2021-01-25T16:49:55-06:00 2020-06-30 300038643 VARNEY & ASSOCIATES CPAS LLC 1501 POYNTZ AVENUE MANHATTAN KS 665026092 990 2019-07-01 481152279 MERCY COMMUNITY HEALTH FOUNDATION INC MERC 7855875462 PO BOX 13 MANHATTAN KS 665050013 DAVE ROGERS TREASURER 7855875462 2020-12-14 1 TAMMY M BRYANT P00733332 7855372202 2019 2022-09-23 18:48:47Z DAVE ROGERS PO BOX 13 MANHATTAN KS 665050013 390416 0 X WWW.MERCYFDN.ORG X 1994 KS TO RAISE FUNDS IN SUPPORT OF VIA CHRISTI HOSPITAL IN MANHATTAN, KANSAS AND ITS PROGRAMS. 14 14 0 16 0 0 201170 133302 0 0 51950 134802 -26307 58520 226813 326624 606366 62289 0 0 0 0 0 0 0 50861 81950 657227 144239 -430414 182385 4708101 4926846 0 207 4708101 4926639 X TO PROMOTE HEALTH IN THE MANHATTAN, KANSAS COMMUNITY AND THE SURROUNDING AREAS IN A MANNER NOT INCONSISTENT WITH THE MISSION OF VIA CHRISTI HOSPITAL OF MANHATTAN, KANSAS BYDEVELOPING AND MAINTAINING INITIATIVES IN PRIVATE FUNDRAISING, FINANCIAL MANAGEMENT, ANDVOLUNTEERISM. 0 0 113538 62289 SINCE 1994 MERCY COMMUNITY HEALTH FOUNDATION, A NON-PROFIT SUPPORTING ORGANIZATION FOR ASCENSION VIA CHRISTI MANHATTAN, HAS BEEN RAISING SUPPORT TO FOSTER GROWTH, EXPANSION, AND IMPROVEMENTS OF LOCAL HEALTHCARE. IN RECENT YEARS, OUR PRIMARY EMPHASIS HAS BEEN UPGRADES AND INSTALLATION OF STATE-OF-THE-ART EQUIPMENT TO ENSURE OUR PHYSICIANS AND CLINICIANS HAVE THE FINEST AND LATEST TECHNOLOGY TO CARE FOR OUR PATIENTS' HEALTHCARE NEEDS. OTHER PROGRAMS AND EQUIPMENT SUPPORTED IN FY 2020 INCLUDE: VENTILATORS PRIMARILY FOR COVID 19 PATIENTS, PRESCRIPTION ASSISTANCE FOR UNINSURED OR UNDERINSURED PATIENTS, EMERGENCY HARDSHIP ASSISTANCE FOR EMPLOYEES, SLEEP SACKS FOR NEWBORNS, A CAR SIMULATOR FOR PHYSICAL THERAPY PATIENTS, AND CONTINUING EDUCATION ASSISTANCE FOR EMPLOYEES. 113538 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 1 2 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 X 14 14 1 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X CHRISTINA ROCKHOLD 7855875462 1823 COLLEGE AVE MANHATTAN KS 66502 DAVID PAULS MD CHAIR 1.00 X X 0 0 0 DAN MESSELT VICE CHAIR 0.25 X X 0 0 0 DAVID ROGERS TREASURER 2.00 X X 0 0 0 MARK KNACKENDOFFEL TRUSTEE 0.25 X 0 0 0 KAREN BROKENICKY TRUSTEE 0.25 X 0 0 0 RANDALL ANDERES TRUSTEE 0.25 X 0 0 0 RICHARD BAKER MD TRUSTEE 0.25 X 0 0 0 TOM BARTH DDS TRUSTEE 0.25 X 0 0 0 ANDREW ELLIS TRUSTEE 0.25 X 0 0 0 MARK DUFF MD TRUSTEE 0.25 X 0 0 0 RUTH DYER PHD TRUSTEE 0.25 X 0 0 0 MARK GROS MD TRUSTEE 0.25 X 0 0 0 EILEEN HINKIN TRUSTEE 0.25 X 0 0 0 MARK HUNGERFORD DDS TRUSTEE 0.25 X 0 0 0 CHRISTINA ROCKHOLD EXECUTIVE DIRECTOR 40.00 X 0 74713 16457 0 74713 16457 0 0 0 0 0 23511 35738 74053 46099 133302 110789 110789 24013 0 24013 24013 24013 122312 23511 63792 58520 58520 326624 24013 0 169309 27397 27397 34892 34892 13200 13200 14469 14469 14131 11099 3032 PROGRAM - UNRESTRICTED 36141 36141 DONOR APPRECIATION 3134 3134 PROGRAM - PAINTER FUND 440 440 MEMBERSHIPS DUES 245 245 190 190 144239 113538 30701 0 21108 47771 4686993 4879075 4708101 4926846 207 0 207 X 333810 558608 4374291 4368031 4708101 4926639 4708101 4926846 182385 36153 0 X 0 0 0 X 280610 148501 355058 201170 133302 1118641 280610 148501 355058 201170 133302 1118641 15607 1103034 123413 110672 93732 103900 110789 542506 58520 58520 1719667 0.64140 0.68670 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1072957 36247 14247 3231 1091726 1063788 32300 20000 3131 1072957 996012 70921 3145 1063788 909575 89275 2838 996012 922775 -662 9850 2688 909575 0 0 0 UNRESTRICTED FUNDS 711388 C CAPITAL CAMPAIGN AND OTHERS 2126292 C WITHEE GIFT ANNUNITY 9982 C RICKEL LIBRARY FUND 77166 C SCHOLARSHIP ENDOWMENT FUND 810930 C AUXILIARY EXPENDABLE FUND 119988 C PAINTER TRUST - PERM RESTRD 686540 C PAINTER TRUST - TEMP RESTRD 20568 C ENDOWMENT FUND 280796 C MANHATTAN COMMUNITY FOUNDATION 35425 C 4879075 PART V, LINE 4: THE FUNDS ARE USED FOR SCHOLARSHIP DISTRIBUTIONS. CRYSTAL GALA 109359 13768 95591 5136 23468 3763 3654 4941 GOLF TOURNAMENT 31441 9568 21873 18 16078 196 2006 1 5023 175 4848 85 399 4048 145823 23511 122312 5239 39945 3959 3654 10995 63792 58520 0 ASCENSION VIA CHRISTI HOSPITAL MANHATTAN INC 1823 COLLEGE AVE MANHATTAN KS 66502 481186704 501C(3) 27397 PAYMENT FOR CAR SIMULATOR, 3D MAMMOGRAPHY EQUIPMENT, AND BLOOD PRESSURE MONTIOR 1 EMPLOYEES EDUCATION ASSISTANCE, SCHOLARSHIPS, AND ASSISTANCE WITH PATIENT EXPENSES SUCH AS PRESCRIPTION COST AND NEWSPAPERS PROVIDED TO ROOMS 748 34892 CASH PAID PART I, LINE 2: MERCY COMMUNITY HEALTH FOUNDATION, INC. DOES NOT SOLICIT GRANT APPLICATIONS FROM ORGANIZATIONS TO WHICH IT PROVIDES ASSISTANCE. THE FOUNDATION PROVIDES ASSISTANCE TO CERTAIN ORGANIZATIONS LISTED IN SCHEDULE I BASED ON EMPLOYEE PAYROLL CONTRIBUTIONS; THE INDIVIDUAL CONTRIBUTIONS ARE FORWARDED TO THE ORGANIZATION AS SOON AS THE FUNDS ARE RECEIVED. 0 1 0 0 0 0 0 0 0 PART I, LINE 3 THE ORGANIZATION DOES NOT COMPENSATE THE TOP MANAGEMENT OFFICIAL FOR THEIR ROLE AS SENIOR ADMINISTRATOR OF THE ORGANIZATION. HOWEVER, IF THEY DID, THIS PERSON'S SALARY WOULD BE SET USING THE FOLLOWING POLICIES ESTABLISHED BY VIA CHRISTI HEALTH, INC., A RELATED ORGANIZATION: - COMPENSATION COMMITTEE, - INDEPENDENT COMPENSATION CONSULTANT, - COMPENSATION SURVEY OR STUDY, AND - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINE 4B ELIGIBLE EXECUTIVES PARTICIPATE IN A PROGRAM THAT PROVIDES FOR SUPPLEMENTAL RETIREMENT BENEFITS. THE PAYMENT OF BENEFITS UNDER THE PROGRAM, IF ANY, IS ENTIRELY DEPENDENT UPON THE FACTS AND CIRCUMSTANCES UNDER WHICH THE EXECUTIVE TERMINATES EMPLOYMENT WITH THE ORGANIZATION. BENEFITS UNDER THE PROGRAM ARE FUNDED ANNUALLY BASED ON PARTICIPATION AND ARE NOT VESTED UNTIL THE 5 YEAR SERVICE REQUIREMENT IS REACHED. DUE TO THE SUBSTANTIAL RISK OF FORFEITURE PROVISION, THERE IS NO GUARANTEE THAT THESE EXECUTIVES WILL EVER RECEIVE ANY BENEFIT UNDER THE PROGRAM. THE AMOUNT FUNDED ANNUALLY UNDER THE PROGRAM TO THE EXECUTIVES IS REPORTED AS COMPENSATION ON FORM 990 SCHEDULE J, PART II, COLUMN B IN THE YEAR FUNDED, THE AMOUNT ULTIMATELY PAID UNDER THE PROGRAM TO EXECUTIVES IS REPORTED ON FORM 990 SCHEDULE J, PART II, COLUMN F. THERE WERE NO DISTRIBUTIONS FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN DURING THE YEAR. X PPE/COVID SUPPLIES 83 35735 COST X AUCTION ITEMS 29 10361 COST 0 0 0 FORM 990, PART VI, SECTION A, LINE 2 MANY OF THE PERSONS LISTED ON PART VII HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTUE OF SITTING ON RELATED VIA CHRISTI HEALTH, INC. ENTITY BOARDS. - BUSINESS RELATIONSHIP FORM 990, PART VI, SECTION A, LINE 6 MERCY COMMUNITY HEALTH FOUNDATION, INC. HAS A SINGLE CORPORATE MEMBER, VIA CHRISTI HOSPITAL MANHATTAN, INC. FORM 990, PART VI, SECTION A, LINE 7A MERCY COMMUNITY HEALTH FOUNDATION, INC. HAS A SINGLE CORPORATE MEMBER, VIA CHRISTI HOSPITAL MANHATTAN, INC, WHO HAS THE RESERVE POWER TO APPROVE TWO OF THE NOMINEES AND REMOVE THESE TWO MEMBERS OF THE BOARD OF TRUSTEES OF MERCY COMMUNITY HEALTH FOUNDATION, INC. FORM 990, PART VI, SECTION B, LINE 11B MANAGEMENT, INCLUDING CERTAIN OFFICERS, WORK DILIGENTLY TO COMPLETE THE FORM 990 AND ATTACHED SCHEDULES IN THROUGH MANNER, PRIOR TO FILING THE RETURN, ALL BOARD MEMBERS ARE PROVIDED THE FORM 990 AND MANAGEMENT TEAM MEMBERS ARE AVAILABLE TO ANSWER ANY BOARD MEMBERS' QUESTIONS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION'S CONFLICT OF INTEREST POLICY IS MONITORED AS PART OF THE SYSTEM-WIDE PROCEDURES OF VIA CHRISTI HEALTH, INC. AND NOT AT THE ORGANIZATIONAL LEVEL. THE SYSTEM-WIDE PROCEDURES ARE AS FOLLOWS: 1 - AT TIME OF APPOINTMENT AND ANNUALLY THEREAFTER, ALL INTERESTED PERSONS, INCLUDING BOARD AND COMMITTEE MEMBERS, COMPLETE A DISCLOSURE STATEMENT WHICH ADDRESSES ACTUAL OR POTENTIAL CONFLICTS OF INTEREST; 2 - THE DISCLOSURE STATEMENT IS DONE ELECTRONICALLY AND THE RETURN OF THE COMPLETED STATEMENT IS A CONDITION OF CONTINUED APPOINTMENT, EMPLOYMENT, OR PARTICIPATION WITH THE ORGANIZATION; 3 - ALL ACTUAL OR POTENTIAL CONFLICTS ARE REVIEWED, INVESTIGATED, AND RESOLVED BY THE CHIEF GOVERNANCE OFFICER AND THE CORPORATE RESPONSIBILITY OFFICER, WITH THE RESULTS SHARED WITH THE CHIEF EXECUTIVE OF THE ORGANIZATION; AND 4 - PERIODIC REVIEWS ARE CONDUCTED BY GOVERNANCE, COMPLIANCE, AND INTERNAL AUDIT TO ENSURE THE ORGANIZATION IS OPERATING CONSISTENT WITH THE POLICY AND ENFORCING THE POLICY'S TERMS. FORM 990, PART VI, SECTION B, LINE 15 MERCY COMMUNITY HEALTH FOUNDATION USES THE POLICIES ESTABLISHED BY VIA CHRISTI HEALTH, INC. (VCH). VCH HAS ESTABLISHED A COMMON PHILOSOPHY, STRATEGY, AND PROCESSES FOR EXECUTIVE COMPENSATION. THROUGH THE OVERSIGHT OF THE VCH EXECUTIVE COMPENSATION COMMITTEE, EXECUTIVE COMPENSATION IS COMPETITIVELY POSITIONED AT ITS STATED MARKET POSITION WHEN COMPARED TO THE COMPENSATION PAID BY RELEVANT ORGANIZATIONS (COMPARABLY-SIZED HEALTH SYSTEMS, HOSPITALS, AND LONG-TERM CARE PROVIDERS). VCH RECOGNIZES ITS RESPONSIBILITY TO ENSURE THAT ITS EXECUTIVE COMPENSATION PROGRAM IS APPROPRIATE IN VIEW OF ITS MISSION AND TAX EXEMPT STATUS AND THAT ITS COMPENSATION LEVELS AND EXPENDITURES ARE REASONABLE AND NOT EXCESSIVE. TO ENSURE THESE ENDS, THE VCH EXECUTIVE COMPENSATION COMMITTEE HAS ESTABLISHED AND APPROVED THE EXECUTIVE COMPENSATION PHILOSOPHY FOR VCH AND ALL RELATED ENTITIES. IT WILL ALSO APPROVE ALL CHANGES IN THE COMPENSATION PACKAGE FOR VCH EXECUTIVES IN ADVANCE. ON AN ANNUAL BASIS, THE COMMITTEE CONDUCTS A COMPREHENSIVE REVIEW OF TOTAL COMPENSATION FOR ALL EXECUTIVES. IT ALSO REVIEWS AND APPROVES "OFF-CYCLE" COMPENSATION TRANSACTIONS AS NEEDED. IN THEIR REVIEW, THE COMMITTEE CONSIDERS THE FOLLOWING FACTORS: - MARKET DATA FROM INDEPENDENT COMPENSATION SURVEYS AND SOURCES THAT REFLECT COMPARABLE POSITIONS IN ORGANIZATIONS OF SIMILAR SIZE AND SCOPE; - DIFFICULTIES IN RECRUITING AND RETAINING EXECUTIVES; - SKILLS, EXPERIENCE AND PERFORMANCE HISTORY OF INDIVIDUAL EXECUTIVES; - CRITICAL BUSINESS OR STRATEGIC ISSUES THAT THE ORGANIZATION MAY FACE; AND - MARKET POSITION FOR TOTAL COMPENSATION. THE ADEQUACY, COMPETITIVENESS, AND COST OF THE VCH TOTAL EXECUTIVE COMPENSATION PROGRAM ARE REVIEWED ON AN ONGOING BASIS AND CHANGES ARE MADE AS THE COMMITTEE DETERMINES APPROPRIATE. THE EXECUTIVE COMPENSATION PROGRAM WILL BE MAINTAINED SUCH THAT IT WILL FALL WITHIN THE SAFE HARBOR GUIDELINES ESTABLISHED BY THE INTERMEDIATE SANCTIONS REGULATIONS. THE COMMITTEE ALSO EMPLOYS THE SERVICES OF AN INDEPENDENT COMPENSATION CONSULTANT TO PREPARE MARKET ANALYSIS TO AID AND SUPPORT THE COMMITTEE'S ACTIONS, PROVIDE DOCUMENTATION OF MARKET TRENDS FOR BUDGET SETTING PURPOSES, REVIEW ANNUAL COMPENSATION CHANGES TO ENSURE "REASONABLENESS AND PROVIDE ATTESTATION, AND PROVIDE CONSULTATION ON ALL EXECUTIVE COMPENSATION ISSUES. THE COMMITTEE ALSO RELIES ON THIRD-PARTY VALIDATION OF PERFORMANCE MEASURES USED IN THE DETERMINATION OF COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE AVAILABLE UPON REQUEST. VIA CHRISTI HEALTH INC 8200 E THORN DRIVE SUITE 300 WICHITA KS 67226 481172107 HEALTH SYSTEM PARENT KS 501(C)(3) LINE 12D, III-O ASCENSION HEALTH ALLIANCE 0 VIA CHRISTI HOSPITAL MANHATTAN INC 1823 COLLEGE AVENUE MANHATTAN KS 66502 481186704 HOSPITAL KS 501(C)(3) LINE 3 VIA CHRISTI HEALTH INC 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0