2023-05-12T15:41:43-05:00 2022-06-30 264532849 PURK & ASSOCIATES PC 1034 SOUTH BRENTWOOD BLVD STE 2000 SAINT LOUIS MO 63117 990 2021-07-01 463433074 MERCY HOSPITAL KINGFISHER INC MERC 4059365649 1000 HOSPITAL CIRCLE KINGFISHER OK 73750 SHERRY CLOUSEDAY VP FINANCE 4178208439 2023-05-09 1 SHERRY CLOUSEDAY 999009999 DOUGLAS G PLEUS CPA P00013488 3148844000 2023-05-09 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z JIM GEBHART 1000 HOSPITAL CIRCLE KINGFISHER OK 73750 15673948 0 0928 X WWW.MERCY.NET X 2013 OK AS THE SISTERS OF MERCY BEFORE US, WE BRING TO LIFE THE HEALING MINISTRY OF JESUS THROUGH OUR COMPASSIONATE CARE AND EXCEPTIONAL SERVICE. 4 0 0 10 0 0 102504 269452 14643514 15265527 0 0 210272 137444 14956290 15672423 132235 53574 0 0 8242716 10163030 0 0 0 4741347 5629728 13116298 15846332 1839992 -173909 3781535 3917601 431522 437504 3350013 3480097 X AS THE SISTERS OF MERCY BEFORE US, WE BRING TO LIFE THE HEALING MINISTRY OF JESUS THROUGH OUR COMPASSIONATE CARE AND EXCEPTIONAL SERVICE. 0 0 3608427 4448085 MERCY HOSPITAL KINGFISHER PROVIDES QUALITY MEDICAL HEALTH CARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY BY OFFERING ESSENTIAL HEALTH SERVICES TO ITS COMMUNITY. IN ACTIVE PURSUIT OF THIS MISSION, MERCY HOSPITAL KINGFISHER PROVIDES A WIDE VARIETY OF SERVICES IN THEIR 25 BED FACILITY AND IN FY22, HAD 10,728 TOTAL CASES. MERCY HOSPITAL KINGFISHER'S PULMONOLOGISTS ARE EXPERIENCED IN DIAGNOSING AND TREATING BREATHING DISORDERS, FROM ASTHMA TO LUNG CANCER TO SLEEP DISORDERS. MERCY'S TEAM OF PULMONOLOGISTS WILL WORK WITH YOU TO MEASURE YOUR LUNG FUNCTION, MAKE AN ACCURATE DIAGNOSIS AND DETERMINE THE RESPIRATORY TREATMENT THAT'S RIGHT FOR YOU. ADDITIONAL RESPIRATORY CONDITIONS MERCY TREATS INCLUDE COPD, PNEUMONIA, AND OBSTRUCTIVE SLEEP APNEA. IN FY22, MERCY HOSPITAL KINGFISHER HAD 194 CASES AND 1,606 PATIENT DAYS FOR THIS SERVICE LINE. 3303253 4071900 MERCY HOSPITAL KINGFISHER HAS A TEAM OF EXPERT DOCTORS, NURSES AND TECHNICIANS THAT BLEND COMPASSIONATE CARE WITH THE LATEST, MOST ADVANCED DIAGNOSTIC AND TREATMENT RESOURCES IN PROVIDING EMERGENCY CARE. MERCY HOSPITAL KINGFISHER'S EMEGENCY DEPARTMENT IS READY 24 HOURS A DAY, 7 DAYS A WEEK, 365 DAYS A YEAR WITH FAST, EXPERIENCED AND PROFESSIONAL CARE. IN FY22, MERCY HOSPITAL KINGFISHER HAD 3,494 CASES FOR THIS SERVICE LINE. 2295150 2829218 MERCY HOSPITAL KINGFISHER HAS A TEAM THAT SPECIALIZES IN THE DIAGNOSIS AND TREATMENT OF DISEASES OF THE URINARY SYSTEM IN MEN AND WOMEN, AND DISORDERS OF THE MALE REPRODUGIVE SYSTEM. MERCY'S UROLOGISTS TREAT ISSUES THAT MAY APPEAR IN YOUR KIDNEYS, BLADDER, ADRENAL GLANDS, URETERS AND URETHRA. MERCY'S NETWORK OF SPECIALISTS COLLABORATES TO OFFER THE FULL SPECTRUM OF CARE IN UROLOGY, ONCOLOGY, CANCER TREATMENT AND RECONSTRUCTIVE SURGERY. IN FY22, MERCY HOSPITAL KINGFISHER HAD 140 CASES AND 1,008 PATIENT DAYS FOR THIS SERVICE LINE. 3263243 53574 4022579 IN ADDITION TO THE PROGRAM SERVICES DESCRIBED ABOVE, MERCY HOSPITAL KINGFISHER ALSO SERVES PATIENTS IN ADDITIONAL SERVICE LINES, INCLUDING BUT NOT LIMITED TO THE FOLLOWING AREAS: GASTROENTEROLOGY; NEUROSCIENCE; RADIOLOGY; REHABILIATION; WOMEN & INFANTS. 3263243 53574 4022579 12470073 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 4 0 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 1 0 OK X SHERRY CLOUSEDAY 4178208439 3265 S NATIONAL AVE SPRINGFIELD MO 65807 X CIARAMITA MD JEFFREY SVP CHIEF PHYSICIAN EXECUTIVE & BM 1.00 54.00 X 0 1375830 127049 JOHNSTON JEFFREY A EVP COMMUNITY OPERATIONS & BM 10.00 45.00 X 0 2317690 159599 MOHART MD JOHN PRESIDENT, MERCY COMMUNITIES & CHAIRMAN OF BOARD 1.00 59.00 X 0 827557 86789 SCAMMAHORN ERIN MANAGER - PHYSICAL MEDICINE & BM 1.00 39.00 X 0 111458 19834 WILLIAMS CHELSEA MANAGER - NURSING SERVICES & BM 1.00 39.00 X 0 93577 2786 CLOUSE DAY SHERRY VP, FINANCE & TREASURER 5.00 45.00 X 0 324378 20679 ECKHARDT CHRISTIE VP, CHIEF OPERATIONS COUNSEL & SECRETARY 1.00 57.00 X 0 330556 21872 STITT BOBBY J PRESIDENT & ADMINISTRATOR 10.00 30.00 X 0 220495 20503 BERTUS MATTHEW PHYSICIAN ASSISTANT 40.00 0.00 X 0 251023 12735 BRANDT-THOMAS EVA REGISTERED NURSE II 40.00 0.00 X 0 115102 18514 GRANTZ JAMI W ADVANCED PRACTICE RN - CERT NP 40.00 0.00 X 0 220416 20849 HARRIS DANIEL PHYSICIAN ASSISTANT 40.00 0.00 X 0 205242 20383 PERDUE DEBRA ADVANCED PRACTITIONER RN 40.00 0.00 X 0 155292 21551 ENLOE TRACY FORMER OFFICER 0.00 0.00 X 0 515964 27283 GEBHART JIM FORMER OFFICER 0.00 50.00 X 0 1225667 101372 HAHNE CHRISTOPHER FORMER OFFICER 0.00 50.00 X 0 232168 23114 RAJU GARY FORMER OFFICER 0.00 0.00 X 0 136710 0 SMALLEY DIANA L FORMER OFFICER 0.00 0.00 X 0 800010 0 VITIELLO JONATHAN FORMER OFFICER 0.00 0.00 X 0 269178 4238 LE BICH-VI FORMER KEY EMPLOYEE 0.00 50.00 X 0 519584 21737 0 10247897 730887 0 1 1 0 HEALTH TRUST WORKFORCE SOLUTIONS 5429 LYNDON B JOHNSON FWY STE 425 DALLAS TX 75240 STAFFING SERVICES 236710 AMN HEALTHCARE 12400 HIGH BLUFF DR SAN DIEGO CA 92130 STAFFING SERVICES 169491 2 269452 269452 PATIENT SERVICE REVENUE 622110 14777244 14777244 OTHER OPERATING REVENUE 622110 455071 455071 RENTAL INCOME 531120 33212 33212 15265527 12805 1525 11280 11280 11280 OTHER MEDICAL REVENUE 622110 106255 106255 CAFETERIA 722210 19909 19909 126164 15672423 15371782 0 31189 5712 5712 47862 47862 8627980 7790088 837892 321690 6378 315312 673671 8148 665523 539689 10021 529668 1916 1916 2820 2820 274020 249969 24051 275 275 328924 189725 139199 10 10 870559 838829 31730 31069 24743 6326 139931 125192 14739 84060 84060 BAD DEBTS 1662193 1662193 SHARED SERVICE FEE 1124803 461169 663634 DRUGS & MEDICAL EXPENSE 761426 752818 8608 REPAIRS & MAINTENANCE 302060 276407 25653 45662 20809 24853 15846332 12470073 3376259 0 1539537 1745344 1446904 1576453 152618 174159 1937960 1516315 635131 421645 7345 0 3781535 3917601 427607 182878 3915 254626 431522 437504 X 3350013 3480097 3350013 3480097 3781535 3917601 X -173909 -43102 347095 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 2820 0 0 0 2820 0 PART II-B, LINE 1: 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, 2022, DUES WERE $11,578 AND $1,468, RESPECTIVELY. APPROXIMATELY 21.00% OF OKLAHOMA HOSPITAL ASSOCIATION DUES AND 26.47% OF AMERICAN HOSPITAL ASSOCIATION DUES WERE ATTRIBUTABLE TO LOBBYING ACTIVITIES PERFORMED. 129029 36232 92797 1808931 1480083 328848 421645 PART X, LINE 2 FEDERAL INCOME TAX PRIMARILY ALL OF THE MERCY HEALTH ENTITIES ARE RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(A) OF THE INTERNAL REVENUE CODE AS CHARITABLE ORGANIZATIONS QUALIFYING UNDER INTERNAL REVENUE CODE SECTION 501(C)(3), BY VIRTUE OF IRS DETERMINATION LETTERS OR INCLUSION IN THE OFFICIAL CATHOLIC DIRECTORY. MERCY COMPLETED AN ANALYSIS OF ITS TAX POSITIONS IN ACCORDANCE WITH APPLICABLE ACCOUNTING GUIDANCE AND DETERMINED THAT NO AMOUNTS WERE REQUIRED TO BE RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS AT JUNE 30, 2022 OR 2021. 1 1 X 1 X 1 X 1 0 1 1 310848 310848 0.02190 1940349 1614349 326000 0.02300 2251197 1614349 636848 0.04490 2251197 1614349 636848 0.04490 1 790131 0 6841988 7635878 -793890 X 1 1 1 1 MERCY HOSPITAL KINGFISHER INC 1000 HOSPITAL CIRCLE KINGFISHER OK 73750 WWW.MERCY.NET 2226 X X X X MERCY HOSPITAL KINGFISHER INC 1 0 0 1 X X X X X X X X X X 21 1 0 1 1 X SEE PART V, SECTION C X 1 22 1 SEE PART V, SECTION C 0 1 X 200.000000000000 300.000000000000 X 1 1 X X X 1 X HTTPS://WWW.MERCY.NET/PATIENTS-VISITORS/BILLING/FINANCIAL-ASSISTANCE/ X HTTPS://WWW.MERCY.NET/PATIENTS-VISITORS/BILLING/FINANCIAL-ASSISTANCE/ X HTTPS://WWW.MERCY.NET/PATIENTS-VISITORS/BILLING/FINANCIAL-ASSISTANCE/ X X X X X X 1 X 0 X X X X X 1 X 0 0 MERCY HOSPITAL KINGFISHER, INC. PART V, SECTION B, LINE 3J: THE HOSPITAL FACILITY DID INCLUDE A PRIORITIZED LIST OF THE COMMUNITY'S SIGNIFICANT HEALTH NEEDS IN ITS MOST RECENT CHNA REPORT.THE CHNA HAS ALL THE SECTIONS REFERENCED ABOVE AND INCLUDES AN EXECUTIVE SUMMARY, POTENTIALLY AVAILABLE RESOURCES, EVALUATION OF IMPACT, REFERENCES, AND APPENDICES. MERCY HOSPITAL KINGFISHER, INC. PART V, SECTION B, LINE 5: DUE TO THE UNPRECEDENTED COVID-19 PANDEMIC, MERCY HOSPITAL KINGFISHER WAS NOT ABLE TO HOST THREE COMMUNITY MEETINGS TO SEEK FEEDBACK FROM KEY STAKEHOLDERS. IN AN EFFORT TO PROMOTE SOCIAL DISTANCING AND FOLLOWING RECOMMENDATIONS OUTLINED THE CDC'S WEBSITE, THE HOSPITAL COLLABORATED WITH THE KINGFISHER COUNTY COLLABORATIVE TO PARTICIPATE IN ONE MEETING TO GATHER COMMUNITY FEEDBACK. THE MEETING WAS HELD ON MARCH 14, 2022. THIS SPECIFIC GROUP WAS SELECTED DUE TO THEIR EXPERTISE OF PUBLIC HEALTH NEEDS AND THEIR VAST REPRESENTATION OF THE COMMUNITY. STAKEHOLDERS INCLUDE THOSE THAT REPRESENT OR WORK CLOSELY WITH LOW INCOME AND RACIALLY DIVERSE POPULATIONS. MERCY HOSPITAL KINGFISHER, INC. PART V, SECTION B, LINE 6B: COMMUNITY MEMBERS WHO WERE INCLUDED TO PROVIDE INPUT: - OKLAHOMA OFFICE OF RURAL HEALTH, OSU CENTER FOR RURAL HEALTH- RED ROCK BEHAVIORAL - KINGFISHER PUBLIC SCHOOLS- KINGFISHER COUNTY COOPERATIVE EXTENSION - KINGFISHER COMMUNITY COLLABORATIVE - TSET - KINGFISHER COUNTY HEALTH DEPARTMENT - SOONER SUCCESS MERCY HOSPITAL KINGFISHER, INC. PART V, SECTION B, LINE 11: IN CONJUNCTION WITH THE CHNA, MERCY HOSPITAL KINGFISHER'S BOARD ADOPTED AN IMPLEMENTATION STRATEGY IN FY23 RELATED TO THE 2021 CHNA. MERCY HOSPITAL KINGFISHER WILL ADDRESS THE FOLLOWING COMMUNITY HEALTH NEEDS BEGINNING IN FY23:- OBESITY - THE HOSPITAL PLANS TO COLLABORATE WITH THE LOCAL CHAMBER OF COMMERCE AND KINGFISHER COMMUNITY COLLABORATIVE TO HOST A WALKING COLLABORATION. - THE HOSPITAL ALSO PLANS TO CONTINUE TO COLLABORATE WITH THE COMPASSION CLINIC TO PROVIDE SERVICES AND RESOURCES TO THE PATIENTS OF THE CLINIC. THESE PATIENTS ARE OFTEN THE LOW-INCOME AND/OR UNINSURED RESIDENTS IN THE COMMUNITY. THIS PARTNERSHIP INCLUDES PROVIDING CARE AS WELL AS MAKING REFERRALS AS NEEDED AND LINKING PATIENTS TO RESOURCES. - MENTAL HEALTH - MERCY HOSPITAL KINGFISHER IS WORKING TO PARTNER WITH AN ORGANIZATION TO PROVIDE AN OUTPATIENT GEROPSYCH PROGRAM THAT ENCOURAGES ENGAGEMENT AND SOCIALIZATION FOR PARTICIPANTS. - EMERGENCY DEPARTMENT SCREENINGS/ASSESSMENTS - MERCY HOSPITAL KINGFISHER ADMINISTERS A SCREENING QUESTIONNAIRE TO ALL PATIENTS SEEN THROUGH THE EMERGENCY DEPARTMENT TO DETERMINE MENTAL HEALTH NEEDS. FROM THERE, PATIENTS WHO ARE IDENTIFIED AS NEEDING SERVICES OR CARE ARE THEN REFERRED TO THE APPROPRIATE PROVIDER OR FACILITY. THE HOSPITAL PLANS TO CONTINUE A STRONG COLLABORATION WITH THE COMPASSION CLINIC TO PROVIDE CARE AND RESOURCES TO PATIENTS AS NEEDED. MERCY HOSPITAL KINGFISHER RECOGNIZES THE IMPORTANCE OF THE COMPASSION CLINIC AND THE STRAIN POVERTY HAS ON THE MEDICAL SERVICE AREA. THEREFORE, THESE ITEMS ARE INCORPORATED INTO THE PRIORITIES IDENTIFIED AND IN THE IMPLEMENTATION OF PROGRAMMING TO ADDRESS THESE PRIORITIES. MERCY HOSPITAL KINGFISHER, INC. PART V, SECTION B, LINE 20E: OTHER AREAS FROM A NOTICE PERSPECTIVE: FAP IS POSTED IN ALL REGISTRATION AREAS, FULL POLICY AND PLAIN LANGUAGE DOCUMENT POSTED ON WEBSITE, PLAIN LANGUAGE DOCUMENT IS AVAILABLE WHEN REQUESTED, THERE IS A NOTICE ON STATEMENT, AND ALL PATIENTS GET THREE STATEMENTS BEFORE THEY CAN GO TO A COLLECTION AGENCY. FORM 990, SCHEDULE H, PART V, SECTION B, LINE 7A HTTPS://WWW.MERCY.NET/CONTENT/DAM/MERCY/EN/PDF/CHNA/KINGFISHER-CHNA-2022.PDF FORM 990, SCHEDULE H, PART V, SECTION B, LINE 10A HTTPS://WWW.MERCY.NET/CONTENT/DAM/MERCY/EN/PDF/CHNA/KINGFISHER-CHNA-2022.PDF FORM 990, SCHEDULE H, PART V, SECTION B, LINE 22 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 200% OR BELOW, THE FEDERAL POVERTY GUIDELINES WILL BE ELIGIBLE FOR FREE CARE. INDIVIDUALS WITH INCOMES GREATER THAN 200% OF THE FEDERAL POVERTY GUIDELINES FOR MOST COMMUNITIES, MAY BE ELIGIBLE FOR CARE AT DISCOUNTED RATES DEPENDING ON THEIR INCOME LEVEL AND/OR THE AMOUNT DUE TO THE HOSPITAL. TO DETERMINE THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE, THE HOSPITAL FACILITY USES AMOUNTS GENERALLY BILLED TO INDIVIDUALS WHO HAVE INSURANCE COVERING SUCH CARE. THE HOSPITAL USES A LOOK BACK METHOD THAT CONSIDERS DISCOUNTS ALLOWED TO MEDICARE AND ALL PRIVATE HEALTH INSURERS. 1 1 - MHK OUTPATIENT REHAB 1000 HOSPITAL CIRCLE KINGFISHER OK 73750 REHABILITATION SERVICES PART I, LN 7 COL(F): TOTAL EXPENSES FROM FORM 990, PART IX, LINE 25, COLUMN (A) ARE $15,846,332. INCLUDED IN THIS AMOUNT WAS BAD DEBT EXPENSE (CHARGES) OF $1,662,193. EXPENSES FOR THE PURPOSE OF CALCULATING LINE 7, COLUMN (F) ARE $14,184,139. PART I, LINE 6A COMMUNITY BENEFIT REPORTTHE ORGANIZATION'S COMMUNITY BENEFIT REPORT IS PREPARED BY ITS ULTIMATE PARENT ENTITY, MERCY HEALTH (EIN: 43-1423050). PART II, COMMUNITY BUILDING ACTIVITIES: MERCY HOSPITAL KINGFISHER (MHK) COMMUNITY BUILDING ACTIVITIES PROMOTE THE HEALTH OF THE COMMUNITIES IN WHICH THEY SERVE. THROUGH PARTICIPATION IN NEIGHBORHOOD/COMMUNITY MEETINGS, COMMUNITY BOARDS, AND INVOLVEMENT IN COMMUNITY-BASED EVENTS, MHK 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 MHK PARTICIPATES/SERVES ARE:- PROVIDED SUPPORT FOR COVID-19 COMMUNITY VACCINE CLINICS- SUPPORTING COUNT HEALTH FAIR- HEALTH FAIR FOR SCHOOLS- CONDUCTING COMMUNITY BLOOD DRIVES- PARTICIPATING IN RELAY FOR LIFE- TOY LAND FOR DHW- FOOD BANK FOR KINGFISHER- SUPPORT OF LOCAL AMBUCS CHAPTER- MEALS ON WHEELS- KINGFISHER CHAMBER MEMBER- THANKSGIVING MEAL ADOPTION- CHRISTMAS GIFT ADOPTIONA FULL DESCRIPTION OF THE COMMUNITY'S BUILDING ACTIVITIES CAN BE FOUND AT: HTTPS://WWW.MERCY.NET/ABOUT/COMMUNITY-BENEFITS/ PART III, LINE 2: TO DETERMINE THE AMOUNT OF BAD DEBT EXPENSE, AT COST, BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENT ACCOUNTS WAS MULTIPLIED BY A RATIO OF COST TO CHARGES. THE RATIO OF COST TO CHARGES USED WAS BASED ON DETAILED COST ACCOUNT, WHERE AVAILABLE. WHERE COST ACCOUNTING IS NOT AVAILABLE, COST REPORT COST TO CHARGE RATIOS WERE UTILIZED. PART III, LINE 3: THE FILING ORGANIZATION DETERMINED THAT THE ESTIMATED AMOUNT OF BAD DEBT EXPENSE (AT COST) ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS $0. ALTHOUGH THE CHARITY CARE POLICY REQUIRES THE PARTICIPATION OF THE PATIENT REQUESTING ASSISTANCE, WE HAVE A PROCESS UNDER PRESUMPTIVE CHARITY 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 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: IN MAY 2014, THE FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) AND INTERNATIONAL ACCOUNTING STANDARDS BOARD ISSUED ACCOUNTING STANDARDS UPDATE (ASU) 2014-09, REVENUE FROM CONTRACTS WITH CUSTOMERS (TOPIC 606). THE HEALTH SYSTEM ADOPTED ASU 2014-09 ON JULY 1, 2018 USING A FULL RETROSPECTIVE BASIS. UPON ADOPTION, THE MAJORITY OF WHAT WAS PREVIOUSLY CLASSIFIED AS PROVISION FOR UNCOLLECTIBLE ACCOUNTS AND PRESENTED AS A REDUCTION TO PATIENT SERVICE REVENUE ON THE CONSOLIDATED STATEMENT OF OPERATIONS AND CHANGES IN NET ASSETS IS TREATED A PRICE CONCESSION THAT REDUCES THE TRANSACTION PRICE, WHICH IS REPORTED AS PATIENT SERVICE REVENUE. AS SUCH, BAD DEBT EXPENSE IS NOT REFERENCED IN MERCY HEALTH AND SUBSIDIARIES AUDITED FINANCIAL STATEMENTS. BAD DEBT EXPENSE IS TRACKED FOR FORM 990 REPORTING AS FOLLOWS: PATIENT ACCOUNTS RECEIVABLE THAT ARE DEEMED UNCOLLECTIBLE, INCLUDING THOSE PLACED WITH COLLECTION AGENCIES, ARE INITIALLY CHARGED AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IN ACCORDANCE WITH COLLECTION POLICIES OF THE HEALTH SYSTEM AND, IN CERTAIN CASES, ARE RECLASSIFIED TO CHARITY CARE IF DEEMED TO OTHERWISE MEET THE HEALTH SYSTEM'S CHARITY CARE POLICY. THE PROVISION FOR UNCOLLECTIBLE RECEIVABLES IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. PERIODICALLY THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES BASED UPON THE PAYOR COMPOSITION AND AGING OF RECEIVABLES 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 PATIENT BALANCES WITH COLLECTION AGENCIES. PART III, LINE 8: IT IS THE POSITION OF MERCY HOSPITAL KINGFISHER THAT 100% OF ANY SHORTFALL 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'S COLLECTION POLICY PROVIDES THAT MERCY WILL PERFORM A REASONABLE COMMUNICATION AND/OR REVIEW OF PATIENT ACCOUNTS AS IT RELATES TO ANY SERVICE PROVIDED AT OUR FACILITIES BEFORE TURNING THE ACCOUNT TO BAD DEBT OR TAKING LEGAL ACTION FOR NONPAYMENT. MERCY ACTIVELY SCRUBS ACCOUNTS FOR PAYOR PLAN COVERAGE, INCLUDING MEDICAID. IN THE EVENT AN ACCOUNT IS TURNED TO COLLECTIONS AND IS IDENTIFIED IN NEED OF FINANCIAL ASSISTANCE DUE TO CIRCUMSTANCE CHANGES, OR IS NOW REQUESTING ASSISTANCE, THE ACCOUNTS ARE RETURNED BY THE AGENCY AND CONSIDERED FOR CHARITY IF THE PATIENT PROVIDES THE REQUESTED INFORMATION. IF THE PATIENT FAILS TO RETURN THE INFORMATION, THE ACCOUNT WILL QUALIFY FOR COLLECTIONS. MERCY UTILIZES THE EXPERIAN TOOL TO ENHANCE THE ABILITY TO DETERMINE THE CHARITY QUALIFICATION PRIOR TO TURNING TO BAD DEBT, A PROCESS KNOWN AS PRESUMPTIVE CHARITY FOR ALL COMMUNITIES EXCEPT JOPLIN, MAUDE NORTON, CARTHAGE AND SOUTHEAST KANSAS. THIS PRESUMPTIVE SCREENING PROCESS DETAILS EVALUATIONS THAT TAKE PLACE PRIOR TO PATIENT BILLING AND ADDITIOANLLY PRIOT TO BAD DEBT PLACEMENT. THE PRESUMPTIVE SCREENING WAS PER ENCOUNTER AND DID NOT PROMOTE ANY LOOK-BACK ADJUSTMENTS.MERCY WILL GRANT CHARITY IN SITUATIONS WHERE THERE HAS BEEN AN INABILITY TO OBTAIN INFORMATION FROM PATIENTS OR THE INFORMATION PROVIDED IS NOT COMPLETE ENOUGH TO MAKE A CHARITY DETERMINATION WHEN A PATIENT HAS SUBMITTED AN APPLICATION. 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 AFTER SENDING 3 MONTHLY STATEMENTS WITH THE FINAL INCLUDING NOTIFICATION; IF NO RESOLUTION THEY WILL BE TURNED TO COLLECTIONS. ADDITIONALLY, THEY MAY INCLUDE LIENS UPON REAL PROPERTY AND REASONABLE WAGE GARNISHMENTS. LEGAL ACTIONS WILL GENERALLY NOT INCLUDE BANK GARNISHMENTS, REPOSSESSION OF ASSETS OR FORECLOSURES TO ENSURE SATISFACTION OF A LIEN. MERCY HAS POLICIES AND PROCEDURES ESTABLISHED TO ADDRESS THE INITIATION OF LEGAL ACTION AND ANNUALLY REVIEW COMPLIANCE WITH POLICIES BUT ENSURE 120 DAYS OF BILLING AND COLLECTIONS OCCUR PRIOR TO ANY EXTRAORDINARY COLLECTIONS ARE PURSUED. PART VI, LINE 2: THE KINGFISHER COMMUNITY COLLABORATIVE IN PARTNERSHIP WITH THE OKLAHOMA OFFICE OF RURAL HEALTH CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT DURING 2021 ALONG WITH A COMMUNITY HEALTH IMPROVEMENT PLAN. THIS THROUGH ASSESSMENT IDENTIFIED CONCERNS IN THE COMMUNITY. THIS PROCESS AND FINDINGS WERE USED AS THE BASELINE DATA FOR THE CHNA FOR MERCY HOSPITAL, KINGFISHER. THE KINGFISHER COMMUNITY COLLABORATIVE IS A LOCAL HEALTH COALITION AND A CERTIFIED HEALTH IMPROVEMENT ORGANIZATION THAT MEETS QUARTERLY. THIS GROUP IS COMPOSED OF REPRESENTATIVES FROM SERVICE PROVIDERS, HEALTHCARE PROVIDERS, EDUCATION, SAFETY, FAITH-BASED GROUPS, AND COMMUNITY MEMBERS WHO ALL HAVE THE SAME DESIRE TO IMPROVE THE QUALITY OF LIFE IN THE COMMUNITY. MERCY HOSPITAL, KINGFISHER IS AN ACTIVE AND ENGAGED MEMBER OF THE COALITION. DUE TO THE UNPRECEDENTED COVID-19 PANDEMIC, MERCY HOSPITAL KINGFISHER WAS NOT ABLE TO HOST THREE COMMUNITY MEETINGS TO SEEK FEEDBACK FROM KEY STAKEHOLDERS. IN AN EFFORT TO PROMOTE SOCIAL DISTANCING AND FOLLOWING RECOMMENDATIONS OUTLINED THE CDC'S WEBSITE, THE HOSPITAL COLLABORATED WITH THE KINGFISHER COUNTY COLLABORATIVE TO PARTICIPATE IN ONE MEETING TO GATHER COMMUNITY FEEDBACK. THE MEETING WAS HELD ON MARCH 14, 2022. OKLAHOMA OFFICE OF RURAL HEALTH FACILITATED THE GATHERING OF THE SECONDARY DATA, THE COMPLETION OF THE SURVEY, AND THE HYBRID COMMUNITY MEETING. STEPS TAKEN TO CONDUCT A CHNA FOR MERCY HOSPITAL, KINGFISHER BEGAN WITH A DESCRIPTION OF THE HOSPITAL'S MEDICAL SERVICE AREA, INCLUDING A DEMOGRAPHIC ANALYSIS AND A SUMMARY OF THE COMMUNITY MEETING. THE CHNA PROCESS IS FACILITATED BY STAFF OF THE OKLAHOMA OFFICE OF RURAL HEALTH AND MERCY HOSPITAL, KINGFISHER. THE OKLAHOMA OFFICE OF RURAL HEALTH WORKED CLOSELY WITH THE HOSPITAL AND COMMUNITY MEMBERS TO DEVELOP AN ECONOMIC IMPACT OF THE LOCAL HEALTH SECTOR, DEVELOP AND ANALYZE A LOCAL HEALTH SERVICES SURVEY, AND GATHER AND ANALYZE LOCAL HEALTH DATA. THE COMMUNITY MEETINGS WERE FACILITATED BY THE OKLAHOMA OFFICE OF RURAL HEALTH. AFTER THE MEETINGS CONCLUDED, THE OKLAHOMA OFFICE OF RURAL HEALTH ASSISTED THE HOSPITAL IN DEVELOPING THEIR IMPLEMENTATION STRATEGY. AFTER IMPLEMENTATION, THE OKLAHOMA OFFICE OF RURAL HEALTH WILL ASSIST IN EVALUATION OF THE STRATEGIES IMPLEMENTED AND PROVIDE CONTINUED ASSISTANCE WITH DATA AND RESOURCES. COMMUNITY MEMBERS PRESENT REPRESENTED A CROSS SECTION OF THE COMMUNITY. THIS SPECIFIC GROUP WAS SELECTED DUE TO THEIR EXPERTISE OF PUBLIC HEALTH NEEDS AND THEIR VAST REPRESENTATION OF THE COMMUNITY. STAKEHOLDERS INCLUDE THOSE THAT REPRESENT OR WORK CLOSELY WITH LOW INCOME AND RACIALLY DIVERSE POPULATIONS. ALL STAKEHOLDERS RECEIVED ALL OF THE TYPICAL PRIMARY AND SECONDARY DATA PRIOR TO THEIR RESPECTIVE MEETINGS. THEY PROVIDE GREAT INSIGHT INTO THE NEEDS OF THE COMMUNITY. A SURVEY WAS DESIGNED TO GAUGE HOSPITAL USAGE, SATISFACTION, AND COMMUNITY HEALTH NEEDS FROM DECEMBER 13, 2021 THROUGH JANUARY 21,2022. A TOTAL OF 100 SURVEYS WERE COMPLETED. OF THOSE SURVEYS, 99 WERE ELECTRONIC RESPONSES. PART VI, LINE 3: MERCY INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS OR UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY THROUGH SEVERAL MEANS. IF AT ANY TIME A PATIENT EXPRESSES HARDSHIP AND INABILITY TO PAY, THE ACCOUNT IS PLACED FOR REVIEW. IN ADDITION, PATIENTS HAVE SIGNAGE ABOUT THE POLICY AT THE ACCESS POINTS, AND ALL STAFF WORKING WITH THE PATIENT AT POINT OF SERVICE, SCHEDULING, CUSTOMER SERVICE, AND EVEN THROUGH THE MEDICAID ELIGIBILITY SCREENING HAVE THE MEANS TO SEND THE ACCOUNT FOR REVIEW. THERE IS THE PLAIN LANGUAGE SUMMARY THAT IS BEING PROVIDED TO ALL WHOM EXPRESS HARDSHIP, IN ADDITION TO THE WEB ADDRESS PROVIDING THE APPLICATION, POLICIES, AND EVEN HOW UNINSURED ACCOUNTS ARE HANDLED. LASTLY, THE STATEMENTS MESSAGE TO THE PATIENT THAT MERCY DOES HAVE A FINANCIAL ASSISTANCE PROGRAM AND TO CALL TO SEE IF THEY ARE ELIGIBLE. MERCY STAFF'S INTERNAL RESOURCES CERTIFIED TO ASSIST PATIENTS WITH MEDICAID APPLICATIONS AS WELL. PART VI, LINE 4: THE PRIMARY SERVICE AREA FOR MERCY HOSPITAL KINGFISHER INCLUDES KINGFISHER COUNTY, OKLAHOMA. THE FOLLOWING INFORMATION IS DERIVED FROM THE ADVISORY BOARD DEMOGRAPHICS AND THE OK DEPARTMENT OF HEALTH 2021-2022 ANALYTICS. THE AREA'S POPULATION IS 16,664. THE MEDIAN HOUSEHOLD INCOME IS $68,000. 41.2% OF THE POPULATION IS 45 AND OLDER. 79% OF THE POPULATION IS A HIGH SCHOOL GRAD OR GREATER AND THE MEDIAN AGE IS 39. PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTHMERCY PROVIDES QUALITY MEDICAL HEALTH CARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY. MERCY 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 COMMUNITIES. MERCY OFFERS SERVICES AND PROGRAMS WHICH FURTHER HEALTH PROMOTION, MAINTENANCE AND CARE TO THE COMMUNITY. PROGRAMS PROVIDED TO MEET THE COMMUNITY INCLUDE SUPPORT GROUPS, OUTREACH EVENTS, BLOOD DRIVES, AND CO-WORKER WORKDAYS. MERCY IS GOVERNED BY A BOARD OF DIRECTORS WHICH INCLUDES REPRESENTATION FROM COMMUNITY LEADERS FROM A VARIETY OF SECTORS. ALL BOARD MEMBERS ARE REQUIRED TO COMPLETE AN ANNUAL CONFLICT OF INTEREST SURVEY. ANY POTENTIAL CONFLICTS OF INTEREST DISCLOSED ARE REVIEWED AND RESOLVED. THIS PROCESS ENSURES THAT PUBLIC, RATHER THAN PRIVATE INTERESTS ARE SERVED. SURPLUS FUND AND UNRESTRICTED ASSETS HELD 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. PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEMTHE 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 ARKANSAS, LOUISIANA, MISSISSIPPI, AND TEXAS. MERCY'S MISSION IS "AS THE SISTERS OF MERCY BEFORE US, WE BRING TO LIFE THE HEALING MINISTRY OF JESUS THROUGH OUR COMPASSIONATE CARE AND EXCEPTIONAL SERVICE." AS OF JUNE 30, 2022, MERCY FACILITIES INCLUDED 30 ACUTE CARE HOSPITALS, 5 HEART HOSPITALS, 5 REHAB HOSPITALS, 2 CHILDREN'S HOSPITALS, 2 ORTHOPEDIC HOSPTIALS, AND 1 VIRTUAL CARE COMMAND CENTER. FOR THE FISCAL YEAR ENDED JUNE 30, 2022, MERCY HAD MORE THAN 10.4 MILLION OUTPATIENT AND PHYSICIAN OFFICE VISITS, APPROXIMATELY 2,300 EMPLOYED PHYSICIANS, AND APPROXIMATELY 42,000 FULL-TIME EQUIVALENT EMPLOYEES, MAKING MERCY THE SIXTH LARGEST CATHOLIC HEALTH SYSTEM IN THE UNITED STATES. 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: FINANCE (INCLUDING TREASURY, FINANCIAL ACCOUNTING AND REPORTING, REVENUE MANAGEMENT, INTERNAL AUDIT, ACCOUNTS PAYABLE AND PAYROLL OPERATIONS, ANALYTICS AND DECISION SUPPORT); ENVIRONMENTAL SERVICES SUPPORT; CLINICAL INTEGRATION; CARE MANAGEMENT; CLINICAL PERFORMANCE ACCELERATION; CLINICAL ENGINEERING; CLINICAL QUALITY MANAGEMENT; COMPLIANCE; GRANTS AND RESEARCH SERVICES; LEGAL AND COMPLIANCE COUNSEL; MARKETING AND COMMUNICATIONS; PLANNING, DESIGN AND CONSTRUCTION; PRODUCT DEVELOPMENT INFORMATICS; REAL ESTATE; SUPPLY CHAIN MANAGEMENT; MANAGED CARE STRATEGY SUPPORT; HUMAN RESOURCES (INCLUDING COMPENSATION, BENEFITS AND RECRUITING); MISSION SERVICES AND ETHICS; PHILANTHROPY SUPPORT; INFORMATION TECHNOLOGY; AND, COMMUNITY RELATIONS. THE CENTRALIZATION OF SUCH SUPPORT SERVICES ENABLES MERCY TO ENSURE THAT EACH OF ITS COMMUNITIES, WHETHER LARGE OR SMALL, HAS THE SERVICES IT NEEDS. PART VI, LINE 7, REPORTS FILED WITH STATES OK COVID-19 PLEASE SEE SCHEDULE O FOR INFORMATION RELATED TO COVID-19. 1 MERCY HEALTH FOUNDATION OF OKLAHOMA 4300 W MEMORIAL RD OKLAHOMA CITY OK 73120 454732301 501C3 5212 0 GENERAL SUPPORT 1 0 FREE MEDICAL CARE FOR COMPASSION CLINIC 54 47862 COST FREE MEDICAL CARE PART I, LINE 2: GRANTS ARE SOMETIMES MADE TO ORGANIZATIONS WHICH HAVE AN ESTABLISHED HISTORY OF PROVIDING HEALTH CARE SUPPORT AND\OR COMMUNITY BENEFIT. IF NECESSARY, PERIODIC REPORTS ARE PROVIDED TO US. GRANTS ARE MADE TO RELATED ORGANIZATIONS, WHICH PROVIDE REPORTING ON THE USE OF THE FUNDS AND WORK CLOSELY WITH OUR ORGANIZATION. THE ORGANIZATION USES AN APPROVAL PROCESS, WHEN APPLICABLE, TO DETERMINE WHICH INDIVIDUALS WILL RECEIVE GRANTS DURING THE FISCAL YEAR. THE FUNDS ARE THEN GIVEN DIRECTLY TO THE INDIVIDUALS. X X X 1 1 1 1 0 0 0 0 0 0 0 JOHNSTON JEFFREY A EVP COMMUNITY OPERATIONS & BM 0 805383 0 859816 0 652491 0 144663 0 14936 0 2477289 0 623555 CIARAMITA MD JEFFREY SVP CHIEF PHYSICIAN EXECUTIVE & BM 0 765459 0 415086 0 195285 0 112113 0 14936 0 1502879 0 0 GEBHART JIM FORMER OFFICER 0 536090 0 472975 0 216602 0 88203 0 13169 0 1327039 0 172468 MOHART MD JOHN PRESIDENT, MERCY COMMUNITIES & CHAIR 0 122146 0 658499 0 46912 0 69335 0 17454 0 914346 0 0 SMALLEY DIANA L FORMER OFFICER 0 0 0 0 0 800010 0 0 0 0 0 800010 0 0 ENLOE TRACY FORMER OFFICER 0 316520 0 172610 0 26834 0 9745 0 17538 0 543247 0 0 LE BICH-VI FORMER KEY EMPLOYEE 0 349840 0 117337 0 52407 0 4159 0 17578 0 541321 0 0 ECKHARDT CHRISTIE VP, CHIEF OPERATIONS COUNSEL & SECRE 0 237476 0 77869 0 15211 0 7250 0 14622 0 352428 0 0 CLOUSE DAY SHERRY VP, FINANCE & TREASURER 0 206367 0 75392 0 42619 0 7161 0 13518 0 345057 0 0 VITIELLO JONATHAN FORMER OFFICER 0 0 0 0 0 269178 0 4238 0 0 0 273416 0 0 BERTUS MATTHEW PHYSICIAN ASSISTANT 0 227554 0 8500 0 14969 0 6191 0 6544 0 263758 0 0 HAHNE CHRISTOPHER FORMER OFFICER 0 165799 0 31060 0 35309 0 6001 0 17113 0 255282 0 0 GRANTZ JAMI W ADVANCED PRACTICE RN - CERT NP 0 189650 0 8500 0 22266 0 4125 0 16724 0 241265 0 0 STITT BOBBY J PRESIDENT & ADMINISTRATOR 0 176023 0 31163 0 13309 0 3407 0 17096 0 240998 0 0 HARRIS DANIEL PHYSICIAN ASSISTANT 0 168381 0 8500 0 28361 0 3388 0 16995 0 225625 0 0 PERDUE DEBRA ADVANCED PRACTITIONER RN 0 127113 0 8500 0 19679 0 4567 0 16984 0 176843 0 0 RAJU GARY FORMER OFFICER 0 0 0 0 0 136710 0 0 0 0 0 136710 0 0 PART I, LINE 1A CHARTER TRAVEL IS PROVIDED TO CERTAIN EMPLOYEES AS AND WHEN APPROPRIATE, AND AS DEEMED NECESSARY FOR BUSINESS TRAVEL. AFTER CHARTER TRAVEL APPROVAL HAS BEEN GRANTED IN ACCORDANCE WITH THE FINANCIAL JUSTIFICATION PROCESS, THE APPROVED CHARTER TRAVEL FOR BUSINESS IS A REIMBURSABLE EXPENSE WHICH IS NOT TAXABLE TO THE EMPLOYEES. TRAVEL FOR COMPANIONS FOR NONBUSINESS REASONS IS PROVIDED IN CERTAIN INSTANCES AND IN ACCORDANCE WITH THE CO-WORKER TRAVEL AND OTHER EXPENSE POLICY AND PROCEDURES. WHERE COMPANION TRAVEL HAS RESULTED IN A TAXABLE EVENT, THE EMPLOYEES ARE TAXED FOR SUCH TRAVEL. SPOUSAL TRAVEL WAS PROVIDED FOR A BOARD MEMBER. LIMITED INSTANCES OF GROSS-UPS OCCURRED WITH RESPECT TO EXECUTIVES. PART I, LINES 4A-B THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE PAYMENTS FROM A RELATED ORGANIZATION: JONATHAN VITIELLO $269,178; DIANA SMALLEY $800,010; GARY RAJU $136,710. PART I, LINE 4B: MERCY HEALTH, THE ULTIMATE PARENT COMPANY, OFFERS A SUPPLEMENTAL RETIREMENT PLAN TO CERTAIN EXECUTIVES WHICH PROVIDE BENEFITS UPON VESTING DATE 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 FOLLOWING INDIVIDUALS PARTICIPATED IN THE PLAN. JIM GEBHART; JEFFREY JOHNSTON THE AMOUNT OF ALL ACCRUED BENEFITS IS INCLUDED IN COMPENSATION AMOUNTS PROVIDED IN SCHEDULE J, PART II, COLUMN (C). THE AMOUNTS REPORTED FOR JIM GEBHART AND JEFFREY JOHNSTON IN COLUMN (F) ARE EITHER INCLUDED IN B(I) BASE COMPENSATION, B(II) AS BONUS AND INCENTIVE COMPENSATION, OR B(III) AS OTHER REPORTABLE COMPENSATION. THESE AMOUNTS ARE A PAYOUT OF THE SUPPLEMENTAL RETIREMENT PLAN AND EXECUTIVE RETENTION PLAN AND WERE INCLUDED IN COLUMN (C) OF PREVIOUSLY FILED FORMS 990. 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. FORM 990, PART VI, SECTION A, LINE 6 MERCY HEALTH OKLAHOMA COMMUNITIES IS THE SOLE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A MERCY HEALTH OKLAHOMA COMMUNITIES (THE MEMBER) MAY APPOINT OR REMOVE MEMBERS OF THE BOARD OF DIRECTORS AT ANY TIME AT THE MEMBER'S DISCRETION. FORM 990, PART VI, SECTION A, LINE 7B MERCY HEALTH OKLAHOMA COMMUNITIES HAS THE FOLLOWING POWERS AND RESPONSIBILITIES: -TO APPROVE AND ESTABLISH THE MISSION AND PHILOSOPHY ACCORDING TO WHICH THE CORPORATION AND ALL ORGANIZATIONS CONTROLLED BY THE CORPORATION SHALL OPERATE; -TO ADOPT OR AMEND THE ARTICLES OF INCORPORATION AND BYLAWS OF THE CORPORATION AND TO AMEND THE ORGANIZATIONAL DOCUMENTS OF ANY ORGANIZATION CONTROLLED BY THE CORPORATION; -TO APPOINT OR REMOVE, WITH OR WITHOUT CAUSE, ANY MEMBER OF THE BOARD OF DIRECTORS OF THE CORPORATION; -TO APPOINT OR REMOVE, WITH OR WITHOUT CAUSE, THE PRESIDENT/CEO OF THE CORPORATION OR ANY ORGANIZATION CONTROLLED BY THE CORPORATION AFTER CONSULTATION WITH THE SYSTEM; -TO APPROVE OR AMEND THE OVERALL STRATEGIC, LONG RANGE, BUSINESS PLANS, GOALS, AND OBJECTIVES OF THE CORPORATION OR ANY ORGANIZATION CONTROLLED BY THE CORPORATION; -TO APPROVE OR AMEND THE CONSOLIDATED OPERATING, CAPITAL AND CONSTRUCTION BUDGETS FOR THE CORPORATION OR ANY ORGANIZATION CONTROLLED BY THE CORPORATION AND CHANGES IN BUDGETS IN EXCESS OF AN AMOUNT ESTABLISHED FROM TIME TO TIME BY MERCY; -TO AUTHORIZE AND APPROVE THE LEASE OR SALE OF ANY OF THE ASSETS OF THE CORPORATION OR ANY ORGANIZATION CONTROLLED BY THE CORPORATION IN EXCESS OF ANY AMOUNT ESTABLISHED FROM TIME TO TIME BY MERCY; -TO AUTHORIZE AND APPROVE THE INCURRENCE OF DEBT BY THE CORPORATION OR ANY ORGANIZATION CONTROLLED BY THE CORPORATION (OTHER THAN DEBT INCURRED FOR THE ACQUISITION OF GOODS 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; AND -TO MERGE, DISSOLVE, OR ABANDON THE CORPORATION OR ANY ORGANIZATION CONTROLLED BY THE CORPORATION, SUBJECT TO APPROVAL BY THE BOARD AS REQUIRED PURSUANT TO THE OKLAHOMA NONPROFIT CORPORATION ACT. -TO APPROVE THE CREATION, OWNERSHIP OR ACQUISITION OF, OR AFFILIATION WITH, ANY OTHER ORGANIZATION CONTROLLED BY THE CORPORATION; AND, -TO APPROVE CONTRACTS IN WHICH THE CORPORATION ASSUMES FINANCIAL RISK, INCLUDING BUT NOT LIMITED TO MANAGED CARE CONTRACTS. FORM 990, PART VI, SECTION B, 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 ORGANIZATION'S FINANCE TEAM. THE DRAFT FORM 990 IS ALSO REVIEWED BY MERCY HEALTH'S TAX DEPARTMENT, TO ENSURE ACCURACY AND CONSISTENCY WITH OTHER RELATED ORGANIZATIONS' FORM 990S. AFTER QUESTIONS ARISING FROM THE VARIOUS REVIEWS ARE ADDRESSED AND INCORPORATED INTO THE FORM 990, A REVISED DRAFT IS PROVIDED TO THE FILING ORGANIZATION'S LEADERSHIP TEAM, INCLUDING THE CFO AND CEO, FOR REVIEW. ONCE REVIEWED AND APPROVED BY THE FILING ORGANIZATION'S LEADERSHIP TEAM, THE FORM 990 IS THEN SIGNED AND FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C OFFICERS, DIRECTORS, KEY EMPLOYEES AND OTHER DISQUALIFIED PERSONS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE ANNUALLY AND DID SO IN THE NORMAL COURSE FOR THE YEAR ENDED JUNE 30, 2022. THIS PROCESS IS ADMINISTERED AT THE MERCY HEALTH LEVEL BY MERCY'S CORPORATE COMPLIANCE DEPARTMENT. THE QUESTIONNAIRES ARE REVIEWED WITH LEADERSHIP AT THE LOCAL LEVEL AND POTENTIAL CONFLICTS DISCUSSED AND RESOLVED. THE CONFLICTS AND THEIR RESPECTIVE RESOLUTIONS ARE SHARED AT THE MERCY LEVEL WITH A TEAM INCLUDING MERCY'S CHIEF FINANCIAL OFFICER, CHIEF COMPLIANCE OFFICER AND OTHER MEMBERS OF FINANCE, LEGAL AND HR. SUMMARY RESULTS ARE REVIEWED WITH MERCY'S STEWARDSHIP COMMITTEE OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15B 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 COMPENSATION COMMITTEE OF THE BOARD OF MERCY HEALTH. FOR THOSE CLASSIFIED AS KEY EMPLOYEES, THE ORGANIZATION USES THE FOLLOWING TO ESTABLISH THE COMPENSATION: EXTERNAL MARKET SALARY SURVEYS, EXTERNAL MARKET SALARY STUDIES, AND REVIEW/APPROVAL OF EXECUTIVE MANAGEMENT. COMPENSATION REVIEWS ARE COMPLETED ON AN ANNUAL BASIS, AND A REVIEW WAS COMPLETED DURING THE REPORTING YEAR. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE FROM TIME TO TIME BUT ARE NOT PUBLISHED PUBLICLY. FORM 990, PART VII, SECTION A, COLUMN B AVERAGE HOURS PER WEEK THE HOURS PER WEEK DISCLOSED IN PART VII IS THE AVERAGE HOURS THE LISTED PERSON WORKED OR DEVOTED PER WEEK WHILE EMPLOYED OR ASSOCIATED WITH THE FILING ORGANIZATION AND RELATED ORGANIZATIONS (IF APPLICABLE). FORM 990, PART XI, LINE 9: NET TRANSFERS TO/FROM AFFILIATES 601,720. ROUNDING 1. GRANTS UNEARNED ADVANCE PAYMENTS -254,626. PART XII, LINE 2 AUDITED FINANCIAL STATEMENTS 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 2022 (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 STEWARDSHIP COMMITTEE OF THE MERCY HEALTH BOARD OF DIRECTORS. AUDIT RESULTS ARE COMMUNICATED TO THIS COMMITTEE. PART XII, QUESTION 3A AND 3B SINGLE AUDIT ACT AND 2 CFR 200 AUDIT MERCY HEALTH UNDERGOES A CONSOLIDATED 2 CFR 200 AUDIT EVERY YEAR AND THIS AUDIT WAS COMPLETED FOR THE FISCAL YEAR ENDING JUNE 30, 2022 BY MARCH 31, 2023. EACH ENTITY THAT RECEIVES FEDERAL FUNDS DURING THE YEAR IS INCLUDED ON THE SCHEDULE OF EXPENDITURES OF FEDERAL AWARDS (SEFA) AND IS ALSO INCLUDED IN THE POPULATION INCLUDED IN THE AUDIT. IF THE FILING ENTITY RECEIVED FEDERAL FUNDS DURING THE YEAR ENDED JUNE 30, 2022, IT WILL BE INCLUDED ON THE MERCY HEALTH CONSOLIDATED SEFA, AND THEREFORE, ALSO INCLUDED IN THE POPULATION INCLUDED IN THE AUDIT. FORM 990, PART V, LINE 2A W-3 FILING SALARIES AND WAGES WITH LIMITED EXCEPTIONS, THE SALARIES AND WAGES REPORTED ON FORM 990, PART IX, LINE 7 REPRESENT AN ALLOCATION OF SALARIES AND WAGES FROM A RELATED ORGANIZATION. MOST EMPLOYEES ARE PAID BY A RELATED ORGANIZATION UNDER A COMMON PAYMASTER ARRANGEMENT. AS SUCH, ALL REQUIRED PAYROLL FILING FOR THESE EMPLOYEES (INCLUDING W-2 AND W-3'S) IS REPORTED UNDER THE RELATED ORGANIZATION, MHM SUPPORT SERVICES,EIN 20-2553101. FORM 990, SCHEDULE R, PART II MERCY HOSPITALS EAST COMMUNITIES 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, PART V SYSTEM LIMITATIONS LAWSON ERP SOFTWARE IS THE PRIMARY ACCOUNTING SOFTWARE USED BY 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 P AND Q. FORM 990, PART V, LINE 1A INDEPENDENT CONTRACTORS 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. COVID-19 EARLY IN 2020, THE MERCY HEALTH SYSTEM WAS CALLED TO SERVE AS THE COVID-19 PANDEMIC SWEPT ACROSS THE WORLD. DURING FY 2022, THE IMPACT OF COVID-19 AND INFLATION HAS BEEN AND STILL IS SIGNIFICANT TO OUR COMMUNITIES WITH CHANGES IN PATIENT CARE REVENUES DUE TO SURGES, INCREASING THE COSTS OF SALARIES AND AGENCY LABOR, AND SUPPLY CHAIN IMPACTS. ALL MERCY FACILITIES ADJUSTED OPERATIONS FOR THE IMPACTS OF THE PANDEMIC. IN ADDITION, MERCY FOUNDATIONS AND OUTREACH MINISTRIES EXPERIENCED LIMITATIONS IN FUNDRAISING FOR PROGRAM AND CAPITAL SUPPORT EFFORTS THAT ASSIST THE UNDERSERVED IN OUR COMMUNITIES. MERCY DID RECEIVE FUNDING FROM THE CORONAVIRUS AID RELIEF AND ECONOMIC SECURITY ACT ("CARES ACT"). MERCY RECEIVED CARES ACT FUNDING FOR THE PAST THREE YEARS ACROSS VARIOUS ENTITIES AND RECOGNIZED A PORTION OF THIS FUNDING IN OTHER OPERATING REVENUE. THESE FUNDS HELPED TO OFFSET REVENUE LOSSES AND ADDITIONAL EXPENSES INCURRED DUE TO THE PANDEMIC; HOWEVER, THESE FUNDS FELL SHORT OF THE SYSTEM LOSSES EXPERIENCED SINCE THE START OF THE PANDEMIC. MERCY CONTINUES TO MONITOR THE IMPACTS OF THE PANDEMIC BOTH TO THE HEALTH SYSTEM AND THE COMMUNITIES SERVED AS WE CONTINUE TO PROVIDE ASSISTANCE AND MAINTAIN ACCESS TO CARE WITHIN OUR COMMUNITIES. 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HEALTH OK COMMUNITIES 1 MERCY HEALTH FOUNDATION OK CITY 4300 W MEMORIAL ROAD OKLAHOMA CITY OK 73120 463184231 FOUNDATION OK 501C3 12A MERCY HEALTH OK COMMUNITIES 1 MERCY HEALTH FOUNDATION SPRINGFIELD 1235 E CHEROKEE STREET SPRINGFIELD MO 65804 320195818 FOUNDATION MO 501C3 12B MERCY HEALTH SPRINGFIELD COMM 1 MERCY HEALTH FOUNDATION ST FRANCIS 100 W HIGHWAY 60 MOUNTAIN VIEW MO 65548 431873914 FOUNDATION MO 501C3 12A MERCY ST FRANCIS HOSPITAL 1 MERCY HEALTH FOUNDATION STL 615 SOUTH NEW BALLAS ROAD ST LOUIS MO 63141 562410020 FOUNDATION MO 501C3 12B MERCY HEALTH EAST COMMUNITIES 1 MERCY HEALTH FOUNDATION WASHINGTON 901 E FIFTH STREET WASHINGTON MO 63090 562410022 FOUNDATION MO 501C3 12B MERCY HEALTH EAST COMMUNITIES 1 MERCY HEALTH NW ARK COMMUNITIES 2710 RIFE MEDICAL LN ROGERS AR 72758 621684203 PHYSICIAN GROUP AR 501C3 10 MERCY HEALTH 1 MERCY HEALTH OK COMMUNITIES 4300 W MEMORIAL ROAD OKLAHOMA CITY OK 73120 731453048 HEALTH SYSTEM OK 501C3 12A MERCY HEALTH 1 MERCY HEALTH PLANS OF 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CHESTERFIELD MO 63017 464953543 CORP PARENT OF VCC TAXABLE COMMERCIALIZ SVCS OK MHN INC AND MHNSR INC C 0 ST ANTHONY'S PHYSICIAN ORGANIZATION OF ILLINOIS 10010 KENNERLY ROAD ST LOUIS MO 63128 320457168 HEALTH CARE MO MERCY HOSPITAL SOUTH C 0 MCAULEY INSURANCE COMPANY LTD AON HOUSE 30 WOODBOURNE AVENUE PEMBROKE BD HM 08 INACTIVE BD MERCY HEALTH C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 MERCY ACO CLINICAL SERVICES Q 166230 FMV MERCY CLINIC OKLAHOMA COMMUNITIES INC P 33212 FMV MERCY HEALTH EAST COMMUNITIES Q 15543 FMV MERCY HEALTH OKLAHOMA COMMUNITIES Q 824973 FMV MERCY HEALTH SPRINGFIELD COMMUNITIES Q 1110 FMV MERCY HOSPITAL JOPLIN Q 10562 FMV MERCY HOSPITAL OKLAHOMA CITY Q 259054 FMV MERCY HOSPITALS EAST COMMUNITIES Q 2300 FMV MHM SUPPORT SERVICES Q 4499403 FMV