2025-07-25T10:57:52+00:00 2024-09-30 440160260 Forvis Mazars LLP 1551 N Waterfront Pkwy Ste 300 Wichita KS 672066601 990 2023-10-01 480663711 Mercy Hospital Inc MERC 6203456391 PO Box 180 Moundridge KS 671070180 AARON J HERBEL ADMINISTRATOR AND CFO 6203456391 2025-07-25 true true Kevin Ensminger P01310558 3162652811 2025-07-25 2023 2025-03-06 01:10:19Z AARON J HERBEL 218 E PACK ST MOUNDRIDGE KS 67107 6484717 false 1971 X WWW.MERCYH.ORG X 1945 KS TO MEET THE HEALTHCARE NEEDS OF THOSE LIVING IN MOUNDRIDGE, KANSAS AND SURROUNDING RURAL AREAS REGARDLESS OF AGE, RACE, ETHNICITY, OR ECONOMIC STATUS. OUR MISSION STATEMENT IS "BY LOVE SERVE ONE ANOTHER." 12 12 95 20 0 0 1740379 962325 3358737 5468970 0 8 44260 53288 5143376 6484591 16000 6000 0 0 3391612 3942232 0 0 5307 2240522 2751572 5648134 6699804 -504758 -215213 3899711 4170641 1973120 2459263 1926591 1711378 X TO PROVIDE HEALTH CARE SERVICES TO PERSONS IN MOUNDRIDGE, KANSAS AND THE SURROUNDING RURAL AREAS. WE, THE STAFF AT MERCY BELIEVE THAT PAUL'S INJUNCTION: BY LOVE SERVE ONE ANOTHER, SHOULD BE THE BASIS OF OUR SERVICE HERE. false true 5244438 6000 5505281 MERCY HOSPITAL, INC., HAS CONTINUED TO SERVE THE MOUNDRIDGE COMMUNITY SINCE 1944. WITH THE CONVERSION TO A RURAL EMERGENCY HOSPITAL (REH) ON 1-1-2024, MERCY HOSPITAL PROVIDES 24-7 EMERGENCY ROOM CARE, OBSERVATION SERVICES, OUTPATIENT LAB, RADIOLOGY, AND SURGERY, OUTPATIENT PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPY, AND OUTPATIENT INFUSION SERVICES. OUR MEDICAL STAFF CONSISTS OF SEVEN FAMILY-PRACTICE PHYSICIANS, FIVE APRNS AND FOUR PHYSICIAN ASSISTANTS. THE FOLLOWING STATISTICS ARE OFFERED FOR THE FISCAL YEAR ENDING 9-30-2024: 27 MEDICARE, MEDICAID, AND MEDICARE ADVANTAGE ADMISSIONS AND 29 DISMISSALS (ALL PRIOR TO 12-31-23); SWING BED DAYS - 823; EKGS PERFORMED - 254; OUTPATIENT THERAPY - 5,780 INSTANCES OF SERVICE; ER VISITS - 840; OBSERVATION ENCOUNTERS - 57; OUTPATIENT SURGICAL PROCEDURES - 108, OUTPATIENT LAB ENCOUNTERS - 4,821. 5244438 true true false true false false false false false true false false false false false false false false false false false false false false false true true false true false false false false false false false true false false false false false false true false false false true 13 0 true 95 true false false false false false false false false false false false false X 12 12 true false true false true true true true true false false true true true true true false true true false X AARON HERBEL 6203456391 218 E PACK ST MOUNDRIDGE KS 67107 DAVID LITWILLER BOARD CHAIR 3.0 0 X X 0 0 0 STEVE JOHNSON BOARD SECRETARY/TREASURER 3.0 0 X X 0 0 0 WAYLAN WIGGERS ASSISTANT BOARD CHAIR 2.0 0 X X 0 0 0 DAVID BECKER DIRECTOR 1.0 0 X 0 0 0 DONAVON LEE KOEHN DIRECTOR 1.0 0 X 0 0 0 DOYLE WIEBE DIRECTOR 1.0 0 X 0 0 0 KENDEL KOEHN DIRECTOR 1.0 0 X 0 0 0 LONNIE UNRUH DIRECTOR 1.0 0 X 0 0 0 MERLE ENSZ DIRECTOR 1.0 0 X 0 0 0 MERRILL YOST DIRECTOR 1.0 0 X 0 0 0 TERRY ISAAC DIRECTOR 1.0 0 X 0 0 0 VINCE KOEHN DIRECTOR 1.0 0 X 0 0 0 AARON J HERBEL ADMINISTRATOR 40.0 0 X 90702 0 8866 BENJAMIN R KIMBALL PA-C, EMERGENCY 40.0 0 X 108406 0 8488 ROBERT H WILGERS RADIOLOGY DIRECTOR 40.0 0 X 136678 0 13030 335786 0 30384 2 false false false REVIVE THERAPY AND PERFORMANCE 506 WEDGEWOOD CT HESSTON KS 67062 OUTPATIENT THERAPY SERVICES 582600 GREAT PLAINS HEALTH ALLIANCE 250 NORTH ROCK ROAD WICHITA KS 67206 MEDICAL RECORDS 292198 WADEL NP LLC 17400 SW 110 AVE ZENDA KS 67159 CONTRACT APRN ER COVERAGE 136663 CASCADE HEALTH SERVICES 1001 NW BARRY RD KANSAS CITY MO 64155 CONTRACT NURSING SERVICES 129028 WESTERMAN NP LLC 13514 SW 175TH ST NASHVILLE KS 67112 CONTRACT APRN ER COVERAGE 123906 7 331000 427877 203448 962325 NET PATIENT SERVICE REVENUE 621493 5468970 5468970 0 0 0 0 5468970 8 8 933 933 35850 126 35724 0 35724 35724 0 0 EMPLOYEE/GUEST MEALS 722514 15154 15154 VENDING MACHINE INCOME 900099 890 890 MEDICAL RECORD FEES 621300 587 587 0 0 0 0 16631 6484591 5505281 0 16985 X 6000 6000 0 0 106141 5307 95527 5307 15784 15784 3360840 2872783 488057 48667 35331 13336 169711 147333 22378 241089 205900 35189 104680 104680 10946 10946 895921 883545 12376 0 45132 45132 526885 26574 500311 144883 84162 60721 1126 741 385 8374 8374 388300 388300 53956 39329 14627 MEDICAL SUPPLIES 408818 408818 FOOD/DIETARY SUPPLIES 67361 67361 EQUIPMENT RENTAL/MAINTENANCE 64387 64219 168 MISCELLANEOUS 30803 361 30442 0 0 0 0 6699804 5244438 1450059 5307 45746 37969 650946 1255950 0 0 0 0 204783 208752 20218 24124 7075843 4433824 2976191 2642019 0 1827 1827 0 0 3899711 4170641 642755 357215 0 0 1330365 2102048 0 0 1973120 2459263 X 1907480 1707870 19111 3508 1926591 1711378 3899711 4170641 -215213 0 X true X false true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false true 5733 true 2778 true 1189 false true 0 false true 1246 10946 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY Lobbying activities reported on Part II-B include the following: Lines 1c, 1d, 1e: Mercy Hospital worked together with the other three hospitals in the county to renew a sales tax that benefited all three organizations. The hard costs in lines 1c through 1e were related to media and materials to educate the public about the sales tax and its benefits to the hospitals. Line 1g: Direct contact with legislators is due to presence at KHA-sponsored events. No funds were expended expressly for the purpose of interacting with legislators. Line 1i: A portion of the KHA/AHA dues paid annually is used for lobbying purposes. AHA determined that the percentage of dues used for lobbying in 2023 was 39% and KHA indicated the percentage was 13.9% for their dues. This came to a total of $1,246 for the year. 69011 69011 4319885 2461964 1857921 0 0 0 2590728 1927958 662770 96219 43902 52317 2642019 Schedule D, Part X, Line 2 UNCERTAIN TAX POSITIONS MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. true true X true X false true true false true true 1 19 45022 0 45022 0.0067 1 367 321353 79942 241411 0.0360 0 0 0 0 0 0.0 2 386 366375 79942 286433 0.0428 2 3038 10143 0 10143 0.0015 0 0 0 0 0 0.0 2 698 2049231 579719 1469512 0.2193 0 0 0 0 0 0.0 0 0 0 0 0 0.0 4 3736 2059374 579719 1479655 0.2209 6 4122 2425749 659661 1766088 0.2636 1 0 152 0 152 0.0000 0 0 0 0 0 0.0 0 0 0 0 0 0.0 0 0 0 0 0 0.0 1 10 3115 0 3115 0.0005 1 0 654 0 654 0.0001 1 0 500 0 500 0.0001 0 0 0 0 0 0.0 0 0 0 0 0 0.0 4 10 4421 0 4421 0.0007 false 75906 35415 258567 1321910 -1063343 X true true 1 1 MERCY HOSPITAL INC 218 E PACK STREET MOUNDRIDGE KS 67107 WWW.MERCYH.ORG REH059003 X X X MERCY HOSPITAL INC 1 false false true X X X X X X X X X 21 true false true true X HTTPS://WWW.MERCYH.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ X true 22 true HTTPS://WWW.MERCYH.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ false true X 200.0 X X X X true true X X X true X WWW.MERCYH.ORG/FINANCIAL-ASSISTANCE/ X WWW.MERCYH.ORG/FINANCIAL-ASSISTANCE/ X WWW.MERCYH.ORG/FINANCIAL-ASSISTANCE/ X X X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 3E THE PATIENTS SERVED BY THE COMMUNITY WERE ACTIVELY INVOLVED IN SELECTING WHICH IDENTIFIED HEALTH NEEDS WOULD BE PRIORITIZED BY THE HOSPITAL IN 2022-2025. MERCY HOSPITAL IDENTIFIED WHICH NEEDS WERE ALREADY BEING MET BY OTHER HEALTHCARE ENTITIES AND PRIORITIZED THOSE NEEDS WHICH WE WERE UNIQUELY SITUATED TO BEST MEET. Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - MERCY HOSPITAL INC.. IN 2022, A JOINT COMMUNITY HEALTH NEEDS ASSESSMENT WAS PERFORMED WITH TWO OTHER AREA HOSPITALS, IN CONJUNCTION WITH THE COUNTY HEALTH DEPARTMENT. RESIDENTS WERE ASKED TO COMPLETE ONLINE OR PAPER SURVEYS REGARDING HEALTH CONCERNS AND OPPORTUNITIES. AFTER INITIAL HEALTH ISSUES WERE IDENTIFIED, A WORKGROUP WAS FORMED REPRESENTING A CROSS SECTION OF SURVEY RESPONDENTS ALONG WITH COMMUNITY HEALTH EXPERTS AND RESOURCES. THIS WORKGROUP PRIORITIZED THE ISSUES AFFECTING THE COMMUNITY USING PUBLIC HEALTH DATA TO CONFIRM ADDITIONAL FACTORS. MERCY HOSPITAL HOSTED A TOWN-HALL MEETING WITH COMMUNITY RESIDENTS AND TOWN LEADERS TO FURTHER DRILL DOWN INTO NEEDS AND SURVEY THE POPULATION. PHYSICIANS FROM THE CONTRIBUTING HOSPITALS, AS WELL AS THE COUNTY HEALTH DIRECTOR WERE IN ATTENDANCE, AND PROVIDED THEIR INSIGHT AND EXPERTISE. MEMBERS OF THE COMMUNITY, INCLUDING REPRESENTATIVES FROM COUNTY EMERGENCY SERVICES, DISABILITY SUPPORT AND SOCIAL PROGRAMS (INCLUDING THE COUNTY FOOD BANK) AS WELL AS OTHER INDIVIDUALS WERE ALSO IN ATTENDANCE AND CONTRIBUTED THEIR INPUT. FOLLOWING THE COUNTY-WIDE MEETING, MERCY HOSPITAL HOSTED A MOUNDRIDGE-SPECIFIC TOWN-HALL MEETING WITH MEMBERS OF OUR COMMUNITY TO DRILL INTO COMMUNITY-SPECIFIC DATA AND NEEDS. THE RESULTS OF BOTH OF THESE EFFORTS WERE USED TO COMPILE THE CHNA REPORT. THOSE IN ATTENDANCE AT THE TOWN-HALL INCLUDED CITY LEADERSHIP, SCHOOL DISTRICT LEADERSHIP, CITY EMS, LOCAL LTC LEADERS, COMMUNITY MEMBERS AT LARGE, HOSPITAL BOARD MEMBERS, HOSPITAL EXECUTIVES, COMMUNITY FOUNDATION BOARD MEMBERS, MOUNDRIDGE POLICE CHIEF, REPRESENTATIVES FROM THE FAITH-BASED COMMUNITY AND LOCAL COMMUNITY MENTAL HEALTH CENTER REPRESENTATIVES. ALL THIS INFORMATION WAS COMPILED INTO A REPORT WHICH HAS BEEN PUBLISHED ON OUR WEBSITE. MERCY HOSPITAL IDENTIFIED SOLUTIONS TO THESE IDENTIFIED HEALTH CONCERNS AND RELEASED A FACILITY-SPECIFIC IMPLEMENTATION PLAN, WHICH IS BEING CARRIED OUT STARTING IN 2023 THROUGH THE END OF 2025. ALL THESE DOCUMENTS ARE REVIEWED AND DISCUSSED WITH THE HOSPITAL'S PATIENT AND FAMILY ENGAGEMENT COMMITTEE PERIODICALLY. Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - MCPHERSON COUNTY PUBLIC HEALTH DEPARTMENT. COUNTY HEALTH DEPARTMENT Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - Mercy Hospital Inc.. Access to Visiting Specialists (OB, Surgery, CV, Pulmonology, Urology)- Continue to request Moundridge current visiting specialists to increase days of service per month. Focus on Cardiology, Surgery and Urology.; Continue to develop / promote visiting specialist office space at both MH and PIFC locations.; Continue capital investment in facilities & Specialist Equipment necessary to recruit visiting specialists. Mental Health / Crisis Intervention (Diagnosis, Placement, Aftercare, Access to Providers)- Conduct a physician manpower needs assessment to identify the number of Mental Health providers. Recruit Mental Health providers to meet specific mental inventory needs as identified; Continue to update & maintain MH Community Inventory documenting specific Mental Health service offerings,availability of services by hours and qualified insurance; Launch a MH Community Partners Lunch & Learn session to improve communication and share best practices. Develop & deploy a communication plan; Support new 988 24-hour crisis hotline. Promote toll free number on hospital website; Consider MH recruitment of locum visiting provider. Explore adding potential space for visiting MH providers within the hospital. Health Insurance Options (Education)- Continue to educate public on payment options at the hospital. Continue to support enrolling in Medicaid, Acts of Mercy program and enhance CMS Transparency website reporting.; Complete hospital filing for Exception status for participating in the Medicaid PE program; Develop white paper & collateral materials about what affordable health insurance means to Moundridge.; Provide education to public and community in regards to how to properly navigate the using your health insurance coverage properly. Obesity (Nutrition / Exercise)- Support wellness program at clinic and explore MH launching of wellness program.; (This health need is not part of hospital mission of critical operations. Will partner with others as appropriate) Cancer Care- Recruit & support specialists coming from Hutchison, Newton, McPherson to hospital/clinic locations; Develop campaign to education community of ways to protect themselves from different forms of cancer such as proper sun screen usage to prevent skin cancer, smoking cessation to prevent lung cancer, etc. Workforce Staffing- Continue to educate high school students on health care career options. Offer hospital School Scholarship / Internship / Shadowing Program opportunities; Partner with Health Department, Schools and Economic Development groups to host job fairs and seminars on: employee readiness, dress for success, skill building, interview guides, resume workshops, etc. After Hours Urgent Care / Walk-in Clinic- Explore the feasibility of expanding the hospital's after-hours care program to allow for more walk-ins. Further the discussion of Saturday hours at one or more clinics once the need is establish plausible; This need was met in early 2024 when Mercy Hospital opened the walk-in clinic Parenting- Continue to support STEPS program (County); Promote within community church and/or school-based parenting programs with a focus of mind, body, and spirit.; (This health need is not part of hospital mission of critical operations. Will partner with others as appropriate.) 1 MERCY HOSPITAL WALK-IN CLINIC 218 E PACK ST MOUNDRIDGE KS 67107 MEDICAL CLINIC Schedule H, Part I, Line 3c Eligibility criteria for free or discounted care Mercy Hospital only provides 100% free care to those who qualify for financial assistance. We do not use a graduated qualification process or discounted care. If someone qualifies for Financial Assistance, they end up owing $0.00 Schedule H, Part I, Line 7g Subsidized Health Services NONE OF THE COSTS INCLUDED IN LINE 7G ARE FROM A PHYSICIAN CLINIC. ONLY PROFESSIONAL COSTS ASSOCIATED WITH OPERATION OF THE HOSPITAL'S EMERGENCY ROOM ARE INCLUDED. Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance THE METHOD USED WAS THE COST-TO-CHARGE RATIO FROM THE MEDICARE COST REPORT. Schedule H, Part II Community Building Activities THE COSTS REPORTED IN PART II OF SCHEDULE H ARE LARGELY FOR THE ADMINISTRATOR TO ATTEND COMMUNITY HEALTH COALITION MEETINGS AND OTHER COMMUNITY BUILDING EVENTS WHILE BEING PAID BY THE HOSPITAL, AS WELL AS FOR MEETINGS HELD AT THE HOSPITAL WHERE PAID HOSPITAL STAFF WERE INVOLVED. THESE MEETINGS BRING TOGETHER COMMUNITY STAKEHOLDERS TO ENGAGE THEM IN DECISIONS IMPACTING THE HEALTH OF THE COMMUNITY AND HOW THE HOSPITAL ALLOCATES FUNDING TO ADDRESS IDENTIFIED NEEDS, INCLUDING COUNTY HEALTHCARE COALITION MEETINGS, COMMUNITY HEALTH NEEDS ASSESSMENT MEETINGS, PATIENT AND FAMILY ENGAGEMENT MEETINGS, AND COMMUNITY FOUNDATION MEETINGS. MERCY HOSPITAL IS COMMITTED TO BEING A GOOD PARTNER IN THE COMMUNITY AND FURTHERING ACTIVITIES THAT PROMOTE THE HEALTH AND WELLBEING OF OUR COMMUNITY MEMBERS. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR UNCOLLECTIBLE ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND CO-PAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED OR PROVIDED BY POLICY) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED, IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. Schedule H, Part III, Line 3 Bad Debt Expense Methodology THERE IS A CERTAIN PERCENTAGE OF INDIVIDUALS EVERY YEAR WHO, DUE TO BEING IN THE HOSPITAL A SHORT TIME, ONLY INTERACTING WITH HOSPITAL STAFF IN THE ER SETTING (I.E. ONLY FOR SHORT PERIODS OF TIME WITH NO OPPORTUNITY TO COLLECT THE NECESSARY INFORMATION), OR DUE TO INSTABILITY IN THEIR LIVING ARRANGEMENTS, ARE UNABLE TO PROVIDE THE REQUIRED INFORMATION FOR A CHARITY CARE APPLICATION TO BE PROCESSED. WE SAW A DECREASE IN PATIENT PAYMENTS ON ACCOUNTS WHICH IS BELIEVED TO BE DUE TO LOWER PATIENTS' CASH-ON-HAND AND MEDICAL DEBTS NOT BEING FIRST PRIORITY. MEDICAID RE-DETERMINATIONS MOVED SOME INDIVIDUALS OFF STATE MEDICAID ROLLS AND INTO HIGH DEDUCTIBLE HEALTH PLANS, LEAVING PATIENT BALANCES WHICH THEY WERE UNPREPARED TO PAY. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote DISCUSSION OF PATIENT SERVICE REVENUE AND BAD DEBTS CAN BE FOUND IN NOTE 2 OF THE ATTACHED FINANCIAL STATEMENTS. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs WE PROVIDE EMERGENCY SERVICES AS A BENEFIT TO OUR COMMUNITY, ALLOWING OUR LOCAL CITIZENS TO RECEIVE CARE CLOSE TO HOME AND WITHIN TIMEFRAMES THAT MEET THEIR NEEDS. STATISTICS SHOW THAT WHEN THERE IS NOT AN EMERGENCY ROOM NEARBY, THE MORTALITY RATE INCREASES BY 6 PERCENT DUE TO REDUCTION IN ACCESS TO CARE. EVEN WITH THE CONVERSION TO THE REH MODEL DURING THE FISCAL YEAR, MERCY HOSPITAL CONTINUES TO SEE REIMBURSEMENTS OFTEN BELOW COST. THE COST TO CHARGE RATIO FROM THE MOST-RECENTLY FILED MEDICARE COST REPORT WAS USED TO CALCULATE ALLOWABLE COST. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance SELF-PAY ACCOUNTS WITH BALANCES UNPAID OVER 90 DAYS ARE CONSIDERED TO BE DELINQUENT. THE INTERNAL COLLECTIONS DEPARTMENT MAKES MULTIPLE ATTEMPTS TO REACH THESE INDIVIDUALS BY MAIL AND PHONE TO ESTABLISH A PAYMENT PLAN OR OFFER FINANCIAL ASSISTANCE. BANKRUPTCIES WILL HAVE ALL COLLECTIONS EFFORTS STOPPED UPON RECEIPT OF BANKRUPTCY NOTICE. ALL ACCOUNTS BEING WORKED BY OUR INTERNAL COLLECTIONS DEPARTMENT ARE OFFERED THE HOSPITAL'S ESTABLISHED FINANCIAL ASSISTANCE POLICY AND APPLICATION. ANY PATIENT ACCOUNTS WHICH QUALIFY ARE HANDLED ACCORDING TO THAT POLICY. FUTURE ACCOUNTS FOR A GUARANTOR WHO IS KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE MAY BE AWARDED CHARITY CARE BASED ON ADMINISTRATIVE DECISION. ALL FINANCIAL ASSISTANCE APPLICATIONS ARE SUBJECT TO PERIODIC AND ANNUAL REVIEW TO ENSURE THE GUARANTOR'S CURRENT FINANCIAL SITUATION IS CONSIDERED. Schedule H, Part V, Section B, Line 16a FAP website - MERCY HOSPITAL INC.: Line 16a URL: WWW.MERCYH.ORG/FINANCIAL-ASSISTANCE/; Schedule H, Part V, Section B, Line 16b FAP Application website - MERCY HOSPITAL INC.: Line 16b URL: WWW.MERCYH.ORG/FINANCIAL-ASSISTANCE/; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - MERCY HOSPITAL INC.: Line 16c URL: WWW.MERCYH.ORG/FINANCIAL-ASSISTANCE/; Schedule H, Part VI, Line 2 Needs assessment IN 2022, A COMMUNITY HEALTH NEEDS ASSESSMENT WAS PERFORMED, IN CONJUNCTION WITH THE COUNTY HEALTH DEPARTMENT. RESIDENTS WERE ASKED TO COMPLETE ONLINE OR PAPER SURVEYS REGARDING HEALTH CONCERNS AND OPPORTUNITIES. AFTER INITIAL HEALTH ISSUES WERE IDENTIFIED, A WORKGROUP WAS FORMED REPRESENTING A CROSS SECTION OF SURVEY RESPONDENTS ALONG WITH COMMUNITY HEALTH EXPERTS AND RESOURCES. THIS WORKGROUP PRIORITIZED THE ISSUES AFFECTING THE COMMUNITY USING PUBLIC HEALTH DATA TO CONFIRM ADDITIONAL FACTORS. MERCY HOSPITAL HOSTED A TOWN- HALL MEETING WITH COMMUNITY RESIDENTS AND TOWN LEADERS TO FURTHER DRILL DOWN INTO NEEDS AND SURVEY THE POPULATION. ALL THIS INFORMATION WAS COMPILED INTO A REPORT WHICH HAS BEEN PUBLISHED ON OUR WEBSITE. MERCY HOSPITAL IDENTIFIED SOLUTIONS TO THESE IDENTIFIED HEALTH CONCERNS AND RELEASED A FACILITY-SPECIFIC IMPLEMENTATION PLAN, WHICH IS BEING CARRIED OUT STARTING IN 2023 THROUGH THE END OF 2025. ALL THESE DOCUMENTS ARE REVIEWED AND DISCUSSED WITH THE HOSPITAL'S PATIENT AND FAMILY ENGAGEMENT COMMITTEE CHOSEN FROM THE PATIENT POPULATION IN THE COMMUNITY. THESE INDIVIDUALS HELP TO DETERMINE THE WORTHINESS AND EFFICACY OF THE HOSPITAL'S EFFORTS. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance COMMUNICATION OF THE FINANCIAL ASSISTANCE AVAILABLE FROM MERCY HOSPITAL, INC. SHALL BE DISSEMINATED BY VARIOUS MEANS, WHICH MAY INCLUDE, BUT ARE NOT LIMITED TO, THE PUBLICATION OF NOTICES IN PATIENT BILLS AND BY POSTING NOTICES IN EMERGENCY ROOMS, REGISTRATION, PATIENT FINANCIAL SERVICES AND AT OTHER PUBLIC PLACES AS MERCY HOSPITAL, INC. MAY ELECT. INFORMATION SHALL ALSO BE INCLUDED ON THE FACILITY WEBSITE AND IN THE CONDITIONS OF ADMISSION FORM. REFERRAL OF PATIENTS FOR FINANCIAL ASSISTANCE MAY BE MADE BY ANY MEMBER OF THE MERCY HOSPITAL, INC. STAFF OR MEDICAL STAFF, INCLUDING PHYSICIANS, NURSES, FINANCIAL SERVICES STAFF, SOCIAL WORKER AND CASE MANAGER. A REQUEST FOR FINANCIAL ASSISTANCE MAY BE MADE BY THE PATIENT OR A FAMILY MEMBER, CLOSE FRIEND OR ASSOCIATE OF THE PATIENT, SUBJECT TO APPLICABLE PRIVACY LAWS. Schedule H, Part VI, Line 4 Community information MERCY HOSPITAL IS LOCATED IN MOUNDRIDGE, KS AND SERVES A DENSELY-SETTLED RURAL AREA THAT ALSO INCLUDES INDIVIDUALS FROM FOUR SURROUNDING COMMUNITIES. MOUNDRIDGE AND THE SURROUNDING RURAL SPACE HAS A POPULATION OF APPROXIMATELY 6,500 PEOPLE. BENEFICIARIES ARE FROM FARMING AND SOME MANUFACTURING ORGANIZATIONS IN THE APPROXIMATE 30-MILE RADIUS OF THE HOSPITAL. THERE ARE TWO OTHER HOSPITALS WITHIN A 20-MILE RADIUS ALSO SERVING THE AREA. Schedule H, Part VI, Line 5 Promotion of community health THE HOSPITAL HAS AN ACTIVE PATIENT AND FAMILY ENGAGEMENT COMMITTEE THAT MEETS AT LEAST QUARTERLY. THIS GROUP IS COMPRISED OF VOLUNTEER COMMUNITY MEMBERS WHO HAVE BEEN PATIENTS IN THE HOSPITAL. THESE INDIVIDUALS SERVE AS ADVISORS FOR THE BOARD AND MEDICAL STAFF TO PROVIDE INSIGHT FROM THE COMMUNITY TO INFLUENCE HOSPITAL POLICY AND DECISIONS. MEDICAL STAFF IS COMPOSED OF COURTESY AND CONSULTING PHYSICIANS WHO MEET QUARTERLY. TOPICS RELATING TO COMMUNITY HEALTH MAY BE DISCUSSED IN MEDICAL STAFF MEETINGS. THE HOSPITAL'S BOARD IS COMPRISED OF 12 VOLUNTEER MEMBERS FROM VARIOUS REGIONS OF THE SERVICE AREA. true KU School of Medicine Bridging Program- Dr. Olivia Gehring 1 6000 Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. MERCY HOSPITAL IS NOT A FOUNDATION, AND THE GRANTS WE WOULD AWARD ARE ONLY TO INDIVIDUALS WHO MEET VERY SPECIFIC CRITERIA, SUCH AS A NEW PHYSICIAN PROVIDER WHO IS COMING TO TOWN. ALL GRANT TERMS MUST BE MET IN ADVANCE BEFORE THE FUNDS ARE DISBURSED. AGREEMENTS ARE REVIEWED BY THE ORGANIZATION'S LEGAL COUNSEL PRIOR TO BEING SIGNED BY THE GRANTEE. ALL DOCUMENTS PERTAINING TO GRANTS AWARDED TO INDIVIDUALS ARE MAINTAINED IN THE ORGANIZATION'S PERMANENT RECORDS. MERCY HOSPITAL HISTORICALLY HAS LIMITED TO AWARDING OF GRANTS TO INDIVIDUALS WHO ARE BEING EDUCATED IN A FIELD PERTAINING TO HEALTHCARE AND WHO ARE COMMITTED TO SERVING IN THE MOUNDRIDGE COMMUNITY FOR A DEFINED PERIOD OF TIME. BRENDA KOEHN SPOUSE OF A DIRECTOR 15784 SALARIES false Form 990, Part III, Line 3 Significant changes in program services MERCY HOSPITAL CONVERTED TO THE NEW MEDICARE RURAL EMERGENCY HOSPITAL (REH) MODEL ON JANUARY 1, 2024. AS A RESULT OF THE REH CONVERSION, MERCY HOSPITAL CEASED PROVIDING ACUTE INPATIENT HOSPITAL CARE ON 12-31-2023. Form 990, Part VI, Line 1a Delegate broad authority to a committee ALL MEMBERS OF THE BOARD OF DIRECTORS HAVE THE SAME VOTING PRIVILEGES. THE EXECUTIVE COMMITTEE DOES HAVE AUTHORITY TO ACT ON ANY MATTERS WHICH MAY ARISE BETWEEN REGULAR MEETINGS, SUBJECT TO APPROVAL BY THE FULL BOARD AT THEIR NEXT REGULAR MEETING. THE BOARD EXECUTIVE COMMITTEE INCLUDES THE CHAIRPERSON, THE ASSISTANT CHAIR, AND THE SECRETARY/TREASURER. THESE THREE ARE ELECTED TO THESE POSITIONS ANNUALLY BY THE FULL BOARD AND HAVE AUTHORITY TO ACT ON ALL MATTERS ARISING BETWEEN MEETINGS OF THE BOARD, SUBJECT TO APPROVAL BY THE FULL BOARD AT THEIR NEXT MEETING. Form 990, Part VI, Line 2 Family/business relationships amongst interested persons DONAVON LEE KOEHN, KENDEL KOEHN, AND VINCE KOEHN - Family relationship Form 990, Part VI, Line 4 Significant changes to organizational documents THE ORGANIZATION'S BYLAWS WERE AMENDED DURING THE FISCAL YEAR TO REFLECT THE FOLLOWING: A. INCREASE IN THE NUMBER OF MEMBERS OF THE BOARD, B. BROADENING THE ACTIONS UNDER THE BOARD'S RESPONSIBILITY, AND C. REVISIONS TO LANGUAGE ADDRESSING THE END OF THE HOSPITAL'S INPATIENT CARE PROGRAM. Form 990, Part VI, Line 6 Classes of members or stockholders MEMBERSHIP IN MERCY HOSPITAL, INC. IS LIMITED TO THE CONGREGATIONS OF THE VARIOUS CHURCHES OF THE CHURCH OF GOD IN CHRIST MENNONITE WITHIN THE AREA SERVED BY THE HOSPITAL. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body THE VARIOUS CONGREGATIONS, BEING THE MEMBERS OF MERCY HOSPITAL, INC., HAVE THE RIGHT TO ELECT, ADD, OR REMOVE BOARD MEMBERS. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders THE VARIOUS CONGREGATIONS, BEING THE MEMBERS OF MERCY HOSPITAL, INC., HAVE THE RIGHT TO APPROVE THE BYLAWS, ARTICLES OF INCORPORATION, AND APPROVE OR REMOVE BOARD MEMBERS. Form 990, Part VI, Line 11b Review of form 990 by governing body AN INDEPENDENT ACCOUNTING FIRM PREPARES THE FORM 990. THE FORM 990 WITH ALL REQUIRED SCHEDULES IS THEN REVIEWED BY THE ORGANIZATION'S ADMINISTRATOR AND CFO. ANY QUESTIONS OR CONCERNS ARE ADDRESSED AND ANY NECESSARY CHANGES ARE MADE. THE FINAL FORM 990, WITH ALL REQUIRED SCHEDULES, IS PROVIDED TO ALL VOTING MEMBERS OF THE BOARD FOR THEIR REVIEW PRIOR TO FILING THE 990. Form 990, Part VI, Line 12c Conflict of interest policy BOARD MEMBERS AND THE ADMINISTRATOR REVIEW THE CONFLICT OF INTEREST POLICY ANNUALLY. EACH INDIVIDUAL IS RESPONSIBLE FOR DISCLOSING ANY POTENTIAL CONFLICTS. THESE ARE DOCUMENTED WITH SIGNED CONFLICT OF INTEREST STATEMENTS. THE HOSPITAL'S CORPORATE COMPLIANCE COMMITTEE DETERMINES WHETHER A CONFLICT IS PRESENT. IF A CONFLICT OF INTEREST IS PRESENT THE INTERESTED BOARD MEMBER IS EXCUSED FROM THE BOARDROOM DURING THE SUBSEQUENT VOTE. THE COMPLIANCE COMMITTEE IS COMPOSED OF INDIVIDUALS FROM MULTIPLE DEPARTMENTS, AND INCLUDES AARON HERBEL, ADMINISTRATOR AND CFO; FERNETTA PHILLIPS, HR MANAGER, AND HOLLIE BARR, CORPORATE COMPLIANCE OFFICER. Form 990, Part VI, Line 15a Process to establish compensation of top management official AT THE TIME OF HIRE AND ANNUALLY THEREAFTER, THE KHA'S PUBLISHED WAGE SCALE AND AN INFORMAL SURVEY OF AREA COMPENSATION COMPARABLES ARE USED TO ESTABLISH REASONABLE COMPENSATION LEVELS. IN ADDITION, AN ANNUAL PERFORMANCE EVALUATION IS PERFORMED BY THE EXECUTIVE COMMITTEE OF THE HOSPITAL BOARD OF DIRECTORS. THE EVALUATIONS COMPLETED BY THE EXECUTIVE COMMITTEE ARE THEN PRESENTED TO THE BOARD OF DIRECTORS FOR APPROVAL. DOCUMENTATION OF THE APPROVED EVALUATIONS FOR COMPENSATION IS INCLUDED IN THE BOARD MINUTES. SUCH A PROCESS IS COMPLETED FOR THE ADMINISTRATOR (CEO) BY THE BOARD OF DIRECTORS AND WAS LAST CONDUCTED IN 2024. Form 990, Part VI, Line 15b Process to establish compensation of other employees AT THE TIME OF HIRE AND ANNUALLY THEREAFTER, THE KHA'S PUBLISHED WAGE SCALE AND AN INFORMAL SURVEY OF AREA COMPENSATION COMPARABLES ARE USED TO ESTABLISH REASONABLE COMPENSATION LEVELS. IN ADDITION, AN ANNUAL PERFORMANCE EVALUATION IS PERFORMED BY THE EXECUTIVE COMMITTEE OF THE HOSPITAL BOARD OF DIRECTORS. THE EVALUATIONS COMPLETED BY THE EXECUTIVE COMMITTEE ARE THEN PRESENTED TO THE BOARD OF DIRECTORS FOR APPROVAL. DOCUMENTATION OF THE APPROVED EVALUATIONS FOR COMPENSATION IS INCLUDED IN THE BOARD MINUTES. Form 990, Part VI, Line 19 Required documents available to the public THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST TO THE HOSPITAL ADMINISTRATOR. Form 990, Part IX, Line 11g Other Fees PURCHASED MEDICAL SERVICES - Total Expense: 855960, Program Service Expense: 855960, Management and General Expenses: , Fundraising Expenses: ; MAINTENANCE AND ADMINISTRATIVE PURCHASED SERVICES - Total Expense: 39961, Program Service Expense: 27585, Management and General Expenses: 12376, Fundraising Expenses: ; Form 990, Part XII, Line 2c OVERSIGHT PROCESS THE ORGANIZATION'S EXISTING INTERNAL ACCOUNTANT HAS ASSUMED ADDITIONAL RESPONSIBILITIES DURING THE FISCAL YEAR. THE BOARD AS A WHOLE REVIEWS THE FINANCIAL DOCUMENTS PREPARED BY THE CFO, BUT A BOARD MEMBER IS NO LONGER PERSONALLY REQUIRED TO DO DETAILED REVIEW DUE TO ADEQUATE SEGREGATION OF DUTIES. CHURCH OF GOD IN CHRIST MENNONITE 100 AVE C MOUNDRIDGE KS 67107 237022612 CHURCH KS 501(c)(3) 1 NA false false false true false true false false false false false false false true true false false false false false