2017-05-15T08:32:33-05:00 2016-06-30 562632458 PLEUS AND COMPANY LLC 14500 S OUTER 40 SUITE 201A CHESTERFIELD MO 63017 990 2015-07-01 455199762 MERCY HOSPITAL WATONGA INC MERC 4057523495 500 CLARENCE NASH BLVD WATONGA OK 73772 TRACY ENLOE CFO 4057523161 2017-05-10 1 DOUGLAS G PLEUS P00013488 3143179916 2015 2021-01-29 14:40:06Z DIANA SMALLEY 500 CLARENCE NASH BLVD WATONGA OK 73772 8366910 0 0928 X WWW.MERCY.NET/PRACTICE/MERCY-HOSPITAL-WATONGA X 2012 OK TO CARRY OUT THE HEALING MINISTRY OF JESUS BY PROMOTING HEALTH AND WELLNESS THROUGH OUR COMMUNITIES. TO PROVIDE QUALITY HEALTH SERVICES THROUGH A WISE USE OF RESOURCES AND EXCEPTIONAL MERCY SERVICE. 6 4 0 16 0 0 12033 22845 5697541 7513702 -129 313 1068152 830050 6777597 8366910 9322 7847 0 0 4222977 4606054 0 0 0 2444176 2741500 6676475 7355401 101122 1011509 1872286 1189450 460223 448310 1412063 741140 MERCY HOSPITAL WATONGA IS ROOTED IN THE MISSION OF JESUS AND THE HEALING MINISTRY OF THE CHURCH. THIS TRADITION IS MARKED BY VALUES OF JUSTICE, EXCELLENCE, STEWARDSHIP AND RESPECT FOR THE DIGNITY OF EACH PERSON. 0 0 6027979 7847 8328276 MERCY HOSPITAL WATONGA INC. PROVIDES QUALITY MEDICAL HEALTH CARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. DURING FISCAL YEAR END JUNE 30, 2016, WATONGA PROVIDED SERVICES TO 241 INPATIENTS, 5,491 OTHER OUTPATIENTS, AND 3,796 EMERGENCY DEPARTMENT PATIENTS. THE AMOUNT OF UNCOMPENSATED CARE FOR FY 2016 WAS $1,084,706.MERCY HOSPITAL WATONGA INC.'S EXEMPT PURPOSE ACHIEVEMENTS ARE EXPANDED UPON IN VARIOUS SECTIONS OF SCHEDULE H. 6027979 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 0 1 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 6 4 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 OK X LYNN PINAROC 4057523536 4300 WEST MEMORIAL ROAD OKLAHOMA CITY OK 73120 X GAUER WILLIAM BOARD MEMBER 1.00 0.00 X 0 0 0 JAMES KARYL CHIEF NURSING OFFICER (OK CITY) & BOARD MEMBER 1.00 59.00 X 0 189250 24780 LUCAS JOYCE BOARD MEMBER 1.00 0.00 X 0 0 0 PARHAM LOREN BOARD MEMBER 1.00 0.00 X 0 0 0 SCHENK MARY BOARD MEMBER 1.00 0.00 X 0 0 0 TUCKER JOSHUA BOARD MEMBER 1.00 51.00 X 0 165224 24164 RAJU GARY CHIEF FINANCIAL OFFICER 1.00 59.00 X 0 318634 14207 SMALLEY DIANA L PRESIDENT, WEST COMMUNITIES 1.00 59.00 X 0 795366 104962 GEBHART JIM R PRESIDENT, MERCY HOSPITAL OKLAHOMA CITY 5.00 55.00 X 0 653640 210209 LE BICH-VI REGIONAL VP-GENERAL COUNSEL 2.00 58.00 X 0 265794 56054 STITT BOBBY J ADMINISTRATOR, RURAL FACILITIES 40.00 0.00 X 114528 0 19699 VITIELLO JONATHAN FORMER OFFICER 0.00 60.00 X 0 716408 103683 114528 3104316 557758 1 1 1 0 SHARED IMAGING 801 PHOENIX LAKE AVE STREAMWOOD IL 60107 RADIOLOGY SERVICES 126750 AMN HEALTHCARE 12400 HIGH BLUFF DR SAN DIEGO CA 92130 STAFFING SERVICES 102584 2 22357 488 22845 PATIENT SERVICE REVENU 622110 7513702 7513702 7513702 313 313 TAX REFUND REVENUE 622110 812987 812987 CAFETERIA & VENDING 722210 15476 15476 1587 1587 830050 8366910 8328276 0 15789 7847 7847 3772523 3251932 520591 160372 131826 28546 451226 370908 80318 221933 182429 39504 916 916 385845 235362 150483 9023 5504 3519 228041 139103 88938 2176 1613 563 95496 58252 37244 26872 10658 16214 52234 15543 36691 46874 46874 BAD DEBTS 859154 859154 DRUGS & MEDICAL EXPENSE 465360 450438 14922 SHARED SERVICE FEES 444327 231050 213277 REPAIRS & MAINTENANCE 85022 51863 33159 40160 24497 15663 7355401 6027979 1327422 0 351 351 3250 831744 807575 111042 111939 3464 6161 355398 149417 373866 205981 548569 57443 1872286 1189450 460223 349013 0 99297 460223 448310 X 1412063 741140 1412063 741140 1872286 1189450 X 1011509 -1682432 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 1601 0 0 0 1601 0 PART II-B, LINE 1: THE FILING ORGANIZATION IS A MEMBER OF AND PAYS DUES TO THE OKLAHOMA HOSPITAL ASSOCIATION, CATHOLIC HOSPITAL ASSOCIATION, AND AMERICAN HOSPITAL ASSOCIATION. FOR THE YEAR ENDED JUNE 30, 2016, DUES WERE $6,719, $1,189, AND $1,848, RESPECTIVELY. APPROXIMATELY 17.20% OF OKLAHOMA HOSPITAL ASSOCIATION DUES, 3.11% OF CATHOLIC HOSPITAL ASSOCIATION DUES, AND 22.12% OF AMERICAN HOSPITAL ASSOCIATION DUES WERE ATTRIBUTABLE TO LOBBYING ACTIVITIES PERFORMED. 12500 4375 8125 342898 145042 197856 205981 DUE TO TAX-EXEMPT AFFILIATES 99297 99297 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 0 645912 645912 0.09940 1440603 1001809 438794 0.06750 2086515 1001809 1084706 0.16690 4644 4644 0.00070 1667 1667 0.00030 6311 6311 0.00100 2092826 1001809 1091017 0.16790 18675 18675 0.00290 1093 1093 0.00020 19768 19768 0.00310 1 470355 0 3352737 3455145 -102408 X 1 1 1 1 MERCY HOSPITAL WATONGA INC 500 CLARENCE NASH BLVD WATONGA OK 73772 WWW.MERCY.NET 2214 X X X X MERCY HOSPITAL WATONGA INC 1 0 0 1 X X X X X X X X X 15 1 0 1 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 WATONGA, INC. PART V, SECTION B, LINE 5: WHEN CONDUCTING ITS MOST RECENT CHNA, MERCY HOSPITAL WATONGA WORKED CLOSELY WITH THE FOLLOWING:- BLAINE COUNTY HEALTH DEPARTMENT - OPTOMETRIST - CITY COUNCIL MEMBERS- RETIRED COMMUNITY MEMBERS - OPPORTUNITIES, INC. - WATONGA CHAMBER OF COMMERCE- OKLAHOMA STATE UNIVERSITY CENTER FOR RURAL HEALTH STAFF- MERCY HOSPITAL AND MERCY CLINIC WATONGA LEADERSHIP PLEASE REFER TO THE COMMUNITY HEALTH NEEDS ASSESSMENT WHICH CAN BE FOUND AT: WWW/MERCY.NET/COMMUNITY-BENEFITS MERCY HOSPITAL WATONGA, INC. PART V, SECTION B, LINE 6B: SEE PART V, SECTION B, LINE 5 RESPONSE MERCY HOSPITAL WATONGA, INC. PART V, SECTION B, LINE 11: THE STRUCTURE OF THIS CHIP REVOLVES AROUND THE KEY STRATEGIES OF EDUCATION, PREVENTION, AND COLLABORATION. THE HEALTH NEEDS THAT HAVE BEEN PRIORITIZED IN THIS CHIP ARE:- SMOKING (PREVENTION)- MORE PHYSICIANS (PRIMARY CARE AND SPECIALISTS)- NURSING HOME OR ASSISTED LIVING - HEALTH EDUCATION IN THE COMMUNITY - DRUG USE/ABUSE PLEASE REFER TO THE COMMUNITY HEALTH IMPLEMENTATION PLAN WHICH CAN BE FOUND AT: WWW/MERCY.NET/COMMUNITY-BENEFITS MERCY HOSPITAL WATONGA, INC. 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. 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 $7,355,401. INCLUDED IN THIS AMOUNT WAS BAD DEBT EXPENSE (CHARGES) OF $859,154. EXPENSES FOR THE PURPOSE OF CALCULATING LINE 7, COLUMN (F) ARE $470,355. 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 WATONGA (MHW) COMMUNITY BUILDING ACTIVITIES PROMOTE THE HEALTH OF THE COMMUNITIES IN WHICH THEY SERVE. THROUGH ACTIVE PARTICIPATION IN COMMUNITY BOARDS, NEIGHBORHOOD/COMMUNITY MEETINGS AND INVOLVEMENT IN COMMUNITY-BASED EVENTS, MHW DEMONSTRATES ITS ONGOING COMMITMENT TO THE COMMUNITY. COMMUNITY BUILDING ACTIVITIES SERVE AS A LINK TO ENGAGE MERCY COWORKERS TO LOOK BEYOND THE WALLS OF THE FACILITIES IN WHICH THEY SERVE. SOME OF THE COMMUNITY BUILDING ACTIVITIES IN WHICH MHW PARTICIPATES/SERVES ARE:- PROVIDES PHYSICALS FOR PUBLIC SCHOOL SYSTEM- MIDDLE SCHOOL MENTORS/TUTORING EACH SEMESTER- PROVIDE BLOOD PRESSURE SCREENING PROGRAMS TO SENIOR CITIZENS- SMOKING CESSATION INFORMATION AND HOTLINE- COMMUNITY EDUCATION PROGRAMS AND YEARLY HEALTH FAIR- VOLUNTARY CONTRIBUTIONS TO THE UNITED WAY- PARTNERED WITH THE LOCAL FOOD PANTRY AND SUPPORT COMMUNITY FOOD DRIVES- ORGANIZED A HOLIDAY SEASON BASKET DRIVE AND COLLECTS FOOD, CLOTHES AND TOYS FOR AREA FAMILIES IN NEED. - HOSTS A NEIGHBORHOOD BLOCK PARTY EACH SUMMER, COMPLETE WITH A BOUNCY HOUSE, FOOD AND GAMES.- THROUGH A PROGRAM CALLED "LIFE WISE," COWORKERS HELP STUDENTS DEVELOP LIFE SKILLS SUCH AS BETTER DECISION-MAKING, COMMUNICATIONS AND RELATIONSHIP-BUILDING.- THE NATIONAL ORGANIZATION OF STATE OFFICES OF RURAL HEALTH (NOSORH) SELECTED MHW AS A "COMMUNITY STAR" FOR ITS COMMITMENT TO AREA RESIDENTS. 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 WATONGA 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: A SURVEY WAS DESIGNED TO GAUGE HOSPITAL USAGE, SATISFACTION, AND COMMUNITY HEALTH NEEDS. THE SURVEY WAS AVAILABLE IN BOTH PAPER AND WEB FORMAT. THE SURVEY WAS MADE AVAILABLE AT THE HOSPITAL AND CLINIC. THE SURVEY WAS ALSO HAND DELIVERED TO BUSINESSES AND PROVIDERS IN WATONGA. THE ELECTRONIC SURVEY LINK WAS EMAILED OUT TO ALL HOSPITAL EMPLOYEES WHO WERE ENCOURAGED TO SHARE THE SURVEY WITH THEIR FRIENDS, FAMILY, AND NEIGHBORS. THE SURVEY LINK WAS ALSO PLACED ON THE MERCY HOSPITAL WATONGA FACEBOOK PAGE. SURVEYS WERE ALSO DISTRIBUTED AT THE FIRST COMMUNITY MEETING ON JULY 16, 2015. THE SURVEY RAN FROM JULY 16, 2015 TO JULY 30, 2015. A TOTAL OF 200 SURVEYS FROM THE MERCY HOSPITAL WATONGA MEDICAL SERVICE AREA WERE COMPLETED. OF THE SURVEYS RETURNED, 129 WERE ELECTRONIC RESPONSES, AND 71 WERE HARD COPY SURVEYS. THE SURVEY RESULTS WERE PRESENTED AT THE AUGUST 6, 2015, COMMUNITY MEETING.MERCY HOSPITAL WATONGA HOSTED FOUR COMMUNITY MEETINGS BETWEEN JULY 16, 2015 AND AUGUST 20, 2015. THE OKLAHOMA OFFICE OF RURAL HEALTH FACILITATED THESE MEETINGS. AVERAGE ATTENDANCE AT THE COMMUNITY MEETINGS WAS 15-20 COMMUNITY MEMBERS. A LETTER WAS SENT OUT TO COMMUNITY MEMBERS INVITING THEM TO BE PARTICIPANTS IN THE COMMUNITY MEETINGS. FOLLOW UP LETTERS WERE ALSO DISTRIBUTED. PERSONAL VISITS WERE ALSO MADE TO SHARE INFORMATION ABOUT THE COMMUNITY HEALTH NEEDS ASSESSMENT. THE HOSPITAL MADE SIGNIFICANT EFFORTS TO REACH A DIVERSE AND REPRESENTATIVE POPULATION OF THE MEDICAL SERVICE AREA AND PATIENTS SERVED INCLUDING LOW INCOME AND RACIALLY DIVERSE POPULATIONS. REPRESENTATIVES FROM THE PUBLIC HEALTH SECTOR AND OPPORTUNITIES, INC. WERE INCLUDED TO PROVIDE INSIGHT INTO WHAT THEY SEE FROM A PUBLIC HEALTH AND UNDERSERVED POPULATION PERSPECTIVE OF COMMUNITY NEEDS.VARIOUS SOURCES OF HEALTH DATA WERE UTILIZED INCLUDING DATA FROM THE COUNTY HEALTH RANKINGS AND ROADMAPS PROGRAM THROUGH THE UNIVERSITY OF WISCONSIN POPULATION HEALTH INSTITUTE, AND THE ROBERT WOODS JOHNSON FOUNDATION AND THE 2014 OKLAHOMA STATE OF THE STATE'S HEALTH REPORT COMPILED BY THE OKLAHOMA STATE DEPARTMENT OF HEALTH.PLEASE REFER TO THE COMMUNITY HEALTH NEEDS ASSESSMENT WHICH CAN BE FOUND AT: WWW/MERCY.NET/COMMUNITY-BENEFITS 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 WATONGA'S PRIMARY SERVICE AREA IS BLAINE COUNTY, OKLAHOMA. THE FOLLOWING INFORMATION IS DERIVED FROM 2016 SG2 ANALYTICS DATA AND SG2 INSURANCE COVERAGE ESTIMATES. THE AREA'S POPULATION IS 10,035. 26% OF THE POPULATION'S AVERAGE HOUSEHOLD INCOME IS OVER $75,000. 47% OF THE POPULATION IS 45 AND OLDER. 40% OF THE HOUSEHOLDS IS ON MEDICARE, 12% ON MEDICAID, AND 11% UNINSURED. PART VI, LINE 5: MERCY PROVIDES QUALITY MEDICAL HEALTH CARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY. MERCY IS A CATHOLIC HEALTH CARE CORPORATION THAT, PURSUANT TO THE ORGANIZATIONAL CORE BELIEF, THAT HEALTH CARE SERVICES ARE A VITAL AND INTEGRAL PART OF THE CHURCH'S HEALING MISSION, ENGAGES IN A MINISTRY WHICH PROVIDES GENERAL ACUTE CARE, AMBULATORY, LONG-TERM AND HOME CARE HEALTH SERVICES TO INDIVIDUALS AND FAMILIES IN ITS COMMUNITIES. MERCY OFFERS SERVICES AND PROGRAM WHICH FURTHER HEALTH PROMOTION, MAINTENANCE AND CARE TO THE COMMUNITY. PROGRAMS PROVIDED TO MEET THE COMMUNITY INCLUDE SUPPORT GROUPS, OUTREACH EVENTS, BLOOD DRIVES, AND CO-WORKER WORK DAYS.MERCY IS GOVERNED BY A BOARD OF DIRECTORS WHICH INCLUDES REPRESENTATION FROM COMMUNITY LEADERS FROM A VARIETY OF SECTORS. ALL BOARD MEMBERS ARE REQUIRED TO COMPLETE AN ANNUAL CONFLICT OF INTEREST SURVEY. ANY POTENTIAL CONFLICTS OF INTEREST DISCLOSED ARE REVIEWED AND RESOLVED. THIS PROCESS ENSURES THAT PUBLIC, RATHER THAN PRIVATE INTERESTS ARE SERVED.SURPLUS FUND AND UNRESTRICTED ASSETS HELD 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. 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. 1 MERCY HEALTH FOUNDATION OF OKLAHOMA 4300 W MEMORIAL ROAD OKLAHOMA CITY OK 73120 454732301 501(C)(3) 7847 FMV GENERAL SUPPORT 1 0 PART I, LINE 2: THE ORGANIZATION USES AN APPROVAL PROCESS TO DETERMINE WHICH ORGANIZATIONS WILL RECEIVE GRANTS DURING THE FISCAL YEAR. THE FUNDS ARE THEN GIVEN DIRECTLY TO THE NONPROFIT ORGANIZATION. 0 1 0 0 0 0 0 0 0 JAMES KARYL CHIEF NURSING OFFICER (OK CITY) & BO 0 129666 0 33653 0 25931 0 8394 0 16386 0 214030 0 0 TUCKER JOSHUA BOARD MEMBER 0 123198 0 16361 0 25665 0 7857 0 16307 0 189388 0 0 RAJU GARY CHIEF FINANCIAL OFFICER 0 198469 0 44196 0 75969 0 9898 0 4309 0 332841 0 0 SMALLEY DIANA L PRESIDENT, WEST COMMUNITIES 0 544835 0 241632 0 8899 0 85731 0 19231 0 900328 0 0 GEBHART JIM R PRESIDENT, MERCY HOSPITAL OKLAHOMA C 0 395608 0 183326 0 74706 0 192173 0 18036 0 863849 0 0 LE BICH-VI REGIONAL VP-GENERAL COUNSEL 0 188135 0 50580 0 27079 0 38260 0 17794 0 321848 0 0 VITIELLO JONATHAN FORMER OFFICER 0 420946 0 233293 0 62169 0 84728 0 18955 0 820091 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. 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 ARE TAXED TO THE EMPLOYEE OF A RELATED ORGANIZATION, GARY RAJU. 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 MERCY HEALTH, THE 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 INDIVIDUAL PARTICIPATED IN A SUPPLEMENTAL MANAGEMENT RETIREMENT PLAN: JONATHAN VITIELLO; BICH-VI LE; THE INDIVIDUALS LISTED ABOVE DID NOT RECEIVE PAYMENTS FROM THE SUPPLEMENTAL MANAGEMENT RETIREMENT PLAN DURING THE YEAR FROM THE FILING ORGANIZATION OR RELATED ORGANIZATIONS. THE FOLLOWING INDIVIDUAL PARTICIPATED IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN: DIANA SMALLEY (DC) THE INDIVIDUAL LISTED ABOVE DID NOT RECEIVE PAYMENTS FROM THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN DURING THE YEAR FROM THE FILING ORGANIZATION OR RELATED ORGANIZATIONS. THE AMOUNT OF ALL ACCRUED BENEFITS IS INCLUDED IN COMPENSATION AMOUNTS PROVIDED IN SCHEDULE J, PART II, COLUMN (C). PART I, LINE 3 THE FILING ORGANIZATION RELIES ON A RELATED ORGANIZATION; REFER TO SCHEDULE O, PART VI, QUESTION 15A AND 15B FOR THE PROCESS THE RELATED ORGANIZATION FOLLOWS. FORM 990, PART VI, SECTION A, LINE 6 THE FILING ORGANIZATION HAS A SOLE CORPORATE MEMBER, MERCY HEALTH OKLAHOMA COMMUNITIES, INC. FORM 990, PART VI, SECTION A, LINE 7A MERCY HEALTH OKLAHOMA COMMUNITIES (THE MEMBER) MAY APPOINT OR REMOVE MEMBERS OF THE BOARD OF DIRECTORS AS PROVIDED BY THE BYLAWS OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING CORPORATE POWERS AND RESPONSIBILITIES SHALL BE RESERVED TO 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; C. APPOINTMENT AND REMOVAL OF MEMBERS OF THE BOARD, AS PROVIDED IN SECTIONS 5.2 AND 5.9 OF THE BYLAWS; D. APPROVAL OF THE APPOINTMENT AND REMOVAL OF THE ADMINISTRATOR OF THE CORPORATION, AS PROVIDED IN SECTION 6.2.1 OF THE BYLAWS; 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 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 (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; 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. APPROVAL OF THE CREATION, OWNERSHIP OR ACQUISITION OF, OR AFFILIATION WITH, ANY OTHER ORGANIZATION CONTROLLED BY THE CORPORATION. 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), THE ORGANIZATION USES THE FOLLOWING TO ESTABLISH 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 BOARD OF MERCY HEALTH. 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, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE FROM TIME TO TIME BUT ARE NOT PUBLISHED PUBLICLY. 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: NET TRANSFERS TO/FROM AFFILIATES -1,682,432. FORM 990, PART XII, QUESTION 2C AUDIT OF FINANCIAL STATEMENTS 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 2016 (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 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. FORM 990, PART V, LINE 2A W-3 FILING SALARIES AND WAGES WITH LIMITED EXEPTIONS, 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, PART V, QUESTION 1A FORM 1099/1096 FILING VENDORS 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 MERCY HEALTH SYSTEM (WITH LIMITED EXCEPTIONS) UNDER THE MERCY HEALTH EIN. FORM 990, SCHEDULE R, PART V SYSTEM LIMITATIONS MERCY HEALTH (MERCY) HAS MANY LEGAL ENTITIES WITHIN ITS STRUCTURE. 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 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 AND THE INFORMATION INCLUDES RELATED PARTY TRANSACTIONS FOR ALL OF MERCY, RATHER THAN ONLY THE FILING ENTITY. 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 JEFFERSON 1400 HIGHWAY 61 SOUTH FESTUS MO 63028 430687077 HOSPITAL MO 501C3 3 MERCY HEALTH EAST COMMUNITIES - SR 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 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 - 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