APPROVE THE INCURRENCE OF DEBT (OTHER THAN DEBT INCURRED FOR THE ACQUISITION OF GOODS THAT ARE ACQUIRED IN THE ORDINARY COURSE OF BUSINESS) BY THE CORPORATION OR ANY ORGANIZATION CONTROLLED BY THE CORPORATION AND THE GRANT ANY SECURITY INTERESTS, THE PLACEMENT OF ANY ENCUMBRANCES, THE ENTERING INTO ANY COVENANTS, AND THE EXECUTION OF ANY DOCUMENTS AND THE TAKING OF ANY ACTIONS NECESSARY OR APPROPRIATE IN CONNECTION WITH THE INCURRENCE OF SUCH DEBT; - MERGE, DISSOLVE OR ABANDON THE CORPORATION OR ANY ORGANIZATION CONTROLLED BY THE CORPORATION; - AMEND THE CERTIFICATE OF INCORPORATION AND BYLAWS OF THE CORPORATION AND ANY ORGANIZATION CONTROLLED BY THE CORPORATION; - ESTABLISH ALL COMPENSATION AND BENEFIT TERMS FOR PHYSICIANS AND OTHER MEDICAL PROFESSIONALS EMPLOYED OR OTHERWISE RETAINED BY THE CORPORATION; - APPROVE THE CREATION, OWNERSHIP OR ACQUISITION OF, OR AFFILIATION WITH, ANY OTHER ORGANIZATION CONTROLLED BY THE CORPORATION; - APPROVE CONTRACTS IN WHICH THE CORPORATION ASSUMES FINANCIAL RISK, INCLUDING BUT NOT LIMITED TO MANAGED CARE CONTRACTS, SUBJECT TO CONSULTATION WITH THE MANAGED CARE CONTRACTING COMMITTEE OF THE MEMBER; - APPROVE THE CLINIC'S MANPOWER PLAN; - THROUGH THE SOLE ACTION OF THE PRESIDENT OF THE MEMBER (WITH THE APPROVAL OF THE PRESIDENT OF MERCY, APPOINT AND REMOVE THE PRESIDENT OF THE CORPORATION; AND - AUTHORIZE AND AMEND THE CHARITY CARE POLICY OF THE CLINIC. FORM 990, PART VI, SECTION B, LINE 11 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. THE DRAFT FORM 990 IS ALSO REVIEWED BY THE MERCY HEALTH 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 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, SECTION B, LINE 12C THE BOARD ANNUALLY RECEIVES A CONFLICT OF INTEREST QUESTIONAIRE. THE ORGANIZATION HAS A COMPLIANCE DEPARTMENT TO MONITOR AND ENFORCE COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION B, LINE 15A FOR THOSE CLASSIFIED AS OFFICERS (AND THUS DISQUALIFIED PERSONS), THE ORGANIZATION 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 THE SISTER OF MERCY HEALTH SYSTEM. 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, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS HAVE BEEN MADE AVAILABLE FROM TIME TO TIME BUT ARE NOT PUBLISHED PUBLICLY. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: TRANSFERS TO AFFILIATES -742,058. CONTRIBUTION ADJUSTMENTS 3,589. TRANSFERS TO MCS -413,887. MIF FUND TRANSFER 25,000,000. TOTAL TO FORM 990, PART XI, LINE 5: 23,847,644. AUDITED FINANCIAL STATEMENTS PART XI, LINE 2 THE FILING ORGANIZATION'S FINANCIAL STATEMENTS WERE INCLUDED IN THE MERCY HEALTH AND SUBSIDIARIES ANNUAL FINANCIAL STATEMENT AUDIT. MERCY HEALTH AND SUBSIDIARIES RECEIVED AN UNQUALIFIED OPINION FROM THE EXTERNAL AUDITORS FOR FISCAL 2011 (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 THE MERCY HEALTH BOARD OF DIRECTORS. AUDIT RESULTS ARE COMMUNICATED TO THIS COMMITTEE. SINGLE AUDIT ACT AND OMB CIRCULAR A-133 PART XI, LINE 3 THE CONSOLIDATED GROUP OF MERCY HEALTH IS REQUIRED TO UNDERGO AN AUDIT AS SET FORTH IN THE SINGLE AUDIT ACT AND OMB CIRCULAR A-133. THE SINGLE AUDIT WAS CONDUCTED ON A CONSOLIDATED BASIS. RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION FORM 990, SCHEDULE L, PART IV DIANA SMALLEY, BOARD MEMBER, AND JAMES NEWMAN (THRU 8/31/10) AND MARK JOHNSON, OFFICERS OF THE ORGANIZATION, ARE ALL BOARD MEMBERS OF OKLAHOMA HEART HOSPITAL, LLC BROOK D. SCOTT, MD, IS A BOARD MEMBER OF THE ORGANIZATION AND OKLAHOMA CARDIOVASCULAR ASSOCIATION MERCY HOSPITALS EAST COMMUNITIES FORM 990, SCHEDULE R, PART II MERCY HOSPITALS EAST COMMUNITIES CONSISTS OF MERCY HOSPITALS EAST COMMUNITIES ST. LOUIS, EIN 43-0653493, AND MERCY HOSPITALS EAST COMMUNITIES WASHINGTON, EIN 43-1066883. FORM 990, SCHEDULE R LAWSON ERP SOFTWARE IS THE PRIMARY ACCOUNTING SOFTWARE USED BY SISTERS OF MERCY HEALTH SYSTEM, INC. AND SUBSIDIARIES. 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. HOURS PER WEEK FORM 990, PART VII SEVERAL INDIVIDUALS ARE DISCLOSED AS OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES ON MULTIPLE FORM 990S THAT ARE FILED BY ORGANIZATIONS INCLUDED IN THE MERCY HEALTH OKLAHOMA COMMUNITIES SYSTEM. THE AVERAGE HOURS PER WEEK REPORTED INCLUDES HOURS WORKED FOR ALL OF THESE ORGANIZATIONS. FORM 990, PART V, QUESTION 1A INDEPENDENT CONTRACTORS 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. SCHEDULE O DISCLOSURE FORM 990, HEADING, BOX B DURING THE TAX YEAR ENDED JUNE 30, 2012, SISTERS OF MERCY HEALTH SYSTEM ("MERCY HEALTH") BEGAN A SYSTEM-WIDE REBRANDING INITIATIVE TO HELP PATIENTS, PHYSICIANS, CO-WORKERS, AND THE PUBLIC BETTER UNDERSTAND THE FULL SCOPE AND LOCATIONS OF MERCY HEALTH'S SERVICES. SEVERAL OF THE MERCY HEALTH AFFILIATES HAVE CHANGED OR ARE IN THE PROCESS OF CHANGING LEGAL NAMES. PRIOR TO FILING THE 2010 FORMS 990 (DUE MAY 15, 2012), MERCY HEALTH NOTIFIED THE IRS OF THESE NAME CHANGES, THEREFORE BOX B "NAME CHANGE" HAS NOT BEEN CHECKED ON THIS FORM 990. REFER TO SCHEDULE R, PART VII FOR A LIST OF THE NAME CHANGES. NEUROSCIENCE INSTITUTE SERVICES ORGANIZATION LLC 4300 W MEMORIAL ROAD OKLAHOMA CITY OK 73120 300487934 MGD CARE SERVICES OK 0 3981512 MERCY HOSPITAL OKLAHOMA CITY ADVANCE CARE HOSPITAL 300 WERNER ST 3RD FLOOR HOT SPRINGS AR 71913 710816634 LONG TERM ACUTE-CARE HOSPITAL AR 501C3 3 MERCY HEALTH 0 CASA DE MISERICORDIA 1602 MCCLELLAND STREET LAREDO TX 78044 742912461 WOMEN'S DOMESTIC VIOLENCE SHELTER TX 501C3 9 MERCY MINISTRIES OF LAREDO 0 LAREDO MEDICAL GROUP 14528 S OUTER FORTY ST 100 CHESTERFIELD MO 63017 742764726 INACTIVE TX 501C3 9 MERCY HEALTH SYSTEM TX 0 MCAULEY PORTFOLIO MGMT CO 14528 S OUTER FORTY ST 100 CHESTERFIELD MO 63017 261708048 PORTFOLIO MANAGEMENT MO 501C3 11-II MERCY HEALTH 0 MERCY CLINIC EAST COMMUNITIES 645 MARYVILLE CTR DR STE 100 ST LOUIS MO 63141 431771217 PHYSICIAN GROUP MO 501C3 9 MERCY HEALTH EAST COMMUNITIES 0 MERCY CLINIC FORT SMITH COMM 7301 ROGERS AVENUE FORT SMITH AR 72917 261318597 PHYSICIAN CLINIC AR 501C3 3 MERCY HEALTH FORT SMITH COMM 0 MERCY CLINIC HOT SPRINGS COMM 1 MERCY LANE HOT SPRINGS AR 71913 261125131 PHYSICIAN CLINIC AR 501C3 9 MERCY HEALTH HOT SPRINGS COMM 0 MERCY CLINIC OKLAHOMA COMM 4300 W MEMORIAL ROAD OKLAHOMA CITY OK 73120 270473057 PHYSICIAN GROUP/CLINIC OK 501C3 9 MERCY HEALTH OK COMMUNITIES 0 MERCY CLINIC SPRINGFIELD COMM 1965 FREMONT STREET SUITE 2950 SPRINGFIELD MO 65804 431560263 PHYSICIAN GROUP MO 501C3 3 MERCY HEALTH SPRINGFIELD COMM 0 MERCY EMERGENCY MED SRVS 4300 W MEMORIAL ROAD OKLAHOMA CITY OK 73120 810627035 INACTIVE OK 501C3 9 MERCY HOSPITAL OKLAHOMA CITY 0 MERCY FDTN HEALTH INNOV 14528 S OUTER FORTY ST 100 CHESTERFIELD MO 63017 200901499 FOUNDATION MO 501C3 11-II MERCY HEALTH 0 MERCY HEALTH 14528 S OUTER FORTY ST 100 CHESTERFIELD MO 63017 431423050 HEALTH SYSTEM - CORPORATE OFFICE MO 501C3 11-II N/A 0 MERCY HEALTH EAST COMMUNITIES 645 MARYVILLE CTR DR STE 100 ST LOUIS MO 63141 431718408 HEALTH SYSTEM MO 501C3 11-II MERCY HEALTH 0 MERCY HEALTH FORT SMITH COMM 7301 ROGERS AVENUE FORT SMITH AR 72917 261318515 HOLDING COMPANY AR 501C3 11-II MERCY HEALTH 0 MERCY HEALTH FOUNDATION ARDMORE 1011 14TH AVENUE NW ARDMORE OK 73401 710962525 FOUNDATION OK 501C3 11-I MERCY HOSPITAL ARDMORE 0 MERCY HEALTH FOUNDATION BERRYVILLE 214 CARTER STREET BERRYVILLE AR 72616 710759301 FOUNDATION AR 501C3 11-I MERCY HOSPITAL BERRYVILLE 0 MERCY HEALTH FOUNDATION FT SCOTT 401 WOODLAND HILLS BLVD FORT SCOTT KS 66701 481077073 FOUNDATION KS 501C3 11-III MERCY KANSAS COMMUNITIES INC 0 MERCY HEALTH FOUNDATION HOT SPRINGS 300 WERNER STREET HOT SPRINGS AR 71913 710804718 FOUNDATION AR 501C3 11-II MERCY HOSPITAL HOT SPRINGS 0 MERCY HEALTH FOUNDATION INDEPENDENCE 800 W MYRTLE INDEPENDENCE KS 67301 481079981 FOUNDATION KS 501C3 11-I MERCY KANSAS COMMUNITIES INC 0 MERCY HEALTH FOUNDATION JOPLIN 2727 MCCLELLAND BLVD JOPLIN MO 64804 270906136 FOUNDATION MO 501C3 11-I MERCY HEALTH SW MOKS COMM 0 MERCY HEALTH FOUNDATION NW ARK 2710 RIFE MEDICAL LN ROGERS AR 72858 710601687 FOUNDATION AR 501C3 11-III MERCY HOSPITAL ROGERS 0 MERCY HEALTH FOUNDATION OK CITY 4300 W MEMORIAL ROAD OKLAHOMA CITY OK 73120 731593024 FOUNDATION OK 501C3 11-I MERCY HOSPITAL OKLAHOMA CITY 1 MERCY HEALTH FOUNDATION SPRINGFIELD 1235 E CHEROKEE STREET SPRINGFIELD MO 65804 320195818 FOUNDATION MO 501C3 11-II MERCY HEALTH SPRINGFIELD COMM 0 MERCY HEALTH FOUNDATION STL 615 SOUTH NEW BALLAS ROAD ST LOUIS MO 63141 562410020 FOUNDATION MO 501C3 11-II MERCY HEALTH EAST COMMUNITIES 0 MERCY HEALTH FOUNDATION WASHINGTON 901 E FIFTH STREET WASHINGTON MO 63090 562410022 FOUNDATION MO 501C3 11-II MERCY HEALTH EAST COMMUNITIES 0 MERCY HEALTH HOT SPRINGS COMM 300 WERNER STREET HOT SPRINGS AR 71913 261125064 HOLDING COMPANY AR 501C3 11-II MERCY HEALTH 0 MERCY HEALTH NW ARK COMMUNITIES 2710 RIFE MEDICAL LN ROGERS AR 72758 621684203 PHYSICIAN GROUP AR 501C3 11-II MERCY HEALTH 0 MERCY HEALTH OK COMMUNITIES 4300 W MEMORIAL ROAD OKLAHOMA CITY OK 73120 731453048 HOLDING COMPANY OK 501C3 11-II MERCY HEALTH 0 MERCY HEALTH SW MOKS COMM 2727 MCCLELLAND BLVD JOPLIN MO 64804 300584463 HEALTH SYSTEM MO 501C3 11-II MERCY HEALTH 0 MERCY HEALTH SPRINGFIELD COMM 1235 E CHEROKEE STREET SPRINGFIELD MO 65804 431856028 HOLDING COMPANY MO 501C3 11-II MERCY HEALTH 0 MERCY HEALTH SYSTEM TX 14528 S OUTER FORTY ST 100 CHESTERFIELD MO 63017 742764727 INACTIVE TX 501C3 11-II MERCY HEALTH 0 MERCY HOME HEALTH BERRYVILLE 214 CARTER STREET BERRYVILLE AR 72616 870781247 HOME HEALTH AND HOSPICE OPERATIONS. AR 501C3 11-III MERCY HOSPITAL SPRINGFIELD 0 MERCY HOSPITAL ARDMORE 1011 14TH AVENUE NW ARDMORE OK 73401 731500629 HOSPITAL OK 501C3 3 MERCY HEALTH OK COMMUNITIES 0 MERCY HOSPITAL AURORA 500 PORTER AVENUE AURORA MO 65605 431936696 OPERATING CO FOR LEASED HOSP MO 501C3 3 MERCY HEALTH SPRINGFIELD COMM 0 MERCY HOSPITAL BERRYVILLE 214 CARTER STREET BERRYVILLE AR 72616 710759299 HOSPITAL AR 501C3 3 MERCY HEALTH SPRINGFIELD COMM 0 MERCY HOSPITAL CASSVILLE 94 MAIN STREET CASSVILLE MO 65625 431936699 OPERATING CO FOR LEASED HOSP MO 501C3 3 MERCY HEALTH SPRINGFIELD COMM 0 MERCY HOSPITAL COLUMBUS 220 PENNSYLVANIA AVENUE COLUMBUS KS 66725 270842031 CRITICAL ACCESS HOSPITAL MO 501C3 9 MERCY HEALTH SW MOKS COMM 0 MERCY HOSPITAL EL RENO 2115 PARKVIEW DRIVE EL RENO OK 73036 736617948 OPERATING CO FOR LEASED HOSP OK 501C3 3 MERCY HEALTH OK COMMUNITIES 0 MERCY HOSPITAL FORT SMITH 7301 ROGERS AVENUE FORT SMITH AR 72917 710240352 HOSPITAL AR 501C3 3 MERCY HEALTH FORT SMITH COMM 0 MERCY HOSPITAL HEALDTON 918 SOUTH STREET HEALDTON OK 73438 263173902 HOSPITAL OK 501C3 3 MERCY HOSPITAL ARDMORE 0 MERCY HOSPITAL HOT SPRINGS 300 WERNER STREET HOT SPRINGS AR 71913 710236913 HOSPITAL AR 501C3 3 MERCY HEALTH HOT SPRINGS COMM 0 MERCY HOSPITAL JOPLIN 2727 MCCLELLAND BLVD JOPLIN MO 64804 270814858 HOSPITAL MO 501C3 9 MERCY HEALTH SW MOKS COMM 0 MERCY HOSPITAL LEBANON 100 HOSPITAL DRIVE LEBANON MO 65536 431767432 HOSPITAL MO 501C3 3 MERCY HEALTH SPRINGFIELD COMM 0 MERCY HOSPITAL OF LAREDO 14528 S OUTER FORTY ST 100 CHESTERFIELD MO 63017 741189682 INACTIVE TX 501C3 3 MERCY HEALTH SYSTEM TX 0 MERCY HOSPITAL OZARK 801 W RIVER STREET OZARK AR 72949 710689680 HOSPITAL AR 501C3 3 MERCY HOSPITAL FORT SMITH 0 MERCY HOSPITAL PARIS 500 E ACADEMY PARIS AR 72855 710655753 HOSPITAL AR 501C3 3 MERCY HOSPITAL FORT SMITH 0 MERCY HOSPITAL ROGERS 2710 RIFE MEDICAL LN ROGERS AR 72758 710294390 HOSPITAL AR 501C3 3 MERCY HEALTH NW ARK COMMUNITIES 0 MERCY HOSPITAL SPRINGFIELD 1235 E CHEROKEE STREET SPRINGFIELD MO 65804 440552485 HOSPITAL MO 501C3 3 MERCY HEALTH SPRINGFIELD COMM 0 MERCY HOSPITAL TISHOMINGO 1000 SOUTH BYRD TISHOMINGO OK 73460 274433830 HOSPITAL OK 501C3 3 MERCY HOSPITAL ARDMORE 0 MERCY HOSPITAL WALDRON 1341 W 6TH STREET WALDRON AR 72958 710557895 HOSPITAL AR 501C3 3 MERCY HOSPITAL FORT SMITH 0 MERCY HOSPITALS EAST COMM 645 MARYVILLE CTR DR STE 100 ST LOUIS MO 63141 430653493 HOSPITAL MO 501C3 3 MERCY HEALTH EAST COMMUNITIES 0 MERCY KANSAS COMMUNITIES INC 401 WOODLAND HILLS BLVD FT SCOTT KS 66701 480956045 HOSPITAL;RURAL HEALTH CLINICS KS 501C3 3 MERCY HEALTH SW MOKS COMM 0 MERCY MEDICAL RESEARCH INST 1235 E CHEROKEE STREET SPRINGFIELD MO 65804 870796305 RESEARCH - CLINICAL TRIALS MO 501C3 3 MERCY HEALTH SPRINGFIELD COMM 0 MERCY MINISTRIES OF LAREDO 2500 ZACATECAS LAREDO TX 78043 200198462 HEALTHCARE, OUTREACH,FOOD PANTRY. TX 501C3 3 MERCY HEALTH 0 MERCY ST FRANCIS HOSPITAL 100 W HIGHWAY 60 MOUNTAIN VIEW MO 65548 440607149 HOSPITAL MO 501C3 3 MERCY HEALTH SPRINGFIELD COMM 0 MERCY SUPPORT SERVICES 615 S NEW BALLAS ROAD ST LOUIS MO 63141 431677952 INACTIVE MO 501C3 11-III MERCY HOSPITALS EAST COMM 0 MHM SUPPORT SERVICES 14528 S OUTER FORTY ST 100 CHESTERFIELD MO 63017 202553101 CENTRALIZED HEALTH SYSTEM FUNCTIONS MO 501C3 11-II MERCY HEALTH 0 MISSION CLINICAL SERVICES 300 WERNER STREET HOT SPRINGS AR 71913 134239691 PHYSICIAN CLINICS AR 501C3 11-II MERCY HEALTH HOT SPRINGS COMM 0 SISTERS OF MERCY MINISTRIES 14528 S OUTER FORTY ST 100 CHESTERFIELD MO 63017 721069468 FAMILY COUNSELING;SOCIAL JUSTICE ADVOCACY MO 501C3 9 MERCY HEALTH 0 ST EDWARD MERCY FOUNDATION PO BOX 17000 FORT SMITH AR 72917 237330425 FOUNDATION AR 501C3 3 MERCY HOSPITAL FORT SMITH 0 ST JOHNS CHILDRENS HOSP 1235 E CHEROKEE STREET SPRINGFIELD MO 65804 INACTIVE MO 501C3 3 MERCY HEALTH SPRINGFIELD COMM 0 ST MARYS HOSP ENID OK 14528 S OUTER FORTY ST 100 CHESTERFIELD MO 63017 730614655 INACTIVE OK 501C3 3 MERCY HEALTH OK COMMUNITIES 0 THE SR M CORNELIA BLASKO FN 100 W HIGHWAY 60 MOUNTAIN VIEW MO 65548 431873914 FOUNDATION MO 501C3 11-I MERCY ST FRANCIS HOSPITAL 0 UNITY AMBULATORY CARE 645 MARYVILLE CTR DR STE 100 ST LOUIS MO 63141 431861745 INACTIVE MO 501C3 11-III MERCY HEALTH EAST COMMUNITIES 0 SOUTHERN OKLAHOMA DIAG CTR LLC 1011 FOURTEENTH AVENUE NW ARDMORE OK 73401 431971232 MRI SERVICES OK N/A N/A 0 0 RESOURCE OPTIMIZ & INNOVLLC 645 MARYVILLE CTR DRSTE 200 ST LOUIS MO 63141 460468368 CENTRAL DISTRIBUTION CENTER MO N/A N/A 0 0 MERCY AMBULATORY SURGERY CENTER LLC 7301 ROGERS AVENUE FORT SMITH AR 72917 710827721 AMBULATORY SURGERY CENTER AR N/A N/A 0 0 FORT SMITH EMERGENCY MEDICAL SERVICES 1701 SOUTH GREENWOOD FORT SMITH AR 72901 710416615 EMERGENCY MEDICAL SERVICES AR N/A N/A 0 0 ST EDWARD MERCY MC M-P OFFICE BLDG 7301 ROGERS AVENUE FORT SMITH AR 72903 710554050 OFFICE BUILDING AR N/A N/A 0 0 MERCY COMM SERVICES INC 401 WOODLAND HILLS BLVD FORT SCOTT KS 66701 481078101 CATERING OPERATIONS KS N/A C FRONTENAC PROPERTIES INC 14528 S OUTER FORTY SUITE 100 CHESTERFIELD MO 63017 521914421 HOLDS ANCILLARY ASSETS & OWNS AIRCRAFT DE N/A C MHP INC 14528 S OUTER FORTY SUITE 300 CHESTERFIELD MO 63017 431697084 HOLDING COMPANY SOLD 10/1/10 DE N/A C INVENO HEALTH INC 1235 E CHEROKEE STREET SPRINGFIELD MO 65804 264509571 TECHNOLOGY TRANSFER COMPANY MO N/A C UNITY SUPPORT SERVICES INC 645 MARYVILLE CENTRE DRIVE SUITE 10 ST LOUIS MO 63141 431797042 INACTIVE MO N/A C UH L CORP INC 645 MARYVILLE CENTRE DRIVE SUITE 10 ST LOUIS MO 63141 742499535 HOLDING COMPANY MO N/A C MHN OF THE SOUTHERN REGION INC 1011 14TH AVENUE NW ARDMORE OK 73401 731580607 EMPLOYED PHYSICIANS, PHYSICIAN ASSISTANTS, AND NURSE PRACTITIONERS OK N/A C MERCY HEALTH CENTER CONDOMINIUM INC 4300 W MEMORIAL RD OKLAHOMA CITY OK 73120 680640970 ADMINISTRATOR OF CERTAIN REAL PROPERTY AND IMPROVEMENTS OK MERCY HOSPITAL OKLAHOMA CITY C 869281 1818494 0.88000 MERCY MANAGED CARE CORPORATION 4300 W MEMORIAL ROAD OKLAHOMA CITY OK 73120 731441665 HOLDING COMPANY OK N/A C MERCY HEALTH NETWORK INC 4300 W MEMORIAL ROAD OKLAHOMA CITY OK 73120 731381689 EMPLOYED PHYSICIANS, PHYSICIAN ASSISTANTS, AND NURSE PRACTITIONERS OK N/A C 0 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 MERCY HOSPITAL HEALDTON O 5006589 CASH TRANSFER MERCY HOSPITALS EAST COMMUNITIES P 155059 CASH TRANSFER MERCY HEALTH NETWORK OF THE SOUTHERN REGION INC O 2740019 CASH TRANSFER MERCY HEALTH NETWORK INC N 60083 CASH TRANSFER MERCY HEALTH NETWORK INC O 16709153 CASH TRANSFER MERCY CLINIC OKLAHOMA COMMUNITIES O 48167714 CASH TRANSFER MERCY HOSPITAL EL RENO O 5901602 CASH TRANSFER MERCY HEALTH OKLAHOMA COMMUNITIES P 74398 CASH TRANSFER MERCY HOSPITAL ROGERS P 97586 CASH TRANSFER MERCY CLINIC OKLAHOMA COMMUNITIES N 318606 CASH TRANSFER MERCY HOSPITAL EL RENO N 56918 CASH TRANSFER RESOURCE OPTIMIZATION & INNOVATION LLC P 13047470 CASH TRANSFER MERCY HEALTH FOUNDATION OKLAHOMA CITY C 2431152 CASH TRANSFER MHM SUPPORT SERVICES O 51726198 CASH TRANSFER MERCY HEALTH O 382950 CASH TRANSFER MERCY HEALTH EAST COMMUNITIES O 102747 CASH TRANSFER MERCY HOSPITAL ARDMORE O 124487414 CASH TRANSFER MERCY HEALTH FOUNDATION OKLAHOMA CITY O 1125667 CASH TRANSFER PART II: SCHEDULE R, PART VII DISCLOSURE NAME CHANGES DUE TO MERCY HEALTH REBRANDING MERCY MEDICAL GROUP IS NOW MERCY CLINIC EAST COMMUNITIES ST. EDWARD MERCY CLINIC, INC. IS NOW MERCY CLINIC FORT SMITH COMMUNITIES ST. JOSEPH'S MERCY CLINIC, INC. IS NOW MERCY CLINIC HOT SPRINGS COMMUNITIES MERCY PHYSICIANS OF OKLAHOMA, INC. IS NOW MERCY CLINIC OKLAHOMA COMMUNITIES ST. JOHN'S CLINIC, INC. IS NOW MERCY CLINIC SPRINGFIELD COMMUNITIES SISTERS OF MERCY HEALTH SYSTEM IS NOW MERCY HEALTH ST. JOHN'S MERCY HEALTH CARE IS NOW MERCY HEALTH EAST COMMUNITIES ST. EDWARD MERCY HEALTH SYSTEM, INC. IS NOW MERCY HEALTH FORT SMITH COMMUNITIES MERCY MEMORIAL HEALTH CENTER FOUNDATION IS NOW MERCY HEALTH FOUNDATION ARDMORE CARROLL HEALTH FOUNDATION IS NOW MERCY HEALTH FOUNDATION BERRYVILLE MERCY HEALTH CENTER FOUNDATION IS NOW MERCY HEALTH FOUNDATION FORT SCOTT ST. JOSEPH'S MERCY HEALTH FOUNDATION IS NOW MERCY HEALTH FOUNDATION HOT SPRINGS MERCY HOSPITAL FOUNDATION OF INDEPENDENCE, INC. IS NOW MERCY HEALTH FOUNDATION INDEPENDENCE MERCY HEALTH OF JOPLIN FOUNDATION IS NOW MERCY HEALTH FOUNDATION JOPLIN ST. MARY'S HOSPITAL FOUNDATION IS NOW MERCY HEALTH FOUNDATION NORTHWEST ARKANSAS MERCY HEALTH CENTER FOUNDATION, INC. IS NOW MERCY HEALTH FOUNDATION OKLAHOMA CITY ST. JOHN'S FOUNDATION FOR COMMUNITY HEALTH INC. IS NOW MERCY HEALTH FOUNDATION SPRINGFIELD ST. JOHN'S MERCY FOUNDATION IS NOW MERCY HEALTH FOUNDATION ST. LOUIS ST. JOHN'S MERCY HOSPITAL FOUNDATION IS NOW MERCY HEALTH FOUNDATION WASHINGTON ST. JOSEPH'S MERCY HEALTH SYSTEM, INC. IS NOW MERCY HEALTH HOT SPRINGS COMMUNITIES MERCY HEALTH SYSTEM OF NORTHWEST ARKANSAS, INC. IS NOW MERCY HEALTH NORTHWEST ARKANSAS COMMUNITIES MERCY HEALTH SYSTEM, INC. IS NOW MERCY HEALTH OKLAHOMA COMMUNITIES MERCY HEALTH SYSTEM-JOPLIN, INC. IS NOW MERCY HEALTH SOUTHWEST MISSOURI/KANSAS COMMUNITIES ST. JOHN'S HEALTH SYSTEM, INC. IS NOW MERCY HEALTH SPRINGFIELD COMMUNITIES ST. JOHN'S HOME CARE OF BERRYVILLE, INC. IS NOW MERCY HOME HEALTH BERRYVILLE MERCY MEMORIAL HEALTH CENTER, INC. IS NOW MERCY HOSPITAL ARDMORE ST. JOHN'S AURORA, INC. IS NOW MERCY HOSPITAL AURORA OZARKS REGIONS HEALTH SYSTEM, INC. IS NOW MERCY HOSPITAL BERRYVILLE ST. JOHN'S CASSVILLE, INC. IS NOW MERCY HOSPITAL CASSVILLE MERCY HEALTH MHMCH, INC. IS NOW MERCY HOSPITAL COLUMBUS MERCY EL RENO HOSPITAL CORPORATION IS NOW MERCY HOSPITAL EL RENO ST. EDWARD MERCY MEDICAL CENTER IS NOW MERCY HOSPITAL FORT SMITH HEALDTON MERCY HOSPITAL CORPORATION IS NOW MERCY HOSPITAL HEALDTON ST. JOSEPH'S MERCY HEALTH CENTER IS NOW MERCY HOSPITAL HOT SPRINGS MERCY HEALTH OF JOPLIN, INC. IS NOW MERCY HOSPITAL JOPLIN BREECH REGIONAL MEDICAL CENTER IS NOW MERCY HOSPITAL LEBANON MERCY HEALTH CENTER, INC. IS NOW MERCY HOSPITAL OKLAHOMA CITY ST. EDWARD HEALTH FACILITIES OF FRANKLIN COUNTY IS NOW MERCY HOSPITAL OZARK ST. EDWARD HEALTH FACILITIES OF LOGAN COUNTY IS NOW MERCY HOSPITAL PARIS ST. EDWARD HEALTH FACILITIES OF SCOTT COUNTY IS NOW MERCY HOSPITAL WALDRON ST. MARY-ROGERS MEMORIAL HOSPITAL, INC. IS NOW MERCY HOSPITAL ROGERS ST. JOHN'S REGIONAL HEALTH CENTER IS NOW MERCY HOSPITAL SPRINGFIELD MERCY TISHOMINGO HOSPITAL CORPORATION IS NOW MERCY HOSPITAL TISHOMINGO ST. JOHN'S MERCY HEALTH SYSTEM IS NOW MERCY HOSPITALS EAST COMMUNITIES ST. JOHN'S MERCY MEDICAL CENTER IS NOW MERCY HOSPITAL ST LOUIS ST. JOHN'S MERCY HOSPITAL IS NOW MERCY HOSPITAL SPRINGFIELD MERCY HEALTH SYSTEM OF KANSAS, INC. IS NOW MERCY KANSAS COMMUNITIES MERCY HEALTH CENTER, INC. IS NOW MERCY HOSPITAL FORT SCOTT MERCY HOSPITAL IS NOW MERCY HOSPITAL INDEPENDENCE ST. JOHN'S MEDICAL RESEARCH INSTITUTE, INC. IS NOW MERCY MEDICAL RESEARCH INSTITUTE ST. FRANCIS HOSPITAL, MOUNTAIN VIEW, MISSOURI IS NOW MERCY ST. FRANCIS HOSPITAL ST. JOHN'S MERCY SUPPORT SERVICES IS NOW MERCY SUPPORT SERVICES