2012-08-10T17:11:43-05:00 2011-09-30 GRANT THORNTON LLP 8300 THORN DRIVE SUITE 300 WICHITA KS 672262708 990 2010-10-01 481186704 MERCY REGIONAL HEALTH CENTER INC MERC 7857763322 1823 COLLEGE AVENUE MANHATTAN KS 66502 SUSAN MORGAN 7857763322 2012-08-01 true Kimberly Temple 3162653231 2010 2016-02-24 21:20:13Z JOHN BROBERG 1823 COLLEGE AVE MANHATTAN KS 66502 92972973 false X WWW.MERCYREGIONAL.ORG X 1996 KS Inspired by the Gospel our Catholic tradition, Mercy Regional Health Center, Inc. serves as a healing presence with special concerns for our neighbors, who are vulnerable. 18 15 1191 298 192205 98716 7533 2974 87419842 87632302 1316745 2192574 6177566 2981047 94921686 92808897 174233 0 0 0 43214226 41265985 0 0 0 43052415 47892893 86440874 89158878 8480812 3650019 124045113 122667093 53966551 50708841 70078562 71958252 X "INSPIRED BY THE GOSPEL OUR CATHOLIC TRADITION, MERCY REGIONAL HEALTH CENTER, INC. SERVES AS A HEALING PRESENCE WITH SPECIAL CONCERNS FOR OUR NEIGHBORS WHO ARE VULNERABLE. AS PART OF THE VIA CHRISTI HEALTH SYSTEM THE HISTORY EXTENDS BACK OVER 100 YEARS AND TODAY, ALONG WITH OUR SPONSORING CONGREGATIONS THE SISTERS OF THE SORROWFUL MOTHER, CONGREGATION OF ST JOSEPH, SISTERS OF ST JOSEPH OF CARONDOLET AND THE DAUGHTERS OF CHARITY WE CONTINUE TO RESPOND TO COMMUNITY NEEDS IN KANSAS AND NORTHEASTERN OKLAHOMA. false false 3307424 Charity Care - Free or discounted health services provided to persons who cannot afford to pay and who meet Mercy Regional Health Center, Inc.'s criteria for financial assistance. Charity care is reported in terms of costs, not charges. Charity care does not include bad debt. 1810874 Government Sponsored Means-Tested Health Care - Includes unpaid costs of public programs for low-income persons. This is the shortfall created when Mercy Regional Health Center, Inc. receives payments that are less than the cost of caring for public program beneficiaries. This payment shortfall is not the same as a contractual allowance, which is the full difference between charges and government payments. 67067343 91012487 Mercy Regional Health Center, Inc. provides a full range of inpatient and outpatient services to individuals in the community regardless of socioeconomic or demographic background. Mercy Regional Health Center, Inc. is committed to community health with programs including but not limited to Diabetes Education, Nutrition Education, Fitness Education, and Lifesaving Education. Mercy Regional Health Center, Inc. sponsors the American Heart Walk, provides fitness centers, exercise classes, ergonomic reviews, and provides scholarships to students attending nursing school. 72185641 true false false true false false false false false true true false true true false false true false false false false false false false false true true false false true false false false false false false false false false false false false false true true true false false true 116 0 true 1191 true true true false false false false false false false false false X 18 15 false false false false true true true true true false false true true true true true true true true true false KS X SHELLY TRENT 3167193200 8200 E THORN DRIVE WICHITA KS 67226 X PAT BOSCO 1.0 X 0 0 0 MIKE DANIELS 1.0 X X 0 0 0 TRACEY DEBRUYN 1.0 X X 0 0 0 MARK GROS MD 1.0 X 0 0 0 DOUG HINKIN MD 1.0 X 0 0 0 TOM HOLCOMBE 1.0 X X 0 0 0 MARK KNACKENDOFFEL 1.0 X 0 0 0 SISTER LOIS ANN O'MALLEY 1.0 X X 0 0 0 JERRY PETTLE DDS 1.0 X 0 0 0 LANCE WHITE 1.0 X 0 0 0 DAVID HADLEY 1.0 X 0 552725 98018 RANDALL PETERSON 1.0 X 0 537324 159950 JOHN BROBERG 49.0 X X 0 310763 47614 MICHAEL CATES 1.0 X 0 0 0 MATT FOSTER MD 1.0 X 0 0 0 APOSTOLOS EVANGELIDIS MD 1.0 X 0 0 0 NANCY O'CONNOR 1.0 X 0 0 0 MARK DUFF MD 1.0 X 0 0 0 JANET CRIQUI 50.0 X 142210 0 17771 GERALD LUEGER 50.0 X 100125 0 11192 MARCIA BUBAK 50.0 X 149093 0 19734 WILLIAM FREUND MD 50.0 X 373667 0 6107 PRIYANTHA S RANAWEERA MD 50.0 X 567542 0 12563 CASEY M POELL MD 50.0 X 268269 0 5839 DAVID M WICHMAN MD 50.0 X 225148 0 12874 FADI V BEDROS MD 50.0 X 383348 0 14665 RICHARD ALLEN 0.0 X 0 175331 0 2209402 1576143 406327 28 true true false EMERGENCY PHYSICIANS OF MANHATTAN 10975 BENSON DRIVE OVERLAND PARK KS 66210 PROFESSIONAL SERVICE 841277 AUREUS RADIOLOGY LLC POBOX 3037 OMAHA NE 681030037 CONTRACT LABOR 422572 TRIMEDX LLC POBOX 636129 CINCINNATI OH 45263 MANAGEMENT SERVICES 1678800 INSTITUTE OF EXTRACORPOREAL THERAPI 3521 GARY AVENUE MANHATTAN KS 66503 DIALYSIS PROCEDURES 243281 KANSAS LITHOTRIPSY 9825 SPECTRUM DR BLDG 3 AUSTIN TX 78717 LITHOTRIPSY PROCEDUR 111200 13 420 2500 54 2974 NET PATIENT SERVICE REVENUE 621110 87632302 87523464 108838 87632302 919960 919960 0 0 147785 158351 -10566 -10566 16874 -27440 1269439 8900 5725 1269439 3175 1272614 1272614 0 0 0 EMS 621910 2080017 2080017 FOOD SERVICES 722210 509783 509783 MANAGEMENT 551114 447673 447673 -45860 451550 66493 -563903 2991613 92808897 91012487 192205 1601231 0 0 0 0 985299 215744 769555 0 32401315 28648678 3752637 1928485 149968 1778517 3316335 2597975 718360 2634551 2066105 568446 0 46176 7075 39101 29330 29330 0 0 0 13851869 6553592 7298277 235721 4033 231688 16943986 16416645 527341 178971 34666 144305 0 2031234 1819242 211992 215745 118162 97583 0 22720 414 22306 2400708 2397371 3337 0 5524821 5340279 184542 1183174 1132147 51027 SALES & OTHER TAXES 41922 37861 4061 BAD DEBTS 4566604 4566604 DUES 187131 24643 162488 PERSONNEL RECRUITING 164068 2140 161928 UNRELATED BUS. INCOME TAXES 34920 34920 233793 17377 216416 89158878 72185641 16973237 0 0 7342087 18493957 7723776 10397594 12300853 3008630 2577413 347021 28042 113017148 52519765 62369472 60497383 28101087 19226297 1327352 12971242 124045113 122667093 9672819 7027590 31936061 30101599 1827943 795393 10529728 12784259 53966551 50708841 X 69918050 71958252 160512 70078562 71958252 124045113 122667093 X 3650019 -1770329 X false true true X false X false false false false false false false false true 11462 11462 false false LOBBYING ACTIVITIES SCHEDULE C, PART II-B, LINE I A Portion of dues paid to the various organizations listed below is used for lobbying. Dues % Lobbying Total AHA 16,444 24.60% 4,045 KHA 48,413 15.00% 7,262 Chamber of Commerce 3,097 5.00% 155 ------ ----- 67,954 11,462 733250 733250 70692003 22933430 47758573 1764210 1547716 216494 35123253 25770539 9352714 4704432 2268080 2436352 60497383 UNAMORT LOAN COSTS-BOND 1017457 F NOTES REC-LT-PHYSICIAN 0 F PENSION CONTROL NET OF ADJ 0 F INVESTMENT IN AFFILIATES 2329826 F FUNDED DEPR-SWEEP ACCT 0 F FUNDED DEPR-UMB 0 F UMB-2001-DEBT SERVICE RESERVE 0 F UMB-2001-INTEREST ACCOUNT 0 F UMB-2001-PRINCIPAL ACCOUNT 0 F OPERATING-INVESTMENT-UMB BANK 0 F AMBULANCE RESERVE FUND 0 F FUNDED DEPR-UMB 0 F LONG TERM INVESTMENTS 15879014 F 19226297 DEPOSITS 0 OTHER RECEIVABLES 0 CHAMPUS/TRICARE SETTLEMENT 550500 SETTLEMENT RECEIVABLE 8502 DUE TO/FROM RELATED PARTIES -201263 OTHER ASSETS-UNRELATED PART 888953 BOARD DESIG FUNDS-CAP IMPROVEM 8155066 SELF INSURANCE ARRANGEMENTS 2565493 EDUCATION LOAN RECEIVABLE 16511 PREPAID PENSION 987480 12971242 0 ASSET RETIREMENT OBLIGATION 4697240 ESTIMATED AMOUNTS DUE TO THIRD PARTY PAYORS 888785 LONG TERM DEBT LESS CURRENT MATURITIES RELATED PARTY 5715158 CURRENT MATURITIES OF LONG TERM DEBT UNRELATED PARTY 1283177 CURRENT MATURITIES OF LONG TERM DEBT RELATED PARTY 199899 12784259 FIN 48 SCHEDULE D, PART X THE ORGANIZATION FOLLOWS THE FIN 48 POLICY OF VIA CHRISTI HEALTH, INC. (VCH) AND THE POLICY IS PROVIDED IN THE VCH CONSOLIDATED AUDITED FINANCIAL STATEMENTS. WITH THE EXCEPTION OF CERTAIN ENTITIES, ALL OF THE ENTITIES IN THE HEALTH SYSTEM ARE ORGANIZATIONS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND ARE GENERALLY EXEMPT FROM PAYMENT OF INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE INTERNAL REVENUE CODE. SUBSIDIARIES, WHICH ARE FOR-PROFIT ORGANIZATIONS, ARE SUBJECT TO FEDERAL AND STATE INCOME TAXES. TAX ASSETS AND LIABILITIES ARE RECOGNIZED FOR THE FUTURE TAX CONSEQUENCES ATTRIBUTABLE TO DIFFERENCES BETWEEN THE FINANCIAL STATEMENT CARRYING AMOUNTS OF EXISTING ASSETS AND LIABILITIES AND THEIR RESPECTIVE TAX BASES AND OPERATING LOSS AND TAX CREDIT CARRYFORWARD. INCOME TAX EXPENSE OR BENEFIT IS INCLUDED IN OTHER NON-OPERATING GAINS AND LOSSES IN THE CONSOLIDATED STATEMENTS OF OPERATION AND CHANGES IN NET ASSETS. DEFERRED TAX ASSETS AND LIABILITIES ARE MEASURED USING ENACTED TAX RATES EXPECTED TO BE RECOVERED OR SETTLED. THE EFFECT ON DEFERRED TAX ASSETS AND LIABILITIES OF A CHANGE IN TAX RATES IS RECOGNIZED IN INCOME IN THE PERIOD THAT INCLUDES THE ENACTMENT DATE. true true X true X true X true true false true true 3127398 0 3127398 0.03510 6698385 4669020 2029365 0.02280 0 0 0 0.00000 9825783 4669020 5156763 0.05790 396916 23618 373298 0.00420 255323 0 255323 0.00290 128985 0 128985 0.00140 781224 23618 757606 0.00850 10607007 4692638 5914369 0.06640 892 0 892 0.00000 1136 0 1136 0.00000 2028 0 2028 0.00000 true 1580045 0 25617959 27922128 -2304169 X true true 1 1 MERCY REGIONAL HEALTH CENTER INC

1823 COLLEGE AVE MANHATTAN KS 66502

X X X MERCY REGIONAL HEALTH CENTER INC 1 12 WOMEN'S IMAGING

1133 COLLEGE AVE BLDG G SUITE 130 MANHATTAN KS 66502

OUTPATIENT DIAGNOSTIC SERVICES BEHAVIORAL HEALTH SERVICES

1105 SUNSET AVE MANHATTAN KS 66505

OUTPATIENT BEHAVIORAL HEALTH CLINIC DIABETES CENTER

1105 SUNSET AVE MANHATTAN KS 66505

DIABETES EDUCATION CLINIC RILEY COUNTY EMS

2011 CLAFLIN ROAD MANHATTAN KS 66505

EMERGENCY MEDICAL SERVICES POTTAWATOMIE COUNTY EMS - WAMEGO STATION

406 MILLER DR SUITE F WAMEGO KS 66547

EMERGENCY MEDICAL SERVICES POTTAWATOMIE COUNTY EMS - WESTMORELAND S

312 MAIN STREET WESTMORELAND KS 66549

EMERGENCY MEDICAL SERVICES MERCY EAST

415 E POYNTZ AVE MANHATTAN KS 66502

OUTPATIENT REHABILITATION SERVICES MERCY WEST

315 S SETH CHILD RD MANHATTAN KS 66502

OUTPATIENT REHABILITATION SERVICES AND OCCUPATIONAL HEALTH SERVICES SLEEP DISORDERs SERVICES

1105 SUNSET AVE MANHATTAN KS 66505

SLEEP LAB SERVICES PAIN MANAGEMENT CLINIC

1105 SUNSET AVE MANHATTAN KS 66505

OUTPATIENT PAIN MANAGEMENT CLINIC MERCY LIGHT

1105 SUNSET AVE MANHATTAN KS 66505

MEDICALLY SUPERVISED WEIGHT MANAGEMENT SENIOR ADULT PROGRAM

1105 SUNSET AVE MANHATTAN KS 66505

SENIOR ADULT DAY PROGRAM ANNUAL COMMUNITY BENEFIT REPORT PART I, LINE 6a MRHC and WCH's annual report is prepared and printed in "Up Close", a magazine printed with 2,400 copies distributed to surrounding communities of Clay Center, Manhattan and Wamego. "Up Close" is also available on MRHC's website at www.mercyregional.org. COMMUNITY BENEFIT PROGRAMS PART I, LINE 7 For examples of some of the community benefit programs provided by Mercy Regional Health Center and Wamego Hospital Association (a combined report) see the Schedule O footnote for Part III, Statement of Program Services. COMMUNITY BUILDING ACTIVITIES PART II Community building activities are essential roles for health-care organizations in that they address many of the underlying determinants of health. Research has consistently shown that when the socioeconomic factors influencing health are explored, health care actually plays the smaller role proportionately. A report in the Journal of American Medical Association and the Center for Disease Control suggests that the factors impacting health are as follows: lifestyle and behaviors, 50 percent; environment, 20 percent; genetics and human biology, 20 percent and health care, 10 percent. Community building activities help to address the other indicators outside of the role traditionally played by health care organizations. These activities are almost exclusively done in some form of partnership in which the community or other organizations are better suited to address identified community needs. VCH provides timely and specific resources to help community organizations through donations to fulfill their missions of improving the well-being of the community and contributing to its overall health status in ways that may differ from direct clinical services provided by the hospital. Donations such as staff time and expertise for trainings or presentations to Chamber, Rotary or other service groups, special population outreach efforts for at-risk children in need of mentoring, assistance in building homes for the homeless or domestic violence victims, donating outdated equipment to free clinics, or other durable goods provided to area shelters and other organizations are all ways to maximize those agencies' resources so they can provide more program services. Manhattan - Wamego, KS Presentations made to the Chamber of Commerce meetings in Manhattan, Wamego and other surrounding communities to update them on the results of the community health needs assessments, strategic plans of the hospital and participation in discussions regarding economic development and workforce development all benefit the communities. By actively sharing the findings of the community health needs assessments, it allows other Chamber members to be aware of the most up-to-date information and gives them an opportunity to partner with the hospital and other area businesses in finding solutions. BAD DEBT EXPENSE PART III, LINE 3 The organization has no suitable basis for estimating bad debt expense that would be attributable to patients eligible under the organization's charity care policy. AUDIT FOOTNOTE - BAD DEBT EXPENSE PART III, LINE 4 The provision for bad debt expense is based upon management's assessment of expected net collections considering economic conditions, historical experience, trends in health care coverage, and other collection indicators. Periodically throughout the year, management assesses the adequacy of the allowance for uncollectible accounts based upon historical write-off experience by payer category, including those amounts not covered by insurance. The results of this review are then used to make any modifications to the provision for bad debt expense to establish an appropriate allowance for uncollectible accounts. After satisfaction of amounts due from insurance and reasonable efforts to collect from the patient have been exhausted, The Health System follows established guidelines for placing certain past-due patient balances with collection agencies, subject to terms of certain restrictions on collection efforts as determined by the Health System. Accounts receivable are written off after collections efforts have been followed in accordance with the Health System's policies. MRHC reports bad debts in accordance with generally accepted accounting principles (GAAP). Healthcare Financial Management Statement 15 is followed to the extent that it aligns with the guidelines set forth by GAAP. Bad debt expense at cost is determined using the same cost-to-charge ratio that is used for charity care and Medicaid shortfall. VCH follows the guidance from CHA and does not consider bad debt as a community benefit. MEDICARE SHORTFALL PART III, LINE 8 MRHC follows the CHA guidelines regarding Medicare and does not include it as community benefit. The methodology described in the instructions to Schedule H, Part III, Section B, Line 7 for reporting Medicare shortfall does not take into account all costs incurred by the Hospital and does not represent the total Medicare shortfall. The Medicare shortfall reported on Schedule H, Part III, Section B, Line 7 was determined using information from the organization's Medicare cost report (using the Medicare Cost report step-down methodology of allocating costs). However, utilizing an internal cost accounting system actually results in a Medicare shortfall of $3,207,050. The most common reason for a difference between the Medicare shortfall reported on Schedule H and the actual shortfall reported above include inclusion of Medicare Advantage revenue and expenses; inclusion of Medicare Part B Revenue and Expenses; inclusion of other fee schedule revenue, other timing issues, and costs that are considered unallowable on the Medicare cost report that are, in fact, related to Medicare patient care. DEBT COLLECTION POLICY PART III, LINE 9B It is the policy of MRHC to promote socially just practices for billing and collections for all patients receiving care. The policy is intended to further the MRHC mission by requiring ethical conduct in billing and collecting self-pay balances from patient/guarantor's regardless of ability to pay. The policy ensures that prior to turning an account over to a Third Party Collection Agent (Agent) for collection activity, MRHC will perform a reasonable review of each account to verify that the patient/guarantor is not potentially eligible for any government assistance program (e.g., Medicaid, Medicare, etc.) and would likely not qualify for charity care. MRHC will direct its staff and Agents to periodically assess each patient/guarantor's ability to pay or to determine eligibility for charity care. The review and assessment should include but may not be limited to the following: a. Ensure the patient/guarantor has been notified of VCH's financial assistance policy; b. Ensure the patient/guarantor was offered a financial assistance application; c. Ensure documentation of any known extraordinary financial circumstances of the patient/guarantor or if they are medically indigent NEEDS ASSESSMENT PART VI, LINE 2 Ministry representatives are involved with numerous coalitions that periodically assess community needs (e.g. Flint Hills Community Clinic, Kansas Health Care Collaborative, United Way of Riley County, Shepherds' Crossing and others) and in 2010 conducted their own health assessment. Secondary data, other community assessments and one-on-one interviews with community leaders, social service providers, health care providers and government representatives were used to conduct the MRHC and WCH assessments. PATIENT ELIGIBILITY FOR ASSISTANCE PART VI, LINE 3 VCH financial assistance staff is trained on how to qualify patients for Medicaid, SCHIP and other income-based programs. During the patient's registration, admissions and discharge processes, VCH attempts to identify patients who may be eligible for charity or discounted care through the charity care policy. In addition, VCH uses a percentage of the Federal Poverty Guidelines (FPG) to determine free and discounted care. COMMUNITY INFORMATION PART VI, LINE 4 For Manhattan based ministries - The primary counties for Manhattan ministries includes Riley, Geary and Pottawatomie. Riley County has a land area of 609 square miles with a 2010 population of 71,115. Pottawatomie County has a land area of 844 square miles with a 2010 population of 21,604. Geary County has a land area of 385 square miles with a 2010 population of 34,362. Riley County's population demographics includes: 83.2% white, 6.4% Black, 0.6% American Indian; 4.25% Asian and 6.5% persons of Hispanic or Latino origin. The diversity of the population in Riley County is greater than for Pottawatomie County. Racial breakout for Pottawatomie County includes: 93.6% white; 1.1% Black; 0.8% American Indian; 0.7% Asian persons; and 4.4% persons of Hispanic or Latino origin. The demographic distribution for Geary County includes: 66.2% white; 18.4% Black; 1.0% American Indian; 3.2% Asian; and 12.4% Hispanic or Latino origin. Geary County has the highest diversity rates primarily due to Fort Riley, an Army base and Home of the 1st Infantry Division. Almost 8.0% of the Riley County residents, 4.1% of the Pottawatomie County residents and 10.1% of the Geary County residents report that a language other than English is spoken at home. When it comes to education, 94.2% of Riley County residents completed high school and 41.2% had a bachelor's degree or higher. This compares to 92.8% and 27.1% for Pottawatomie County and 90.5% and 19.6% for Geary County. Median household income for Riley County residents in 2010 was $40,612 compared to $54,949 for Pottawatomie County and $44,033 for Geary County. The median value of owner-occupied housing units in Riley County was $148,600 in 2010 compared to $124,600 in Pottawatomie and $110,700 for Geary County residents. Riley County reports 26.3% of its residents are below poverty level compared to 9.1% for Pottawatomie and 11.4% for Geary County. The Statewide poverty level is around 13.2%. MRHC is the only hospital in the City of Manhattan and is the largest full-service medical center in the area that is available to all persons regardless of their ability to pay. PROMOTION OF COMMUNITY HEALTH PART VI, LINE 5 MRHC and its affiliates enrich the communities in which they operate as well as the broader community, improving medicine through research, educating physicians and other healthcare providers, and providing care and support to people in need. MRCH further supports this mission with a community board, open medical staff and an emergency room available to patients regardless of ability to pay. Community representation on the Governing Body - The Board of Trustees is the governing body of MRCH. The majority of its members are external members comprised of persons who reside in or around Sedgwick County and has overall responsibility for the charitable mission of the organization as set forth in its Articles of Incorporation and By Laws. These trustees are selected based on their expertise, experience and other criteria established by the nominating committee of the Board of Trustees. Areas of expertise and experience include such areas as healthcare, finance, education, and local government. The Board actively debates and sets policy and strategic direction for the ministry but does not get involved in issues related to daily operations. The Board takes a balanced approach when addressing community and business/financial concerns. The Board is also the primary group for determining the use of surplus funds generated by the organization which are reinvested in the ministry in order to allow the ministry to sustain its mission and prepare for the future. Open Medical Staff - The medical staff of MRCH is an open medical staff and is composed of physicians, dentists and podiatrists licensed to practice medicine in the State of Kansas. MRHC staff also participates in the community on boards of other not-for-profit organizations, government entities, foundations, area colleges and university committees, state-wide coalitions, etc. AFFILIATED HEALTH CARE SYSTEM PART VI, LINE 6 MRHC is an affiliate of Via Christi Health, Inc (VCH). VCH's affiliates are large multi-faceted, integrated, not-for-profit ministries including Hospital and Non-Hospital ministries (Physician Group Practices, Hospital organizations, Research, Home Health, Durable Medical Equipment and Senior Facilities). These ministries work together to care for patients, joined by common systems and a philosophy of serving as a healing presence with special concern for our neighbors, especially those who are vulnerable. This community benefit happens through its focus on patient care, education and research. The organizations work together to serve their communities at the local, regional and state level. STATE FILING OF COMMUNITY BENEFIT REPORT PART VI, LINE 7 Kansas does not require hospitals to file community benefit reports but Via Christi Health distributes our community benefit totals and activities annually in press releases as well as in our annual report. X X X X true true false false false false false false false DAVID HADLEY 0 419685 0 123438 0 9602 0 87169 0 10849 0 650743 0 0 RANDALL PETERSON 0 443357 0 81238 0 12729 0 151362 0 8588 0 697274 0 0 JOHN BROBERG 0 260198 0 43850 0 6715 0 37141 0 10473 0 358377 0 0 JANET CRIQUI 136653 0 40 0 5517 0 9882 0 7889 0 159981 0 0 0 WILLIAM FREUND MD 369627 0 0 0 4040 0 0 0 6107 0 379774 0 0 0 PRIYANTHA S RANAWEERA MD 564690 0 40 0 2812 0 2450 0 10113 0 580105 0 0 0 CASEY M POELL MD 249060 0 18040 0 1169 0 0 0 5839 0 274108 0 0 0 RICHARD ALLEN 0 0 0 0 0 175331 0 0 0 0 0 175331 0 0 MARCIA BUBAK 144487 0 40 0 4566 0 9636 0 10098 0 168827 0 0 0 DAVID M WICHMAN MD 223953 0 40 0 1155 0 2314 0 10560 0 238022 0 0 0 FADI V BEDROS MD 381240 0 40 0 2068 0 2450 0 12215 0 398013 0 0 0 SEVERANCE PAYMENTS FROM A RELATED ORGANIZATION PART I, QUESTION 4A Richard Allen 168,807.74 SUPPLEMENTAL NON-QUALIFED RETIREMENT PLAN PAID BY A RELATED ORGANIZATION PART I, QUESTION 4B Randall Peterson $132,987.12 David Hadley $71,243.56 John Broberg $21,216.00 Janet Criqui $ 8,474.66 FORM 990 REVIEW PART VI, SECTION A, QUESTION 11A THE AUDIT COMMITTEE REVIEWS AND APPROVES THE FORM 990 PRIOR TO THE DATE OF FILING. THE AUDIT COMMITTEE REPORTS ON THE REVIEW TO THE BOARD OF TRUSTEES AND ASSURES THAT THE BOARD HAS THE OPPORTUNITY TO REVIEW THE FINAL FORM 990 AS FILED. A COPY OF FORM 990 IS PROVIDED TO THE BOARD OF TRUSTEES VIA A SECURE EMAIL PRIOR TO FILING WITH THE IRS. CONFLICT OF INTEREST POLICY PART VI, SECTION B, QUESTION 12C MERCY REGIONAL HEALTH CENTER, INC. FOLLOWS VIA CHRISTI HEALTH, INC.'S CONFLICT OF INTEREST POLICY. IT IS MONITORED AND ENFORCED AS PART OF THE SYSTEM-WIDE PROCEDURES AND IS NOT HANDLED AT THE ORGANIZATION LEVEL. THE SYSTEM MONITORS AND ENFORCES THE CONFLICT OF INTEREST POLICY AS FOLLOWS: 1) AT TIME OF APPOINTMENT AND ANNUALLY THEREAFTER, ALL INTERESTED PERSONS, INCLUDING BOARD AND COMMITTEE MEMBERS COMPLETE A DISCLOSURE STATEMENT WHICH ADDRESSES ACTUAL OR POTENTIAL CONFLICTS OF INTEREST. 2) THE DISCLOSURE STATEMENT IS DONE ELECTRONICALLY AND THE RETURN OF THE COMPLETED STATEMENT IS A CONDITION OF CONTINUED APPOINTMENT, EMPLOYMENT OR PARTICIPATION WITH THE ORGANIZATION. 3) ALL ACTUAL OR POTENTIAL CONFLICTS ARE REVIEWED, INVESTIGATED AND RESOLVED BY THE CHIEF GOVERNANCE OFFICER AND THE CORPORATE RESPONSIBILITY OFFICER, WITH THE RESULTS SHARED WITH THE CHIEF EXECUTIVE OF THE ORGANIZATION. 4) PERIODIC REVIEWS ARE CONDUCTED BY GOVERNANCE, COMPLIANCE AND INTERNAL AUDIT TO ENSURE THE ORGANZIATION IS OPERATING CONSISTENT WITH THE POLICY AND ENFORCING THE POLICY'S TERMS. COMPENSATION REVIEW PART VI, SECTION B, QUESTION 15 Mercy Regional Health Center, Inc. uses the policies established by Via Christi Health, Inc. (VCH). VCH has established a common philosophy, strategy, and processes for executive compensation to be used throughout the Via Christi Health System. VCH's philosophy, strategy and process for executive compensation are described next. Through the oversight of the VCH Executive Compensation Committee, executive compensation is competitively positioned at its stated market position when compared to the compensation paid by relevant organizations (comparably-sized health systems, hospitals, and long-term care providers). VCH recognizes its responsibility to ensure that its executive compensation program is appropriate in view of its mission and tax-exempt status and that its compensation levels and expenditures are reasonable and not excessive. To ensure these ends, the VCH Executive Compensation Committee has established and approved the executive compensation philosophy for VCH and all related entities. It will also approve all changes in the compensation package for VCH executives in advance. On an annual basis, the Committee conducts a comprehensive review of total compensation for all executives. It also reviews and approves "off-cycle" compensation transactions as needed. In their review, the Committee considers the following factors: * Market data from independent compensation surveys and sources that reflect comparable positions in organizations of similar size and scope * Difficulties in recruiting and retaining executives * Skills, experience and performance history of individual executives * Critical business or strategic issues that the organization may face * Market position for total compensation The adequacy, competitiveness, and cost of the VCH total executive compensation program are reviewed on an ongoing basis and changes are made as the Committee determines appropriate. The executive compensation program will be maintained such that it will fall within the safe harbor guidelines established by the Intermediate Sanctions regulations. The Committee also employs the services of an independent compensation consultant to prepare market analysis to aid and support the Committee's actions, provide documentation of market trends for budget setting purposes, review annual compensation changes to ensure "reasonableness" and provide attestation, and provide consultation on all executive compensation issues. The Committee also relies on third-party validation of performance measures used in the determination of compensation. GOVERNING DOCUMENTS PART VI, SECTION C, QUESTION 19 MERCY REGIONAL HEALTH CENTER, INC.'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON REQUEST. RELATED TAX-EXEMPT ORGANIZATIONS SCHEDULE R, PART II MERCY REGIONAL HEALTH CENTER, INC. IS CONTROLLED BY VIA CHRISTI HEALTH, INC. VIA CHRISTI HEALTH, INC. IS JOINTLY SPONSORED AND CONTROLLED BY ASCENSION HEALTH AND MARIAN HEALTH SYSTEM, WHICH IN TURN ARE SPONSORED BY THE SISTERS OF THE SORROWFUL MOTHER, FOUR PROVINCES OF THE DAUGHTERS OF CHARITY, THE CONGREGATION OF ST. JOSEPH, AND THE SISTERS OF ST. JOSEPH OF CARONDELET. DUE TO SUCH SPONSORSHIP AND CONTROL, AND IN THE INTEREST OF INCREASED CLARITY AND TRANSPARENCY, BOTH ASCENSION HEALTH AND MARIAN HEALTH SYSTEM ARE BEING LISTED AS RELATED ORGANIZATIONS ON SCHEDULE R. MEMBERS PART VI, SECTION A, Q6, 7A, AND 7B VIA CHRISTI HEALTH, INC. AND MEMORIAL HOSPITAL ASSOCIATION, INC. ARE THE MEMBERS. THE MEMBERS MAY APPROVE AND REMOVE INDIVIDUALS ON THE BOARD OF TRUSTEES. ARTICLE 2 OF THE BYLAWS PROVIDE THE MEMBERS WITH THE FOLLOWING POWERS: *Approve, before they may become effective, all mission, philosophy, and value statements of the corporation and all amendments thereto. *Monitor compliance with the mission and philosophy of the corporation through receipt of annual reports, financial statements and other pertinent information. *Approve Articles of Incorporation and Bylaws of the corporation or amendments thereto. *Approve appointment and removal of all Directors of the corporation. *Approve, before it may become effective, any merger or consolidation involving the corporation. *Approve any partial or total dissolution of the corporation. *Approve the issuance of any debt by the corporation in excess of $1 million or the amount specified in writing from time to time by the Corporate Members. *Approve all transfers, leases, encumbrances or other conveyances of the property of all assets of the corporation in excess of $1 million or the amount specified in writing from time to time by the Corporate Members. *Approve, before it may become effective, the creation of any subsidiary organization to the corporation. *Receive reports on all operating and capital budgets of the corporation. *Receive reports on all unbudgeted expenses in excess of $50,000 or the amount specified in writing from time to time by the Members. *Receive information and reports on all long-range strategic and financial plans of the corporation. *Receive reports on all alliances and affiliations entered into by the corporation. OTHER CHANGES IN NET ASSETS PART XI LINE 5 UNREALIZED LOSS (2,386,191) NET PENSION ADJUSTMENT (115,715) RELEASED FROM RESTRICTION (50,000) K-1 ADJUSTMENTS: PFI LLC (1,711) MERCY IMAGING LLC 783,288 781,577 ----------- PART XI LINE 5 (1,770,329) COMMUNITY BENEFIT REPORT PART III Part I - Summary As a part of Via Christi Health, we share this Mission: Inspired by the Gospel and our Catholic tradition, we serve as a healing presence with special concern for our neighbors who are vulnerable. Part III - Statement of Program Service Accomplishments Mercy Regional Health Center (MRHC) is a member of Via Christi Health, Inc. (VCH). As a Catholic health system, VCH has its origins in faith-based responses to health needs of our communities, with a particular concern for those living in poverty and who are vulnerable. In addition to typical inpatient and outpatient services, VCH operates primary care clinics, a low income neighborhood outreach clinic, specialty hospitals and centers, home medical services, therapy centers and long-term care villages. The obligation to reach out to those in need and to improve community health flows directly from VCH's identity as a faith-based healing ministry. VCH continues its tradition in providing community benefit because we are committed to: - Promoting and defending human dignity - Caring for persons living in poverty and other vulnerable populations - Promoting the common good - Stewarding resources responsibly According to the VCH mission statement, "As a part of Via Christi Health, we share this Mission: Inspired by the Gospel and our Catholic tradition, we serve as a healing presence with special concern for our neighbors who are vulnerable." The financial information in this report was prepared in accordance with the Catholic Health Association's (CHA) A Guide for Planning and Reporting Community Benefit Guidelines. Per these Guidelines, we report the net expense for community benefit services (i.e., the total community benefit expense minus any associated revenue from patients, residents, payers, and other external sources). The CHA Guidelines reflect a conservative approach to reporting quantifiable community benefit. The goal of the Guidelines is to produce community benefit financial reports that reflect true costs and that describe community benefit activities that increase access to health care and improve community health for all. The following are MRHC's definitions for quantifiable community benefits. Charity Care - Free or discounted health services provided to persons who cannot afford to pay and who meet VCH's criteria for financial assistance. Charity care is reported in terms of costs, not charges. Charity care does not include bad debt. Government Sponsored Means-Tested Health Care - Includes unpaid costs of public programs for low-income persons - the shortfall created when VCH receives payments that are less than the cost of caring for public program beneficiaries. This payment shortfall is not the same as a contractual allowance, which is the full difference between charges and government payments. Health Professions Education - Helping to prepare future health care professionals is a distinguishing characteristic of not-for-profit health care and constitutes a significant community benefit. This category includes programs and financial assistance for physicians and medical students, nurses and nursing students, interns and other health professionals. For fiscal year ended September 30, 2011 Community Benefit (MRHC, Inc and Subsidiaries): 1. Charity care - at cost $3.1 million 2. Government sponsored health care - net expense $2.0 million Unpaid cost of public indigent care programs (includes Medicaid, SCHIP, other safety net programs; does not include Medicare shortfall) 3. Community Benefit Programs - net expense $0.8 million 4. Total Quantifiable Community Benefit $5.9 million Listed below are just a few of the community benefit programs offered by Mercy Regional Health Center (MRHC) and Wamego City Hospital (WCH) during FY2011. This is not a complete listing but a sampling of how the hospital gives back to the community while meeting current needs. COMMUNITY BENEFIT REPORT PART III CONTINUED Car Seat Clinics - MRHC conducts various car seat inspection clinics that the general public is invited to participate in to assess and educate parents on how to properly use the car seat and to ensure its base is securely installed in the parent's vehicle. Nearly 150 car seats were checked for a cost of $1,095 in community benefit. Heart Education Health News - Numerous newsletters were printed and distributed on cardiac related issues and shared with patients who have had a history of heart disease but who are now under physician care to improve their cardiac efficiency. Approximately $1,800 was spent to print and distribute their heart education newsletter. Targeted Population Health Fairs are conducted annually for children, seniors and the broader community. During this tax year, 290 people were served for a cost of $1,505 by having their blood pressure checked, eye exams, hearing tests and recommendations for establishing a medical home with either a physician and/or the free clinic. Several Support Groups are hosted (e.g. cardiac, bereavement) and numerous educational presentations (e.g. Bereaved Parents, Cardiac, etc) are given in the Manhattan/Wamego area. In FY2011, over 125 attendees participated in these educational events at a cost of nearly $500. Community Education is a program shared with the community to improve their understanding of specific diseases or improve their skills in taking care of others. MRHC offered educational forums on advance directives, babysitter's basics, breastfeeding and child birth basics, CPR, depression/anxiety, EMS, fitness/wellness and a host of other topics for the general public during FY2011. Nearly 3,000 attendees took advantage of these educational opportunities at a cost of just below $5,000. SANE/SART is a program in response to all victims of sexual assault who present themselves to MRHC hospital by providing immediate and follow-up medical, advocacy and criminal justice services in an ethical and compassionate manner. Over 106 individuals were assisted by the SANE/SART team of nurses at a cost of $17,626. Flint Hills Community Clinic, in partnership with MRHC, oversees uninsured and underinsured individuals. MRHC provides staff support, as well as free diagnostic testing (e.g. lab, x-rays, etc) for the clinic. During this fiscal year, nearly 2,100 instances of service were provided by MRHC at a cost of $231,282. Similarly, Wamego City Hospital provided 245 free labs for individuals helped by the Community Health Ministries Clinic in Wamego for a cost of $23,939. Health Profession Education of area physicians, nurses, physician assistants, nursing students and other health care professionals who are either looking for continuing education credits, wanting more hands-on training, or are in need of field practicum placements, etc are welcomed at MRHC and WCH for additional training opportunities. Nearly 660 health care professionals and/or students hoping to enter the health care field were offered training opportunities through the various programs offered by MRHC and WCH at a cost of $255,781. Security Transport is a support service provided by MRHC when patients are brought to the hospital emergency department but are in need of psychiatric placement but are unable to pay for transportation to get access to the facilities, which are located outside of the Manhattan area. Most of these patients are transferred to Larned, Osawatomie, Kansas University Medical Center in Kansas City or other locations. In FY2011, MRHC supplied security transport 140 times at a cost of $27,189. In-Kind Donations through service on community boards that are health related (e.g. American Red Cross, United Way, Flint Hills Community Clinic), and sharing of hospital space to conduct health related not-for-profit business is another area in which MRHC and WCH gives back to the community. In fiscal year 2011, MRHC and WCH contributed just over $129,052 through financial and in-kind contributions. Nearly $31,000 was expended in tracking community benefit activities offered by MRHC and WCH for fiscal year 2011. This includes the gearing up for a community-wide health needs assessment that was scheduled for FY2011. Community benefit staff uses and trains others to use the Community Benefit Inventory Social Accountability (CBISA) software, developed by Lyon Software and used by over 1,700 hospitals throughout the country. CBISA software follows the reporting guidelines adopted by Catholic Health Association and does not include bad debt or unpaid Medicare reimbursements as community benefit. Community Benefit Operations - Community benefit staff uses and trains others to use the Community Benefit Inventory Social Accountability (CBISA) software, developed by Lyon Software and used by over 1,700 hospitals throughout the country. CBISA software follows the reporting guidelines adopted by Catholic Health Association and does not include bad debt or unpaid Medicare reimbursements as community benefit. Overall, MRCH and WCH combined community benefit programs (not counting traditional charity care, unpaid reimbursement of Medicaid, and/or Community-Building activities) accounted for $758,452 to the geographical area of Manhattan and Wamego, Kansas during FY2011. HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DAVID HADLEY TITLE:TRUSTEE HOURS:49 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:RANDALL PETERSON TITLE:TRUSTEE HOURS:49 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JOHN BROBERG TITLE:EX-OFFICIO(CEO) HOURS:1 Catholic Care Center Inc 6700 E 45th St N Wichita KS 67226 481067110 Rtrmnt Home KS 501(c)(3) 9 na CIBOR INC 9229 E 27TH ST N SUITE 200 Wichita KS 67226 270564463 Research KS 501(c)(3) 7 na Cornerstone Assisted Living Inc 3636 N Ridge Road Wichita KS 67205 481241079 Rtrmnt Home KS 501(c)(3) 9 na Gerard House Inc 3144 N Hood Wichita KS 67204 481049532 Shelter KS 501(c)(3) 7 na Marian Health System Inc 1923 South Utica Avenue Tulsa OK 74104 363659989 Hospital Supp DE 501(c)(3) 11 na Mercy Community Health Foundation Inc 1823 College Ave Manhattan KS 66502 481152279 Foundation KS 501(c)(3) 11 na Mercy Regional Home Medical Services LLC 2439 Claflin Road Manhattan KS 66502 432024491 Home Medical KS 501(c)(3) 11 na MOUNT CARMEL FOUNDATION INC 1102 E Centennial Dr Pittsburg KS 66762 480961283 Foundation KS 501(c)(3) 11 na Salina Regional Home Medical Services 520 S Santa Fe Ave Ste 140 Salina KS 67401 431948057 Home Medical KS 501(c)(3) 11 na St John's Inc 2225 Cantebury Dr Hays KS 67601 202828680 Rtrmnt Home KS 501(c)(3) 9 na Via Christi Foundation Inc 723 N McLean Blvd Wichita KS 67203 481173588 Foundation KS 501(c)(3) 11 na Via Christi Health Partners Inc 8200 E Thorn DR SUITE 300 Wichita KS 67226 480958974 Mgmnt Co. 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