2012-05-15T12:08:44-05:00 2011-06-30 ERNST & YOUNG US LLP 190 CARONDELET PLAZA SUITE 1300 CLAYTON MO 63105 990 2010-07-01 710240352 Mercy Hospital Fort Smith f/k/a St Edward Mercy Medical Center MERC 3146283557 PO BOX 17000 7301 ROGERS AVENUE FORT SMITH AR 729177000 GRETA WILCHER 2012-05-07 3142901000 2010 2016-02-24 21:20:13Z GRETA WILCHER VP OF FINANCE PO BOX 17000 FORT SMITH AR 729177000 206372756 false 0928 X www.mercy.net X 1905 AR AS THE SISTERS OF MERCY BEFORE US, WE BRING TO LIFE THE HEALING MINISTRY OF JESUS THROUGH OUR COMPASSIONATE CARE AND EXCEPTIONAL SERVICE. 10 9 1974 140 3149447 629382 172765 216765554 213538096 682874 629717 -195225 -9790238 217882585 204550340 387181 285849 0 0 82359513 87968774 0 0 0 123411673 114715280 206158367 202969903 11724218 1580437 228287133 257632068 22781580 50459312 205505553 207172756 X AS THE SISTERS OF MERCY BEFORE US, WE BRING TO LIFE THE HEALING MINISTRY OF JESUS THROUGH OUR COMPASSIONATE CARE AND EXCEPTIONAL SERVICE. false false 17522284 0 42617605 SURGERY - THE SURGICAL AREA OF MERCY HOSPITAL FORT SMITH PERFORMED 7,459 PROCEDURES ON 4,952 PATIENTS. MERCY HOSPITAL FORT SMITH HAS TAKEN STATE-OF-THE-ART TECHNOLOGY, STAFF EXPERIENCE, BEST PRACTICES, AND PATIENT SAFETY INITIATIVES AND CREATED AN EXCEPTIONAL SURGICAL SERVICES DEPARTMENT MAINTAINED WITHIN AN ATMOSPHERE OF CARING FOR THE PATIENT AND THEIR FAMILY. THE SURGERY UNIT OPERATES ON A TWENTY-FOUR (24) HOUR A DAY BASIS, 365 DAYS PER YEAR. THE SURGERY UNIT IS STAFFED WITH REGISTERED NURSES, LICENSED PRACTICAL NURSES, CERTIFIED SCRUB TECHNICIANS, OPERATING ROOM TECHNICIANS, AND OTHER SUPPORT STAFF. UTILIZING A COMBINED TWENTY-ONE (21) OPERATING SUITES, MERCY HOSPITAL FORT SMITH OFFERS A MULTITUDE OF SURGICAL PROCEDURES IN AN ARRAY OF SURGICAL SERVICE LINES INCLUDING: ENT, CARDIOVASCULAR, OBSTETRICS/GYNECOLOGY, NEUROSURGERY, AMONG OTHERS. 5720390 0 24455203 CARDIAC CATH LAB - CARDIOVASCULAR IMAGING PROVIDES IMAGES OF THE HEART AND THE SURROUNDING ARTERIES THAT ARE USED IN DIAGNOSING DISEASE AND THE APPROPRIATE CARE TO FOLLOW. THE CATH LAB AT MERCY HOSPITAL FORT SMITH IS EQUIPPED WITH THE LATEST CARDIAC AND VASCULAR IMAGING TECHNOLOGY AVAILABLE. OUR CATH LABS WERE THE FIRST IN THE AREA TO UTILIZE "FLAT PLATE" DIGITAL TECHNOLOGY TO OBTAIN THE HIGHEST QUALITY IMAGES POSSIBLE. THIS COMBINED WITH OUR PROFESSIONAL CARING STAFF MAKES MERCY HOSPITAL FORT SMITH AND THE HEART CENTER THE HOSPITAL OF CHOICE FOR CARDIOVASCULAR SERVICES. 61,460 RVU (RELATIVE VALUE UNITS) WERE PERFORMED DURING FY2011. 5971888 0 19098731 INTENSIVE CARE UNIT (ICU) - THE ICU AREA HAS 38 BEDS, AND HAD 7,766 DAYS OF PATIENT CARE. ALL ICU ROOMS ARE EQUIPPED FOR CARDIAC MONITORING AND PROVIDE MAXIMUM SURVEILLANCE, SUPPORT OF VITAL FUNCTIONS, AND DEFINITIVE THERAPY FOR SURGICAL, MEDICAL, CARDIAC, AND TRAUMA CRITICAL PATIENTS. A NEW EDITION TO ICU, AS OF MARCH 26, 2007, IS MERCY SAFEWATCH. MERCY SAFEWATCH IS A TELEMEDICINE PROGRAM THAT CONNECTS CRITICAL CARE PATIENT ROOMS TO A CENTRALIZED INTENSIVE CARE UNIT (ELECTRONIC ICU). USING MICROPHONES, CAMERAS, AND HIGH-SPEED COMPUTER DATA LINES INSTALLED IN ICU PATIENT ROOMS, MERCY SAFE WATCH SUPPORTS THE PATIENT'S PHYSICIANS AND BEDSIDE CARE TEAM AROUND-THE-CLOCK WITH BOARD CERTIFIED INTENSIVE CARE PHYSICIANS AND EXPERIENCED ICU NURSES WHO MONITOR MERCY HOSPITAL FORT SMITH ICU PATIENTS REMOTELY. MERCY SAFEWATCH ADDS ANOTHER LAYER OF SERVICE AND PROTECTION FOR ICU PATIENTS AT MERCY HOSPITAL FORT SMITH. 116994852 285849 110699989 146209414 true true false true false false false false false true false false true true false false true false false false false false false false false true true true false true false false false false false false false false false false false false false true true true false false true X 0 0 true 1974 true true true false false false false false false false false false X 10 9 false false false false true true true true true false false true true true true true true false true true true X GRETA WILCHER VP OF FINANCE 4793146104 7301 Rogers Avenue Fort Smith AR 72903 X Nathan Bennett DO 60.0 X 0 535647 37961 Delilah Easom MD 60.0 X 0 354582 27328 JOHN T WOMACK 1.0 X 0 0 0 RICHARD R HAHN 1.0 X 0 0 0 SR DIANE KOORIE RSM 1.0 X 0 0 0 SR MARY ANNRENE BRAU RSM 1.0 X 0 0 0 SR MARY JEREMY BUCKMAN RSM 1.0 X 0 0 0 SUSAN GROBMYER 1.0 X 0 0 0 JEFFERY A JOHNSTON 60.0 X X 0 513656 154704 JON HENDRICKSON MD 1.0 X 0 0 0 JONATHAN R VITIELLO 60.0 X 0 375238 49437 Steve Loveless 60.0 X 0 243469 14587 Sheryl Tilus 60.0 X 224048 0 18245 GRETA WILCHER 60.0 X 0 259563 38491 DOUGLAS GAUTIER 60.0 X 366964 0 59178 LARRY PEARCE MD 60.0 X 353057 0 93279 Monte A Wilson 60.0 X 286430 0 28621 Joel James 60.0 X 169175 0 20277 ERIC ADAMS 40.0 X 145803 0 15529 RONALD C Cox 40.0 X 205307 0 9607 WILLIAM GENTRY 40.0 X 149837 0 12785 MICHAEL GUSDORF 40.0 X 163989 0 27989 Loyd G Welbern 40.0 X 147800 0 25680 RONNIE SUMMERHILL 0.0 X 0 325687 42907 2212410 2607842 676605 41 true true false MED STAFF OKLAHOMA 8321 E 61ST STREET STE 221 TULSA OK 741331504 NURSING STAFF 2439467 WEAR CONSTRUCTION MGT PO BOX 3218 FORT SMITH AR 72913 CONSTRUCTION 1142496 SUPERIOR LINEN SERVICE PO BOX 580787 TULSA OK 74158 LINEN SERVICES 698053 COOPER CLINIC PA 6801 ROGERS AVE FORT SMITH AR 72913 EKG READ SERVICES 662663 FORT SMITH REGIONAL DIALYSIS CENTER PO BOX 2107 FORT SMITH AR 72901 DIALYSIS SERVICES 584314 39 172765 172765 SURGERY 622110 42617605 42617605 CARDIAC CATH 622110 24455203 24455203 INTENSIVE CARE UNIT 622110 19098731 19098731 CONTRACT REVENUE 525100 1066041 1066041 OTHER PATIENT REVENUE 621990 117072924 116319241 753683 9227592 6841275 1329723 1056594 213538096 598669 598669 0 0 3482068 1227355 2254713 2254713 2254713 31048 0 31048 31048 31048 0 0 1010637 595061 415576 415576 CHANGE IN INVESTMENT IN SUBSIDIARIES 900099 -12460527 -12460527 -12460527 204550340 196871528 3149447 4356600 285849 285849 0 0 0 1800115 1460551 339564 0 67093877 54437630 12656247 2453146 1990397 462749 11994145 9731631 2262514 4627491 3754585 872906 0 477890 477890 242706 2988 239718 16829 16829 0 0 264048 23767 240281 191339 15843 175496 67186351 52308297 14878054 14274474 22144 14252330 0 5482001 1039689 4442312 396347 202833 193514 0 204448 63300 141148 193958 2109 191849 0 10367565 5689041 4678524 1056382 814727 241655 PROVISION FOR BAD DEBTS 14107697 14107697 TAXES 7286 7286 MISCELLANEOUS 245959 256336 -10377 202969903 146209414 56760489 0 36715969 28289918 24942 24997 24047599 30680693 12083235 983574 3141653 3704097 541077 295801 348818907 185470203 132489392 163348704 -9315941 4444965 0 3516904 28559207 22342415 228287133 257632068 19047355 13096332 26025 42819 3708200 2508326 0 7784064 0 27027771 22781580 50459312 X 205505553 207172756 205505553 207172756 228287133 257632068 X 1580437 86766 X X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 15845 15845 false SUPPLEMENTAL LOBBYING INFORMATION SCHEDULE C, PART IV THE FILING ORGANIZATION IS A MEMBER OF AND PAYS DUES TO THE FOLLOWING HOSPITAL ASSOCIATIONS: ARKANSAS HOSPITAL ASSOCIATION, AMERICAN HOSPITAL ASSOCIATION, AND CATHOLIC HEALTH ASSOCIATION. FOR THE YEAR ENDED JUNE 30, 2011, DUES WERE $65,720, $19,334, AND $32,513, RESPECTIVELY. APPROXIMATELY 17% OF ARKANSAS HOSPITAL ASSOCIATION DUES, 16.30% OF AMERICAN HOSPITAL ASSOCIATION DUES, AND 4.68% OF CATHOLIC HEALTH ASSOCIATION DUES WERE ATTRIBUTABLE TO LOBBYING ACTIVITIES PERFORMED BY THESE ASSOCIATIONS. 4841906 16690900 21532806 50454940 112189248 61623340 100970848 2149343 1415301 734042 155930057 122431562 33498495 6612513 0 6612513 163348704 ACCOUNTS RECEIVABLE-AFFILIATES 22342415 22342415 0 INVESTMENT IN SUBSIDIARY 27027771 27027771 FIN 48 (ASC 740) FOOTNOTE SCHEDULE D, PART X, LINE 2 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 (ASC 740), AS THEY ARE DEEMED IMMATERIAL FOR DISCLOSURE. true true X true X 300. true X true true false true true 7857160 0 7857160 0.04160 22454596 13534070 8920526 0.04720 30311756 13534070 16777686 0.08880 931377 0 931377 0.00490 929 0 929 153291 0 153291 0.00080 334122 0 334122 0.00180 1419719 0 1419719 0.00750 31731475 13534070 18197405 0.09630 1507 0 1507 0.00000 1481 0 1481 0.00000 164519 0 164519 0.00090 9050 0 9050 0.00000 176557 0 176557 0.00090 true 4094054 0 70161790 80150199 -9988409 X true true MERCY OUTPATIENT CTR OUTPATIENT SURGERY 0.51990 0.48010 FORT SMITH EMS AMBULANCE SERVICES 0.50000 0.50000 1 1 MERCY HOSPITAL FORT SMITH

7301 ROGERS AVENUE FORT SMITH AR 72903

X X X MERCY HOSPITAL FORT SMITH 1 SUPPLEMENTAL INFORMATION PART I, LINE 3C: N/A PART I, LINE 6A: THERE IS A CONSOLIDATED ANNUAL COMMUNITY BENEFIT REPORT PREPARED THAT INCLUDES THE FOLLOWING FORT SMITH ENTITIES: MERCY HOSPITAL FORT SMITH, MERCY HOSPITAL OZARK, MERCY HOSPITAL PARIS, AND MERCY HOSPITAL WALDRON. IT IS NOT PUBLISHED PUBLICLY BUT IS MADE AVAILABLE FOR PUBLIC VIEWING UPON REQUEST. PART I, LINE 7, COLUMN F: OUR TOTAL EXPENSE FROM FORM 990, PART IX, LINE 25, COLUMN (A) WAS $202,969,903. THE BAD DEBT EXPENSE INCLUDED IN THIS AMOUNT WAS $14,107,697. THIS LEFT A TOTAL EXPENSE OF $188,862,206 FOR PURPOSES OF CALCULATING LINE 7, COLUMN (F). PART II: N/A 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 IS AS FOLLOWS: "PATIENT ACCOUNTS THAT ARE UNCOLLECTED, INCLUDING THOSE PLACED WITH COLLECTION AGENCIES, ARE INITIALLY CHARGED AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IN ACCORDANCE WITH COLLECTIONS POLICIES OF THE HEALTH SYSTEMS AND, IN CERTAIN CASES, ARE RECLASSIFIED TO CHARITY CARE IF DEEMED TO OTHERWISE MEET THE HEALTH SYSTEM'S CHARITY CARE POLICY. THE PROVISION FOR UNCOLLECTIBLE RECEIVABLES IS BASED ON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS. PERIODICALLY THROUGHOUT THE YEAR, MANAGEMENT ASSESS THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES BASED UPON THE PAYOR COMPOSITION AND AGING OF RECEIVABLES AS OF THE REPORTING DATE WITH CONSIDERATION OF THE HISTORICAL PAYMENT AND WRITE-OFF EXPERIENCE BY PAYOR CATEGORY. THE RESULTS OF THESE REVIEWS ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR UNCOLLECTIBLE RECEIVABLES TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES. AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE, THE HEALTH SYSTEM FOLLOWS ESTABLISHED GUIDELINES FOR PLACING PAST-DUE BALANCES WITH COLLECTION AGENCIES." 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 THE ORGANIZATION'S CHARITY CARE POLICY IS $0. ALTHOUGH THE CHARITY CARE POLICY REQUIRES THE PARTICIPATION OF THE PATIENT REQUESTING ASSISTANCE, WE HAVE A PROCESS UNDER PRESUMPTIVE CHARITY (REFER TO DISCLOSURE FOR PART III, #9B) TO ADDRESS ACCOUNTS FOR PATIENTS WHO DO NOT PROVIDE THE INFORMATION. WE BELIEVE THAT OUR CHARITY POLICY IS COMPREHENSIVE ENOUGH TO CAPTURE ALMOST ALL PATIENTS WHO QUALIFY FOR CHARITY CARE. PART III, LINE 8: IT IS THE POSITION OF MERCY HOSPITAL FORT SMITH 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 CHARGES NET OF THE COST TO CHARGE RATIO LESS ANY PAYMENTS, DEDUCTIONS OR REIMBURSEMENTS USING THE ANNUAL MEDICARE COST REPORT (CMS FORM 2552-96). PART III, LINE 9B: MERCY HOSPITAL FORT SMITH'S ("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 HAVE MET THE MERCY HOSPITAL COMMUNITY ASSISTANCE POLICY IS REQUIRED TO BE RETURNED IMMEDIATELY BY THE THIRD-PARTY COLLECTION AGENT TO MERCY FOR APPROPRIATE FOLLOW-UP. MERCY REQUIRES ITS THIRD-PARTY COLLECTION AGENTS TO INCLUDE A MESSAGE ON ALL STATEMENTS INDICATING THAT IF A PATIENT OR PATIENT GUARANTOR MEETS CERTAIN STIPULATED INCOME REQUIREMENTS, THE PATIENT OR PATIENT GUARANTOR MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE. MERCY UTILIZES THE "SEARCH AMERICA" TOOL TO ENHANCE THE ABILITY TO DETERMINE CHARITY QUALIFICATION. PRESUMPTIVE CHARITY WILL BE GRANTED IN SITUATIONS WHERE MERCY HAS BEEN UNABLE TO OBTAIN INFORMATION FROM PATIENTS OR THE INFORMATION PROVIDED IS NOT COMPLETE ENOUGH TO MAKE A CHARITY DETERMINATION. MERCY UTILIZES PRESUMPTIVE CHARITY PRIOR TO BAD DEBT PLACEMENT FOR CHARITY ADJUSTMENTS IN EXCESS OF $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 CONSISTENT WITH MERCY MISSION AND VALUES. ADDITIONALLY THEY MAY INCLUDE LIENS UPON REAL PROPERTY AND REASONABLE WAGE GARNISHMENTS. LEGAL ACTIONS WILL GENERALLY NOT INCLUDE BANK GARNISHMENT, REPOSSESSION OF ASSETS OR FORECLOSURES TO ENFORCE SATISFACTION OF A LIEN. MERCY HAS POLICIES AND PROCEDURES ESTABLISHED TO ADDRESS THE INITIATION OF LEGAL ACTION AND ANNUALLY REVIEWS COMPLIANCE WITH ALL POLICIES. NEEDS ASSESSMENT: PART VI, LINE 2: MERCY HOSPITAL FORT SMITH'S OBJECTIVES OF COMMUNITY NEEDS ASSESSMENT ARE TO IDENTIFY HEALTH NEEDS IN FORT SMITH, ARKANSAS AND THE SURROUNDING COMMUNITIES, AND TO INVOLVE THE COMMUNITY IN THE HEALTH PLANNING EFFORTS. THE INFORMATION GATHERED IS USED TO PLAN STRATEGICALLY, AND BETTER MEET THE HEALTH AND HUMAN SERVICE NEEDS OF THESE COMMUNITIES. MERCY HOSPITAL FORT SMITH LOOKS AT COMMUNITY NEEDS ASSESSMENT AS AN OPPORTUNITY TO BUILD RELATIONSHIPS, EDUCATE THE COMMUNITY AND IDENTIFY RESOURCES THAT ARE AVAILABLE TO MEET IDENTIFIED NEEDS. BASIC DISCUSSION FORUMS HAVE BEEN UTILIZED TO FOSTER CONVERSATION WITH KEY STAKEHOLDERS. EXAMPLES OF FORUMS INCLUDE AN ADVISORY BOARD, FOCUS GROUPS, OPINION SURVEYS, AND COMMUNITY ROUND TABLE DISCUSSIONS. STAKEHOLDER PARTICIPANTS INCLUDE BOARD MEMBERS, COMMUNITY/CIVIC LEADERS, LOCAL EMPLOYERS, OTHER HEALTH CARE PROVIDERS, FORMER PATIENTS, AND CO-WORKERS. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: PART VI, LINE 3: THE FILING ORGANIZATION HAS PRINTED MATERIAL AVAILABLE AT EACH POINT OF REGISTRATION IN OUR FACILITY, IN ADDITION TO ELECTRONIC 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. COMMUNITY INFORMATION: PART VI, LINE 4: THE SERVICE AREA IS MADE UP OF 13 COUNTIES IN WESTERN ARKANSAS AND EASTERN OKLAHOMA INCLUDING LATIMER, LEFLORE, HASKELL, SEQUOYAH, AND ADAIR IN OKLAHOMA, AND CRAWFORD, FRANKLIN, JOHNSON, LOGAN, YELL, SCOTT, POLK, AND SEBASTIAN IN ARKANSAS. THE TOTAL POPULATION SERVICED IS BASED ON THE STATE FILING OF COMMUNITY BENEFIT REPORT 990 SCHEDULE H, PART VI MO, true ARKANSAS HOSPITAL ASSOC 419 NATURAL RESRCS DR LITTLE ROCK AR 72205 710306406 501(c)(3) 10528 charitable contribution DONALD W REYNOLDS CANCER SUPPORT HOUSE 3324 SOUTH M STREET FORT SMITH AR 72903 710507617 501(c)(3) 21500 CHARITABLE CONTRIBUTION FT SMITH CHAMBER OF COMMERCE 612 GARRISON AVE FORT SMITH AR 72901 710029620 501(c)(3) 26500 CHARITABLE CONTRIBUTION FT SMITH REGIONAL ART MUSEUM PO BOX 1257 FORT SMITH AR 72902 716056672 501(c)(3) 17000 CHARITABLE CONTRIBUTION FT SMITH SYMPHONY PO BOX 3151 FORT SMITH AR 72913 710292138 501(c)(3) 12000 charitable contribution RONALD MCDONALD HOUSE CHARITY PO BOX 1366 SPRINGDALE AR 72765 731563845 501(c)(3) 12250 charitable contribution ST EDWARD AUXILIARY PO BOX 17000 FORT SMITH AR 72917 710240352 501(c)(3) 150000 charitable contribution UNITED WAY OF FT SMITH PO BOX 2300 FORT SMITH AR 72902 710329530 501(c)(3) 25000 charitable contribution 8 0 DESCRIPTION OF ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANTS SCHEDULE I, PART I, LINE 2 ALL PAYMENTS LISTED IN SCHEDULE I ARE CHARITABLE CONTRIBUTIONS (NO GRANT ACTIVITY). REQUESTS FOR PAYMENT ARE RECEIVED EITHER VIA PHONE CALL OR MAIL. ONCE THE PROPER DOCUMENTATION IS RECEIVED AND THE APPROPRIATE APPROVAL LEVELS ARE FOLLOWED IT IS DETERMINED IF THE CONTRIBUTION WILL BE MADE. THE USE OF GRANT FUNDS IS NOT MONITORED AFTER GRANTS ARE GIVEN. X X X X true true true true false false false false false true false Nathan Bennett DO 0 362770 0 95057 0 77820 0 26022 0 11939 0 573608 0 0 Delilah Easom MD 0 235389 0 54485 0 64708 0 11998 0 15330 0 381910 0 0 JEFFERY A JOHNSTON 0 325561 0 166734 0 21361 0 138924 0 15780 0 668360 0 0 JONATHAN R VITIELLO 0 260553 0 108343 0 6342 0 35784 0 13653 0 424675 0 0 Steve Loveless 0 152648 0 42041 0 48780 0 4900 0 9687 0 258056 0 0 Sheryl Tilus 149466 0 35904 0 38678 0 4602 0 13643 0 242293 0 0 0 GRETA WILCHER 0 189810 0 66825 0 2928 0 32360 0 6131 0 298054 0 0 DOUGLAS GAUTIER 198671 0 62965 0 105328 0 47706 0 11472 0 426142 0 0 0 LARRY PEARCE MD 240279 0 72029 0 40749 0 81474 0 11805 0 446336 0 0 0 Monte A Wilson 212092 0 54891 0 19447 0 13830 0 14791 0 315051 0 0 0 Joel James 122999 0 36401 0 9775 0 6221 0 14056 0 189452 0 0 0 ERIC ADAMS 105108 0 0 0 40695 0 9857 0 5672 0 161332 0 0 0 RONALD C Cox 39755 0 31821 0 133731 0 6438 0 3169 0 214914 0 0 0 WILLIAM GENTRY 30928 0 7991 0 110918 0 11150 0 1635 0 162622 0 0 0 MICHAEL GUSDORF 133406 0 0 0 30583 0 14087 0 13902 0 191978 0 0 0 Loyd G Welbern 29101 0 7298 0 111401 0 22463 0 3217 0 173480 0 0 0 RONNIE SUMMERHILL 0 24769 0 36302 0 264616 0 40216 0 2691 0 368594 0 0 Supplemental Compensation Information FORM 990, SCHEDULE J, PART I, QUESTION 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. FORM 990, SCHEDULE J, PART I, QUESTION 3 MERCY HOSPITAL FORT SMITH RELIES ON A RELATED ORGANIZATION; REFER TO SCHEDULE O, PART VI, QUESTION 15B FOR THE PROCESS THE RELATED ORGANIZATION FOLLOWS. FORM 990, SCHEDULE J, PART I, QUESTION 4A THE FOLLOWING INDIVIDUAL RECEIVED A SEVERANCE PAYMENT DURING CALENDAR 2010: WILLIAM GENTRY $83,382, LOYD WELBERN $84,155, RONALD COX $104,372 AND RONNIE SUMMERHILL $195,182 FORM 990, SCHEDULE J, PART I, QUESTION 4B MERCY HOSPITAL FORT SMITH OFFERS SUPPLEMENTAL RETIREMENT PLANS TO CERTAIN EXECUTIVES WHICH PROVIDE BENEFITS UPON RETIREMENT BASED ON COMPENSATION, AGE AT THE TIME OF BENEFIT COMMENCEMENT, LENGTH OF SERVICE WITH THE COMPANY AND/OR ITS AFFILIATES, AND LENGTH OF TENURE IN THE PLAN. THE INDIVIDUALS REPORTABLE ON THIS RETURN WHO PARTICIPATE IN THE SUPPLEMENTAL RETIREMENT PLANS INCLUDE JEFFREY JOHNSTON, LARRY PEARCE, STEVE LOVELESS, JONATHAN VITIELLO AND GRETA WILCHER. THE AMOUNT OF ALL ACCRUED BENEFITS IS INCLUDED IN COMPENSATION AMOUNTS PROVIDED IN SCHEDULE J, PART II, COLUMN (C). FORM 990, SCHEDULE J, PART I, QUESTION 7 MERCY HEALTH PROVIDES A NON-FIXED BONUS PLAN FOR WHICH CERTAIN TIERS OF ITS EMPLOYEES ARE ELIGIBLE. FOR FISCAL YEAR 2011 (JULY 1, 2010 - JUNE 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 AND ARE THEN TAKEN INTO ACCOUNT WHEN ANALYZING EXECUTIVE COMPENSATION FOR REASONABLENESS. SUPPLEMENTAL INFORMATION 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 VI FOR A LIST OF THE NAME CHANGES. VOLUNTEERS FORM 990, PART I, LINE 6 MERCY HOSPITAL FORT SMITH UTILIZES AN AUXILIARY PROGRAM FOR VOLUNTEERS TO PERFORM VARIOUS FUNCTIONS. SUCH FUNCTIONS INCLUDE FLOWER DELIVERY, INFORMATION DESK, AND PATIENT TRANSPORT. DESCRIPTION OF OTHER PROGRAM SERVICES FORM 990, PART III, LINE 4D MERCY HOSPITAL FORT SMITH (MHFS) PROVIDES QUALITY CARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. IN ACTIVE PURSUIT OF THE ABOVE STATED MISSION, MHFS PROVIDED 75,082 INPATIENT SERVICE DAYS OF ACUTE OR SUB-ACUTE CARE. MHFS PERFORMED 2,228 BIRTHS, RESPONDED TO 51,495 EMERGENCY ROOM ENCOUNTERS, MADE 24,996 HOME HEALTH CARE VISITS AND COMPLETED 127,965 OUTPATIENT VISITS. COMMUNITY OUTREACH/BENEFIT PROGRAMS INCLUDE SUPPORT GROUPS FOR CURRENT AND PAST PATIENTS (DIABETIC, CARDIAC, CANCER, ETC.), EXPECTING/NEW PARENTS (CHILD BIRTH CLASSES, HELPING HANDS, ETC.), LOCAL/SURROUNDING COMMUNITY (LIFELINE SERVICES, WELLNESS COMMITTEES, HEALTH FAIRS, HOME HEALTH AND HOSPICE PROGRAMS, MOBILE MAMMOGRAPHY, ETC...) $285,849 OF GRANTS ARE MAINLY CHARITABLE CONTRIBUTIONS THAT ARE FOCUSED TO HELP ADDRESS THE HEALTH CARE NEEDS OF UNDERSERVED AREAS, WITH A PRIMARY FOCUS IN RURAL SERVICE AREAS, OR TO MEET IDENTIFIED HEALTH DISPARITIES IN THE LOCAL COMMUNITY. FORM 1099/1096 FILING FORM 990, PART V, QUESTION 1A VENDORS FOR THE FILING ORGANIZATION ARE PAID BY MERCY HEALTH (EIN 43-1423050). AS SUCH, ALL REQUIRED FORM 1099 AND FORM 1096 REPORTING IS MADE FOR THE ENTIRE HEALTH (WITH LIMITED EXCEPTIONS) UNDER THE MERCY HEALTH EIN. DESCRIPTION OF CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS FORM 990, PART VI, LINES 6, 7A & 7B THE FILING ORGANIZATION HAS A SOLE CORPORATE MEMBER, MERCY HEALTH FORT SMITH COMMUNITIES. THE FOLLOWING CORPORATE POWERS AND RESPONSIBILITIES SHALL BE RESERVED SOLELY UNTO THE CORPORATE MEMBER: - TO APPROVE THE MISSION AND ESTABLISH THE PHILOSOPHY ACCORDING TO WHICH THE CORPORATION SHALL OPERATE; - TO AMEND THE ARTICLES OF INCORPORATION AND BYLAWS; - TO APPOINT AND REMOVE MEMBERS OF THE BOARD; - TO APPOINT AND REMOVE THE CHIEF EXECUTIVE OFFICER OF THE CORPORATION; - TO APPROVE OR AMEND THE STRATEGIC PLAN, GOALS, AND OBJECTIVES OF THE CORPORATION; - TO APPROVE OR AMEND THE OPERATING, CAPITAL, AND CONSTRUCTION BUDGETS OF THE CORPORATION; - TO LEASE OR SELL ANY OF THE ASSETS OF THE CORPORATION OR ANY CORPORATION CONTROLLED BY THE CORPORATION IN EXCESS OF ONE MILLION DOLLARS ($1,000,000); - TO ENCUMBER ANY OR ALL OF THE ASSETS OF THE CORPORATION OR ANY CORPORATION CONTROLLED BY THE CORPORATION; - TO AUTHORIZE OR APPROVE THE INCURRENCE OF DEBT BY THE CORPORATION OR ANY CORPORATION CONTROLLED BY THE CORPORATION (OTHER THAN DEBT INCURRED FOR THE ACQUISITION OF GOODS THAT ARE ACQUIRED IN THE ORDINARY COURSE OF BUSINESS) AND TO GRANT ANY SECURITY INTERESTS, PLACE ANY ENCUMBRANCES, ENTER INTO ANY COVENANTS, AND EXECUTE ANY DOCUMENTS AND TAKE ANY ACTIONS NECESSARY OR APPROPRIATE IN CONNECTION WITH THE INCURRENCE OF SUCH DEBT; - TO MERGE, DISSOLVE OR ABANDON THE CORPORATION; AND, - TO APPROVE THE CREATION, OWNERSHIP OR ACQUISITION OF, OR AFFILIATION WITH, ANY OTHER ORGANIZATION BY THE CORPORATION. DESCRIBE THE PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990 FORM 990, PART VI, LINE 11B 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 ORGANIZAITON'S FINANCE TEAM, INCLUDING THE MANAGER OF ACCOUNTING AND THE VICE-PRESIDENT OF FINANCE. THE DRAFT FORM 990 IS ALSO REVIEWED BY MERCY HEALTH'S TAX DEPARTMENT, TO ENSURE ACCURACY AND CONSISTENCY WITH OTHER RELATED ORGANIZATIONS' FORM 990. AFTER QUESTIONS ARISNG FROM THE VARIOUS REVIEWS ARE ADDRESSED AND INCORPORATED INTO THE FORM 990, A REVISED DRAFT IS PROVIDED TO THE FILING ORGANIZATION'S LEADERSHIP TEAM, INCLUDING THE CFO AND CEO, FOR REVIEW. ONCE REVIEWED AND APPROVED BY THE FILING ORGANIZATION'S LEADERSHIP TEAM, THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS FOR REVIEW; IT IS THEN SIGNED AND FILED WITH THE IRS. DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST FORM 990, PART VI, LINE 12C THE COMPLIANCE POLICY COVERAGE INCLUDES: CO-WORKERS, LEADERS, PROVIDERS, BOARD MEMBERS, AND ADMINISTRATORS. THE DETERMINATION OF A CONFLICT OF INTEREST IS MADE AND REVIEWED AT ALL LEVELS. A CORPORATE COMPLIANCE COMMITTEE MEETS TO REVIEW ANY CONFLICTS AND PROVIDE A REASONABLE ALTERNATIVE TO RESOLVE THE CONFLICT, WHICH MAY INCLUDE SUPERVISORY PROCEDURES OR TRANSFER OF DECISION-MAKING ROLE. BOARD MEMBERS INVOLVED IN THE CONFLICT OF INTEREST ARE EXCLUDED FROM THE DELIBERATIONS AND DECISION MAKING PROCESS. OFFICES & POSITIONS FOR WHICH PROCESS WAS USED, & YEAR PROCESS WAS BEGUN FORM 990, PART VI, LINE 15B FOR THOSE CLASSIFIED AS OFFICERS (AND THUS DISQUALIFIED PERSONS), THE ORGANIZATION RELIES UPON MERCY HEALTH, WHICH USES THE FOLLOWING TO ESTABLISH THE COMPENSATION: EXTERNAL MARKET SALARY SURVEYS, EXTERNAL MARKET SALARY STUDIES, ENGAGEMENT OF AN INDEPENDENT COMPENSATION CONSULTANT, AND REVIEW/APPROVAL OF COMPENSATION BY THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF MERCY HEALTH. FOR THOSE CLASSIFIED AS KEY EMPLOYEES, 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. AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY & FIN STMTS TO GEN PUBLIC FORM 990, PART VI, QUESTION 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS HAVE BEEN MADE AVAILABLE UPON REQUEST BUT ARE NOT PUBLISHED PUBLICLY. AVERAGE HOURS PER WEEK FORM 990, PART VII, SECTION A, COLUMN B SEVERAL INDIVIDUALS LISTED IN PART VII ARE DISCLOSED AS TRUSTEES, DIRECTORS, OFFICERS, AND KEY EMPLOYEES ON MULTIPLE FORMS 990 OF ENTITIES INCLUDED WITHIN MERCY HEALTH. THE AVERAGE HOURS PER WEEK DISCLOSED IN PART VII IS AN ESTIMATE OF THE HOURS PER WEEK THAT THE LISTED INDIVIDUAL SPENDS ON BOTH THE FILING ORGANIZATION AND ALL RELATED ORGANIZATIONS. RECONCILIATION OF NET ASSETS FORM 990, PART XI, LINE 5 TRANSFER TO/FROM RELATED ORGANIZATION (MCS) - $86,767 AUDIT OF FINANCIAL STATEMENTS FORM 990, PART XII, QUESTION 2B THE FILING ORGANIZATION'S FINANCIAL STATEMENTS WERE INCLUDED IN MERCY HEALTH AND SUBSIDIARIES ANNUAL FINANCIAL STATEMENT AUDIT. MERCY HEALTH AND SUBSIDIARIES RECEIVED AN UNQUALIFIED OPINION FROM THE EXTERNAL AUDITORS FOR FISCAL 2011(THE TAX YEAR CURRENTLY BEING REPORTED). HOWEVER, NO SEPERATE AUDIT OPINION IS ISSUED ON THE FINANCIAL STATEMENTS OF THE FILING ORGANIZATION. THE ULTIMATE RESPONSIBILITY FOR OVERSIGHT OF THE FINANCIAL STATEMENT AUDIT AND SELECTION OF THE EXTERNAL AUDITOR LIES WITH THE FINANCE, AUDIT, AND COMPLIANCE COMMITTEE OF MERCY HEALTH BOARD OF DIRECTORS. AUDIT RESULTS ARE COMMUNICATED TO THIS COMMITTEE. Advance Care Hospital 300 Werner St 3rd Floor Hot Springs AR 71913 710816634 Hospital AR 501(C)(3) 3 Mercy Health Mercy Hospital Lebanon 100 Hospital Drive Lebanon MO 65536 431767432 Hospital MO 501(C)(3) 3 MHSC Mercy Health Foundation Berryville 214 Carter Street Berryville AR 72616 710759301 Foundation AR 501(C)(3) 11a MH Berryvill Casa de Misericordia 1000 Mier Street Laredo TX 780404653 742912461 Shelter TX 501(C)(3) 7 MM Laredo Mercy Hospital Healdton 918 South Street Healdton OK 73438 263173902 Hospital OK 501(C)(3) 3 MH Ardmore Laredo Medical Group 14528 S Outer Forty Ste 100 Chesterfield MO 63017 742764726 Inactive TX 501(C)(3) 9 MHS-TX McAuley Portfolio Management Company 14528 S Outer Forty Ste 100 Chesterfield MO 63017 261708048 Port Mgmt MO 501(C)(3) 11b Mercy Health Mercy Hospital El Reno 2115 Parkview Drive El Reno OK 73036 736617948 Hospital OK 501(C)(3) 3 Mercy Health Mercy Emergency Medical Services Inc 4300 W Memorial Road Oklahoma City OK 73120 810627035 Inactive OK 501(C)(3) 9 MHOC Mercy Foundation for Health Innovation 14528 S Outer Forty Ste 100 Chesterfield MO 63017 200901499 Foundation MO 501(C)(3) 11b Mercy Health Mercy Health Foundation Fort Scott 401 Woodland Hills Blvd Fort Scott KS 66701 481077073 Foundation KS 501(C)(3) 11c Mercy KS Com Mercy Health Foundation OK City 4300 W Memorial Road Oklahoma City OK 73120 731593024 Foundation OK 501(C)(3) 11a MHOC Mercy Hospital Oklahoma City 4300 W Memorial Road Oklahoma City OK 73120 730579285 Hospital OK 501(C)(3) 3 MHOC Mercy Hospital Columbus 220 Pennsylvania Avenue Columbus KS 66725 270842031 Hospital MO 501(C)(3) 3 MHSMKC Mercy Health Foundation Joplin 2727 McClelland Blvd Joplin MO 64804 270906136 Foundation MO 501(C)(3) 11a MHSMKC Mercy Hospital Joplin 2727 McClelland Blvd Joplin MO 64804 270814858 Hospital MO 501(C)(3) 3 MHSMKC Mercy Health SW MOKS Communitites 2727 McClelland Blvd Joplin MO 64804 300584463 Hlth System MO 501(C)(3) 11b Mercy Health Mercy Kansas Communities Inc 401 Woodland Hills Blvd Ft Scott KS 66701 480956045 Hospital KS 501(C)(3) 3 MHSMKC Mercy Health NW Arkansas Communities 2710 Rife Medical Drive Rogers AR 72758 621684203 Phys Group AR 501(C)(3) 11b Mercy Health Mercy Health System of Texas Inc 14528 S Outer Forty Ste 100 Chesterfield MO 63017 742764727 Inactive TX 501(C)(3) 11b Mercy Health Mercy Health Oklahoma Communities 4300 W Memorial Road Oklahoma City OK 73120 731453048 Holding co. OK 501(C)(3) 11b Mercy Health Mercy Health Foundation Independence 800 W Myrtle Independence KS 67301 481079981 Foundation KS 501(C)(3) 11a Mercy KS Com Mercy Hospital of Laredo 14528 S Outer Forty Ste 100 Chesterfield MO 63017 741189682 Inactive TX 501(C)(3) 3 MHS-TX Mercy Clinic East Communites 645 Maryville Centre Dr St 100 St Louis MO 63141 431771217 Phys Group MO 501(C)(3) 9 MHEC Mercy Health Foundation Ardmore 1011 14th Avenue NW Ardmore OK 73401 710962525 Foundation OK 501(C)(3) 11a MH Ardmore Mercy Hospital Ardmore 1011 14th Avenue NW Ardmore OK 73401 731500629 Hospital OK 501(C)(3) 3 MHOC Mercy Clinic Oklahoma Communities 4300 W Memorial Road Oklahoma City OK 73120 270473057 Phys Group OK 501(C)(3) 9 MHOC MHM Support Services 14528 S Outer Forty Ste 100 Chesterfield MO 63017 202553101 Sup Hlth Sys MO 501(C)(3) 11b Mercy Health Mission Clinical Services 300 Werner Street Hot Springs AR 71913 134239691 nursing home AR 501(C)(3) 9 MHHSC Mercy Hospital Berryville 214 Carter Street Berryville AR 72616 710759299 Hospital AR 501(C)(3) 3 MHSC Mercy Health 14528 S Outer Forty Ste 100 Chesterfield MO 63017 431423050 Sup Hlth Sys MO 501(C)(3) 1 NA Mercy Family Center 14528 S Outer Forty Ste 100 Chesterfield MO 63017 721069468 counseling MO 501(C)(3) 7 Mercy Health Mercy Hospital Ozark 801 W River Street Ozark AR 72949 710689680 Hospital AR 501(C)(3) 3 MHFS Mercy Hospital Paris 500 E Academy Paris AR 72855 710655753 Hospital AR 501(C)(3) 3 MHFS Mercy Hospital Waldron 1341 W 6th Street Waldron AR 72958 710557895 Hospital AR 501(C)(3) 3 MHFS Mercy Clinic Fort Smith Communitites 7301 Rogers Avenue Fort Smith AR 72917 261318597 Phys Clinic AR 501(C)(3) 9 MHFSC St Edward Mercy Foundation PO Box 17000 Fort Smith AR 72917 237330425 Foundation AR 501(C)(3) 7 MHFS Mercy Health Fort Smith Communities 7301 Rogers Avenue Fort Smith AR 72917 261318515 Holding Co. AR 501(C)(3) 11b Mercy Health Mercy St Francis Hospital 100 W Highway 60 Mountain View MO 65548 440607149 Hospital MO 501(C)(3) 3 MHSC Mercy Hospital Aurora 500 Porter Avenue Aurora MO 65605 431936696 Hospital MO 501(C)(3) 3 MHSC Mercy Hospital Cassville 94 Main Street Cassville MO 65625 431936699 Hospital MO 501(C)(3) 3 MHSC St John's Children's Hospital Inc 1235 E Cherokee Street Springfield MO 65804 431423050 Inactive MO 501(C)(3) 3 MHSC Mercy Clinic Springfield Communities 1965 Fremont Street Ste 2950 Springfield MO 65804 431560263 Phys Group MO 501(C)(3) 9 MHSC Mercy Health Foundation Springfield 1235 E Cherokee Street Springfield MO 65804 320195818 Foundation MO 501(C)(3) 11b MHSC Mercy Health Springfield Communitites 1235 E Cherokee Street Springfield MO 65804 431856028 Holding Co MO 501(C)(3) 11b Mercy Health Mercy Home Health Berryville 214 Carter Street Berryville AR 72616 870781247 Home Health AR 501(C)(3) 11c MH Sprngfld Mercy Medical Research Institute 1235 E Cherokee Street Springfield MO 65804 870796305 Research MO 501(C)(3) 4 MHSC Mercy Health Foundation St Louis 14528 S Outer Forty Ste 100 Chesterfield MO 63017 562410020 Foundation MO 501(C)(3) 11b MHEC Mercy Health East Communities 14528 S Outer Forty Ste 100 Chesterfield MO 63017 431718408 Hlth System MO 501(C)(3) 11b Mercy Health Mercy Hospitals East Communities 14528 S Outer Forty Ste 100 Chesterfield MO 63017 430653493 Hospital MO 501(C)(3) 3 MHEC Mercy Health Foundation Washington 901 E Fifth Street Washington MO 63090 562410022 Foundation MO 501(C)(3) 11b MHEC Mercy Support Services 615 S New Ballas Road St Louis MO 63141 431677952 Inactive MO 501(C)(3) 11c MHEC Mercy Hospital Springfield 1235 E Cherokee Street Springfield MO 65804 440552485 Hospital MO 501(C)(3) 3 MHSC Mercy Clinic Hot Springs Communitites 1 Mercy Lane Hot Springs AR 71913 261125131 Phys Clinic AR 501(C)(3) 9 MHHSC Mercy Hospital Hot Springs 300 Werner Street Hot Springs AR 71913 710236913 Hospital AR 501(C)(3) 3 MHHSC Mercy Health Foundation Hot Springs 300 Werner Street Hot Springs AR 71913 710804718 Foundation AR 501(C)(3) 11b MHHS Mercy Health Hot Springs Communities 300 Werner Street Hot Springs AR 71913 261125064 Holding Co AR 501(C)(3) 11b Mercy Health Mercy Hospital Rogers 2710 Rife Medical Lane Rogers AR 72758 710294390 Hospital AR 501(C)(3) 3 MHNWAC Mercy Health Foundation NW Arkansas 2710 Rife Medical Lane Rogers AR 72758 710601687 Foundation AR 501(C)(3) 11c MH Rogers St Mary's Hospital of Enid Oklahoma 14528 S Outer Forty Ste 100 Chesterfield MO 63017 730614655 Inactive OK 501(C)(3) 3 MHOC The Sister M Cornelia Blasko Foundation 100 W Highway 60 Mountain View MO 65548 431873914 Foundation MO 501(C)(3) 11a MSFH Unity Ambulatory Care 645 Maryville Centre Dr St 100 St Louis MO 63141 431861745 Inactive MO 501(C)(3) 11c MHEC Mercy Hospital Tishomingo 1000 South Byrd Tishomingo OK 73460 274433830 Hospital OK 501(C)(3) 3 MH Ardmore Mercy Ministries of Laredo 2500 Zacatecas Laredo TX 780466814 200198462 outreach TX 501(C)(3) 7 Mercy Health Merc Ambu Surg CTR 7301 Rogers Av Fort Smith AR 72903 710827721 AMBUL SURG CENTER AR NA RES OPT & INNOV 645 Maryville Centre Dr 200 St Louis MO 63141 460468368 CENTRAL DIST. MO NA SO OK DIAG CTR 1011 14TH Ave NW Ardmore OK 73401 431971232 MRI Services OK NA Fort Smith EMS 1701 S Greenwood Fort Smith AR 72901 710416615 Emergency Med AR NA St Ed Mer Med MOB 7301 Rogers Ave Fort Smith AR 72903 710554050 Office Building AR NA Frontenac Properties Inc 14528 S Outer Forty Suite 100 Chesterfield MO 63017 521914421 HOLDING COMP DE NA C-Corp Inveno Health Inc 1235 E Cherokee Street Springfield MO 65804 264509571 IT SERVICES MO NA C-Corp Mercy Community Services Inc 401 Woodland Hills Blvd Fort Smith KS 66701 481078101 CATERING KS NA C-Corp Mercy Health Center Condominium Inc 4300 W Memorial Rd Oklahoma City OK 73120 680640970 REAL ESTATE OK NA C-Corp Mercy Health Network of the Southern Reg 1011 14th Avenue NW Ardmore OK 73401 731580607 HEALTH CARE OK NA C-Corp Mercy Health Network Inc 4300 W Memorial Road Oklahoma City OK 73120 731381689 HEALTH CARE OK NA C-Corp Mercy Managed Care Corporation 4300 W Memorial Road Oklahoma City OK 73120 731441665 HOLDING COMP OK NA C-Corp MHP Inc 14528 S Outer Forty Suite 300 Chesterfield MO 63017 431697084 HOLDING COMP DE NA C-Corp UH L Corp Inc 645 Maryville Centre Drive Suite 1 St Louis MO 63141 742499535 HOLDING COMP MO NA C-Corp Unity Support Services Inc 645 Maryville Centre Drive Suite 1 St Louis MO 63141 431797042 INACTIVE MO NA C-Corp false false true false false false false false false true false false false false true true false false MHM SUPPORT SERVICES O 39978027 MERCY HOSPITALS EAST COMMUNITITES P 110401 MERCY HEALTH O 308378 RESOURCE OPTIMIZATION & iNNOVATION LLC P 11704529 MERCY HOSPITAL WALDRON O 5552336 MERCY HOSPITAL PARIS O 4492326 MERCY HOSPITAL OZARK O 6181081 MERCY CLINIC FORT SMITH COMMUNITIES O 3784946 ST EDWARD MERCY FOUNDATION P 2034539 MERCY AMBULATORY SURGERY CENTER LLC P 3747033 ST EDWARD MMC MULTI-PURPOSE OFFICE BLDG PROP J 128340 MERCY HOSPITAL HOT SPRINGS P 60377 MERCY HEALTH NW ARKANSAS COMMUNITIES P 55749 MHM SUPPORT SERVICES C 50000 FORM 990, SCHEDULE R, PART II *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 FORM 990, SCHEDULE R, PART V LAWSON ERP SOFTWARE IS THE PRIMARY ACCOUNTING SOFTWARE USED BY MERCY HEALTH 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.