2017-05-15T11:50:26-05:00 2016-06-30 562632458 Pleus and Company LLC 14500 S Outer 40 Suite 201A Chesterfield MO 63017 990 2015-07-01 430687077 Mercy Hospital Jefferson MERC 6369331107 PO Box 350 Crystal City MO 63109 Cheryl Matejka Treasurer 3143643532 2017-05-10 1 DOUGLAS G PLEUS P00013488 3143179916 2015 2021-01-29 14:40:06Z Carl E Eric Ammons PO Box 350 Crystal City MO 63109 173273337 0 X www.mercy.net/crystalcitymo X 1953 MO A community based integrated healthcare system consisting of a 251 bed licensed facility which provides a full range of diagnostic, preventative and healthcare services along with 24 hour emergency room care. 9 5 176 125 162108 51657 45310 48156 163550035 170193604 4244 -3295488 739244 1402017 164338833 168348289 38937 23338 0 0 67993543 71655440 0 0 0 88899557 84920710 156932037 156599488 7406796 11748801 173921716 179763466 8067825 11173838 165853891 168589628 X As the Sisters of Mercy before us, we bring to Life the healing ministry of Jesus through our compassionate care and exceptional service. 0 0 142227854 23338 171114214 Mercy Hospital Jefferson consists of a 251 bed licensed facility which provides a wide range of services. In fiscal year 2016, the following services were provided - 45,236 patient days, 406 deliveries, 32,835 emergency visits, 1,808 inpatient surgeries and 2,663 outpatient surgery procedures. It is the policy of Mercy Hospital Jefferson to provide uncompensated care to patients in need of financial assistance in accordance with the hospital's established guidelines and without regard to race, religion, sex, age,or national origin. Charity and uncompensated care for the year totaled $36,072,977. Mercy Hospital Jefferson is committed to providing educational programs to the community. Free seminars and presentations are provided on a wide variety of health issues which impact patients and their families. Free services are also offered to the community such as lipid, cholesterol, bone density and glucose screenings as well as hearing and memory screenings. 142227854 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 2 0 1 176 1 1 1 0 0 0 0 0 0 0 0 0 X 9 5 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X Daniel Eckenfels 6369331107 PO Box 350 Crystal City MO 63019 X Ammons Carl E Eric President, Mercy Hospital Jefferson & Board member 54.50 5.50 X 562345 0 211670 Breeze Tonda Board member 0.50 0.50 X 0 0 0 Carron RSM Sr Judith Ann Board member 1.00 1.00 X 0 0 0 Enger MD Kevin Board member 0.50 0.00 X 0 0 0 Gannon Dennis Board member 0.50 0.50 X 0 0 0 Kennen E William Physician & board member 40.00 0.00 X 567293 0 24167 King BA M Div Rev Jack Board member 0.50 0.50 X 0 0 0 Patel MD Ash Board member 4.00 0.50 X 0 36000 0 Rehm MD Charles Chief Admin Officer & Board member 4.00 56.00 X 0 717088 48718 Hannasch Susan Regional VP-General Counsel 10.00 50.00 X 0 373926 58299 Matejka Cheryl L Chief Financial Officer 10.00 47.00 X 0 552339 82953 Sorensen Donn President-East Communities 5.00 59.00 X 0 1021817 325703 Bryson Jared VP Mission 29.00 31.00 X 210730 0 24340 Eckenfels Daniel VP Finance 58.50 1.50 X 281402 0 26135 Julien Sheila CNO 40.00 0.00 X 219573 0 19842 Meyer Michele VP Operations 60.00 0.00 X 282476 0 26840 Al Furgani Mahmud M Physician 54.00 6.00 X 731132 0 27944 Alam Tariq Physician 34.00 6.00 X 795579 0 28466 Albano Benjamin Y Physician 40.00 0.00 X 544851 0 28037 Barakat Ammar Physician 39.00 1.00 X 568309 0 26734 Misra Aayushman Physician 60.00 0.00 X 371515 0 23044 5135205 2701170 982892 78 0 1 0 McCarthy Building Co 1341 North Rock Hill Road St Louis MO 63124 Construction 5261753 Bates and Associates 433 W Walnut Springfield MO 65806 Architectural Services 4423273 Acuity Anesthesiology LLC 1734 Clarkson Road Suite 147 Chesterfield MO 63017 Anesthesia Services 3608744 Rehabcare Group Inc 7733 Forsyth Blvd Ste 1700 St Louis MO 63105 IP Acute Rehab and OP Rehab Services 3002350 Northstar Management Company LLC 10820 Sunset Office Drive Suite 20 St Louis MO 63127 Project Management Services 440363 34 48156 48156 Net Patient Service Re 621110 169399135 169399135 Rental From Affiliated 531120 621509 621509 Lab Services 621500 172960 17769 155191 170193604 1621 1621 613230 1558764 -945534 -945534 -945534 3297109 -3297109 -3297109 -3297109 76092 69175 6917 6917 Cafe & vending 722210 986970 986970 Gift shop sales 900099 439971 439971 Pharmacy Revenue 624100 76092 76092 837601 837601 2340634 168348289 170952106 162108 -2814081 23338 23338 2259767 2259767 54993237 52918458 2074779 2655198 2558402 96796 7946713 7655682 291031 3800525 3662596 137929 12822 12822 17549 17549 9872139 9446086 426053 151458 10500 140958 4489251 4332583 156668 20697 20697 1106123 984449 121674 418864 397532 21332 600 600 3295 3295 8586463 4511177 4075286 919622 919622 Drugs & medical expense 34515794 34304632 211162 Shared service fees 12907203 6711746 6195457 Bad debt expense 9858149 9858149 0 Repairs and maintenance 1293425 1147081 146344 747256 501462 245794 156599488 142227854 14371634 0 4379330 4778989 21935190 19460498 3034853 3166970 190400 113210 118017243 23395117 76628804 94622126 52924664 52924664 14828475 4697009 173921716 179763466 7591937 10334897 1253 113295 474635 725646 8067825 11173838 X 165831886 168551277 22005 38351 165853891 168589628 173921716 179763466 X 11748801 -9013064 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 24240 0 0 0 24240 0 Part II-B, Line 1: The filing organization is a member of and pays dues to the following hospital associations: Catholic Hospital Association, American Hospital Association and the Missouri Hospital Association. For the year ended June 30, 2016, dues were $18,362, $15,553, and $56,192, respectively. Approximately 3.11% of the Catholic Hospital Association dues, 22.12% of the American Hospital Association dues, and 36.00% of Missouri Hospital Association dues were attributable to lobbying activities performed by this association. 3509000 3509000 43627143 6192154 37434989 10317 860 9457 41576254 16511489 25064765 29294529 690614 28603915 94622126 Other Liabilities 403313 DUE TO AFFILIATES 322333 725646 Part X, Line 2 FEDERAL INCOME TAX PRIMARILY ALL OF THE MERCY HEALTH ENTITIES ARE RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(A) OF THE INTERNAL REVENUE CODE AS CHARITABLE ORGANIZATIONS QUALIFYING UNDER INTERNAL REVENUE CODE SECTION 501(C)(3), BY VIRTUE OF IRS DETERMINATION LETTERS OR INCLUSION IN THE OFFICIAL CATHOLIC DIRECTORY. MERCY COMPLETED AN ANALYSIS OF ITS TAX POSITIONS IN ACCORDANCE WITH APPLICABLE ACCOUNTING GUIDANCE AND DETERMINED THAT NO AMOUNTS WERE REQUIRED TO BE RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS AT JUNE 30, 2016 OR 2015. 1 1 X 1 X 1 X 1 1 1 0 1 1 6054550 6054550 0.04130 18304091 17498465 805626 0.00550 24358641 17498465 6860176 0.04680 290460 27860 262600 0.00180 306060 306060 0.00210 2844789 2668892 175897 0.00120 15087 4081 11006 0.00010 3456396 2700833 755563 0.00520 27815037 20199298 7615739 0.05200 6045 338 5707 0.00000 7192 7192 0.00000 55232 15323 39909 0.00030 68469 15661 52808 0.00030 1 805626 0 56809578 66959739 -10150161 X 1 1 1 1 Mercy Hospital Jefferson PO Box 350 Crystal City MO 63019 www.mercy.net/crystalcitymo 529-2 X Mercy Hospital Jefferson 1 0 0 1 X X X X X X X X X 15 1 0 0 1 X www.mercy.net/about/community/benefits X 1 15 1 www.mercy.net/about/community-benefits 0 0 1 X 100.000000000000 400.000000000000 1 1 X X X 1 X www.mercy.net X www.mercy.net X www.mercy.net X X X X X 1 X 0 X 1 X 0 0 Mercy Hospital Jefferson Part V, Section B, Line 5: When conducting its most recent CHNA and developing the Community Health Improvement Plan (CHIP), Mercy Hospital Jefferson worked with the Jefferson County Health Department (JCHD) as a primary community partner. JCHD utilizes the Mobilizing Action through Planning and Partnerships (MAPP) model, bringing agencies across Jefferson County together in a collaborative process. MHJ is currently engaged in the MAPP process through the Jefferson County Community Health Network (JCCHN). Below are a few examples of JCCHN agencies with coworkers who have special knowledge and expertise in the field of public health:- Jefferson County Health Department (JCHD): (Kelley Vollmar, Director of JCHD; Chrissy Oberle, Health Education Supervisor)- Community Treatment (COMTREA): (Dr. Nathan Suter, Dentist and Oral Health Director; Margo Pigg, Executive Vice President of Adult Behavioral Health)- Jefferson Franklin Community Action: (Paulette Hensley, Chief Program Officer) Additionally, a Mercy Hospital Jefferson Community Outreach Coordinator focuses on identifying unmet needs and gaps in services, making connections and referrals, developing partnerships, improving community health, and advocating for the most vulnerable. Partnering task forces with agency coworkers who have special knowledge and expertise in the field of public health include: - Methamphetamine Action Coalition (Cassie Miller, Tobacco Control Coordinator for JCHD; Kristen Bengston, Manager of Community Strategy for NCADA; Jillian Bissell, Project Coordinator for Jefferson County Drug Prevention Coalition (JCDPC))- Smoke Free Jefferson County (Adam Hunn, Health educator for JCDH; Linda Hardgrave, Program Coordinator Jefferson County Drug Prevention Coalition (JCDPC))In order to better understand the broad interests of the community, a Mercy Community Health Qualtrics (a top data collection software application) survey (available in both hard-copy and on-line format) was designed to assess the perceptions and thoughts of community members about the health needs of their community (Appendix F). A total of 84 individuals completed the survey over a 15-month time frame (from the fall of 2014 to the end of 2015). A significant effort was made to bring hard-copy surveys to local food pantries in order to include the voices of populations less likely to access the survey via the internet. A total of 39 survey responses were received as a result of direct distribution in areas with high populations of underserved, low-income individuals. Additionally, in collaboration with MHJ, a community health survey was created by Victory Health Ministry, the health and wellness arm of Victory Church (Appendix G). The survey was distributed to the church's parishioners, and a total of 154 responses were collected and reviewed. Mercy Hospital Jefferson Part V, Section B, Line 11: Based on the findings of its most recently conducted CHNA, Mercy Hospital Jefferson has chosen to address the following three significant health needs identified in Jefferson County: - Access to care- Mental health- Substance useThese needs are being addressed in the hospital's Community Health Improvement Plan (CHIP), which can be accessed here: https://www.mercy.net/sites/default/files/vendor-resources/mhj_chip_161003.pdf. Additional needs being addressed by the hospital include: - Violence: Domestic, Elderly, Child Abuse, and TraffickingMercy will continue its collaboration and involvement with A Safe Place, a local domestic violence shelter, as well as the awareness and education campaigns it has begun with restroom resource posters, a training video, and the incorporation of a screening question/referral process in Mercy's Electronic Medical Record (EMR). MHSL and Alternatives to Living in Violent Environments (ALIVE), a St. Louis based domestic violence agency, have implemented Project HOPE, the only program in the St. Louis area that allows domestic violence survivors to file for, and potentially have granted, orders of protection while still in a hospital setting. Inpatient care management is currently looking into expanding this resource to MHJ.- Cancer: Lung/Tobacco UseEfforts to address tobacco cessation will continue through Mercy's Certified Health and Wellness Coach/Mercy Road to Freedom program though Mercy's Cardiopulmonary Rehab area. Additionally, Mercy will continue to advocate around measures that promote tobacco cessation. For example, Tobacco 21, a bill introduced by a MHSL physician in 2016 to raise the tobacco products purchase age to 21 in St. Louis County, was recently passed and will go into effect on December 1, 2016. MHJ will look for opportunities to collaborate with MHSL and potentially expand legislation to Jefferson County. - Obesity/Poor Nutrition/Physical InactivityAlthough MHJ did not choose healthy lifestyles as a priority community health need to be addressed, Mercy has focused on its own coworkers, 10,000+ in the St Louis region, as a start to addressing this need. A robust initiative, Mercy's Healthification program, provides comprehensive health evaluation, screening, education, and incentives to increase healthy behaviors and improve health among Mercy coworkers. - Chronic Conditions: Heart Disease, Diabetes, or Asthma and AllergiesMHJ continues to provide education and support to those patients and community members with chronic conditions. In addition to having a Deaconess Faith Community Nurse and Mercy home health team, who provide patients with chronic disease management and education, a specialized congestive heart failure clinic was just established within the cardiology clinic in Jefferson. Clinic operations are also currently partnering with Novo Nordisk to provide Diabetic Academy, a 6 week free course focused on diabetes management. The following need is not being addressed by the hospital:- Environmental: Air/Water Quality MHJ will continue its partnership with the Jefferson County Health Department (JCHD) and will collaborate with any environmental initiatives they develop.However, it was felt by Mercy's Community Health Council (CHC) that while continued attention to this issue was important, Mercy's focus remains on providing quality healthcare. Therefore, the issues of access, and the community's crisis with behavioral health and addiction demanded Mercy's focus at this time. Mercy Hospital Jefferson Part V, Section B, Line 22d: ELIGIBILITY GUIDELINES FOR CHARITY CARE DISCOUNTS THE FEDERAL POVERTY GUIDELINES FOR INCOME ARE THE BASIS FOR DETERMINING ELIGIBILITY FOR CHARITY CARE DISCOUNTS. FOR EXAMPLE, INDIVIDUALS WITH INCOMES BELOW 100% OF THE FEDERAL POVERTY GUIDELINES WILL BE ELIGIBLE FOR FREE CARE. INDIVIDUALS WITH INCOMES GREATER THAN 100% OF THE FEDERAL POVERTY GUIDELINES MAY BE ELIGIBLE FOR CARE AT DISCOUNTED RATES DEPENDING ON THEIR INCOME LEVEL AND/OR THE AMOUNT DUE TO THE HOSPITAL. TO DETERMINE THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE, THE HOSPITAL FACILITY USES AMOUNTS GENERALLY BILLED TO INDIVIDUALS WHO HAVE INSURANCE COVERING SUCH CARE. THE HOSPITAL USES A LOOK BACK METHOD THAT CONSIDERS DISCOUNTS ALLOWED TO MEDICARE AND ALL PRIVATE HEALTH INSURERS.ADDITIONAL FINANCIAL ASSISTANCE AFTER APPROPRIATE DISCOUNTS HAVE BEEN APPLIED, ARRANGEMENTS MAY BE MADE FOR AN INTEREST-FREE MONTHLY PAYMENT PLAN. GENERALLY, NO PATIENT'S FINANCIAL RESPONSIBILITY WILL BE GREATER THAN 20% OF ANNUAL HOUSEHOLD INCOME. IT IS OUR GOAL TO WORK WITH OUR PATIENTS ON THEIR REMAINING LIABILITY. 8 1 - Mercy Home Health-Jefferson 5 Industrial Drive Festus MO 62028 Hospital based outpatient depts: Home care services 2 - Mercy Hospice-Jefferson 5 Industrial Drive Festus MO 62028 Hospital based outpatient depts: Hospice services 3 - Mercy Imaging Services-Calvary Church Ro 1500 Calvary Church Rd Festus MO 62028 Hospital based outpatient depts: Lab & Imaging 4 - Mercy Surgery Center-Jefferson 1377 Highway 61 South Festus MO 62028 Hospital based outpatient depts: Surgery 5 - Mercy Home Health-Farmington 620 Maple Valley Dr Ste A Farmington MO 63640 Hospital based outpatient depts: Home health 6 - Mercy Hospice-Farmington 620 Maple Valley Dr Ste A Farmington MO 63640 Hospital based outpatient depts: Hospice services 7 - Mercy Therapy Services-Imperial 1250 Main Street Imperial MO 63012 Hospital based outpatient depts: physical therapy 8 - Mercy Therapy Services 702 N Main St DeSoto MO 63020 Hospital based outpatient depts: physical therapy Part I, Line 7g: SUBSIDIZED HEALTH SERVICESTHE ORGANIZATION DID NOT INCLUDE ANY PHYSICIAN CLINIC COSTS ON LINE 7G. Part I, Ln 7 Col(f): TOTAL EXPENSES FROM FORM 990, PART IX, LINE 25, COLUMN (A) ARE $159,896,597. INCLUDED IN THIS AMOUNT WAS BAD DEBT EXPENSE (CHARGES) OF $9,858,149. EXPENSES FOR THE PURPOSE OF CALCULATING LINE 7, COLUMN (F) ARE $805,626. PART I, LINE 6A COMMUNITY BENEFIT REPORTTHE ORGANIZATION'S COMMUNITY BENEFIT REPORT IS PREPARED BY ITS ULTIMATE PARENT ENTITY, MERCY HEALTH (EIN: 43-1423050). Part II, Community Building Activities: MERCY HOSPITAL JEFFERSON'S (MHJ) COMMUNITY BUILDING ACTIVITIES PROMOTE THE HEALTH, WELLNESS, AND SAFETY OF THE COMMUNITY IT SERVES. THROUGH ACTIVE PARTICIPATION ON COMMUNITY BOARDS, NEIGHBORHOOD/COMMUNITY COALITIONS, AND INVOLVEMENT IN COMMUNITY-BASED EVENTS, MERCY BUILDS PARTNERSHIPS TO DEVELOP COLLABORATIVE SOLUTIONS TO ADDRESS COMMUNITY NEEDS. SOME OF THESE COMMUNITY BUILDING PARTNERSHIPS AND COMMUNITY ENGAGEMENT ACTIVITIES INCLUDE: - JEFFERSON COUNTY HEALTH DEPARTMENT- JEFFERSON COUNTY GROWTH ASSOCIATION- JEFFERSON COLLEGE BOARD- PARTICIPATION IN THE DESOTO, HILLSBORO, TWIN CITY AREA, AND STE. GENEVIEVE CHAMBERS OF COMMERCE ACTIVITIES- KIWANIS CLUB- YMCA BOARD- COMTREA (COMMUNITY TREATMENT, INC.)IN ADDITION, MHJ ACTIVELY PARTICIPATES IN SEVERAL COALITIONS THAT ALIGN WITH THE HOSPITAL'S CHNA TOP HEALTH PRIORITY OF SUBSTANCE ABUSE, INCLUDING:- JEFFERSON COUNTY DRUG PREVENTION COALITION- JEFFERSON COUNTY METHAMPHETAMINE ACTION COALITION- SMOKE FREE JEFFERSON COUNTY. EXAMPLES OF ONGOING PROJECTS LED BY THE COALITIONS LISTED ABOVE INCLUDE:- CLEARING THE AIR, A MULTI-MEDIA CONTEST FOR YOUTH TO ADDRESS THE HARM OF SMOKING- SUBSTANCE ABUSE AWARENESS DAY, A ONE DAY ANNUAL CONFERENCE THAT FOCUSES ON DRUG USE TRENDS IN THE JEFFERSON COUNTY COMMUNITY, THE EFFECTS OF SUBSTANCE ABUSE ON THE INDIVIDUAL AND THE COMMUNITY AND THE CONNECTION BETWEEN SUBSTANCE ABUSE AND MENTAL HEALTH. EFFORTS WITH THESE COALITIONS WILL CONTINUE AS MHJ DETERMINED SUBSTANCE ABUSE TO BE A TOP HEALTH PRIORITY THROUGH THE 2016-2019 CHNA CYCLE. CASH/IN-KIND DONATIONSMERCY PROVIDES CASH AND IN-KIND DONATIONS THROUGH THE SUPPORT OF CO-WORKER ENGAGEMENT AND COMMUNITY SERVICE ACTIVITIES. THESE COMMUNITY BUILDING ACTIVITIES ALLOW MERCY CO-WORKERS TO LOOK BEYOND THE WALLS OF THE FACILITIES IN WHICH THEY SERVE TO BETTER UNDERSTAND AND ADDRESS THE NEEDS OF THE COMMUNITY.DURING FY16, CASH DONATIONS WERE GIVEN TO ORGANIZATIONS THROUGHOUT THE COMMUNITY THAT INCLUDED:- JEFFERSON COUNTY YMCA- ST. PIUS X CATHOLIC HIGH SCHOOL- JEFFERSON COLLEGE- FOX C-6 SCHOOL DISTRICT- PONY BIRDA FULL DESCRIPTION OF OUR COMMUNITY BUILDING ACTIVITIES CAN BE FOUND AT WWW.MERCY.NET/ABOUT/COMMUNITYBENEFITS. Part III, Line 2: TO DETERMINE THE AMOUNT OF BAD DEBT EXPENSE, AT COST, BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENT ACCOUNTS WAS MULTIPLIED BY A RATIO OF COST TO CHARGES. THE RATIO OF COST TO CHARGES USED WAS BASED ON DETAILED COST ACCOUNT, WHERE AVAILABLE. WHERE COST ACCOUNTING IS NOT AVAILABLE, COST REPORT COST TO CHARGE RATIOS WERE UTILIZED. Part III, Line 3: THE FILING ORGANIZATION DETERMINED THAT THE ESTIMATED AMOUNT OF BAD DEBT EXPENSE (AT COST) ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS $0. ALTHOUGH THE CHARITY CARE POLICY REQUIRES THE PARTICIPATION OF THE PATIENT REQUESTING ASSISTANCE, WE HAVE A PROCESS UNDER PRESUMPTIVE CHARITY TO ADDRESS ACCOUNTS FOR PATIENTS WHO DO NOT PROVIDE THE INFORMATION. WE BELIEVE THAT OUR CHARITY POLICY IS COMPREHENSIVE ENOUGH TO CAPTURE ALMOST ALL PATIENTS WHO QUALIFY FOR CHARITY CARE. Part III, Line 4: THE TEXT OF THE FOOTNOTE THAT IS INCLUDED IN MERCY HEALTH AND SUBSIDIARIES AUDITED FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE IS AS FOLLOWS: "PATIENT ACCOUNTS THAT ARE UNCOLLECTED, INCLUDING THOSE PLACED WITH COLLECTION AGENCIES, ARE INITIALLY CHARGED AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IN ACCORDANCE WITH COLLECTIONS POLICIES OF THE HEALTH SYSTEM AND, IN CERTAIN CASES, ARE RECLASSIFIED TO CHARITY CARE IF DEEMED TO OTHERWISE MEET THE HEALTH SYSTEM'S CHARITY CARE POLICY. THE PROVISION FOR UNCOLLECTIBLE RECEIVABLES IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. PERIODICALLY THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES BASED UPON THE PAYOR COMPOSITION AND AGING OF RECEIVABLES AS OF THE REPORTING DATE WITH CONSIDERATION OF THE HISTORICAL PAYMENT AND WRITE-OFF EXPERIENCE BY PAYOR CATEGORY. THE RESULTS OF THESE REVIEWS ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR UNCOLLECTIBLE RECEIVABLES TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES. AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE, THE HEALTH SYSTEM FOLLOWS ESTABLISHED GUIDELINES FOR PLACING PAST-DUE PATIENT BALANCES WITH COLLECTION AGENCIES." Part III, Line 8: IT IS THE POSITION OF MERCY HOSPITAL JEFFERSON THAT 100% OF ANY SHORT FALL SHOULD BE TREATED AS COMMUNITY BENEFIT. THIS AMOUNT REPRESENTS COST OF PROVIDING SERVICES THAT REMAIN UNCOMPENSATED TO THE PROVIDER. THE UNREIMBURSED COSTS OF MEDICARE IS CALCULATED BY THE GROSS CHARGES NET OF THE COST TO CHARGE RATIO LESS ANY PAYMENTS, DEDUCTIONS OR REIMBURSEMENTS USING THE ANNUAL MEDICARE COST REPORT (CMS FORM 2552-96). Part III, Line 9b: MERCY'S COLLECTION POLICY PROVIDES THAT MERCY WILL PERFORM A REASONABLE COMMUNICATION AND/OR REVIEW OF PATIENT ACCOUNTS AS IT RELATES TO ANY SERVICE PROVIDED AT OUR FACILITIES BEFORE TURNING THE ACCOUNT TO BAD DEBT OR TAKING LEGAL ACTION FOR NONPAYMENT. MERCY ACTIVELY SCRUBS ACCOUNTS FOR PAYOR PLAN COVERAGE'S; INCLUDING MEDICAID. IN THE EVENT AN ACCOUNT IS TURNED TO COLLECTIONS, AND IS IDENTIFIED IN NEED OF FINANCIAL ASSISTANCE DUE TO CIRCUMSTANCE CHANGES, OR NOW REQUESTING ASSISTANCE, THE ACCOUNTS ARE RETURNED BY THE AGENCY AND CONSIDERED FOR CHARITY IF THE PATIENT PROVIDES THE REQUESTED INFORMATION. IF THE PATIENT FAILS TO RETURN THE INFORMATION, THE ACCOUNT WILL QUALIFY FOR COLLECTIONS.MERCY UTILIZES THE EXPERIAN TOOL TO ENHANCE THE ABILITY TO DETERMINE THE CHARITY QUALIFICATION PRIOR TO TURNING TO BAD DEBT; KNOWN AS PRESUMPTIVE CHARITY. MERCY WILL GRANT CHARITY IN SITUATIONS WHERE THERE HAS BEEN AN INABILITY TO OBTAIN INFORMATION FROM PATIENTS OR THE INFORMATION PROVIDED IS NOT COMPLETE ENOUGH TO MAKE A CHARITY DETERMINATION WHEN A PATIENT HAS SUBMITTED AN APPLICATION. IN ADDITION, MERCY UTILIZES THE SAME TOOL TO QUALIFY ACCOUNTS PER THE PRACTICE OF PRESUMPTIVE CHARITY PRIOR TO BAD DEBT PLACEMENT FOR BALANCES IN EXCESS OF $6500. ALL ACCOUNT BALANCES RELATING TO ACCOUNTS IDENTIFIED BY THE HIGHER BALANCES WILL BE CONSIDERED AND FLAGGED FOR CHARITY IF THERE IS AN INABILITY TO PAY AFTER A RETURN FROM THE COLLECTION AGENCY AT APPROXIMATELY 120 DAYS. MERCY WILL PURSUE APPROPRIATE MEANS IN THE COLLECTION OF DELINQUENT ACCOUNTS FROM PATIENTS WITH AN ESTABLISHED ABILITY TO PAY OR AN UNWILLINGNESS TO COOPERATE IN VALIDATING ELIGIBILITY FOR FINANCIAL ASSISTANCE. THESE APPROPRIATE MEANS MAY INCLUDE LEGAL ACTION CONSISTENT WITH MERCY MISSION AND VALUES AFTER A SENDING 3 MONTHLY STATEMENTS WITH THE FINAL INCLUDING NOTIFICATION; IF NO RESOLUTION THEY WILL BE TURNED TO COLLECTIONS. ADDITIONALLY, THEY MAY INCLUDE LIENS UPON REAL PROPERTY AND REASONABLE WAGE GARNISHMENTS. LEGAL ACTIONS WILL GENERALLY NOT INCLUDE BANK GARNISHMENTS, REPOSSESSION OF ASSETS OR FORECLOSURES TO ENSURE SATISFACTION OF A LIEN. MERCY HAS POLICIES AND PROCEDURES ESTABLISHED TO ADDRESS THE INITIATION OF LEGAL ACTION AND ANNUALLY REVIEW COMPLIANCE WITH POLICIES BUT ENSURE 120 DAYS OF BILLING AND COLLECTIONS OCCURS PRIOR TO ANY EXTRAORDINARY COLLECTIONS ARE PURSUED. Part VI, Line 2: COMMUNITY HEALTH NEEDS ASSESSMENT PROCESSIN JANUARY OF 2015, MERCY HOSPITAL JEFFERSON (MHJ) BEGAN PLANNING FOR ITS 2016-2019 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THE JEFFERSON COUNTY HEALTH DEPARTMENT (JCHD) SERVES AS THE PRIMARY COMMUNITY PARTNER FOR MERCY HOSPITAL JEFFERSON IN BOTH THE CHNA AND COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) PROCESSES. JCHD UTILIZES THE MOBILIZING ACTION THROUGH PLANNING AND PARTNERSHIPS (MAPP) MODEL, BRINGING AGENCIES ACROSS JEFFERSON COUNTY TOGETHER IN A COLLABORATIVE PROCESS. MHJ IS CURRENTLY ENGAGED IN THE MAPP PROCESS THROUGH THE JEFFERSON COUNTY COMMUNITY HEALTH NETWORK. A COMMUNITY HEALTH COUNCIL, LED BY ERIC AMMONS, PRESIDENT OF MERCY HOSPITAL JEFFERSON, GUIDED THE NEEDS ASSESSMENT PROCESS. THE COUNCIL CONVENES QUARTERLY AND IS ACCOUNTABLE FOR ENSURING THAT COMMUNITY BENEFIT ACTIVITIES MEET MISSION COMPLIANCE AND IRS GUIDELINES. IT CONSISTS OF MERCY LEADERS FROM VARIOUS DEPARTMENTS, SUCH AS BEHAVIORAL HEALTH, FINANCE, CARE MANAGEMENT, PHILANTHROPY, ETC., AND A HOSPITAL BOARD MEMBER. THE COUNCIL DETERMINES WHICH HEALTH INITIATIVES WILL BE PUT FORTH IN THE HOSPITAL'S THREE-YEAR COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP). CO-WORKERS IN MERCY'S COMMUNITY HEALTH & ACCESS DEPARTMENT SERVED ON THE COUNCIL AND WERE THE PRIMARY LEADS OF THE 2016 CHNA. A SAINT LOUIS UNIVERSITY MASTER OF HEALTH ADMINISTRATION STUDENT PROVIDED SUPPORT BY COLLECTING AND REVIEWING DATA FROM VARIOUS SOURCES. THESE INCLUDED: SURVEYS, FOCUS GROUPS, PUBLISHED DATA, AND HOSPITAL SPECIFIC DATA.THE VOICES OF THE PEOPLE OF JEFFERSON COUNTY WERE CENTRAL TO THE HEALTH NEEDS ASSESSMENT PROCESS. MHJ GATHERED COMMUNITY INPUT THROUGH: - SURVEYS - ONLINE AND PRINTED (FOR THOSE WITH NO COMPUTER ACCESS) - MERCY COMMUNITY ADVISORY PANELS- COMMUNITY COALITIONS AND STAKEHOLDER MEETINGS EXTERNAL SOURCES OF PUBLISHED DATA ARE AS FOLLOWS:- JEFFERSON COUNTY HEALTH DEPARTMENT ANNUAL SUMMARY REPORT - 2014 HTTP://WWW.JEFFCOHEALTH.ORG/IMAGES/STORIES/ADMINSERVICES/2014%20JCHD%20ANNUAL%20REPORT.PDF - JEFFERSON MEMORIAL COMMUNITY FOUNDATION - 2014 REPORTHTTP://JMCFMO.ORG/MEDIA/NEEDS_ASSESSMENT.PDF - COUNTY HEALTH RANKINGS 2016WWW.COUNTYHEALTHRANKINGS.ORG- COMMUNITY DATA PROFILES & MISSOURI INFORMATION FOR COMMUNITY ASSESSMENT (MICA)HTTP://HEALTH.MO.GOV/DATA/COMMUNITYDATAPROFILES/INDEX.HTML- COMMUNITY COMMONSWWW.COMMUNITYCOMMONS.ORGPRIORITIZED SIGNIFICANT COMMUNITY HEALTH NEEDSTHE NOMINAL GROUP TECHNIQUE WAS USED IN THE PRIORITY SETTING PROCESS. THE MERCY HOSPITAL JEFFERSON COMMUNITY HEALTH COUNCIL WAS PRESENTED WITH THE QUANTITATIVE AND QUALITATIVE COMMUNITY HEALTH DATA AND MEMBERS WERE ASKED TO RANK THESE HEALTH ISSUES BY LEVEL OF CONCERN AND ABILITY TO COLLABORATE ON THE ISSUE TO PRODUCE RESULTS. THE STRENGTHS AND SERVICES OF MHJ ALONG WITH THE STRATEGIC PLAN WERE ALSO CONSIDERED. UPON REVIEW AND DISCUSSION OF THE PRIMARY AND SECONDARY DATA GATHERED, THE HOSPITAL'S STRATEGIC PLAN, AND THE RESOURCES AVAILABLE AT THE HOSPITAL AND IN THE COMMUNITY, THE FOLLOWING PRIORITIES WERE SELECTED:- MENTAL HEALTH- SUBSTANCE USE - ACCESS TO CARETHE COMMUNITY HEALTH COUNCIL THEN CREATED A COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) FOR MHJ, IDENTIFYING SPECIFIC INITIATIVES RELATED TO IMPROVING EACH OF THESE HEALTH PRIORITIES. THE CHIP WAS DESIGNED WITH REALISTIC, MEASUREABLE, AND ATTAINABLE GOALS THAT ALIGN WITH THE MISSION AND STRATEGY OF THE ORGANIZATION. MERCY HOSPITAL JEFFERSON ALSO ASSESSES THE NEEDS OF THE COMMUNITY THROUGH REQUESTS BY LOCAL AGENCIES. ACCORDING TO THE CATHOLIC HEALTH ASSOCIATION, A REQUEST FROM A PUBLIC AGENCY OR COMMUNITY GROUP TO INITIATE OR CONTINUE AN ACTIVITY OR PROGRAM MEETS THE REQUIREMENTS FOR A DOCUMENTED COMMUNITY NEED. MERCY'S INVOLVEMENT WITH COMMUNITY ORGANIZATIONS LIKE MEALS ON WHEELS IS BASED ON THE ORGANIZATION'S REQUEST FOR SUPPORT. Part VI, Line 3: Mercy informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization's financial assistance policy through several means. If at any time a patient expresses hardship and inability to pay, the accounts is placed for review. In addition, patient have signage about the policy at the access points, and all staff working with the patient at Point of Service, Scheduling, Customer Service, and even through the Medicaid Eligibility Screening, have the means to send the account for review. There is the plain language summary that is being provided to all whom express hardship, in addition to the web address providing the application, policies, and even how uninsured accounts are handled. Lastly, the statements message to the patient that Mercy does have a Financial Assistance Program and to call to see if they are eligible. Mercy staffs internal resources certified to assist patients with Medicaid Applications as well. Part VI, Line 4: MERCY HOSPITAL JEFFERSON INCLUDES FOUR COUNTIES IN MISSOURI - JEFFERSON,WASHINGTON, STE. GENEVIEVE AND ST. FRANCOIS. THE FOLLOWING INFORMATION IS DERIVED FROM 2016 SG2 ANALYTICS DATA AND SG2 INSURANCE COVERAGE ESTIMATES. THE AREA'S POPULATION IS 304,996. 29% OF THE POPULATION HAS INCOME OVER$75,000. 43% OF THE POPULATION IS AGE 45 AND OLDER. 22% OF THE POPULATION IS ON MEDICARE, 16% ON MEDICAID, AND 11% UNINSURED. Part VI, Line 5: OPEN MEDICAL STAFF MEDICAL STAFF PRIVILEGES ARE EXTENDED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY FOR NEARLY ALL OF OUR DEPARTMENTS. MERCY HOSPITAL JEFFERSON HAS EXCLUSIVE CONTRACTS WITH PHYSICIAN GROUPS FOR THE FOLLOWING SERVICES: RADIOLOGY, PATHOLOGY, ANESTHESIA AND EMERGENCY MEDICINE. THIS MEANS THAT THE MAJORITY OF THE PHYSICIANS ON STAFF ARE IN CATEGORIES THAT ARE OPEN TO QUALIFIED PHYSICIANS IN THE COMMUNITY.COMMUNITY BOARD - FY16 MERCY HEALTH EAST COMMUNITIES FY16 BOARD MEMBERSCRAIG ASHMOREJON BAUERPATRICIA BOLSTER, MDCRAIG BOYD, MDSTEVEN BUSCHSR. JUDY CAREY, RSMSR. KATHERINE GLOSENGER, RSM - EX-OFFICIOARTHUR JOHNSONWILLIAM MCKENNATERI MURRAY, RN, PHDDON MUSICK, IIISR. SUSAN O'CONNOR, RSMCHARLES REHM, MDGEORGE ROMANSTEPHEN SANDERS, MDDONN SORENSEN - EX-OFFICIOSTEVE SWYERS -CHAIRTESSA TRELZSR. MARIA LUISA VERA, RSMRAY WEICK, MDMERCY HOSPITAL JEFFERSON FY16 BOARD MEMBERSERIC AMMONS - EX-OFFICIOTONDA BREEZE - CHAIRDR. BRICCIO CADIZSR. JUDY CARRON, RSMKEVIN ENGER, MDDENNIS GANNONOSLER GUZON, MD - EX-OFFICIO JACK KINGERIC KNOLLCHARLES REHM, MDBASSAM ROUKOZ, MDUSE OF SURPLUS FUNDS SURPLUS FUNDS AND UNRESTRICTED ASSETS HELD BY MERCY HOSPITAL JEFFERSON ARE REINVESTED IN PATIENT CARE, MEDICAL EDUCATION AND RESEARCH INITIATIVES WHICH SUPPORT THE ORGANIZATION'S MISSION TO DELIVER COMPASSIONATE CARE AND EXCEPTIONAL HEALTH CARE SERVICES TO THE COMMUNITIES IT SERVES. EXAMPLES INCLUDE THE FOLLOWING:- NEW PATIENT TOWER PLANNED TO CONVERT MERCY HOSPITAL JEFFERSON TO A PRIVATE ROOM CAMPUS AS WELL AS TO EXPAND WOMEN'S HEALTH SERVICES IN THE REGION, REGARDLESS OF ABILITY TO PAY.- EXPANSION OF PRIMARY CARE AND SPECIALTY CARE PHYSICIANS TO THE MERCY HOSPITAL JEFFERSON SERVICE AREA WITH A FOCUS TO REACH THE UNDERSERVED POPULATIONS CLOSER TO THEIR HOMES.- CONTINUED PARTNERING WITH AREA EDUCATION PROGRAMS TO HELP PROMOTE THE TRAINING OF CRITICALLY NEEDED SERVICES FOR THE COMMUNITY INCLUDING SCHOOLS OF NURSING, RADIOLOGY AND PHARMACY.- EXPANSION OF BEHAVIORAL HEALTH CARE TO PROVIDE ADOLESCENT CARE FOR THE FIRST TIME IN JEFFERSON COUNTY. INITIALLY ADDING CLINIC PHYSICIANS FOR OP COVERAGE AND WILL EXPAND TO IOP (INTENSIVE OUTPATIENT THERAPY) THE FOLLOWING YEAR.- A NEW CANCER CENTER IS UNDER CONSTRUCTION TO BRING CARE CLOSER TO HOME FOR THE COMMUNITY. ADDITIONAL COMMUNITY HEALTH INITIATIVES/INFORMATIONCURRENTLY NOT INCLUDED THROUGH THE REPORTING OF COMMUNITY BENEFIT OR COMMUNITY BUILDING ACTIVITIES ARE:IN KEEPING WITH MHJ'S COMMITMENT TO SERVE ALL MEMBERS OF THE COMMUNITY, MHJ PROVIDES:- FREE CARE AND/OR SUBSIDIZED CARE- CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST- HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY- HEALTH EDUCATION PROGRAMS, AND- A VARIETY OF BROAD COMMUNITY SUPPORT ACTIVITIES.MANY OF THE PROGRAMS MENTIONED BELOW ARE PART OF OUR CURRENT COMMUNITY HEALTH IMPACT PLAN (CHIP). THESE ARE INDICATED BY ASTERISKS.MERCY NEIGHBORHOOD MINISTRY (MNM)MERCY NEIGHBORHOOD MINISTRY IS A DEPARTMENT THAT SUPPORTS THE SERVICE AREAS OF MERCY HOSPITAL JEFFERSON, MERCY HOSPITAL ST. LOUIS AND THE SURROUNDING COUNTIES. IT FOCUSES ON CONNECTING THE ECONOMICALLY UNDERSERVED WITH APPROPRIATE HEALTH AND SOCIAL SERVICES AS WELL AS OVERALL COMMUNITY HEALTH AND ACCESS. MNM PARTNERS WITH OVER 100 COMMUNITY HEALTH AND SOCIAL SERVICE AGENCIES, CLINICS, CHURCHES AND SCHOOLS. NEARLY HALF OF ITS ANNUAL EXPENSES ARE OFFSET THROUGH MERCY FOUNDATION. ACCESS TO CARECERTIFIED APPLICATION COUNSELORS*SINCE THE BEGINNING OF OPEN ENROLLMENT THROUGH THE AFFORDABLE CARE ACT IN AUGUST 2013, MERCY HAS HELPED THOSE IN NEED OF AFFORDABLE HEALTH INSURANCE TO ENROLL IN PLANS AND/OR EDUCATE THEM ABOUT THEIR OPTIONS. THIS COVERAGE ASSISTANCE PROGRAM HAS BEEN ENTIRELY FUNDED THROUGH MISSOURI FOUNDATION FOR HEALTH GRANTS AND WAS AVAILABLE IN THE SERVICE AREAS OF MHJ, MHSL, MHW AND BEYOND. ENROLLMENTS TO-DATE TOTAL OVER 800 AND THE CACS HAVE ATTENDED HUNDREDS OF EVENTS RESULTING IN EDUCATIONAL OPPORTUNITIES IN UNDERSTANDING THE TERMINOLOGY AND USAGE OF HEALTH INSURANCE.HEALTH LEADS*HEALTH LEADS IS A SOCIAL ENTERPRISE THAT ENVISIONS A HEALTHCARE SYSTEM THAT ADDRESSES ALL PATIENTS' BASIC RESOURCE NEEDS AS A STANDARD PART OF QUALITY CARE. IN THE SPRING OF 2016, MERCY HEALTH JOINED THE HEALTH LEADS LEARNING COLLABORATIVE TO BEGIN INTEGRATING THE HEALTH LEADS PROGRAM IN ORDER TO ASSIST PATIENTS WITH HEALTH-RELATED SOCIAL NEEDS THROUGH RESOURCE REFERRAL. THIS PROGRAM IS DESIGNED FOR MERCY CLINIC JEFFERSON PATIENTS AND IS BEING FUNDED THROUGH MERCY CLINICS; THEREFORE THE TOTAL COMMUNITY BENEFIT OF THIS PROGRAM CANNOT BE REPORTED UNDER THE EIN FOR MERCY HOSPITAL JEFFERSON.MENTAL HEALTHALIVE AND WELL IN STL*ALIVE AND WELL STL IS A COMMUNITY-WIDE EFFORT STARTED BY THE REGIONAL HEALTH COMMISSION THAT FOCUSES ON REDUCING THE IMPACT OF TOXIC STRESS AND TRAUMA ON A PERSON'S HEALTH AND WELL-BEING. MERCY ACTS AS A COMMUNITY PARTNER FOR THIS INITIATIVE AND WORKS TO CREATE A MORE TRAUMA AWARE/INFORMED COMMUNITY THROUGH TRAINING OPPORTUNITIES AND ANALYZING BEST PRACTICES IN THE FIELD OF BEHAVIORAL HEALTH. IN FY16 TRAUMA AWARENESS TRAININGS, OPEN TO THE COMMUNITY, WERE HELD AT EACH MERCY EAST COMMUNITY HOSPITAL.SUBSTANCE USEMERCY ROAD TO FREEDOMTHIS PROGRAM WAS OFFERED TO THE COMMUNITY AND MERCY CO-WORKERS AS A TELEPHONIC, ONE-ON-ONE SUPPORT SYSTEM WITH A SPECIALTY TRAINED COUNSELOR. SINCE 2013, OVER 80 PEOPLE HAVE KICKED THE HABIT.PHYSICIANSMERCY HEALTH SYSTEM HAS A LARGE NUMBER OF CLINICS, PHYSICIAN OFFICES AND OTHER HEALTHCARE FACILITIES LOCATED IN THE EAST COMMUNITY THAT ARE NOT ASSOCIATED WITH A HOSPITAL EIN. THESE CLINICS AND FACILITIES PROVIDE FINANCIAL ASSISTANCE, PARTICIPATE IN HEALTH PROFESSIONS EDUCATION (I.E. STUDENT SHADOWING) AND PROVIDE IN-KIND CONTRIBUTIONS TO THEIR COMMUNITIES. THE TOTAL COMMUNITY BENEFIT THAT CANNOT BE REPORTED FOR THESE ACTIVITIES IN FY16 IS $13,384,370. Part VI, Line 6: AFFILIATED HEALTH CARE SYSTEM: THE FILING ORGANIZATION IS PART OF MERCY HEALTH ("MERCY"). MERCY IS A MISSOURI NON-PROFIT CORPORATION WITH ITS HEADQUARTERS ("MINISTRY OFFICE") IN ST. LOUIS, MISSOURI. MERCY PROVIDES HEALTH CARE SERVICES IN FOUR STATES - ARKANSAS, KANSAS, MISSOURI, AND OKLAHOMA - AND HAS OUTREACH MINISTRIES LOCATED IN LOUISIANA, MISSISSIPPI, AND TEXAS. MERCY'S MISSION IS "AS THE SISTERS OF MERCY BEFORE US, WE BRING LIFE TO THE HEALING MINISTRY OF JESUS THROUGH OUR COMPASSIONATE CARE AND EXCEPTIONAL SERVICE." AS OF JUNE 30, 2016, MERCY FACILITIES INCLUDED 33 ACUTE CARE HOSPITALS, 3 MANAGED HOSPITALS, 4 HEART HOSPITALS, 2 CHILDREN'S HOSPITALS, 2 ORTHOPEDIC HOSPITALS AND 3 REHAB HOSPITALS. FOR THE FISCAL YEAR ENDED JUNE 30, 2016, MERCY HAD MORE THAN 9.2 MILLION OUTPATIENT AND PHYSICIAN OFFICE VISITS, APPROXIMATELY 2,100 EMPLOYED PHYSICIANS, AND APPROXIMATELY 40,000 FULL-TIME EQUIVALENT EMPLOYEES, MAKING MERCY THE FIFTH LARGEST CATHOLIC HEALTH SYSTEM IN THE UNITED STATES. MERCY IS SPONSORED BY MERCY HEALTH MINISTRY, WHICH IS GOVERNED BY MEMBERS THAT INCLUDE SISTERS OF MERCY. MANY SERVICES THAT ARE ESSENTIAL TO FULFILLING MERCY'S MISSION ARE CENTRALIZED AT THE MINISTRY OFFICE. SUCH CENTRALIZED SERVICES INCLUDE TREASURY, INFORMATION TECHNOLOGY, CLINICAL QUALITY MANAGEMENT, LEGAL AND COMPLIANCE COUNSEL, COMPENSATION AND BENEFITS, CONSULTING, PERFORMANCE MANAGEMENT, REVENUE MANAGEMENT, INTERNAL AUDIT, ACCOUNTING AND REPORTING, CAPITAL MANAGEMENT, CLINICAL ENGINEERING, AND CLINICAL SAFETY. THE CENTRALIZATION OF SUCH SUPPORT SERVICES ENABLES MERCY TO ENSURE THAT EACH OF ITS COMMUNITIES, WHETHER LARGE OR SMALL, HAS THE SERVICES IT NEEDS. Part VI, Line 7, Reports Filed With States MO 0 AMERICAN HEART ASSOCIATION 7272 GREENVILLE AVE DALLAS TX 75231 135613797 501(C)(3) 7500 FMV GENERAL SUPPORT ARCHDIOCESE OF ST LOUIS 20 ARCHBISHOP MAY DRIVE ST LOUIS MO 63119 430653244 501(C)(3) 10000 FMV GENERAL SUPPORT 2 0 Schedule I, Part I, Line 2 The organization awards assistance to preapproved local charity-based organizations, the amounts of $5,000 to $20,000 are approved by the CFO and amounts over $20,000 are approved by the CEO. X X X 1 1 0 1 0 0 0 0 0 0 0 Ammons Carl E Eric President, Mercy Hospital Jefferson 328268 0 191001 0 43076 0 197182 0 14488 0 774015 0 0 0 Kennen E William Physician & board member 500656 0 22832 0 43805 0 9100 0 15067 0 591460 0 0 0 Rehm MD Charles Chief Admin Officer & Board member 0 485066 0 178689 0 53333 0 34034 0 14684 0 765806 0 0 Hannasch Susan Regional VP-General Counsel 0 234457 0 102417 0 37052 0 44292 0 14007 0 432225 0 0 Matejka Cheryl L Chief Financial Officer 0 348636 0 151352 0 52351 0 64123 0 18830 0 635292 0 0 Sorensen Donn President-East Communities 0 647761 0 345241 0 28815 0 312651 0 13052 0 1347520 0 0 Bryson Jared VP Mission 121934 0 39231 0 49565 0 7591 0 16749 0 235070 0 0 0 Eckenfels Daniel VP Finance 205146 0 61539 0 14717 0 9100 0 17035 0 307537 0 0 0 Julien Sheila CNO 155938 0 45604 0 18031 0 11943 0 7899 0 239415 0 0 0 Meyer Michele VP Operations 194388 0 61482 0 26606 0 8945 0 17895 0 309316 0 0 0 Al Furgani Mahmud M Physician 271148 0 430089 0 29895 0 9100 0 18844 0 759076 0 0 0 Alam Tariq Physician 366749 0 416578 0 12252 0 9100 0 19366 0 824045 0 0 0 Albano Benjamin Y Physician 297683 0 216666 0 30502 0 9100 0 18937 0 572888 0 0 0 Barakat Ammar Physician 259346 0 279125 0 29838 0 9100 0 17634 0 595043 0 0 0 Misra Aayushman Physician 219467 0 117609 0 34439 0 9100 0 13944 0 394559 0 0 0 Part I, Line 1a CHARTER TRAVEL IS PROVIDED TO CERTAIN EMPLOYEES AS AND WHEN APPROPRIATE, AND AS DEEMED NECESSARY FOR BUSINESS TRAVEL. AFTER CHARTER TRAVEL APPROVAL HAS BEEN GRANTED IN ACCORDANCE WITH THE FINANCIAL JUSTIFICATION PROCESS, THE APPROVED CHARTER TRAVEL FOR BUSINESS IS A REIMBURSABLE EXPENSE WHICH IS NOT TAXABLE TO THE EMPLOYEES. TRAVEL FOR COMPANIONS FOR NONBUSINESS REASONS IS PROVIDED IN CERTAIN INSTANCES AND IN ACCORDANCE WITH THE CO-WORKER TRAVEL AND OTHER EXPENSE POLICY AND PROCEDURES. WHERE COMPANION TRAVEL HAS RESULTED IN A TAXABLE EVENT, THE EMPLOYEES ARE TAXED FOR SUCH TRAVEL. SPOUSAL TRAVEL WAS PROVIDED FOR THE FOLLOWING EMPLOYEES OF A RELATED ORGANIZATION: CHARLES REHM. LIMITED INSTANCES OF TAX GROSS-UPS MAY HAVE OCCURRED WITH RESPECT TO EXECUTIVES. HOUSING BENEFITS ARE PROVIDED THROUGH A RELOCATION PROGRAM IN ACCORDANCE WITH COMPANY POLICY. SUCH BENEFITS WERE SUBJECT TO TAX TO THE EMPLOYEE OF A RELATED ORGANIZATION, JARED BRYSON. SUCH BENEFITS WERE SUBJECT TO TAX OF AN EMPLOYEE, AAYUSHMAN MISRA. PAYMENT BY THE COMPANY OF COSTS FOR TEMPORARY HOUSING BY EMPLOYEES FOR THE CONVENIENCE OF THE COMPANY IS MADE IN ACCORDANCE WITH THE CO-WORKER TRAVEL AND OTHER EXPENSE POLICY AND PROCEDURES. AS A REIMBURSABLE EXPENSE, THIS TYPE OF LODGING IS NOT TAXABLE TO THE EMPLOYEE. Part I, Line 4b Part I, Line 4B: Mercy Health, the ultimate parent company, offers supplemental retirement plans to certain executives which provide benefits upon vesting date based on compensation, age at the time of benefit commencement, length of service with the company and/or its affiliates, and length of tenure in the plan. The plans are closed to new entrants. The following individuals participated in the following plans. There were no payments for the fiscal year ended 6/30/2016: Supplemental Executive Retirement Plan (SERP) Sorensen, Donn (DC); Ammons,Carl (DC) Supplemental Management Retirement Plan (SMRP) Sorensen, Donn; Hannasch, Susan; Matejka,Cheryl L; Rehm MD, Charles The amount of all accrued benefits is included in compensation amounts provided in Schedule J, Part II, Column (C). Part I, Line 3 Mercy Health (parent company) is responsible for establishing the compensation of the organization's CEO/Executive Director. The following methods were used by Mercy Health to establish compensation: -Independent compensation consultant -written employment contract -compensation survey or study -approval by the board or compensation committee Form 990, Part VI, Section A, line 6 THE FILING ORGANIZATION HAS A SOLE CORPORATE MEMBER, MERCY HEALTH EAST COMMUNITIES - SOUTHERN REGION, a supporting organization under Section 509(a)(3). The member of MERCY HEALTH EAST COMMUNITIES - SOUTHERN REGION is Mercy Health East Communities, a supporting organization under Section 509(a)(3). The member of Mercy Health East Communities is Mercy Health. Form 990, Part VI, Section A, line 7a Mercy Health, the member of Mercy Health East Communities, has reserve powers to appoint and remove all directors and officers for Mercy Hospital Jefferson. Form 990, Part VI, Section A, line 7b THE FOLLOWING CORPORATE POWERS AND RESPONSIBILITIES SHALL BE RESERVED TO THE CORPORATE MEMBER (AND WITH REGARD TO CERTAIN POWERS AND RESPONSIBILITIES, TO MERCY HEALTH EAST COMMUNITIES AS THE CORPORATE MEMBER OF THE CORPORATE MEMBER): A. APPROVAL OF REVISIONS TO THE MISSION, VISION AND OPERATING VALUES PURSUANT TO WHICH THE CORPORATION OPERATES; B. APPROVAL OF ANY AMENDMENTS TO THE ARTICLES OF INCORPORATION AND THESE BYLAWS AND ANY AMENDMENTS TO THE ORGANIZATIONAL DOCUMENTS OF ANY AFFILIATE OF THE CORPORATION; C. APPOINTMENT AND REMOVAL OF MEMBERS OF THE BOARD; D. APPROVAL OF THE APPOINTMENT AND REMOVAL OF THE PRESIDENT OF THE HOSPITAL SUBJECT TO THE CONSENT OF MERCY HEALTH EAST COMMUNITIES; E. ADOPTION OF THE STRATEGIC PLAN, GOALS, AND OBJECTIVES OF THE CORPORATION; F. ADOPTION OF THE OPERATING, CAPITAL AND ALL OTHER BUDGETS FOR THE CORPORATION; G. APPROVAL OF THE ASSIGNMENT, TRANSFER, SALE OR LEASE OF ANY OF THE ASSETS OF THE CORPORATION OR ANY AFFILIATE OF THE CORPORATION IN EXCESS OF ONE MILLION DOLLARS ($1,000,000) IN ANY ONE OR SERIES OF RELATED TRANSACTIONS OCCURRING WITHIN ANY TWELVE (12) MONTH PERIOD; H. AUTHORIZATION AND APPROVAL OF THE INCURRENCE OF DEBT BY THE CORPORATION OR ANY AFFILIATE OF THE CORPORATION (OTHER THAN DEBT INCURRED FOR THE ACQUISITION OF GOODS THAT ARE ACQUIRED IN THE ORDINARY COURSE OF BUSINESS) AND TO GRANT ANY SECURITY INTERESTS, PLACE ANY ENCUMBRANCES, ENTER INTO ANY COVENANTS, AND EXECUTE ANY DOCUMENTS AND TAKE ANY ACTIONS NECESSARY OR APPROPRIATE IN CONNECTION WITH THE INCURRENCE OF SUCH DEBT; I. APPROVAL OF A PLAN OF MERGER, CONSOLIDATION OR DISSOLUTION OF THE CORPORATION OR ANY AFFILIATE; J. APPROVAL OF THE LEASE, MANAGEMENT OR PURCHASE OF, OR AFFILIATION WITH, ANOTHER HOSPITAL OR HOSPITAL SYSTEM, OR HEALTH CARE FACILITY OR HEALTH CARE SYSTEM BY THE CORPORATION; AND, K. TO APPROVE THE CREATION, OWNERSHIP OR ACQUISITION OF, OR AFFILIATION WITH, ANY OTHER ORGANIZATION BY THE CORPORATION. L. OVERSEE, APPROVE AND MONITOR HUMAN RESOURCE PROGRAMS, WHICH SHALL PROMORTE AN ORGANIZATIONAL ENVIRONMENT THAT: 1. PROVIDES FOR THE RECRUITMENT AND RENTION OF CO-WORKERS WHO ARE SERVICE ORIENTED, COMPASSIONATE, ENGAGED, AND WHO FIND MEANING AND PURPOSE IN WORKING IN A FAITH-BASED ORGANIZATION; 2. ENABLES PEOPLE TO RELATE TO ONE ANOTHER WITH RESPECT AND ACCEPTANCE IN A SPIRIT OF COMMUNITY; 3. PROMOTES CO-WORKER PARTIICPATION AND VOICE IN THEIR WORK LIVES; 4. GIVES CO-WORKERS A FAIR OPPORTUNITY TO DEVLEOP THEIR SKILLS AND TALENTS, AND A MEANS BY WHICH THEIR CONTRIBUTIONS ARE RECOGNIZED; 5. PROVIDES CO-WORKERS WITH THE MATERIALS AND EQUIPMENT TO PROPERLY DO THEIR WORK;AND, 6. ENSURES CO-WORKER SAFETY AND WELL-BEING. Form 990, Part VI, Section B, line 11 THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM, USING INFORMATION PROVIDED BY THE FILING ORGANIZATION. A DRAFT FORM 990 IS REVIEWED BY THE FILING ORGANIZATION'S FINANCE TEAM, INCLUDING THE MANAGER OF ACCOUNTING AND THE VICE-PRESIDENT OF FINANCE. THE DRAFT FORM 990 IS ALSO REVIEWED BY MERCY HEALTH'S TAX DEPARTMENT, TO ENSURE ACCURACY AND CONSISTENCY WITH OTHER RELATED ORGANIZATIONS' FORM 990S. AFTER QUESTIONS ARISING FROM THE VARIOUS REVIEWS ARE ADDRESSED AND INCORPORATED INTO THE FORM 990, A REVISED DRAFT IS PROVIDED TO THE FILING ORGANIZATION'S LEADERSHIP TEAM, INCLUDING THE CFO AND CEO, FOR REVIEW. ONCE REVIEWED AND APPROVED BY THE FILING ORGANIZATION'S LEADERSHIP TEAM, THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS FOR REVIEW; IT IS THEN SIGNED AND FILED WITH THE IRS. Form 990, Part VI, Section B, line 12c OFFICERS, DIRECTORS, KEY EMPLOYEES AND OTHER DISQUALIFIED PERSONS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE ANNUALLY AND DID SO IN THE NORMAL COURSE FOR THE YEAR ENDED JUNE 30, 2016. THIS PROCESS IS ADMINISTERED AT THE MERCY HEALTH LEVEL BY MERCY'S BUSINESS RISK (INTERNAL AUDIT) DEPARTMENT. THE QUESTIONNAIRES ARE REVIEWED WITH LEADERSHIP AT THE LOCAL LEVEL AND POTENTIAL CONFLICTS DISCUSSED AND RESOLVED. THE CONFLICTS AND THEIR RESPECTIVE RESOLUTIONS ARE SHARED AT THE MERCY LEVEL WITH A TEAM INCLUDING MERCY'S CHIEF FINANCIAL OFFICER, CHIEF COMPLIANCE OFFICER AND OTHER MEMBERS OF FINANCE, LEGAL AND HR. SUMMARY RESULTS ARE REVIEWED WITH MERCY'S STEWARDSHIP COMMITTEE (FORMERLY FINANCE, AUDIT AND COMPLIANCE COMMITTEE) OF THE BOARD OF DIRECTORS. Form 990, Part VI, Section B, line 15 FOR THOSE CLASSIFIED AS OFFICERS (AND THUS DISQUALIFIED PERSONS), MERCY HEALTH (ultimate parent company) USES THE FOLLOWING TO ESTABLISH THE COMPENSATION: EXTERNAL MARKET SALARY SURVEYS, EXTERNAL MARKET SALARY STUDIES, ENGAGEMENT OF AN INDEPENDENT COMPENSATION CONSULTANT, AND REVIEW/APPROVAL OF COMPENSATION BY THE COMPENSATION COMMITTEE OF THE MERCY HEALTH BOARD. FOR THOSE CLASSIFIED AS KEY EMPLOYEES, THE ORGANIZATION USES THE FOLLOWING TO ESTABLISH THE COMPENSATION: EXTERNAL MARKET SALARY SURVEYS, EXTERNAL MARKET SALARY STUDIES, AND REVIEW/APPROVAL OF EXECUTIVE MANAGEMENT. COMPENSATION REVIEWS ARE COMPLETED ON AN ANNUAL BASIS, AND A REVIEW WAS COMPLETED DURING THE REPORTING YEAR. Form 990, Part VI, Section C, line 19 Governing documents and financial statements are made available from time to time but are not published publicly; we are not required to make these documents available to the public. Financial results are available via request of copy of Form 990. FORM 990, PART VII, SECTION A, COLUMN B AVERAGE HOURS PER WEEK THE HOURS PER WEEK DISCLOSED IN PART VII IS THE AVERAGE HOURS THE LISTED PERSON WORKED OR DEVOTED PER WEEK WHILE EMPLOYED OR ASSOCIATED WITH THE FILING ORGANIZATION AND RELATED ORGANIZATIONS (IF APPLICABLE). Form 990, Part XI, line 9: Transfer FROM (TO) AFFILIATES -9,039,635. NET ASSETS RELEASED FROM RESTRICTIONS 10,225. RESTRICTED FUND DONATIONS 55,559. RESTRICTED FUND EXPENSES -39,213. Part XII, Line 2C THE FILING ORGANIZATION'S FINANCIAL STATEMENTS WERE INCLUDED IN MERCY HEALTH AND SUBSIDIARIES ANNUAL FINANCIAL STATEMENT AUDIT. MERCY HEALTH AND SUBSIDIARIES RECEIVED AN UNQUALIFIED OPINION FROM THE EXTERNAL AUDITORS FOR FISCAL 2015 (THE TAX YEAR CURRENTLY BEING REPORTED). HOWEVER, NO SEPARATE AUDIT OPINION WAS ISSUED ON THE FINANCIAL STATEMENTS OF THE FILING ORGANIZATION. THE ULTIMATE RESPONSIBILITY FOR OVERSIGHT OF THE FINANCIAL STATEMENT AUDIT AND SELECTION OF THE EXTERNAL AUDITOR LIES WITH THE STEWARDSHIP COMMITTEE (FORMERLY FINANCE, AUDIT, AND COMPLIANCE COMMITTEE) OF THE MERCY HEALTH BOARD OF DIRECTORS. AUDIT RESULTS ARE COMMUNICATED TO THIS COMMITTEE. Form 990, Part XII, Line 3 Single Audit Act and OMB Circular A-133 MERCY HEALTH UNDERGOES A CONSOLIDATED A-133 AUDIT EVERY YEAR AND DID SO FOR THE FISCAL YEAR ENDING JUNE 30, 2016. EACH ENTITY THAT RECEIVES FEDERAL FUNDS DURING THE YEAR IS INCLUDED ON THE SCHEDULE OF EXPENDITURES OF FEDERAL AWARDS (SEFA) AND IS ALSO INCLUDED IN THE POPULATION AVAILABLE FOR AUDIT. THE FILING ENTITY RECEIVED FEDERAL FUNDS DURING THE YEAR ENDED JUNE 30, 2016, WAS INCLUDED ON THE MERCY HEALTH CONSOLIDATED SEFA, AND THEREFORE, WAS ALSO INCLUDED IN THE POPULATION AVAILABLE FOR AUDIT. FORM 990, SCHEDULE R, PART V SYSTEM LIMITATIONS MERCY HEALTH (MERCY) HAS A COMPLEX LEGAL STRUCTURE WITH OVER 60 LEGAL ENTITIES. LAWSON ERP SOFTWARE IS THE PRIMARY ACCOUNTING SOFTWARE USED BY MERCY AND THE MAJORITY OF THE INTERCOMPANY/RELATED ORGANIZATION TRANSACTIONS ARE PROCESSED THROUGH LAWSON. WITH THE CURRENT DESIGN OF THE ERP SYSTEM, THERE ARE VARIOUS LIMITATIONS ON EXTRACTING THE INTERCOMPANY/RELATED ORGANIZATION INFORMATION FROM LAWSON. DUE TO THESE LIMITATIONS, MOST OF THE RELATED ORGANIZATION ACTIVITY FOR THE FILING ORGANIZATION HAS BEEN CLASSIFIED ON SCHEDULE R, PART V, IN LINES P AND Q. WE HAVE CAPTURED AND REPORTED THE KNOWN MATERIAL TRANSACTIONS BETWEEN ENTITIES. THERE MAY BE MINOR AMOUNTS OF RELATED ORGANIZATION TRANSACTION ACTIVITY WHICH IS NOT REFLECTED IN THIS SCHEDULE. Form 990, Part V, Question 1a Independent Contractors Independent contractors for the filing organization are paid by Mercy Health (EIN 43-1423050). As such, all required Form 1099 and Form 1096 reporting is made for the entire health system (with limited exceptions) under the Mercy Health EIN. Form 990, Part V, Question 2a W-3 FILING SALARIES AND WAGES WITH LIMITED EXCEPTIONS, THE SALARIES AND WAGES REPORTED ON FORM 990, PART IX, LINE 7 REPRESENT AN ALLOCATION OF SALARIES AND WAGES FROM A RELATED ORGANIZATION. MOST EMPLOYEES ARE PAID BY A RELATED ORGANIZATION UNDER A COMMON PAYMASTER ARRANGEMENT. AS SUCH, ALL REQUIRED PAYROLL FILING FOR THESE EMPLOYEES (INCLUDING W-2 AND W-3'S) IS REPORTED UNDER THE RELATED ORGANIZATION, MHM SUPPORT SERVICES,EIN 20-2553101. FORM 990, SCHEDULE R, PART II MERCY HOSPITALS EAST COMMUNITIES MERCY HOSPITALS EAST COMMUNITIES CONSISTS OF MERCY HOSPITALS EAST COMMUNITIES ST. LOUIS, EIN 43-0653493, AND MERCY HOSPITALS EAST COMMUNITIES WASHINGTON, EIN 43-1066883. Jefferson Cardiovascular and Thoracic Services LLC 14528 S Outer Forty Suite 100 Chesterfield MO 63017 454423688 Healthcare services MO Mercy Hospital Jefferson Mercy Clinic Adult Hospitalists - Jefferson LLC 14528 S Outer Forty Suite 100 Chesterfield MO 63017 462913068 Managed care contracting MO Mercy Hospital Jefferson Mercy Labs Jefferson LLC 14528 S Outer Forty Suite 100 Chesterfield MO 63017 463478362 Laboratory Services MO Mercy Hospital Jefferson Casa de Misericordia 1602 McClelland Street Laredo TX 78044 742912461 Women's domestic violence shelter TX 501c3 7 Mercy Ministries of Laredo 1 Jefferson Land Company Inc 14528 S Outer Forty St 100 Chesterfield MO 63017 431330360 Holding Company MO 501c2 Mercy Hospital Jefferson 1 McAuley Portfolio Mgmt Co 14528 S Outer Forty St 100 Chesterfield MO 63017 261708048 Portfolio management MO 501c3 11-II Mercy Health 1 Mercy ACO Clinical Services Inc 14528 S Outer Forty St 100 Chesterfield MO 63017 464504901 Virtual Care Center MO 501c3 3 Mercy Health 1 Mercy Clinic East Communities 645 Maryville Ctr Dr Ste 100 St Louis MO 63141 431771217 Physician Group MO 501c3 9 Mercy Health East Communities 1 Mercy Clinic Fort Smith Comm 7301 Rogers Avenue Fort Smith AR 72917 261318597 Physician Clinic AR 501c3 9 Mercy Health Fort Smith Comm 1 Mercy Clinic Oklahoma Comm 4300 W Memorial Road Oklahoma City OK 73120 270473057 Physician Group OK 501c3 3 Mercy Health OK Communities 1 Mercy Clinic Springfield Comm 1965 Fremont Street Suite 2950 Springfield MO 65804 431560263 Physician Group MO 501c3 3 Mercy Health Springfield Comm 1 Mercy Family Center 14528 S Outer Forty St 100 Chesterfield MO 63017 721069468 Family counseling services MO 501c3 7 Mercy Health 1 Mercy Health Foundation 14528 S Outer Forty St 100 Chesterfield MO 63017 200901499 Foundation MO 501c3 11-II Mercy Health 1 Mercy Health 14528 S Outer Forty St 100 Chesterfield MO 63017 431423050 Corporate Office MO 501c3 1 N/A 0 Mercy Health East Communities 645 Maryville Ctr Dr Ste 100 St Louis MO 63141 431718408 Health System MO 501c3 11-II Mercy Health 1 Mercy Health East Communities - SR 645 Maryville Ctr Dr Ste 100 St Louis MO 63141 461412322 Health System MO 501c3 11-II Mercy Health East Communities 1 Mercy Health Fort Smith Comm 7301 Rogers Avenue Fort Smith AR 72917 261318515 Holding Company AR 501c3 11-II Mercy Health 1 Mercy Health Foundation Ada 430 N Monte Vista Street Ada OK 74820 463596274 Foundation OK 501c3 11-I Mercy Hospital Ada 1 Mercy Health Foundation Ardmore 1011 14th Avenue NW Ardmore OK 73401 710962525 Foundation OK 501c3 11-I Mercy Hospital Ardmore 1 Mercy Health Foundation Berryville 214 Carter Street Berryville AR 72616 710759301 Foundation AR 501c3 11-I Mercy Hospital Berryville 1 Mercy Health Foundation Ft Scott 401 Woodland Hills Blvd Fort Scott KS 66701 481077073 Foundation KS 501c3 11-III Mercy Kansas Communities Inc 1 Mercy Health Foundation Hot Springs 300 Werner Street Hot Springs AR 71913 710804718 Foundation AR 501c3 11-II Mission Clinical Services 1 Mercy Health Foundation Independence 800 W Myrtle Independence KS 67301 481079981 Foundation KS 501c3 11-I Mercy Kansas Communities Inc 1 Mercy Health Foundation Jefferson 1400 US Highway 61 South Festus MO 63028 462797051 Foundation MO 501c3 11-II Mercy Health East Communities - SR 1 Mercy Health Foundation Joplin 100 Mercy Way Joplin MO 64804 270906136 Foundation MO 501c3 11-I Mercy Health SW MOKS Comm 1 Mercy Health Foundation Lincoln 1000 East Cherry Street Troy MO 63379 811477159 Foundation MO 501c3 11-II Mercy Health East Communities 1 Mercy Health Foundation NW Ark 2710 Rife Medical Ln Rogers AR 72858 710601687 Foundation AR 501c3 11-III Mercy Hospital Rogers 1 Mercy Health Foundation of OK 4300 W Memorial Road Oklahoma City OK 73120 454732301 Foundation OK 501c3 11-I Mercy Health OK Communities 1 Mercy Health Foundation OK City 4300 W Memorial Road Oklahoma City OK 73120 463184231 Foundation OK 501c3 11-I Mercy Health OK Communities 1 Mercy Health Foundation Springfield 1235 E Cherokee Street Springfield MO 65804 320195818 Foundation MO 501c3 11-II Mercy Health Springfield Comm 1 Mercy Health Foundation STL 615 South New Ballas Road St Louis MO 63141 562410020 Foundation MO 501c3 11-II Mercy Health East Communities 1 Mercy Health Foundation Washington 901 E Fifth Street Washington MO 63090 562410022 Foundation MO 501c3 11-II Mercy Health East Communities 1 Mercy Health NW Ark Communities 2710 Rife Medical Ln Rogers AR 72758 621684203 Physician Group AR 501c3 11-II Mercy Health 1 Mercy Health OK Communities 4300 W Memorial Road Oklahoma City OK 73120 731453048 Health System OK 501c3 11-II Mercy Health 1 Mercy Health Plans of MissouriInc 3265 S National Avenue Springfield MO 65807 320481419 HMO MO 501c4 Mercy Health 1 Mercy Health PlansInc 3265 S National Avenue Springfield MO 65807 320486150 PPO MO 501c4 Mercy Health Plans of MissouriInc 1 Mercy Health SW MOKS Comm 100 Mercy Way Joplin MO 64804 300584463 Health System MO 501c3 11-II Mercy Health 1 Mercy Health Springfield Comm 1235 E Cherokee Street Springfield MO 65804 431856028 Health System MO 501c3 11-II Mercy Health 1 Mercy Home Health Berryville 804 W Freeman Suite 4 Berryville AR 72616 870781247 Home Health and Hospice operations AR 501c3 11-III Mercy Hospital Springfield 1 Mercy Hospital Ada Inc 430 N Monte Vista Street Ada OK 74820 462288155 Hospital OK 501c3 3 Mercy Health OK Communities 1 Mercy Hospital Ardmore 1011 14th Avenue NW Ardmore OK 73401 731500629 Hospital OK 501c3 3 Mercy Health OK Communities 1 Mercy Hospital Aurora 500 Porter Avenue Aurora MO 65605 431936696 Hospital MO 501c3 3 Mercy Health Springfield Comm 1 Mercy Hospital Berryville 214 Carter Street Berryville AR 72616 710759299 Hospital AR 501c3 3 Mercy Health Springfield Comm 1 Mercy Hospital Booneville 880 West Main Street Booneville AR 72927 463851119 Hospital AR 501c3 3 Mercy Hospital Fort Smith 1 Mercy Hospital Carthage 3125 Dr Russell Smith Way Carthage MO 64836 453808607 Hospital MO 501c3 3 Mercy Health SW MOKS Comm 1 Mercy Hospital Cassville 94 Main Street Cassville MO 65625 431936699 Hospital MO 501c3 3 Mercy Health Springfield Comm 1 Mercy Hospital Columbus 220 Pennsylvania Avenue Columbus KS 66725 270842031 Hospital MO 501c3 3 Mercy Health SW MOKS Comm 1 Mercy Hospital El Reno 2115 Parkview Drive El Reno OK 73036 272716065 Hospital OK 501c3 3 Mercy Hospital Oklahoma City 1 Mercy Hospital Fort Smith 7301 Rogers Avenue Fort Smith AR 72917 710240352 Hospital AR 501c3 3 Mercy Health Fort Smith Comm 1 Mercy Hospital Healdton Inc 3462 Hospital Rd Healdton OK 73438 263173902 Hospital OK 501c3 3 Mercy Hospital Ardmore Inc 1 Mercy Hospital Joplin 100 Mercy Way Joplin MO 64804 270814858 Hospital MO 501c3 3 Mercy Health SW MOKS Comm 1 Mercy Hospital Kingfisher Inc 1000 Hospital Circle Kingfisher OK 73750 463433074 Hospital OK 501c3 3 Mercy Hospital Oklahoma City 1 Mercy Hospital Lebanon 100 Hospital Drive Lebanon MO 65536 431767432 Hospital MO 501c3 3 Mercy Health Springfield Comm 1 Mercy Hospital Lincoln 1000 East Cherry Street Troy MO 63379 472219204 Hospital MO 501c3 3 Mercy Health East Communities 1 Mercy Hospital Logan County Inc 200 South Academy Guthrie OK 73044 452998842 Hospital OK 501c3 3 Mercy Hospital Oklahoma City 1 Mercy Hospital Oklahoma City 4300 W Memorial Road Oklahoma City OK 73120 730579285 Hospital OK 501c3 3 Mercy Health OK Communities 1 Mercy Hospital Ozark 801 W River Street Ozark AR 72949 710689680 Hospital AR 501c3 3 Mercy Hospital Fort Smith 1 Mercy Hospital Paris 500 E Academy Paris AR 72855 710655753 Hospital AR 501c3 3 Mercy Hospital Fort Smith 1 Mercy Hospital Rogers 2710 Rife Medical Ln Rogers AR 72758 710294390 Hospital AR 501c3 3 Mercy Health NW Ark Communities 1 Mercy Hospital Springfield 1235 E Cherokee Street Springfield MO 65804 440552485 Hospital MO 501c3 3 Mercy Health Springfield Comm 1 Mercy Hospital Tishomingo 1000 South Byrd Tishomingo OK 73460 274433830 Hospital OK 501c3 3 Mercy Hospital Ardmore 1 Mercy Hospital Waldron 1341 W 6th Street Waldron AR 72958 710557895 Hospital AR 501c3 3 Mercy Hospital Fort Smith 1 Mercy Hospital Watonga Inc 500 Clarence Nash Blvd Watonga OK 73772 455199762 Hospital OK 501c3 3 Mercy Hospital Oklahoma City 1 Mercy Hospitals East Comm 645 Maryville Ctr Dr Ste 100 St Louis MO 63141 430653493 Hospital MO 501c3 3 Mercy Health East Communities 1 Mercy Kansas Communities Inc 401 Woodland Hills Blvd Ft Scott KS 66701 480956045 Hospital KS 501c3 3 Mercy Health SW MOKS Comm 1 Mercy Research 1235 E Cherokee Street Springfield MO 65804 870796305 Research - Clinical Trials MO 501c3 4 Mercy Health Springfield Comm 1 Mercy Ministries of Laredo 2500 Zacatecas Laredo TX 78043 200198462 Outreach TX 501c3 7 Mercy Health 1 Mercy St Francis Hospital 100 W Highway 60 Mountain View MO 65548 440607149 Hospital MO 501c3 3 Mercy Health Springfield Comm 1 MHM Support Services 14528 S Outer Forty St 100 Chesterfield MO 63017 202553101 Centralized Health System Functions MO 501c3 11-II Mercy Health 1 Mission Clinical Services 300 Werner Street Hot Springs AR 71913 134239691 Child Advocacy Center AR 501c3 9 Mercy Health 1 St Edward Mercy Foundation 7301 Rogers Avenue Fort Smith AR 72917 237330425 Foundation AR 501c3 7 Mercy Hospital Fort Smith 1 St Marys Hosp Enid Ok 14528 S Outer Forty St 100 Chesterfield MO 63017 730614655 Inactive OK 501c3 3 Mercy Health OK Communities 1 The Sr M Cornelia Blasko Fn 100 W Highway 60 Mountain View MO 65548 431873914 Foundation MO 501c3 11-I Mercy St Francis Hospital 1 Unity Ambulatory Care 14528 S Outer Forty St 100 Chesterfield MO 63017 431861745 Inactive MO 501c3 11-III Mercy Health East Communities 1 Southern Oklahoma Diag Ctr LLC 1011 Fourteenth Avenue NW Ardmore OK 73401 431971232 MRI Services - Dissolved 12/2015 OK Mercy Hospital Ardmore Inc N/A 0 0 Resource Optimiz & InnovLLC 645 Maryville Ctr DrSte 200 St Louis MO 63141 460468368 Central Distribution Center MO MHN INC - MHNSR INC N/A 0 0 Mercy Ambulatory Surgery Center LLC 7301 Rogers Avenue Fort Smith AR 72917 710827721 Ambulatory Surgery Center AR Mercy Hospital Fort Smith N/A 0 0 Fort Smith Emergency Medical Services 1701 South Greenwood Fort Smith AR 72901 710416615 Emergency Medical Services AR Mercy Hospital Fort Smith N/A 0 0 St Edward Mercy Med Ctr M-P Off Bldg 7301 Rogers Avenue Fort Smith AR 72903 710554050 Office building AR Mercy Hospital Fort Smith N/A 0 0 Mercy Comm Services Inc 401 Woodland Hills Blvd Fort Scott KS 66701 481078101 Retail pharmacy KS MERCY KANSAS COMM INC C 0 Frontenac Properties Inc 14528 S Outer Forty Suite 100 Chesterfield MO 63017 521914421 Holds ancillary assets & owns aircraft DE MERCY HEALTH C 0 Inveno Health Inc 1235 E Cherokee Street Springfield MO 65804 264509571 Technology transfer company MO MERCY HEALTH SPRINGFIELD COMM C 0 Unity Support Services Inc 645 Maryville Centre Drive Suite 10 St Louis MO 63141 431797042 Inactive MO MERCY HEALTH EAST COMMUNITIES C 0 UH L Corp Inc 645 Maryville Centre Drive Suite 10 St Louis MO 63141 742499535 Holding company MO MERCY HEALTH SERVICES LLC C 0 MHN of the Southern Region Inc 1011 14th Avenue NW Ardmore OK 73401 731580607 holding company OK MERCY MANAGED CARE CORP C 0 Mercy Health Center Condominium Inc 4300 W Memorial Rd Oklahoma City OK 73120 680640970 Administrator of certain real property and improvements OK MERCY HOSPITAL OKLAHOMA CITYINC C 0 Mercy Managed Care Corporation 4300 W Memorial Road Oklahoma City OK 73120 731441665 Holding company OK MERCY HEALTH C 0 Mercy Health Network Inc 4300 W Memorial Road Oklahoma City OK 73120 731381689 holding company OK MERCY MANAGED CARE CORP C 0 Mercy Commercial Services Inc 14528 South Outer Forty Suite 100 Chesterfield MO 63017 464953543 Corp Parent of VCC taxable commercializ svcs OK MHN Inc and MHNSR INC C 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 Mercy Clinic East Communities P 915306 FMV Mercy Health East Communities Q 8844136 FMV Mercy Hospitals East Communities P 8751816 FMV Mercy Hospital Springfield Q 185789 FMV MHM Support Services P 8807808 FMV Resource Optimization & Innovation LLC P 5726731 FMV Mercy Health Foundation Jefferson C 48156 FMV