2022-05-06T12:47:57-05:00 2021-06-30 135565207 KPMG LLP 191 W Nationwide Blvd Suite 500 Columbus OH 43215 990 2020-07-01 440605373 The Children's Mercy Hospital CHIL 8162343000 2401 Gillham Road Kansas City MO 64108 Jennifer Kingry Interim CFO 8162343000 2022-05-06 1 Jennifer Kingry 999009999 Mollie P Longhouse P00294881 6142492300 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z Jennifer Kingry 2401 Gillham Road Kansas City MO 64108 1754294543 0 X www.childrensmercy.org X 1901 MO Excellence in healthcare for children 14 11 9724 638 4534026 159573 78650301 114304051 1478886544 1573848853 39078917 30623543 36991514 35334390 1633607276 1754110837 59717011 67683788 0 0 860789103 919618342 359542 621411 7244384 588095765 590480382 1508961421 1578403923 124645855 175706914 2254485183 2689363915 612438487 671608552 1642046696 2017755363 X Children's Mercy is a leading independent children's health organization dedicated to holistic care, translational research, breakthrough innovation, and educating the next generation of caregivers. Together, we transform the health, well-being and potential of children, with unwavering compassion for those most vulnerable. 0 0 1124960236 64078530 1604638313 All expenses for program services relate to providing healthcare. There was a total of 367 licensed beds and 176,316 adjusted patient days during the year from 12,543 admissions. Outpatient encounters totaled 484,848 which includes 48,081 primary care visits, 59,419 urgent care visits, 72,335 emergency department visits and 304,728 specialty clinic visits. Telemedicine visits totaled 91,205 which includes both synchronous and asynchronous visits. There was a total of 19,290 surgical cases which includes 4,317 inpatient cases and 14,793 outpatient cases. Children's Mercy radiology procedures totaled 175,133 for FY21. Children's Mercy's Adele Hall Campus consists of a 314-bed teaching hospital for children located in Kansas City, Missouri, and a 53-bed hospital for children located in Overland Park, Kansas. Children's Mercy Hospital provides the highest level of medical care, technology, services, equipment, and facilities promoting the health and well-being of children in the region, from birth through adolescence. Patients and their families are treated with compassion in a family-centered environment that recognizes their physical, emotional, financial, social, and spiritual needs. The comprehensive healthcare environment provided by the Hospital includes clinical services, research, and teaching efforts, which are designed to serve today's and tomorrow's children, and the community in which they live.The Hospital's services are available to all regardless of ability to pay. 78237934 3605258 Children's Mercy Hospital (CMH) is dedicated to becoming a leader in pediatric translational research. A strategic planning initiative established the Children's Mercy Research Institute ( CMRI) to focus on research and research infrastructure. Through the generosity of two philanthropic gifts totaling $150 million, the hospital has built a nine story, 375,000 square foot facility enabling research scientists to gain access to state-of-the-art research technology as well as dry lab and wet lab space to support that research. The CMRI building opened in the fall of 2020. The building includes an auditorium for presentations to train medical school students and inform the public about pediatric healthcare innovations that are being developed and created by research scientists and physicians here in collaboration with others throughout the nation and world. In addition, these generous gifts will help support funding for scientific programs and recruitment. Research conducted today at CMH includes basic science and clinical research in numerous areas including pharmacology, cancer, cardiology, genetic diseases and health outcomes. Areas of research strength include Precision Therapeutics, Genomics Medicine, Population Health and Innovations in Health Care Delivery. During the year ended June 30, 2021 there were more than 585 active sponsored research projects. The Children's Research Institute occupies about 4% of the space on the main campus and 5% of the total annual operating budget. Children's Mercy spent $69.9 million in the year ended June 30, 2021 on research and per information from the NIH Reporter received more than $7.4 Million in NIH funding in this same time period. More than 900+ publications were accepted and/or published. The Children's Research Institute provides seed funding to Investigators with internal competitive grant programs such as the Midwest Cancer Alliance and the Katherine Berry Richardson (KBR) Fund, with expectations that this funding will lead to applications for externally funded grant programs in the future. 1203198170 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 1 1 0 1 1 0 1 1 1 1 1 1 1 0 0 0 0 0 0 1 1 0 1 0 0 0 1 1 1 1 0 0 1 503 0 1 9724 1 1 1 0 0 0 0 1 1 0 0 0 0 1 0 X 14 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 X Jennifer Kingry Interim CFO 8162343000 2401 Gillham Road Kansas City MO 64108 Paul D Kempinski MS FACHE Director; President & CEO 40.00 1.00 X X 1211278 0 27572 Douglas Swanson MD Director; Start 1/1/21 40.00 0.00 X 238241 0 39472 Laura Fitzmaurice MD Director; End 12/31/20 40.00 0.00 X 449059 0 44860 Elizabeth Braham Chair 2.00 0.00 X X 0 0 0 Bill Krueger Vice Chair 1.50 1.00 X X 0 0 0 Vince Clark Treasurer 1.50 0.00 X X 0 0 0 Andrew Teigen Secretary 1.50 0.00 X X 0 0 0 Kevin Barth Director 1.00 0.00 X 0 0 0 Jean-Paul Chaurand Director 1.50 0.00 X 0 0 0 Jeff Gehab Treasurer 1.00 0.00 X 0 0 0 Carolyn Davis MD Director 1.50 0.00 X 0 0 0 Terry Matlack Director 1.50 0.00 X 0 0 0 Paul McLaughlin Director 1.50 0.00 X 0 0 0 Walter Porter Director 1.00 0.00 X 0 0 0 Edna Talboy Director; End 12/31/20 1.50 0.00 X 0 0 0 Tom Weir Director; End 06/30/21 1.00 0.00 X 0 0 0 David Cauble EVP & CFO 40.00 0.00 X 623456 0 38253 Robin Foster JD EVP, General Counsel; Start 1/31/21 40.00 0.00 X 576647 0 45378 Robert Steele MD EVP & Chief Strategy/Innovation Off. 40.00 0.00 X 589006 0 19728 Jodi Coombs MBA BSN RN EVP & COO 40.00 0.00 X 552840 0 8220 Robert Lane MD EVP & Physician-in-Chief 40.00 0.00 X 623099 0 18106 Alex Daneshmand DO MBA EVP&Chief Quality Off.;Start 5/14/21 40.00 0.00 X 0 0 0 Thomas Wright EVP& Chief HR Officer; Start 1/17/21 40.00 0.00 X 24000 0 0 Shawn St Peter MD SVP/Surgeon-in-Chief;ChairDeptOfSurg 40.00 0.00 X 875477 0 41103 Thomas Curran PhD SVP, CSO, Executive Director-CMRI 40.00 0.00 X 713639 0 29583 James O'Brien Jr MD Physician 40.00 0.00 X 1201698 0 45342 William Douglas MD Physician 40.00 0.00 X 1197653 0 39718 James D Saint Louis MD Physician 40.00 0.00 X 842614 0 21559 Walter Andrews MD Physician 40.00 0.00 X 855207 0 22215 Charles Snyder MD Physician 40.00 0.00 X 801865 0 39246 Randall L O'Donnell PhD Former President & CEO; End 9/1/18 0.00 0.00 X 183333 0 0 Charles Roberts MD EVP & Exec.Med Director; End 8/17/19 40.00 0.00 X 418948 0 0 11978060 0 480355 1651 1 1 0 McCown Gordon Construction LLC 850 Main Street Kansas City MO 64105 Construction 67416229 Anesthesia Associates 8717 West 110th Street Overland Park KS 66210 Anesthesiologists 36808481 Cerner Health Connections Inc 2800 Rockcreek Parkway Kansas City MO 64117 Professional Services 9048044 Lytle Construction Inc 1100 SE Hamblen Road Lees Summit MO 64081 Construction 6314216 Accenture LLP 161 North Clark Street Chicago IL 60601 Consulting 6090665 480 319066 2698442 7604022 66320783 37361738 561413 114304051 Net Patient Services 621110 1573848853 1573848853 1573848853 30623543 30623543 194610 2698442 183706 10904 10904 Contract Revenue 900099 27036240 24417949 2618291 Transport 621910 2671108 2671108 Gift Shop 453220 1258886 1258886 4357252 2441517 1915735 35323486 1754110837 1604638313 4534026 30634447 X 3676207 3676207 63870397 63870397 137184 137184 6867891 2325112 4542779 721634541 568341006 149113697 4179838 38716787 30328462 8166184 222141 103906514 81596523 21719175 590816 48492609 37986268 10228111 278230 2056878 127820 1929058 441333 73295 368038 531724 531724 621411 621411 177586673 88244638 88817208 524827 5993934 23684 5970250 4470447 114359 4309861 46227 18154649 6720598 10839208 594843 2348271 1599387 721075 27809 10027635 8637014 1390621 77239123 36038611 41152686 47826 22540280 18134055 4406225 Medical Supplies 181270118 175717813 5496145 56160 State Medicaid Taxes 61821540 61821540 0 0 Dues & Subscriptions 7197579 3952659 3192045 52875 Inventory- Food Service 5704600 5449812 253475 1313 13095598 8281726 4813804 68 1578403923 1203198170 367961369 7244384 98309413 69008187 75106323 36363988 219007550 237316739 15778184 17422487 24475230 30823421 1565322987 763585696 760179976 801737291 778622503 1226047938 5337331 6483027 277668673 264160837 2254485183 2689363915 135969285 190279556 315960864 305923732 160508338 175405264 612438487 671608552 X 1396871262 1831370960 245175434 186384403 1642046696 2017755363 2254485183 2689363915 X 175706914 -4995945 204997698 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 531724 531724 1202666446 1203198170 1000000 250000 0 0 1000000 1000000 1000000 1000000 4000000 6000000 492239 488841 595374 531724 2108178 250000 250000 250000 250000 1000000 1500000 79934240 14256948 24331407 1676630 116845965 73663733 6974083 1066434 1770010 79934240 69788763 3003013 3300499 2428542 73663733 61620527 6774013 3517083 2122860 69788763 51311822 7334271 5017500 2043066 61620527 0.70580 0.29420 0 1 1 24549276 24549276 937919699 345849331 592070368 547849698 417736365 130113333 55004314 55004314 801737291 Other Assets 75362669 Income Beneficiary and Charitable Remainder Trusts 54964361 Restricted Investments 95637598 Right of Use Asset 38196209 264160837 Reserve for Prof. Liability Claims 43929114 Postretirement Medical Liability 64661370 Other Liabilities 24683361 Unearned Premiums 2625620 Lease Liability 38652418 Due to other funds 614252 Long-term Obligation Under Capital Lease 239129 175405264 X Part V, Line 4: Endowment funds are held by The Children's Mercy Hospital and The Children's Mercy Hospital Foundation, a supporting organization of The Children's Mercy Hospital. The endowment funds are intended to provide a permanent source of funding for designated activities carried out by The Children's Mercy Hospital, the funds for which are provided from the earnings and principal of these endowment funds. Part X, Line 2: At June 30, 2021 and 2020, there were no uncertain tax positions. 1 Europe (Including Iceland & Greenland) 0 0 Program Services Travel for healthcare-related education and information sharing 1200 North America 0 0 Grantmaking 99135 Sub-Saharan Africa 0 0 Grantmaking 24011 Europe (Including Iceland & Greenland) 0 0 Grantmaking 14038 0 0 0 0 0 0 138384 0 138384 North America - Canada and Mexico, but not the United States Research 43555 Check FMV North America - Canada and Mexico, but not the United States Research 55580 Check FMV Sub-Saharan Africa - Angola, Benin, Botswana, Burkina Faso, Research 24011 Check FMV Europe (Including Iceland & Greenland) Research 14038 Check FMV 3 1 0 0 0 0 0 0 Part I, Line 2: Subrecipients sign an agreement which details the subrecipient's plan and budget as well as allowable expenditures of the Federal Awards. The agreement is also approved/signed by the Children's Mercy Hospital (CMH) signing official. Each subrecipient is required to submit periodic invoices (not more than monthly) to CMH for reimbursement. All expenditures on the invoice must be according to the subrecipient's budget that was developed during the application process. Invoices received from subrecipients are certified as complete and accurate by the subrecipient and reviewed and approved by the Principal Investigator or appropriate level of authorization, who forwards them to accounts payable for processing. In addition, Research and Grants (R&G) Accounting monitors these invoices to ensure proper coding to the correct award. The R&G accounting staff captures the amount on the budget-to-actual report to monitor the total amount spent by the subrecipient. Based on the amount budgeted to subrecipients and normal invoiced activity, the R&G accounting staff questions unreasonable invoice amounts with the subrecipient. In addition, any subrecipient that received more than $750,000 in Federal funds during the fiscal year is required to obtain an Uniformed Guidance (formerly A-133) audit and send a copy of the audit report to CMH's accounting department for review. The Post Award Manager is responsible for making sure that for all subrecipients that are required submit Uniform Guidance audits and that CMH has received an audit report. CMH maintains a subrecipient monitoring spreadsheet to track Uniform Guidance audit status, DUNS number, year-to-date spending, etc. for all subrecipients. Part I, line 3: Method Used to Account for Expenditures: Actual expenses for international travel and international grants. Part III Accounting Method: Schedule F, Part II, Line 1 Method Used to Account for Cash Grants and Noncash Assistance on the Organization's Financial Statement: Accrual. X X X X X 1 TrueSense 502 Keystone Dr Warrendale PA 15086 Consult/develop an annual fund and giving program 0 1349060 621411 727649 1349060 621411 727649 KS MO AK AL CA CO CT DC FL GA HI IL KY MA MD ME MN NC ND NH NV NY OH OK OR PA RI SC UT VA WA WI WV Gala/Auction 1918575 1740825 177750 115981 9202 11540 Event/Auction 747191 730581 16610 14358 1432 31193 1 227286 227036 250 2893052 2698442 194610 130339 10634 42733 183706 10904 Schedule G, Part I, Line 2b, Column (v) Payments to TrueSense during FY21 totaled $699,753. This amount includes $621,411 for consulting services and $78,342 of fundraising expenses. The agreement distinguishes consulting costs separate from any expense payments of reimbursements. 1 1 X 1 X 300.000000000000 1 X 500.000000000000 1 1 1 0 1 1 2 57481 28302503 489545 27812958 0.01760 9 292762 727702342 635638054 92064288 0.05830 11 350243 756004845 636127599 119877246 0.07590 41 298338 18858291 3877761 14980530 0.00950 9 20999 39898804 18658414 21240390 0.01350 17 108470 78889324 30767592 48121732 0.03050 585 0 52387527 28696904 23690623 0.01500 4 7462 798054 7290 790764 0.00050 656 435269 190832000 82007961 108824039 0.06900 667 785512 946836845 718135560 228701285 0.14490 3 3 110639 6296 104343 0.00010 3 2 88394 0 88394 0.00010 1 10 979 0 979 0.00000 0 0 0 0 1 1 3524 0 3524 0.00000 4 4 371634 9000 362634 0.00020 3 3 82627 0 82627 0.00010 9 1970 357679 1282 356397 0.00020 24 1993 1015476 16578 998898 0.00070 1 100095 0 3607499 5912031 -2304532 X 1 1 2 1 The Children's Mercy Hospital 2401 Gillham Road Kansas City MO 64108 http://www.childrensmercy.org/ 39-54 X X X X X X Specialty Clinics; Primary Care Clinics A 2 Children's Mercy Kansas 5808 W 110th Overland Park KS 66211 http://www.childrensmercy.org/ H-046-008 X X X X X Specialty Clinics A Facility Reporting Group - A 0 0 1 X X X X X X X X X 18 1 0 0 1 X www.childrensmercy.org/communityneeds X 1 18 1 www.childrensmercy.org/communityneeds 0 1 X 300.000000000000 500.000000000000 X X X X X X X 1 1 X X X 1 X www.childrensmercy.org/financialcounseling/ X Same as 16a X Same as 16a X X X X X X 1 X 0 X X X 1 X 0 0 Part V, Section B Facility Reporting Group A Facility Reporting Group A consists of: - Facility 1: The Children's Mercy Hospital, - Facility 2: Children's Mercy Kansas Group A-Facility 1 -- The Children's Mercy Hospital Part V, Section B, line 5: Children's Mercy developed the most recent CHNA with input from persons who represent broad interests within the community. Between October 2018 and April 2019, Children's Mercy held activities and hosted meetings to solicit input and feedback from community members. Activities included: seven community meetings with 130 community, neighborhood, and parent residents representing low income and vulnerable populations; a telephone survey of 1,000 randomly selected parents/caregivers of children under the age of 18 years old living in the Children's Mercy service area; a Key Informant Online Survey sent to 299 elected officials, physicians, public health leaders, health professionals, social service providers, and business, neighborhood, housing, and community leaders (36% response rate); a Children's Health Summit held April 1, 2019 that invited 350 participants (198 attended). Organizations participating in the CHNA surveys and events included: El Centro; Restart; The Family Conservancy; Urban Neighborhoods Initiative; Advent Health; BikeWalkKC; Catholic Charities of Kansas City-St. Joseph; Child Care Aware of Kansas; Child Protection Center; Children of Incarcerated Parents; Clay County Public Health Center; Communities In Schools; Comprehensive Community Development; Cornerstones of Care; Eitas; First Hand Foundation; Food Equality Initiative; Greater Kansas City Community Foundation; Guadalupe Centers; Happy Bottoms; Harvesters - The Community Food Network; Health Care Collaborative of Rural Missouri; Health Forward Foundation; Healthy Families America; Jackson County Community Children's Service Fund; Johnson County Department of Health and Environment; Kansas Children's Service League; Kansas City Health Department; Kansas City Healthy Start; Kansas City Public Schools; KC Healthy Kids; Kids TLC; Project Eagle; KVC Hospitals of Kansas City; Legal Aid of Western Missouri; Lincoln College Preparatory Academy; Jackson County Health Department; Mid-America Regional Council; Mattie Rhodes Center; Nurture KC; Mid America Head Start; Mid-America Regional Council; Missouri Primary Care Association; No Kid Hungry Missouri; North Kansas City Hospital; North Kansas City Schools; Operation Breakthrough; PACES; Phoenix Family; Platte County Health Department; REACH Healthcare Foundation; Samuel U Rodgers Health Center; Sleepyhead Beds; Sunflower Health Plan; Swope Health Services; Synergy Services Inc.; The Children's Place; The Health Care Collaborative of Rural Missouri; Truman Medical Centers/University Health; Turn The Page KC; UMKC Health Sciences District; United Community Services of Johnson County; United Way of Greater Kansas City; Wyandotte County Health Department; Wyandotte Health Foundation; YMCA of Greater Kansas City; and representatives from private pediatric offices. The CHNA provides a comprehensive list of all organizations and specifics on the data collection process. Data collection for the 2018 CHNA began in June 2018 and ended December 2018. On April 1, 2019, Children's Mercy hosted the Children's Health Summit, bringing together 198 community representatives to review CHNA data and identify critical health needs. Listed in priority order, the needs identified include: mental/behavioral health; access to health services; infant health; nutrition/physical activity/weight; injury and violence; tobacco/alcohol/substance abuse; asthma. The community representatives also recognized that to address the identified priorities, three overarching population level topics must be considered: addressing social determinants of health, focusing on equitable outcomes, and keeping children safe. Between April 2 and May 15, 2019, over 180 Children's Mercy employees and senior leadership were presented the health needs and themes identified by the community. Staff selected three as Priority Health Needs including: access to health services with a focus on asthma; mental and behavioral health; infant health. Priority health needs were selected based on the issue's importance to children's health, potential measurable impact if addressed, and Children's Mercy's ability to mitigate the issue with resources and personnel. The Children's Mercy Board of Directors approved the Priority Health Needs on June 18, 2019. The Priority Health Needs will receive heightened attention and support from Children's Mercy. Significant Health Needs identified by the community will be addressed through ongoing programming but will not receive accelerated attention.Children's Mercy's 2022-2025 CHNA is currently under development and will be presented to the Board of Directors for final approval in June 2022. Group A-Facility 1 -- The Children's Mercy Hospital Part V, Section B, line 11: The implementation strategy plan was approved on October 15, 2019 and made available to the public within the IRS required 4 1/2 months after year end associated with the conducted and approved CHNA completed during the 2018 tax year. The most recently adopted implementation strategy plan can be found on the hospital website:http://www.childrensmercy.org/communityneedsChildren's Mercy continues to support programs that address Priority and Significant Health needs. Due to the ongoing COVID-19 pandemic, new program models and approaches were developed to continue to safely reach children and families. Examples of new approaches included year-round lunches through the Kids Eat Free program, drive-thru community baby showers, open-air provision of sports physicals, telemedicine visits, COVID-19 support program for schools, virtual health education sessions, on- and off-site COVID-19 testing and vaccination programs. Other Children's Mercy programs offered include: Safe sleep improvement efforts at area delivery hospitals (improving infant health); Red Card: Call It When You See It anti-bullying campaign in partnership with local MLS soccer team; Sporting Kansas City (addressing mental/behavioral health); Project Adam- creating heart-safe schools (addressing access to care); Stop the Bleed (injury/violence prevention); the Circulation primary care transportation program (addressing access to care); Kids Eat Free summer food program and a community garden (addressing nutrition/physical activity/weight); Girls on the Run sponsor site; KC Physical Activity Plan implementation (addressing nutrition/physical activity/weight); home visiting programs for families with children birth through three years of age (improving infant health and addressing mental/behavioral health); Safe Kids Greater KC leadership (addressing injury/violence prevention); lead and asthma friendly home assessments (addressing access to care and infant health); Family Therapy CARE Workshop (addressing mental/behavioral health); Bike safety fairs (addressing injury/violence prevention); American Heart Association Community Conversation on Vaping (addressing tobacco, alcohol and substance); Winter Warmth and Safety focusing on winter/cold weather health and safety for kids (addressing access to care); system-wide suicide prevention screening (addressing mental/behavioral health). Children's Mercy's website provides a link that allows community organizations to submit requests for Children's Mercy to provide resources, program support and expertise to identified community needs. Children's Mercy supported 29 events in FY21, including one civic organization presentation, seven community events, one health care organization presentation, two health fairs, five educational lectures, one professional conference, five workshops and trainings, and seven virtual or other events. Organizations receiving financial support from Children's Mercy include: Reach Out and Read KC; Rose Brooks Center; Black Health Care Coalition; Ronald McDonald House; National Kidney Foundation; Community Health Council of Wyandotte County; American Heart Association of Kansas City and Wichita; First Tee Greater Kansas City Junior Golf Foundation; and the Leukemia and Lymphoma Society. Group A-Facility 1 -- The Children's Mercy Hospital Part V, Section B, line 13b: The written financial assistance policy explains criteria beyond FPG to include residency requirements, available payors to applicant, asset levels, and in-network insurance status. Group A-Facility 1 -- The Children's Mercy Hospital Part V, Section B, line 13h: Patients seeking care at organization with out of network insurance plans are not eligible for charity care. Group A-Facility 1 -- The Children's Mercy Hospital Part V, Section B, Line 20a: Because the Hospital is not exercising any extraordinary collection actions in the event of nonpayment, it has no occasion to provide a written notice about upcoming ECAs. Group A-Facility 2 -- Children's Mercy Kansas Part V, Section B, line 5: Children's Mercy developed the most recent CHNA with input from persons who represent broad interests within the community. Between October 2018 and April 2019, Children's Mercy held activities and hosted meetings to solicit input and feedback from community members. Activities included: seven community meetings with 130 community, neighborhood, and parent residents representing low income and vulnerable populations; a telephone survey of 1,000 randomly selected parents/caregivers of children under the age of 18 years old living in the Children's Mercy service area; a Key Informant Online Survey sent to 299 elected officials, physicians, public health leaders, health professionals, social service providers, and business, neighborhood, housing, and community leaders (36% response rate); a Children's Health Summit held April 1, 2019 that invited 350 participants (198 attended). Organizations participating in the CHNA surveys and events included: El Centro; Restart; The Family Conservancy; Urban Neighborhoods Initiative; Advent Health; BikeWalkKC; Catholic Charities of Kansas City-St. Joseph; Child Care Aware of Kansas; Child Protection Center; Children of Incarcerated Parents; Clay County Public Health Center; Communities In Schools; Comprehensive Community Development; Cornerstones of Care; Eitas; First Hand Foundation; Food Equality Initiative; Greater Kansas City Community Foundation; Guadalupe Centers; Happy Bottoms; Harvesters - The Community Food Network; Health Care Collaborative of Rural Missouri; Health Forward Foundation; Healthy Families America; Jackson County Community Children's Service Fund; Johnson County Department of Health and Environment; Kansas Children's Service League; Kansas City Health Department; Kansas City Healthy Start; Kansas City Public Schools; KC Healthy Kids; Kids TLC; Project Eagle; KVC Hospitals of Kansas City; Legal Aid of Western Missouri; Lincoln College Preparatory Academy; Jackson County Health Department; Mid-America Regional Council; Mattie Rhodes Center; Nurture KC; Mid America Head Start; Mid-America Regional Council; Missouri Primary Care Association; No Kid Hungry Missouri; North Kansas City Hospital; North Kansas City Schools; Operation Breakthrough; PACES; Phoenix Family; Platte County Health Department; REACH Healthcare Foundation; Samuel U Rodgers Health Center; Sleepyhead Beds; Sunflower Health Plan; Swope Health Services; Synergy Services Inc.; The Children's Place; The Health Care Collaborative of Rural Missouri; Truman Medical Centers/University Health; Turn The Page KC; UMKC Health Sciences District; United Community Services of Johnson County; United Way of Greater Kansas City; Wyandotte County Health Department; Wyandotte Health Foundation; YMCA of Greater Kansas City; and representatives from private pediatric offices. The CHNA provides a comprehensive list of all organizations and specifics on the data collection process. Data collection for the 2018 CHNA began in June 2018 and ended December 2018. On April 1, 2019, Children's Mercy hosted the Children's Health Summit, bringing together 198 community representatives to review CHNA data and identify critical health needs. Listed in priority order, the needs identified include: mental/behavioral health; access to health services; infant health; nutrition/physical activity/weight; injury and violence; tobacco/alcohol/substance abuse; asthma. The community representatives also recognized that to address the identified priorities, three overarching population level topics must be considered: addressing social determinants of health, focusing on equitable outcomes, and keeping children safe. Between April 2 and May 15, 2019, over 180 Children's Mercy employees and senior leadership were presented the health needs and themes identified by the community. Staff selected three as Priority Health Needs including: access to health services with a focus on asthma; mental and behavioral health; infant health. Priority health needs were selected based on the issue's importance to children's health, potential measurable impact if addressed, and Children's Mercy's ability to mitigate the issue with resources and personnel. The Children's Mercy Board of Directors approved the Priority Health Needs on June 18, 2019. The Priority Health Needs will receive heightened attention and support from Children's Mercy. Significant Health Needs identified by the community will be addressed through ongoing programming but will not receive accelerated attention.Children's Mercy's 2022-2025 CHNA is currently under development and will be presented to the Board of Directors for final approval in June 2022. Group A-Facility 2 -- Children's Mercy Kansas Part V, Section B, line 11: The implementation strategy plan was approved on October 15, 2019 and made available to the public within the IRS required 4 1/2 months after year end associated with the conducted and approved CHNA completed during the 2018 tax year. The most recently adopted implementation strategy plan can be found on the hospital website:http://www.childrensmercy.org/communityneedsChildren's Mercy continues to support programs that address Priority and Significant Health needs. Due to the ongoing COVID-19 pandemic, new program models and approaches were developed to continue to safely reach children and families. Examples of new approaches included year-round lunches through the Kids Eat Free program, drive-thru community baby showers, open-air provision of sports physicals, telemedicine visits, COVID-19 support program for schools, virtual health education sessions, on- and off-site COVID-19 testing and vaccination programs. Other Children's Mercy programs offered include: Safe sleep improvement efforts at area delivery hospitals (improving infant health); Red Card: Call It When You See It anti-bullying campaign in partnership with local MLS soccer team; Sporting Kansas City (addressing mental/behavioral health); Project Adam- creating heart-safe schools (addressing access to care); Stop the Bleed (injury/violence prevention); the Circulation primary care transportation program (addressing access to care); Kids Eat Free summer food program and a community garden (addressing nutrition/physical activity/weight); Girls on the Run sponsor site; KC Physical Activity Plan implementation (addressing nutrition/physical activity/weight); home visiting programs for families with children birth through three years of age (improving infant health and addressing mental/behavioral health); Safe Kids Greater KC leadership (addressing injury/violence prevention); lead and asthma friendly home assessments (addressing access to care and infant health); Family Therapy CARE Workshop (addressing mental/behavioral health); Bike safety fairs (addressing injury/violence prevention); American Heart Association Community Conversation on Vaping (addressing tobacco, alcohol and substance); Winter Warmth and Safety focusing on winter/cold weather health and safety for kids (addressing access to care); system-wide suicide prevention screening (addressing mental/behavioral health). Children's Mercy's website provides a link that allows community organizations to submit requests for Children's Mercy to provide resources, program support and expertise to identified community needs. Children's Mercy supported 29 events in FY21, including one civic organization presentation, seven community events, one health care organization presentation, two health fairs, five educational lectures, one professional conference, five workshops and trainings, and seven virtual or other events. Organizations receiving financial support from Children's Mercy include: Reach Out and Read KC; Rose Brooks Center; Black Health Care Coalition; Ronald McDonald House; National Kidney Foundation; Community Health Council of Wyandotte County; American Heart Association of Kansas City and Wichita; First Tee Greater Kansas City Junior Golf Foundation; and the Leukemia and Lymphoma Society. Group A-Facility 2 -- Children's Mercy Kansas Part V, Section B, line 13b: The written financial assistance policy explains criteria beyond FPG to include residency requirements, available payors to applicant, asset levels, and in-network insurance status. Group A-Facility 2 -- Children's Mercy Kansas Part V, Section B, line 13h: Patients seeking care at organization with out of network insurance plans are not eligible for charity care. Group A-Facility 2 -- Children's Mercy Kansas Part V, Section B, Line 20a: Because the Hospital is not exercising any extraordinary collection actions in the event of nonpayment, it has no occasion to provide a written notice about upcoming ECAs. 12 1 - Children's Mercy West 4313 State Ave Kansas City KS 66102 Outpatient Clinics 2 - Children's Mercy Wichita Clinic 3243 E Murdock Suite 201 Wichita KS 67208 Outpatient Clinics 3 - Children's Mercy Sports Medicine Center 1801 N 98th Street Kansas City KS 66109 Rehabilitation 4 - Children's Mercy at KU Hospital 2000 Olathe Boulevard Kansas City KS 66103 Outreach Clinic 5 - Children's Mercy Joplin Clinic 3333 McIntosh Circle Suite 6 Joplin MO 64804 Outpatient Clinics 6 - Children's Mercy Olathe 20333 W 151st St Olathe KS 66061 Outpatient Clinics 7 - Children's Mercy Heartland Clinic 802 N Riverside Rd Suite 105 St Joseph MO 64502 Outpatient Clinics 8 - Children's Mercy Outreach Garden City 311 E Spruce St Garden City KS 67846 Outreach Clinic 9 - Children's Mercy Outreach Junction City 361 Grant Ave Junction City KS 66441 Outreach Clinic 10 - Children's Mercy Outreach Great Bend 1021 Einsenhower Ave Great Bend KS 65730 Outreach Clinic 11 - Children's Mercy Outreach Springfield 1000 E Primrose Suite 300 Springfield MO 65807 Outreach Clinic 12 - Children's Mercy Pediatric Eye Care 4820 College Blvd Leawood KS 66211 Practice Use Part I, Line 3c: Free care eligibility is based on FPG and other factors such as residency and exhausting other available payor sources. For discounted care, if a financial assistance application was denied and the decision then appealed, the case is reviewed through a multi-disciplinary committee that uses a point system rubric using indicators such as FPG, total balance due as a percentage of annual income, out of pocket responsibility for upcoming year as a percentage of annual income, annual frequency of visits for ongoing care, financial hardship indicators such as recent bankruptcy/foreclosure, and medical complexity due to health condition. Each factor, if applicable, is reviewed and assigned point value based on a preset scale, that serves as a tool for the discounted care scale. Part I, Line 7: The cost-to-charge ratio derived from Worksheet 2 was used for Lines 7a and 7b. Cost from the Medicare Cost Report was used for Lines 7f (Health Professions Education). Cost from our decision support system was used for 7g (Subsidized Health Services). Part I, Line 7g: In FY21, over 108,470 children were reached through clinical services classified as Subsidized Health Services. Subsidized health services included pediatric primary care clinics at Children's Mercy Broadway and West as well as community-based clinics located at Synergy Services (youth-serving agency), Operation Breakthrough (early childhood center) and at University Academy (K-12 charter school). Other subsidized health services include: dialysis; developmental and behavioral sciences; neonatology; hematology/oncology; genetics; pain management; home health services; the fetal health center; neonatology; transport; ophthalmology; and child abuse and neglect. The services are provided at a financial loss to Children's Mercy after removing Charity Care, unreimbursed Medicaid, private insurance shortages and contract, grants and gifts. All subsidized health services meet an identified community need and a shortage of available services would exist in the community if Children's Mercy did not provide the service. Part I, Line 7A: Financial assistance cost reported on this line is derived from Worksheet 1 which takes gross charges for patients who have been awarded financial assistance and then multiplies those charges by a cost-to-charge ratio derived from Worksheet 2 to arrive at cost of providing financial assistance. Part I, Line 7H: Children's Mercy researchers strive to find better ways to prevent, treat and eliminate pediatric disease and to improve community-based health outcomes. In FY21, over 585 studies met Community Benefit criteria. The Children's Research Institute is creating an integrated research environment where no boundaries exist between science and medicine. The hospital's leadership in pediatric genomic medicine and clinical pharmacology is driving research and innovation in nephrology, cardiology, cancer treatment and other subspecialties to provide answers for the most difficult cases and challenging pediatric conditions. In addition, a dedicated, state-of-art biorepository that can advance diagnostic discovery and health outcomes is available for use by all researchers. Part II, Community Building Activities: The Children's Mercy community building activities address identified community health needs such as physical activity, early education, poverty, access to health services, infant mortality, mental and behavioral health, and employment. The activities include programs and/or resources intended to make physical improvements, provide community support, advocate for community health improvements, and address community-wide workforce issues through numerous workforce development outreach initiatives. Examples include the maintenance of the Hospital Hill Park and the Sylvia Nutter Playground, the management of a community garden, advocacy activities, participation on Chamber of Commerce committees related to health improvement, and healthcare workforce development for high school students and community members. Part III, Line 4: Audited Financial Statements Footnote M, Page 13. Part III, Line 8: Cost to charge ratio Part III, Line 9b: Collection attempts are discontinued once charges are determined to be eligible for charity care or financial assistance; insurance collection attempts continue as appropriate. Part VI, Line 2: The hospital has an initiative development process that brings forward new initiatives around strategic, operational, community health, and innovation based on community/market trends and needs and through consultation with community-based organizations. On a routine basis, the Strategic Planning Department monitors demographic and service trends of the region and compares this data to national benchmarks. The hospital strategic planning process also takes into account all of the qualitative and quantitative market data to define strategies and tactics that address the community need. In addition, Trauma Services maintains a Trauma Registry and the Promise 1000 centralizes the data collection on the health services and needs of children (0 - 3 years of age) who receive home visiting services. Part VI, Line 3: Flyers and financial counselor business cards and copies of the Financial Assistance Plain Language Summary are available at all access points within the Hospital. Efforts are made by the financial counselors to contact self pay patients and families, either in person, or through phone call or letters to inform/assist families with charity care and Medicaid or state program eligibility. Self pay or underinsured patients can also be referred to a financial counselor by an Access Representative, Patient Care Services, Social Work, Patient Financial Services, or other staff members for screening and assistance. All billing statements refer patients to financial counseling resources and the financial assistance policy posted on the hospital website. Part VI, Line 4: Children's Mercy serves over 230,000 children from across the states of Kansas and Missouri. In Kansas 102 counties and in Missouri 114 counties have federally designated primary care HPSA areas. Across the two states, Children's Mercy identifies 43 counties as the Outreach Service Area, 50 counties as the Secondary Service Area and 18 counties as the Primary Service Area. Within the Primary Service Area are six counties called the Metro Service Area. Each of the service areas include urban, suburban and rural counties. The Outreach Service Area includes more rural counties than the other service areas. The Metro Service Area includes more urban and suburban areas than rural. Within the Metro Service Area are the four counties (Jackson and Clay counties located in Missouri and Johnson and Wyandotte counties located in Kansas) that comprise the Children's Mercy CHNA service area. Johnson, Wyandotte and Jackson counties have primary care HPSA areas. Children's Mercy is the only children's hospital in the region. Limited pediatric services are available at the Kansas University Medical Center, St. Luke's Health System, Centerpoint, Liberty Hospital, North Kansas City, Research Medical Center, Shawnee Mission Medical Center and Overland Park hospitals. During the fiscal year in which Children's Mercy initiated the CHNA, residents of these counties contribute over 61.5 percent of the encounters at Children's Mercy. The four counties serve as the location of our physical facilities (e.g., Children's Mercy Adele Hall Campus, Children's Mercy Hospital Kansas, Children's Mercy West, Children's Mercy Northland, Children's Mercy Broadway, Children's Mercy College Boulevard, Children's Mercy Olathe, Children's Mercy Blue Valley, Children's Mercy at The University of Kansas Hospital, Children's Mercy Sports Medicine at Village West, and Children's Mercy East) and the source of a majority of our patient encounters. The four counties house a total population of 1,747,030; of these 422,989, or 24 percent, are children. Within this region, Wyandotte County has the greatest proportion of children under 18 and Jackson County has the smallest proportion, but largest in absolute number. The overall population of children in these four counties increased between 1980 and 2015 and the overall make-up of the population shifted as well. In 1980, black, Hispanic or other ethnicities comprised 21 percent of the four counties under 18 years of age population and in 2015 36.4 percent of the region's under 18 population made up these groups. According to the 2019 U.S. Census, the median family income for the four counties was $64,745. The highest percentage of children living in poverty is in Wyandotte County (26.5%), followed by Jackson County (19.0%), Clay County (8.7%) and Johnson County (6.0%). Part VI, Line 5: The Children's Mercy Hospital is a nonprofit hospital operated to serve a public rather than a private interest and meeting the requirements of Revenue Ruling 69-545. Control of the Hospital rests with its Board, which is primarily composed of members of the community, in addition to a few select employees of the Hospital. The Hospital accepts patients paying with Medicaid and Medicare, and operates an active and generally accessible emergency room open to all children without regard to ability to pay. The Hospital uses any surplus funds to improve the quality of patient care, expand its facilities, and advance its medical training, education, and research programs.Children's Mercy provides funding and partnership to community organizations and efforts that support programs addressing the CHNA priority health needs. Organizations include: Black Health Care Coalition; Happy Bottoms; Nurture KC; Harvesters; the Community Health Council of Wyandotte County; Northland Health Alliance; Uzazi Village; Nurture Kansas City; Boys and Girls Clubs of Greater KC; Down Syndrome Guild; Reach Out and Read KC; and Ronald McDonald House Charities of Kansas City. Children's Mercy launched the Kansas City Physical Activity plan that works with organizations across the community to improve physical infrastructures to promote healthy living and eating. Programs working to improve outcomes for children are strengthened through a community-wide strategy to organize home visiting, participation in community health fairs, support for healthy housing, decrease violence, support the mental health of children, service on key community committees (i.e., Infant and Child Mortality review boards, health department planning committees) and through the provision of training and education for families with children at-risk for obesity or diabetes. During the COVID-19 pandemic, Children's Mercy worked closely with school districts to support education around risk mitigation practices. In addition, Children's Mercy participated in a number of programs and partnerships to provide education, testing and vaccination to communities. Part VI, Line 6: The Children's Mercy Hospital is not part of an affiliated health care system. 1 American Heart Association 6800 W 93rd St Overland Park KS 66212 135613797 501(c)3 40500 To support vaping prevention and physical activity work in the Kansas City and Wichita regions. Charlie's House Inc 2425 Campbell St Kansas City MO 64108 061830922 501(c)3 8333 To support injury prevention education across the Kansas City community. Community Health Council of Wyandotte County 803 Armstrong Ave Kansas City KS 66101 010674969 501(c)3 17500 To support access to care initiatives in Wyandotte County. Kansas University Endowment (Reach Out and Read) 3901 Rainbow Blvd MS 1039 Kansas City KS 66106 480547734 501(c)3 35000 To provide early education reading programs at health clinics. Leukemia & Lymphoma Society 6811 Shawnee Mission Pkwy 202 Shawnee Mission KS 66202 135644916 501(c)3 15900 To support education and outreach efforts related to access to care for children living with leukemia and lymphoma conditions. Ronald McDonald House Charities 2502 Cherry St Kansas City MO 64108 431190760 501(c)3 80000 To increase access to care by providing housing for families. National Kidney Foundation 6405 Metcalf Ave Ste 204 Overland Park KS 66202 131673104 501(c)3 10900 To support education and programs for children living with kidney disease. Medical College of Wisconsin 8701 Watertown Plank Rd Milwaukee WI 53226 390806261 501(c)3 50368 Research Oregon Health & Science 3181 SW Sam Jackson Park Rd AD201 Portland OR 97201 931176109 GOVT 14976 Research Seattle Children's Hospital 4800 Sand Point Way NE Seattle WA 98105 910564748 501(c)3 24809 Research Regents UCSF 1955 Folsom Street San Francisco CA 94143 946036493 501(c)3 11329 Research University of California 9500 Gilman Dr La Jolla CA 92093 330833316 GOVT 29937 Research University of New Mexico 1 University of New Mexico Albuquerque NM 87131 856000642 GOVT 31896 Research Cincinnati Children's Hospital 3333 Burnet Avenue Suite 330 Cincinnati OH 45229 310833936 501(c)3 96066 Research Stanford Junior University 3145 Porter Dr Palo Alto CA 94304 941156365 501(c)3 49760 Research KU Center for Research KUCR 2385 Irving Hill Road Lawrence KS 66045 480680117 501(c)3 18299 Research Vanderbilt Medical Center Dept AT 40379 Atlanta GA 31192 352528741 501(c)3 17620 Research KUMC Research Institute Inc 3901 Rainbow Blvd MS 1039 Kansas City KS 66160 481108830 501(c)3 239022 Research University of Missouri UMKC KCUR 118 University Hall Columbia MO 65211 436003859 GOVT 219663 Research Cleveland Clinic 9500 Euclid Avenue NA-4 Cleveland OH 44195 340714585 501(c)3 20514 Research NACHRI NACH Children's Hospital 600 13th Street NW Suite 500 Washington DC 20005 510120256 501(c)3 52439 Research Duke University PO Box 104132 Durham NC 27708 560532129 501(c)3 286848 Research H Lee Moffitt Cancer Center 12902 Magnolia Dr Tampa FL 33612 592451713 501(c)3 22846 Research Midwest Biomedical Research PO Box 300662 Kansas City MO 64130 431496422 184441 Research Illumisoft LLC 1111 Main Street Kansas City MO 64105 823165111 97515 Research CYFT Incorporated 222 Third Street Suite 1130 Cambridge MA 02142 473547678 1235000 Research University of Alabama 701 20th Street S Birmingham AL 35294 636005396 501(c)3 15263 Research Washington University 700 Rosedale Avenue Saint Louis MO 63112 430653611 501(c)3 20544 Research Kaiser Foundation Research Institute 1800 Harrison St 16th Floor Oakland CA 94612 941105628 13675 Research Albert Einstein College of Medicine 1300 Morris Park Ave Bronx NY 10461 830621846 48167 Research University of North Carolina at Chapel Hill PO Box 402420 Atlanta GA 30384 566001393 501(c)3 133842 Research San Diego State University Foundation 5250 Campanile Drive San Diego CA 92182 956042721 156722 Research KU Hospital Authority 3901 Rainbow Blvd Kansas City KS 66160 481202402 GOVT 21938 Research University of Miami PO Box 248106 Coral Gables FL 33124 590624458 501(c)3 40958 Research University of Illinois 506 South Wright Street Urbana IL 61801 376000511 501(c)3 313617 Research 29 6 Patient Financial Assistance 57481 0 63870397 Cost Charity Care Part I, Line 2: Children's Mercy provides charitable contributions to nonprofit organizations which share a common mission to improve the health and well-being of children. The contributions are restricted to meet a community identified need and community benefit requirements. Children's Mercy documents the appropriate use of our funds by sending a restricted contribution letter; attending annual events; reviewing web-based annual reports; and meeting with agency grant recipient to ascertain the outcomes of their work. Subrecipients sign an agreement which details the subrecipient's plan and budget as well as allowable expenditures of the Federal Awards. The agreement is also approved/signed by the Children's Mercy Hospital (CMH) signing official. Each subrecipient is required to submit periodic invoices (not more than monthly) to CMH for reimbursement. All expenditures on the invoice must be according to the subrecipient's budget that was developed during the application process. Invoices received from subrecipients are certified as complete and accurate by the subrecipient and reviewed and approved by the Principal Investigator or appropriate level of authorization, who forwards them to accounts payable for processing. In addition, Research and Grants (R&G) Accounting monitors these invoices to ensure proper coding to the correct award. The R&G accounting staff captures the amount on the budget-to-actual report to monitor the total amount spent by the subrecipient. Based on the amount budgeted to subrecipients and normal invoiced activity, the R&G accounting staff questions unreasonable invoice amounts with the subrecipient. In addition, any subrecipient that received more than $750,000 in Federal funds during the fiscal year is required to obtain a Uniformed Guidance (formerly A-133) audit and send a copy of the audit report to CMH's accounting department for review. The Post Award Manager is responsible for making sure that for all subrecipients that are required submit Uniform Guidance audits and that CMH has received an audit report. CMH maintains a subrecipient monitoring spreadsheet to track Uniform Guidance audit status, DUNS number, year-to-date spending, etc. for all subrecipients. X 1 1 X X X X X 1 1 0 0 0 1 0 0 0 James O'Brien Jr MD Physician 1177721 0 1000 0 22977 0 25650 0 19977 0 1247325 0 0 0 Paul D Kempinski MS FACHE Director; President & CEO 1105143 0 81916 0 24219 0 7844 0 20013 0 1239135 0 0 0 William Douglas MD Physician 1173676 0 1000 0 22977 0 19990 0 20013 0 1237656 0 0 0 Shawn St Peter MD SVP/Surgeon-in-Chief;ChairDeptOfSurg 854167 0 1000 0 20310 0 21375 0 21168 0 918020 0 0 0 Walter Andrews MD Physician 208447 0 0 0 646760 0 17349 0 4933 0 877489 0 0 0 James D Saint Louis MD Physician 824801 0 1000 0 16813 0 21235 0 533 0 864382 0 0 0 Charles Snyder MD Physician 776646 0 1000 0 24219 0 25650 0 13881 0 841396 0 0 0 Thomas Curran PhD SVP, CSO, Executive Director-CMRI 688420 0 1000 0 24219 0 21375 0 8493 0 743507 0 0 0 David Cauble EVP & CFO 602714 0 0 0 20742 0 18525 0 21168 0 663149 0 0 0 Robert Lane MD EVP & Physician-in-Chief 543037 0 0 0 80062 0 0 0 18369 0 641468 0 0 0 Robin Foster JD EVP, General Counsel; Start 1/31/21 539290 0 0 0 37357 0 25650 0 21168 0 623465 0 0 0 Robert Steele MD EVP & Chief Strategy/Innovation Off. 553346 0 0 0 35660 0 0 0 21168 0 610174 0 0 0 Jodi Coombs MBA BSN RN EVP & COO 503665 0 0 0 49175 0 0 0 9660 0 562500 0 0 0 Laura Fitzmaurice MD Director; End 12/31/20 436876 0 1000 0 11183 0 25650 0 19465 0 494174 0 0 0 Charles Roberts MD EVP & Exec.Med Director; End 8/17/19 0 0 0 0 418948 0 0 0 0 0 418948 0 0 0 Douglas Swanson MD Director; Start 1/1/21 207387 0 10441 0 20413 0 20248 0 20241 0 278730 0 0 0 Randall L O'Donnell PhD Former President & CEO; End 9/1/18 0 0 0 0 183333 0 0 0 0 0 183333 0 18937 0 Part I, Line 1a Gross-up payments were provided to two officers. These payments were treated as taxable income to the listed persons. Part I, Lines 4a-b Included in the compensation of Walter Andrews is $639,638 of severance following termination of employment. Included in the compensation of Charles Roberts is $418,948 of severance following termination of employment. Included in the compensation of Randall O'Donnell is $183,333 of severance, $18,937 of which was accrued and reported as deferred compensation in prior years. The amount is a payment from the Plan representing the value no longer subject to substantial risk of forfeiture. Part I, Line 6 A portion of the total cash compensation paid to the President/CEO and all Executive Vice Presidents is determined by a performance based plan approved by the Compensation Committee of the Board of Directors. The plan includes Hospital and individual performance goals, one component of which is based in part on net earnings. A Health and Educational Facilities Authority of the State of Missouri 431178966 60637ALX8 2016-10-13 148207195 see Part VI 0 0 0 B Health and Educational Facilities Authority of the State of Missouri 431178966 60637AMM1 2017-12-20 131226503 see Part VI 0 0 0 C Health and Educational Facilities Authority of the State of Missouri 431178966 000000000 2019-02-28 17940000 see Part VI 0 0 0 D Health and Educational Facilities Authority of the State of Missouri 431178966 000000000 2019-02-28 24750000 see Part VI 0 0 0 A 5655000 148207195 638217 147568978 0 1 1 1 B 133764094 1224610 132404922 134562 0 0 0 1 C 8136200 17940000 17940000 1 0 1 1 D 24750000 24750000 1 0 1 1 A 0 0 1 1 1 1 0 0 1 B 0 0 1 1 1 1 0 0 1 C 0 0 1 1 1 1 0 0 1 D 0 0 1 1 1 1 0 0 1 A 0 1 0 1 0 0 0 0 1 B 0 1 0 1 0 0 0 0 1 C 0 1 1 1 1 0 0 0 1 D 0 1 1 1 1 0 0 0 1 A 1 B 1 C 1 D 1 Schedule K, Part I, Line A, Column (f) Description of Purpose- The Series 2016 Bonds were issued to refinance a portion of the outstanding Series 2009 Bonds (issued Nov. 19, 2009). Schedule K, Part I, Line B, Column (f) Description of Purpose- The Series 2017A Bonds were issued to construct and equip a professional office building and a research institute for the Corporation. Schedule K, Part I, Line C, Column (f) Description of Purpose- The Series 2019A Bonds were issued to refinance 2008A/B Bonds and remaining portion of 2009 Bonds. Schedule K, Part I, Line D, Column (f) Description of Purpose- The Series 2019B Bonds were issued to refinance 2008A/B Bonds and remaining portion of 2009 Bonds. Schedule K, Part II, Line 3, Column B Total Proceeds- Difference between issue price and total proceeds of the Series 2017A Bonds represent $2,537,591 of investment proceeds. Schedule K, Part II, Line 11, Column A Other Spent Proceeds- $147,568,978 of Bond proceeds was used to establish a refunding escrow to refinance a portion of the outstanding Series 2009 Bonds. Schedule K, Part II, Line 11, Column C Other Spent Proceeds- $17,940,000 of Bond proceeds were used to refund the series 2008A/B and 2009 Bonds. Schedule K, Part II, Line 11, Column D Other Spent Proceeds- $24,750,000 of Bond proceeds was used to refund the series 2008A/B and 2009 Bonds. Schedule K, Part II, Line 13, Column A Date of Substantial Completion- The Series 2016 Bonds were issued to refinance the Series 2009 Bonds, and therefore, there were no "new-money" projects financed by the Series 2016 Bonds. Schedule K, Part II, Line 13, Column B Date of Substantial Completion- The projects financed by the Series 2017A Bonds have not yet been completed. Schedule K, Part II, Line 13, Column C Date of Substantial Completion- The Series 2019A Bonds were issued to refinance the Series 2008A/B and 2009 Bonds, and therefore, there were no "new-money" projects financed by the Series 2019A Bonds. Schedule K, Part II, Line 13, Column D Date of Substantial Completion- The Series 2019B Bonds were issued to refinance the Series 2008A/B and 2009 Bonds, and therefore, there were no "new-money" projects financed by the Series 2019B Bonds. John Barth Son of Director Kevin Barth 53091 Employment 0 Francesca Barth Daughter-in-law of Director Kevin Barth 56727 Employment 0 Chandra Swanson Daughter of Director Douglas Swanson 74292 Employment 0 Substantial Contributor Substantial Contributor 4611057 Payment for FMV of Services Provided 0 Substantial Contributor Substantial Contributor 2544242 Payment for FMV of Services Provided 0 Substantial Contributor Substantial Contributor 1194656 Payment for FMV of Services Provided 0 Substantial Contributor Substantial Contributor 5543193 Payment for FMV of Services Provided 0 Substantial Contributor Substantial Contributor 2183984 Payment for FMV of Services Provided 0 Substantial Contributor Substantial Contributor 11424942 Payment for FMV of Services Provided 0 X 5 2875 FMV X 1 33135 FMV X 27 194788 FMV X 7 4165 FMV X 16 34790 FMV X Miscellaneous 13 290660 FMV X Jewelry 2 1000 FMV 0 0 1 0 Part I, Column (b): The amounts in Part I, Column (b) represent the number of contributions received during the taxable year. Form 990, Part VI, Section B, line 11b The final Form 990, including all required schedules, was provided to each voting member of the Board of Directors prior to its filing with the IRS. Form 990, Part VI, Section B, line 12c Corporate compliance reviews all potential conflicts disclosed, and reviews and approves completion of the related management plan. Form 990, Part VI, Section B, line 15 The People and Compensation Committee of the Board of Directors (the "Committee") is responsible for approving the compensation of the CEO and, based on the CEO's recommendation, the compensation of the Executive Vice Presidents ("EVPs"). The Committee's deliberations and approvals of such compensation are documented in the minutes of the Committee's meetings. The Committee is composed of independent directors who receive no compensation for their service on the Board of Directors. The Committee engages an independent consulting firm, with expertise and experience in analysis of compensation of not-for-profit hospital executives (including review and application of market data), to advise the Committee with regard to compensation of the CEO and the EVPs. The consulting firm provides an opinion to the Committee regarding the reasonableness of such compensation, which is maintained in the Committee's records. Form 990, Part VI, Section C, line 19 The organization's governing documents, conflict of interest policy, and audited financial statements are available upon request. Form 990, Part IX, line 11g Other Fees: Program service expenses 88,244,638. Management and general expenses 88,817,208. Fundraising expenses 524,827. Total expenses 177,586,673. Form 990, Part XI, line 9: Change in benefit obligation 120,799. Change in interest rate swap valuation 2,743,042. Net Unrealized Change in Income Beneficiary and Charitable Remainder Trusts 9,269,709. Net Assets Released from Restriction for Use in Operations -1,494,765. Unrealized Loss on Equity Investments 194,358,913. CMH Insurance Company LLC 2401 Gillham Road Kansas City MO 64108 Insurance for The Children's Mercy Hospital MO -5587 13985304 The Children's Mercy Hospital Physician Business Partners LLC 2401 Gillham Road Kansas City MO 64108 Physician network for education and purchasing MO The Children's Mercy Hospital Children's Research Institute LLC 2401 Gillham Road Kansas City MO 64108 Supports research activities of The Children's Mercy Hospital MO The Children's Mercy Hospital Children's Mercy Hospital Foundation 2401 Gillham Road Kansas City MO 64108 431564302 Investment management to benefit Children's Mercy Hospital MO 501(C)(3) line 11, III-NFI N/A 0 Children's Mercy's Family Health Partners Inc 2420 Pershing Kansas City MO 64108 431726517 Integrated health insurance benefits care system MO 501(C)(3) line 9 The Children's Mercy Hospital 1 Children's Mercy Hospital Self-Insurance Trust Commerce Trust Co PO Box 419248 Kansas City MO 64141 436231807 Providing funds for malpractice claims against CMH & employees MO 501(C)(3) line 11, I The Children's Mercy Hospital 1 Children's Mercy Integrated Care Solutions Inc 2401 Gillham Road Kansas City MO 64108 453741386 Coordinates medical care of pediatric patients KS The Children's Mercy Hospital C 64916232 1.00000 1 Children's Mercy- Pediatric Associates Inc 4400 Broadway Suite 206 Kansas City MO 64111 814659989 Medical Practice KS The Children's Mercy Hospital C -5661 2252564 1.00000 1 Children's Mercy- Pediatric Care Specialists Inc 12541 Foster St Suite 260 Overland Park KS 66213 814753049 Medical Practice KS The Children's Mercy Hospital C 7416 1382063 1.00000 1 Children's Mercy- Pediatric Care North Inc 8781 N Platte Purchase Drive Kansas City MO 64155 815020009 Medical Practice KS The Children's Mercy Hospital C -8644 943853 1.00000 1 Children's Mercy- Johnson County Pediatrics Inc 8800 West 75th St Suite 220 Shawnee Mission KS 66204 320505028 Medical Practice KS The Children's Mercy Hospital C 14282 784620 1.00000 1 Children's Mercy- Preferred Pediatrics Inc 241 NW McNary Ct Lees Summit MO 64081 821130197 Medical Practice KS The Children's Mercy Hospital C -118924 609479 1.00000 1 Children's Mercy- Cass County Pediatrics and Adolescents Inc 503 N Scott Belton MO 64012 820881485 Medical Practice KS The Children's Mercy Hospital C -74464 189515 1.00000 1 Children's Mercy- Cradle Thru College Care Inc 1004 Carondelet Dr Suite 30 Kansas City MO 64114 822804086 Medical Practice KS The Children's Mercy Hospital C 243872 440485 1.00000 1 Children's Mercy- Redwood Pediatrics Inc 9151 NE 81st Ter Suite 240 Kansas City MO 64158 822564241 Medical Practice KS The Children's Mercy Hospital C 3313 409093 1.00000 1 Children's Mercy- Summit Pediatrics and Adolescent Medicine Inc 3171 E Carnegie Dr ST A Lees Summit MO 64064 824082519 Medical Practice KS The Children's Mercy Hospital C -7920 846418 1.00000 1 Children's Mercy- Shawnee Mission Pediatrics Inc 7450 Kessler St Suite 105 Merriam KS 66204 841836624 Medical Practice KS The Children's Mercy Hospital C 8752 1640296 1.00000 1 Children's Mercy- Health Care for Children Inc 9051 NE 81st Terrace Suite 100 Kansas City MO 64158 841845668 Medical Practice KS The Children's Mercy Hospital C 13662 445943 1.00000 1 Children's Mercy- Leawood Pediatrics Inc 5401 College Blvd Suite 101 Leawood KS 66211 842411195 Medical Practice KS The Children's Mercy Hospital C 789362 1.00000 1 Children's Mercy- Cockerell and McIntosh Pediatrics Inc 1203 SW State Route 7 Blue Springs MO 64014 844455782 Medical Practice KS The Children's Mercy Hospital C -202201 952207 1.00000 1 Children's Mercy- Community Choice Pediatrics Inc 1425 NW Blue Parkway Lees Summit MO 64086 851139290 Medical Practice KS The Children's Mercy Hospital C 2766 2081741 1.00000 1 Income Beneficiary Trusts(5) Trust MO N/A T 0 1 0 1 1 1 0 0 0 0 1 0 1 0 0 1 1 1 0 1 Children's Mercy Integrated Care Solutions O 6094436 Book Children's Mercy Integrated Care Solutions J 303554 Book Children's Mercy Integrated Care Solutions L 1148288 Book Children's Mercy Integrated Care Solutions P 374302 Book Children's Mercy Integrated Care Solutions Q 26201 Book Children's Mercy Integrated Care Solutions S 194757779 Book Children's Mercy- Pediatric Associates Inc D 200000 Book Children's Mercy- Cass County Pediatrics and Adolescents Inc D 17000 Book Children's Mercy- Cradle thru College Care Inc D 95000 Book Children's Mercy- Cockerell & McIntosh Pediatrics Inc D 650000 Book Children's Mercy- Community Choice Pediatrics Inc D 950000 Book Book Children's Mercy- Pediatric Associates Inc A 4200 Book Children's Mercy- Cass County Pediatrics and Adolescents Inc A 3757 Book Children's Mercy- Cradle thru College Care Inc A 2049 Book Children's Mercy- Shawnee Mission Pediatrics Inc A 2041 Book Children's Mercy- Health Care for Children Inc A 3235 Book Children's Mercy- Leawood Pediatrics Inc A 9593 Book Children's Mercy- Cockerell & McIntosh Pediatrics Inc A 18699 Book Children's Mercy- Community Choice Pediatrics Inc A 26608 Book