2020-07-13T12:33:15-05:00 2019-06-30 135565207 KPMG LLP 1000 Walnut St 1000 Kansas City MO 64106 990 2018-07-01 440605373 The Children's Mercy Hospital CHIL 8162343000 2401 Gillham Road Kansas City MO 64108 David Cauble Executive VP & CFO 8162343000 2020-07-13 1 Justin T Keller P01419781 8168025200 199.242.168.195 2020-07-13 12:27:31 CD P DA5E333CAE2DCB102A5CFD0E36563518F4DB711E DA5E333CAE2DCB102A5CFD0E36563518F4DB711E 2018 2021-01-29 14:40:06Z David Cauble 2401 Gillham Road Kansas City MO 64108 1596674954 0 X www.childrensmercy.org X 1901 MO Excellence in healthcare for children 15 12 13185 1525 3111525 65786 182970176 62229421 1405128243 1452144593 34457449 62846609 32547035 18333669 1655102903 1595554292 47080340 47092567 0 0 784919231 818332794 143077 186376 6253919 556128606 554268668 1388271254 1419880405 266831649 175673887 1965698928 2111702017 579024567 556087441 1386674361 1555614576 X To improve the health and well being of children by providing comprehensive, family-centered health care and committing to the highest level of clinical and psychosocial care, and to research, academic and service excellence. 1 0 990086041 44663386 1485812431 All expenses for program services relate to providing healthcare. There were a total of 367 licensed beds and 92,661 patient days during the year from 16,021 admissions. Interim stays totaled 4,603 and outpatient encounters, including ED and Urgent Care, were 590,075. There were a total of 20,262 surgical cases which includes 4,393 inpatient and 15,869 outpatient cases. Outpatient prescriptions totaled 167,387 Children's Mercy critical care transports totaled 5,679 in fiscal year 2019.The Children's Mercy Hospital (the Hospital) 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. 65321346 2429181 Children's Mercy Hospital (CMH) is dedicated to becoming a leader in pediatric translational research. A recent strategic planning initiative established the Children's Research Institute to focus on research and research infrastructure. Through the generosity of two philanthropic gifts totaling $150 million, the hospital has continued construction of 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 building will include 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. The Children's Mercy Research Institute building is slated to open in the fall of 2020. 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, 2019 there were more than 395 active sponsored research projects. The Children's Mercy Research Institute occupies about 3% of the space on the main campus and is 4% of the total annual operating budget. CMH spent $56 million in the year ended June 30, 2019 on research, and per information from the NIH Reporter received more than $7.8 million in NIH funding in this same time period. More than 900+ publications were accepted and/or published. The Children's Mercy 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. 1055407387 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 0 0 1 1 0 0 0 1 1 1 1 0 0 1 562 0 1 13185 1 1 1 0 0 0 0 1 1 0 0 0 0 1 0 X 15 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 X David Cauble Executive VP & CFO 8162343000 2401 Gillham Road Kansas City MO 64108 Paul McLaughlin Chairman 2.00 1.00 X X 0 0 0 Elizabeth Braham Vice Chairman 2.50 0.00 X X 0 0 0 Andrew Teigen Treasurer 1.50 0.00 X X 0 0 0 Bill Krueger 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 Vince Clark Director 1.00 0.00 X 0 0 0 Carolyn Davis MD Director 1.00 0.00 X 0 0 0 Terry Matlack Director 1.00 0.00 X 0 0 0 Charles Schellhorn Director 1.50 4.00 X 0 0 0 Debbie Sosland-Edelman Director 1.50 0.00 X 0 0 0 Edna Talboy Director 1.00 0.00 X 0 0 0 Tom Weir Director 1.50 0.00 X 0 0 0 Robert Weatherly MD Director; End 12/31/2018 40.00 0.00 X 529804 0 39321 Laura Fitzmaurice MD Director; Start 1/1/2019 40.00 0.00 X 450055 0 43464 Paul D Kempinski MS FACHE Director;Pres. & CEO;Start 11/1/2018 40.00 1.00 X X 414852 0 2374 Randall L O'Donnell PhD President & CEO; End 9/1/2018 40.00 1.00 X 2682617 0 33284 Charles Roberts MD EVP & Exec.Medical Director 40.00 0.00 X 806828 0 37620 Sandra AJ Lawrence Executive VP & CAO; End 2/15/2019 40.00 0.00 X 785705 0 43464 Karen S Cox RN PhD FAAN Executive VP & COO; End 8/24/2018 40.00 0.00 X 752408 0 33284 Jo Stueve Executive VP & COO 40.00 0.00 X 855291 0 37644 David Cauble Executive VP & CFO 40.00 0.00 X 673767 0 33957 Shawn St Peter MD Chairman-Dept of Surgery 40.00 0.00 X 799031 0 37170 Thomas Curran PhD Exec Director & CSO, CRI 40.00 0.00 X 684112 0 28419 Robin Foster JD Senior VP, General Counsel 40.00 0.00 X 670116 0 39339 James D Saint Louis MD Physician 40.00 0.00 X 1215372 0 27307 James O'Brien Jr MD Physician 40.00 0.00 X 1194237 0 43428 William Douglas MD Physician 40.00 0.00 X 1209360 0 18714 Walter Andrews MD Physician 40.00 0.00 X 801184 0 43464 George Holcomb III MD Physician 40.00 0.00 X 802242 0 37620 15326981 0 579873 1506 0 1 0 McCown Gordon Construction LLC 850 Main Street Kansas City MO 64105 Construction 37325480 Accenture LLP 161 North Clark Street Chicago IL 60601 Consulting 36724001 Anesthesia Associates 8717 West 110th Street Overland Park KS 66210 Anesthesiologists 34063528 Sodexho Marriott Services Inc 9801 Washingtonian Blvd Gaithersburg MD 20878 Food Services 9141771 Cerner Health Connections Inc 2800 Rockcreek Parkway Kansas City MO 64117 Professional Services 8306942 438 592528 4195339 8447973 13252284 35741297 665598 62229421 Net Patient Services 621110 1452144593 1452144593 1452144593 62846609 62846609 573130 4195339 1120662 -547532 -547532 Contract Revenue 900099 16753271 16753271 Cafeteria & Vending 722514 3242834 3242834 Loss on Extinguishment of Debt 900099 -17898162 -17898162 16783258 13671733 3111525 18881201 1595554292 1485812431 3111525 44400915 X 2304320 2304320 44490491 44490491 297756 297756 16047014 8178940 7868074 648939607 533437423 112091393 3410791 33539296 27316988 6050281 172027 76144906 62018281 13736069 390556 43661971 35561675 7876349 223947 3278084 164867 3113217 556429 65700 490729 488841 488841 186376 186376 155297484 73029758 81683681 584045 6947013 275005 6671022 986 4436220 111018 4276322 48880 19978594 8686701 10648054 643839 8528339 6624571 1812373 91395 11487310 10602466 884844 65856545 27048943 38804709 2893 10541411 6723399 3818012 Medical Supplies 159735591 147552797 11770197 412597 State Medicaid Taxes 51453343 51453343 Dues & Subscriptions 7151657 3152705 3920493 78459 Inventory- Food Service 5345021 1659107 3679935 5979 43186786 4651133 38534504 1149 1419880405 1055407387 358219099 6253919 141948242 19873775 118037496 80163168 231257514 236235301 13425700 14261595 23665860 25000745 1336583353 649810376 616277826 686772977 578888106 793624486 5874244 5565259 236323940 250204711 1965698928 2111702017 144942092 143890683 338069643 320815446 96012832 91381312 579024567 556087441 X 1163213731 1314609285 223460630 241005291 1386674361 1555614576 1965698928 2111702017 X 175673887 -18550318 11816646 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 488841 488841 1054918546 1055407387 1000000 250000 0 0 1000000 1000000 1000000 1000000 4000000 6000000 374689 421071 492239 488841 1776840 250000 250000 250000 250000 1000000 1500000 69788763 3003013 3300499 2428542 73663733 61620527 6774013 3517083 2122860 69788763 51311822 7334271 5017500 2043066 61620527 48208836 5953303 -1112327 1737990 51311822 48018417 2780952 -916648 1673885 48208836 0.83130 0.16870 0 1 1 26339744 26339744 694225103 287634849 406590254 479197587 362175527 117022060 136820919 136820919 686772977 Other Assets 57462102 Income Beneficiary and Charitable Remainder Trusts 46819881 Restricted Investments 114758864 Unexpended Proceeds of Debt Issuance 31163864 250204711 Reserve for Prof. Liability Claims 30196574 Postretirement Medical Liability 45958379 Other Liabilities 12121572 Unearned Premiums 3104787 91381312 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, 2019 and 2018, there were no uncertain tax positions. 1 North America 0 0 Program Services Travel for healthcare-related education and information sharing 63740 Central America & the Caribbean 0 0 Program Services Travel for healthcare-related education and information sharing 2882 Europe 0 0 Program Services Travel for healthcare-related education and information sharing 51438 East Asia & the Pacific 0 0 Program Services Travel for healthcare-related education and information sharing 17524 South America 0 0 Program Services Travel for healthcare-related education and information sharing 8992 South Asia 0 0 Program ServicesProgram Services Travel for healthcare-related education and information sharing 770 Sub-Saharan Africa 0 0 Program Services Travel for healthcare-related education and information sharing 37937 Middle East and North Africa 0 0 Program Services Travel for healthcare-related education and information sharing 4879 Sub-Saharan Africa 0 0 Grantmaking 192354 Europe 0 0 Grantmaking 17716 North America 0 0 Grantmaking 87686 0 0 0 0 0 0 188162 297756 485918 North America - Canada and Mexico, but not the United States Research 36544 Check FMV North America - Canada and Mexico, but not the United States Research 51142 Check FMV Sub-Saharan Africa - Angola, Benin, Botswana, Burkina Faso, Research 192354 Check FMV Europe (Including Iceland & Greenland) - Albania, Andorra, Austria, Belgium Research 17716 Check FMV 2 2 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 $500,000 in Federal funds during the fiscal year is required to obtain an 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 A-133 audits and that CMH has received an audit report. CMH maintains a subrecipient monitoring spreadsheet to track A-133 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. 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 Schultz & Williams 1617 JFK Blvd Philadelphia PA 19103 Consult/develop an annual fund and giving program 0 1100000 51899 1048101 Rachael Steele 2401 Gillham Rd Kansas City MO 64108 Consult & advise on capital campaign 0 0 134477 -134477 1100000 186376 913624 KS MO AK AL AR CA CO CT DC FL GA HI IL KY MA MD ME MI MN MS NC ND NH NJ NM NV NY OH OK OR PA RI SC TN UT VA WA WI WV Gala/Auction 2310736 2033116 277620 284464 119005 16845 73090 Event/Auction 2257311 2010755 246556 469615 30751 581 102069 4 200422 151468 48954 9832 14410 4768469 4195339 573130 763911 149756 17426 189569 1120662 -547532 1 1 X 1 X 300.000000000000 1 X 500.000000000000 1 1 1 0 1 1 2 26989 18192111 933288 17258823 0.01220 9 424598 645676672 598932755 46743917 0.03290 11 451587 663868783 599866043 64002740 0.04510 38 517480 15588691 2260256 13328435 0.00940 8 12431 35446479 13977210 21469269 0.01510 18 154928 97965996 54554818 43411178 0.03060 567 34349893 15027835 19322058 0.01360 5 852767 8578 844189 0.00060 636 684839 184203826 85828697 98375129 0.06930 647 1136426 848072609 685694740 162377869 0.11440 3 3 105078 8713 96365 0.00010 1 1163 1163 0.00000 1 35 2802 2802 0.00000 1 2537 2537 0.00000 13 481 226803 93237 133566 0.00010 36 2164 857700 27000 830700 0.00060 55 2683 1196083 128950 1067133 0.00080 1 68787 0 3235524 4223810 -988286 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 www.childrensmercy.org/financialcounseling/ X www.childrensmercy.org/financialcounseling/ 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: The most recent CHNA took into account the input from persons who represent the broad interest of the community. The collection of this input began in October of 2018 and continued until April 1, 2019. The CHNA data collection process included: four community meetings (130 community, neighborhood and parent residents); a telephone survey of 1000 randomly selected parents/caregivers of children under the age of 18 years; and a Key Informant Online Survey sent to 299 elected officials, physicians, public health leaders, other health professionals, social service providers, and business, neighborhood, housing and community leaders (107 or 36% responded). Those receiving the Key Informant Online Survey were chosen because of their ability to identify primary concerns of the populations with whom they work as well as the community overall. In addition, 350 representatives from area public health, health care, social services, governmental, community, high school students, neighborhood and housing organizations were invited to a convening (the Children's Health Summit) hosted by Children's Mercy on April 1, 2019. From this group, 198 attended (45 from Children's Mercy) and received the initial findings of the CHNA and participated in a process to identify and rate priority health issues for the region. Organizations that were included or participated in the CHNA surveys and events included: El Centro, Restart, The Family Conservancy, Urban Neighborhood Initiative, Advent Health, Bike Walk KC, 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, Guardian Group, Happy Bottoms, Harvesters- The Community Food Network, Health Care Collaborative of Rural Missouri, Health Forward Foundation, Healthy Families, Hron and Partners, Jackson County Community Children's Service Fund, Johnson County Department of Health 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, Mother and Child Health Coalition, 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 Center, 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. A complete list of all organizations and specifics on the process is in the CHNA provided on the Children's Mercy website. 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/communityneedsBased on the priority and significant health needs identified in the 2015 CHNA, Children's Mercy's Community Benefit/CHNA Advisory Group completed a comprehensive inventory of Children's Mercy programs. As part of this exercise, a list of current and potential community partners was created, and areas of opportunity and key indicators identified. Children's Mercy developed an internal Community Benefit Support program and an externally focused Community Benefit Grant program to support existing and new programs and services targeted at priority and significant health needs. Examples of new programs supported include: a community-based support group for antepartum and postpartum mothers (addressing mental/behavioral health and infant mortality); support of area delivery hospitals in the improvement of safe sleep programs and practices (addressing infant mortality); prescription drug management and disposal videos (addressing mental/behavioral health); Power of Play program for children of refugees and immigrants (addressing mental/behavioral health); Red Card: Call It When You See It anti-bullying campaign in conjunction with Sporting KC the local MLS Soccer team (addressing mental/behavioral health); implementing system-wide suicide prevention screening (addressing mental/behavioral health); Project Adam- creating heart-safe schools (addressing access to care); Stop the Bleed (addressing access to care); and transportation to primary care (addressing access to care). Examples of programs and initiatives to address a significant health needs include: the community garden and the summer lunch program-Kids Eat Free and the provision of medication lock boxes and gun locks to support the safe storage of medications and firearms. Organizations receiving Community Benefit Grants include: for Infant Mortality reduction- the Black Health Care Coalition (to support Community Baby Showers), the New Bethel Community Development Corporation (to develop a faith-based infant mortality reduction initiative), to the Mother and Child Health Coalition of Greater Kansas City (to support an infant mortality conference and follow-up activities), Uzazi Village (to support outreach to pregnant and parenting African American women), and to Sleepyhead Beds (to support a centralized distribution system of port-a-cribs); for Mental/Behavioral Health included Zero Reasons Why (a community mobilization suicide prevention campaign) and for Access to Care- Community Health Council of Wyandotte County. In addition, we continue to work with local health departments to address collaboratively, the priority and significant health needs. The 2018 CHNA was completed January 2019. On April 1, 2019, Children's Mercy hosted the Children's Health Summit which convened over 195 community participants to review CHNA data and identify critical health needs. Needs identified are: mental/behavioral health, access to health services, infant health, nutrition/physical activity/weight, injury and violence, tobacco/alcohol/substance abuse, and asthma (in priority order). The community also recognized that in order 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. From April 2, 2019 through May 15, 2019, over 180 Children's Mercy employees and senior leadership were presented the community-identified health needs and themes and selected three (Access to Health Services with a focus on Asthma; Mental and Behavioral Health, and Infant Heath) as Priority Health Needs, based on the importance, potential measurable impact, and Children's Mercy's ability to address 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 while the other community identified needs (Significant Health Needs) will continue to be addressed through programming, but not receive accelerated attention. 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 written notice about upcoming ECAs. Group A-Facility 2 -- Children's Mercy Kansas Part V, Section B, line 5: The most recent CHNA took into account the input from persons who represent the broad interest of the community. The collection of this input began in October of 2018 and continued until April 1, 2019. The CHNA data collection process included: four community meetings (130 community, neighborhood and parent residents); a telephone survey of 1000 randomly selected parents/caregivers of children under the age of 18 years; and a Key Informant Online Survey sent to 299 elected officials, physicians, public health leaders, other health professionals, social service providers, and business, neighborhood, housing and community leaders (107 or 36% responded). Those receiving the Key Informant Online Survey were chosen because of their ability to identify primary concerns of the populations with whom they work as well as the community overall. In addition, 350 representatives from area public health, health care, social services, governmental, community, high school students, neighborhood and housing organizations were invited to a convening (the Children's Health Summit) hosted by Children's Mercy on April 1, 2019. From this group, 198 attended (45 from Children's Mercy) and received the initial findings of the CHNA and participated in a process to identify and rate priority health issues for the region. Organizations that were included or participated in the CHNA surveys and events included: El Centro, Restart, The Family Conservancy, Urban Neighborhood Initiative, Advent Health, Bike Walk KC, 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, Guardian Group, Happy Bottoms, Harvesters- The Community Food Network, Health Care Collaborative of Rural Missouri, Health Forward Foundation, Healthy Families, Hron and Partners, Jackson County Community Children's Service Fund, Johnson County Department of Health 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, Mother and Child Health Coalition, 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 Center, 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. A complete list of all organizations and specifics on the process is in the CHNA provided on the Children's Mercy website. 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/communityneedsBased on the priority and significant health needs identified in the 2015 CHNA, Children's Mercy's Community Benefit/CHNA Advisory Group completed a comprehensive inventory of Children's Mercy programs. As part of this exercise, a list of current and potential community partners was created, and areas of opportunity and key indicators identified. Children's Mercy developed an internal Community Benefit Support program and an externally focused Community Benefit Grant program to support existing and new programs and services targeted at priority and significant health needs. Examples of new programs supported include: a community-based support group for antepartum and postpartum mothers (addressing mental/behavioral health and infant mortality); support of area delivery hospitals in the improvement of safe sleep programs and practices (addressing infant mortality); prescription drug management and disposal videos (addressing mental/behavioral health); Power of Play program for children of refugees and immigrants (addressing mental/behavioral health); Red Card: Call It When You See It anti-bullying campaign in conjunction with Sporting KC the local MLS Soccer team (addressing mental/behavioral health); implementing system-wide suicide prevention screening (addressing mental/behavioral health); Project Adam- creating heart-safe schools (addressing access to care); Stop the Bleed (addressing access to care); and transportation to primary care (addressing access to care). Examples of programs and initiatives to address a significant health needs include: the community garden and the summer lunch program-Kids Eat Free and the provision of medication lock boxes and gun locks to support the safe storage of medications and firearms. Organizations receiving Community Benefit Grants include: for Infant Mortality reduction- the Black Health Care Coalition (to support Community Baby Showers), the New Bethel Community Development Corporation (to develop a faith-based infant mortality reduction initiative), to the Mother and Child Health Coalition of Greater Kansas City (to support an infant mortality conference and follow-up activities), Uzazi Village (to support outreach to pregnant and parenting African American women), and to Sleepyhead Beds (to support a centralized distribution system of port-a-cribs); for Mental/Behavioral Health included Zero Reasons Why (a community mobilization suicide prevention campaign) and for Access to Care- Community Health Council of Wyandotte County. In addition, we continue to work with local health departments to address collaboratively, the priority and significant health needs. The 2018 CHNA was completed January 2019. On April 1, 2019, Children's Mercy hosted the Children's Health Summit which convened over 195 community participants to review CHNA data and identify critical health needs. Needs identified are: mental/behavioral health, access to health services, infant health, nutrition/physical activity/weight, injury and violence, tobacco/alcohol/substance abuse, and asthma (in priority order). The community also recognized that in order 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. From April 2, 2019 through May 15, 2019, over 180 Children's Mercy employees and senior leadership were presented the community-identified health needs and themes and selected three (Access to Health Services with a focus on Asthma; Mental and Behavioral Health, and Infant Heath) as Priority Health Needs, based on the importance, potential measurable impact, and Children's Mercy's ability to address 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 while the other community identified needs (Significant Health Needs) will continue to be addressed through programming, but not receive accelerated attention. 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 written notice about upcoming ECAs. 14 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 Pediatric Eye Care 4820 College Blvd Leawood KS 66211 Practice Use 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 Junction City 361 Grant Ave Junction City KS 66441 Outreach Clinic 9 - Children's Mercy Outreach Great Bend 1021 Einsenhower Ave Great Bend KS 65730 Outreach Clinic 10 - Children's Mercy Outreach Garden City 311 E Spruce St Garden City KS 67846 Outreach Clinic 11 - Children's Mercy Outreach Springfield 1000 E Primrose Suite 300 Springfield MO 65807 Outreach Clinic 12 - Children's Mercy Outreach Parsons 1902 S US Hwy 59 BLDG E Ste 200 Parsons KS 67357 Outreach Clinic 13 - Children's Mercy at KU Hospital 2000 Olathe Boulevard Kansas City KS 66103 Outreach Clinic 14 - Children's Mercy Outreach Salina 737 E Crawford Salina KS 67401 Outreach Clinic 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-to-charge ratios derived from the Medicare Cost Report were used for Lines 7f and 7g. Part I, Line 7g: In FY19, 154,928 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 medicine, neonatology, hematology/oncology, genetics, pain management, home health services and the fetal health center, 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 FY19, 567 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, heart care, cancer treatment and other subspecialties to provide answers for the most difficult cases and challenging pediatric conditions. In addition, we are building a dedicated, state-of-art biorepository that can advance diagnostic discovery and health outcomes. 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 development and management of a community garden, advocacy activities, participation on the Chamber of Commerce committee, and healthcare workforce development for high school students and community members. Part III, Line 2: During FY2019, and in accordance with new financial reporting guidelines provided in ASC 606, the hospital is reporting significantly less bad debt expense of $68,787 for the current year as compared to the prior year amount of $27,680,522 on their Audited Financial Statements. Part III, Line 4: Audited Financial Statements Footnote M, Page 13, Footnote T, Page 16. 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 243,224 children from across the states of Kansas and Missouri. There are 102 counties in Kansas and 114 counties in Missouri, which have federally designated primary care HPSA areas. Across the two states, Children's Mercy identifies 43 counties as Outreach areas; 50 counties as the secondary service area; and 18 counties as the primary service area. Each of the service areas is comprised of urban, suburban and rural regions. The Outreach service area includes more rural counties than the other listed service areas. The Metro service area (six counties) includes more urban and suburban areas than rural. Within the Metro service area is the Children's Mercy service area for the CHNA. This includes 4 counties located in both Missouri (Jackson and Clay counties) and Kansas (Johnson and Wyandotte Counties). 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 69.7 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, and Children's Mercy East) and the source of a majority of our patient encounters. The four counties house a total population of 1,650,983; of these 421,000 or 25.5 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 2017 U.S. Census, the median family income for the four counties was $77,589. The highest percentage of children living in poverty is in Wyandotte County (37.3%), followed by Jackson County (27.2%), Clay County (10.7%) and Johnson County (7.5%). Of all Kansas City area families led by a single mother, 24.1 percent are living in poverty. Jackson County and especially Wyandotte County have considerably more families led by a single mother living below the federal poverty level. 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 to community organizations to support programs addressing the CHNA priority health needs. Organizations include: the Black Health Care Coalition; Happy Bottoms; the Greater Kansas City Maternal and Child Health Coalition; the Community Health Council of Wyandotte County; New Bethel Neighborhood Development Corporation; Northland Health Alliance; Sleepyhead Beds, El Centro; Restart; Urban Neighborhood Initiative; Uzazi Village; Boys and Girls Clubs of Greater KC; Down Syndrome Guild; Reach Out and Read KC; and Ronald McDonald House Charities of Kansas City. 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 (i.e. Zoom to Health, PHIT Kids, etc.). Part VI, Line 6: The Children's Mercy Hospital is not part of an affiliated health care system. 1 American Public Square 300 E 39th St 4F Kansas City MO 64111 471579944 501(c)3 9875 A nonpartisan nonprofit that seeks to change the tone and quality of public discourse, organizing programs that feature expert panelists and audience members with opposing views talking to each other, civilly, about controversial topics. Kansas University Endowment (Reach Out and Read) 3901 Rainbow Blvd MS 1039 Kansas City KS 66106 480547734 501(c)3 44000 Prepares Kansas City's youngest children to succeed in school by partnering with doctors and nurses to prescribe books and encourage families to read together. Leukemia and Lymphoma Society 6811 Shawnee Mission Pkwy Ste 202 Shawnee Mission KS 66202 135644916 501(c)3 20900 Mission is to cure leukemia, lymphoma, Hodgkin's disease and myeloma, and improve the quality of life of patients and their families. Ronald McDonald House Charities 2502 Cherry St Kansas City MO 64108 431190760 501(c)3 75964 Provide comfort and care for families seeking life-saving medical treatment for their children. National Kidney Foundation 6405 Metcalf Ave Ste 204 Overland Park KS 66202 131673104 501(c)3 5450 Dedicated to preventing kidney and urinary tract diseases, improving the health and well-being of individuals and families affected by kidney disease and increasing the availability of all organs for transplantation. State of Kansas 915 SW Harrison Street Topeka KS 66612 481124839 GOVT 5356 Research Kennedy Krieger Institute 707 North Broadway Baltimore MD 21205 521524965 501(c)3 6414 Research Phoenix Children's Hospital 1919 East Thomas Road Phoenix AZ 85016 860422559 501(c)3 7195 Research Emory Genetics Medical Research 103 B Jones Center Atlanta GA 30322 580566256 501(c)3 23325 Research Medical College of Wisconsin 8701 Watertown Plank Rd Milwaukee WI 53226 390806261 501(c)3 40491 Research Oregon Health & Science 3181 SW Sam Jackson Park Rd AD201 Portland OR 97201 931176109 GOVT 46912 Research Seattle Children's Hospital 4800 Sand Point Way NE Seattle WA 98105 910564748 501(c)3 31322 Research Regents University California One Shields Avenue Davis CA 95616 946036494 501(c)3 32381 Research University of California 9500 Gilman Dr La Jolla CA 92093 330833316 36897 Research Regents University of Michigan 1500 East Medical Center Dr Ann Arbor MI 48109 386006309 GOVT 32068 Research University of New Mexico 1 University of New Mexico Albuquerque NM 87131 856000642 GOVT 12441 Research Cincinnati Children's Hospital 3333 Burnet Avenue Suite 330 Cincinnati OH 45229 310833936 501(c)3 55401 Research Stanford Junior University 3145 Porter Dr Palo Alto CA 94304 941156365 501(c)3 296074 Research KU Center for Research KUCR 2385 Irving Hill Road Lawrence KS 66045 480680117 501(c)3 92084 Research University of Wisconsin State 465 Henry Mall Madison WI 53706 391805963 501(c)3 10748 Research Vanderbilt Medical Center Dept AT 40379 Atlanta GA 31192 352528741 501(c)3 20894 Research KUMC Research Institute Inc 3901 Rainbow Blvd MS 1039 Kansas City KS 66160 481108830 501(c)3 139892 Research University of Missouri UMKC KCUR 118 University Hall Columbia MO 65211 436003859 GOVT 221022 Research Cleveland Clinic 9500 Euclid Avenue NA-4 Cleveland OH 44195 340714585 501(c)3 9778 Research NACHRI NACH Children's Hospital 600 13th Street NW Washington DC 20005 510120256 501(c)3 18891 Research California Los Angeles UCLA 10921 Wilshire Blvd 5th Floor Los Angeles CA 90024 956006143 501(c)3 7596 Research STFM Teachers Family Medicine 11400 Tomahawk Creek Pkwy Ste 240 Leawood KS 66211 431026492 501(c)6 23507 Research Duke University PO Box 104132 Durham NC 27708 560532129 501(c)3 53174 Research H Lee Moffitt Cancer Center 12902 Magnolia Dr Tampa FL 33612 592451713 501(c)3 49945 Research Pennsylvania University 3451 Walnut Street Philadelphia PA 19104 231352685 501(c)3 5117 Research Midwest Biomedical Research PO Box 300662 Kansas City MO 64130 431496422 258625 Research Joslin Diabetes Center Inc One Joslin Place Boston MA 02215 042203836 501(c)3 102700 Research Chips Chocolate Factory KC FUD 2450 Grand Boulevard Suite 239 Kansas City MO 64108 263026388 98219 Research Illumisoft the Agileist 7280 NW 87th Terrace Kansas City MO 64153 462872050 44971 Research CYFT Incorporated 222 Third Street Suite 1130 Cambridge MA 02142 473547678 247398 Research George Washington University 45155 Research Place Suite 250 Ashburn VA 20147 530196584 501(c)3 11006 Research AKDHC Medical Research Service 3333 East Camelback Road Suite 180 Phoenix AZ 85018 651243793 5970 Research Illumisoft LLC 1111 Main Street Kansas City MO 64105 823165111 70135 Research 31 7 Patient Financial Assistance 26989 44490491 Cost Charity Care Part I, Line 2: Grants generally go to nonprofit organizations and agencies with which The Children's Mercy Hospital shares a common mission. These are agencies that generally support the health and well-being of children and families. The Children's Mercy Hospital documents the appropriate use of our funds by attending annual events to collaborate with agency board members and their executive leaders about issues related to the achievement of the agency's mission; reviewing web-based annual reports; and requesting and receiving a report from the agency grant recipient confirming the portion of grant dollars that go directly to the agency's mission-critical enterprise. 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 $500,000 in Federal funds during the fiscal year is required to obtain an 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 A-133 audits and that CMH has received an audit report. CMH maintains a subrecipient monitoring spreadsheet to track A-133 audit status, DUNS number, year-to-date spending, etc. for all subrecipients. X X X X X 1 1 0 0 0 1 0 0 0 Robert Weatherly MD Director; End 12/31/2018 508327 0 0 0 21477 0 20625 0 18981 0 569410 0 0 0 Laura Fitzmaurice MD Director; Start 1/1/2019 445621 0 0 0 4434 0 24750 0 18960 0 493765 0 0 0 Paul D Kempinski MS FACHE Director;Pres. & CEO;Start 11/1/2018 155335 0 250000 0 9517 0 0 0 2418 0 417270 0 0 0 Randall L O'Donnell PhD President & CEO; End 9/1/2018 836934 0 331459 0 1514224 0 24750 0 8724 0 2716091 0 1261704 0 Charles Roberts MD EVP & Exec.Medical Director 620402 0 155647 0 30779 0 24750 0 13155 0 844733 0 0 0 Sandra AJ Lawrence Executive VP & CAO; End 2/15/2019 601456 0 161030 0 23219 0 24750 0 18999 0 829454 0 0 0 Karen S Cox RN PhD FAAN Executive VP & COO; End 8/24/2018 515845 0 198175 0 38388 0 24750 0 9491 0 786649 0 0 0 Jo Stueve Executive VP & COO 603750 0 225028 0 26513 0 24750 0 13179 0 893220 0 0 0 David Cauble Executive VP & CFO 513171 0 132904 0 27692 0 15243 0 20154 0 709164 0 0 0 Shawn St Peter MD Chairman-Dept of Surgery 779721 0 0 0 19310 0 18456 0 20154 0 837641 0 0 0 Thomas Curran PhD Exec Director & CSO, CRI 660893 0 0 0 23219 0 20625 0 8079 0 712816 0 0 0 Robin Foster JD Senior VP, General Counsel 530524 0 117528 0 22064 0 20625 0 20154 0 710895 0 0 0 James D Saint Louis MD Physician 1194475 0 0 0 20897 0 17875 0 9717 0 1242964 0 0 0 James O'Brien Jr MD Physician 1172260 0 0 0 21977 0 24750 0 18963 0 1237950 0 0 0 William Douglas MD Physician 1172338 0 0 0 37022 0 0 0 20154 0 1229514 0 0 0 Walter Andrews MD Physician 774671 0 0 0 26513 0 24750 0 18999 0 844933 0 0 0 George Holcomb III MD Physician 776884 0 0 0 25358 0 24750 0 14310 0 841302 0 0 0 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. Part I, Line 4a and 4b: Included in the compensation of Randall O'Donnell is $1,261,704 of severance, 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. 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 148207195 638217 147568975 0 1 1 1 B 133387161 1224064 100964165 133717 31065216 0 0 0 1 C 2239700 17940000 17940000 1 0 1 1 D 24750000 24750000 1 0 1 1 A 0 0 1 1 1 1 0.00000 0.00000 0.00000 0 0 1 B 0 0 1 1 1 1 0.00000 0.00000 0.00000 0 0 1 C 0 0 1 1 1 1 0.00000 0.00000 0.00000 0 0 1 D 0 0 1 1 1 1 0.00000 0.00000 0.00000 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 outstading 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 $2,160,658 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. Substantial Contributor Substantial Contributor 3687437 Payment for FMV of Sevices Provided 0 Nancy Zirpolo Sister of Officer Karen Cox 98488 Employment 0 John Barth Son of Director Kevin Barth 60011 Employment 0 Francesca Barth Daughter-in-law of Director Kevin Barth 80123 Employment 0 X 5 1715 FMV X 450 FMV X 25575 FMV X 1 50417 FMV X 14 513452 FMV X 9 3900 FMV X 43 28962 FMV X Events 24 37041 FMV X Jewelry 2 2264 FMV X Miscellaneous 4 1822 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. Part I, Line 33: Books and clothing were received and utilized by patients and families; not resold. Form 990, Part III, line 2 Red Card Program was launched in partnership with Sporting Kansas City. Red Card Program tackles bullying in our community by working with local schools to promote awareness and inspire people to "call it when they see it; Children's Mercy Joplin opened a new and expanded location in Joplin, Missouri. "Kids Eat Free" Program provided 7,669 free summer lunches to kids at Adele Hall, Broadway, West, and East. 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 Compensation Committee of the Board of Directors is responsible for approving the compensation of the CEO, which they document in an Employment Agreement between the Board of Directors and the CEO. The Compensation Committee also approves the compensation of the EVP/CAO, the EVP/Chief Medical Officer, two persons with the title EVP/Chief Operating Officer, all officers of the Hospital, and the Chair of the Department of Pediatrics. The Compensation Committee is composed of independent outside directors who receive no compensation for their participation on the Board. The Compensation Committee engages an outside consulting firm, whose practice includes the analysis of compensation for not-for-profit hospitals, to advise the Committee with regard to market data and analysis, which was used to establish compensation. A letter from the compensation consultant opining on the reasonableness of the compensation was provided to the Committee and there is documentation of the Committee's deliberations and decision in existence. 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 73,029,758. Management and general expenses 81,683,681. Fundraising expenses 584,045. Total expenses 155,297,484. Form 990, Part XI, line 9: Change in benefit obligation 272,716. Change in interest rate swap valuation 10,896,423. Net Unrealized Change in Income Beneficiary and Charitable Remainder Trusts 609,288. Intercompany Transfer 38,219. CMH Insurance Company LLC 2401 Gillham Road Kansas City MO 64108 Insurance for The Children's Mercy Hospital MO 115830 17596614 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 24910785 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 1876316 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 1150665 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 -21070 1126310 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 27697 625259 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 433098 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 18907 191470 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 269104 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 12519 198311 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 -35111 620763 1.00000 1 Income Beneficiary Trusts (6) Trust MO N/A T 0 1 0 1 1 1 0 0 0 0 1 0 1 0 0 1 1 1 1 1 Children's Mercy Integrated Care Solutions O 5771968 Book Children's Mercy Integrated Care Solutions J 297528 Book Children's Mercy Integrated Care Solutions L 1179275 Book Children's Mercy Integrated Care Solutions P 368080 Book Children's Mercy Integrated Care Solutions Q 61898 Book Children's Mercy Integrated Care Solutions S 128436244 Book Children's Mercy Hospital Family Health Partners Inc R 38220 Book Children's Mercy- Pediatric Associates Inc D 200000 Book Children's Mercy- Summit Pediatrics & Adolescent Medicine Inc D 225000 Book Children's Mercy- Pediatric Associates Inc A 2591 Book Children's Mercy- Cass County Pediatrics and Adolescents Inc A 2569 Book Children's Mercy- Preferred Pediatrics Inc A 2836 Book Children's Mercy- Redwood Pediatrics Inc A 1420 Book Children's Mercy- Cradle thru College Care Inc A 9314 Book Children's Mercy- Summit Pediatrics & Adolescent Medicine Inc A 9495 Book