2015-05-13T08:16:36-05:00 2014-06-30 861065772 Deloitte Tax LLP 250 East Fifth Street Suite 1900 Cincinnati OH 45202 990 2013-07-01 481152279 Mercy Community Health Foundation Inc MERC 7855875462 PO Box 13 Manhattan KS 665050013 Carol Karp Chief Financial Officer 7855875462 2015-05-13 1 Rebecca Lyons P01487105 5137847100 2013 2016-02-25 16:41:14Z Margaret Michal 1823 College Avenue Manhattan KS 66502 460402 0 X www.via-christi.org/MercyFoundation X 1994 KS Promote health by raising funds in support of Mercy Regional Health Center, Inc. & its programs. 23 22 0 22 0 0 166696 289925 0 0 125918 150562 -14581 -34543 278033 405944 76035 118425 0 0 0 0 0 0 7627 18222 25753 94257 144178 183776 261766 4076125 4299917 54946 6461 4021179 4293456 X To promote health in the Manhattan, Kansas community and the surrounding areas in a manner not inconsistent with the mission of Mercy Regional Health Center, Inc. (MRHC) of Manhattan, Kansas by developing and maintaining initiatives in private fundraising, financial management, and volunteerism. 0 0 132824 118425 Since 2001, the Mercy Foundation has received nearly 62,000 gifts and raised more than $0.3 million to support community health care at Mercy Regional Health Center, including:- $5 million for the capital campaign. This money has helped fund the expansion and modernization of Mercy Regional Health Center, including facilities and equipment.- More than $1,254,000 for the cardiac initiative. This money has helped fund a state-of-the-art catheterization lab and a Cardiology Picture Archiving Computer System (PACS), purchase a 64-slice CT scanner, recruit two interventional cardiologists, and establish The Heart Institute at Mercy Regional. 132824 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 2 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 X 23 22 1 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X Judy Davis 3168584931 8200 E Thorn Drive Wichita KS 67226 Joe Downey Chair 1.00 0.00 X X 0 0 0 David Pauls MD Vice Chair 1.00 0.00 X X 0 0 0 John R Graham Deceased Secretary/Treasurer 1.00 0.00 X X 0 0 0 Mark Knackendoffel Secretary/Treasurer 1.00 0.00 X X 0 0 0 Randall Anderes Trustee 1.00 0.00 X 0 0 0 Richard Baker start 1013 Trustee 1.00 0.00 X 0 0 0 James Barber end 913 Trustee 1.00 49.00 X 0 215182 22758 Tom Barth MD Trustee 1.00 0.00 X 0 0 0 Tammy Bryant Trustee 1.00 0.00 X 0 0 0 Matt Crocker start 1013 Trustee 1.00 0.00 X 0 0 0 Ruth Dyer start 1013 Trustee 1.00 0.00 X 0 0 0 Frederick Freeman MD Trustee 1.00 0.00 X 0 0 0 Jackie Hartman Trustee 1.00 0.00 X 0 0 0 Eileen Hinkin start 0114 Trustee 1.00 0.00 X 0 0 0 Tom Holcombe Trustee 1.00 0.00 X 0 0 0 Judy Hughey Trustee 1.00 0.00 X 0 0 0 Mark Hungerford Trustee 1.00 0.00 X 0 0 0 Richard Jankovich Trustee 1.00 0.00 X 0 0 0 Bob Krause Trustee 1.00 0.00 X 0 0 0 Chad Lohman Trustee 1.00 0.00 X 0 0 0 Peggy Lyons Trustee 1.00 0.00 X 0 0 0 Dan Pennington start 0114 Trustee 1.00 49.00 X 0 79487 5449 Shon Robben Trustee 1.00 0.00 X 0 0 0 David Rogers Trustee 1.00 0.00 X 0 0 0 Laird Veatch start 1013 Trustee 1.00 0.00 X 0 0 0 John Broberg ex-officio Senior Administrator 1.00 49.00 X 0 282896 29769 Margaret Michal Senior Director 50.00 0.00 X 0 55552 21821 0 633117 79797 0 0 1 0 0 112271 115500 62154 289925 113303 113303 37259 0 37259 37259 37259 19915 112271 54458 -34543 -34543 405944 0 0 116019 104268 104268 14157 14157 1651 826 825 1005 1005 2482 1652 830 644 644 435 435 Emergency Preparedness 7828 7828 Donor Appreciation 4967 4967 Women & Children 2657 2657 One Community 1502 1502 2582 2412 170 144178 132824 3727 7627 69654 85558 0 30465 20465 0 0 0 0 0 23262 23262 0 0 3976006 4193894 4076125 4299917 50879 3558 4067 2903 54946 6461 X 227897 306683 3003262 3196753 790020 790020 4021179 4293456 4076125 4299917 X 261766 112038 -101527 X 0 1 X 1 0 X 181484 451569 343296 166696 289925 1432970 181484 451569 343296 166696 289925 1432970 584395 848575 74695 99346 103697 86392 113303 477433 1910403 185364 0.44420 0.47450 X Schedule A, Part II: Effective April 1, 2013, Via Christi Health, the parent of the filing organization, was acquired by Ascension Health. Ascension Health is a subsidiary of Ascension Health Alliance. As part of the acquisition, the organization changed its tax year to June 30 in order to align with the tax year of Ascension Health. Amounts reported on Schedule A, Part II for the 2012 tax year represent the short period October 1, 2012 through June 30, 2013. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 849197 0 101240 12164 2858 935415 778935 4825 67040 1603 849197 596515 78774 105663 2017 778935 367088 240149 -9401 1321 596515 225912 119815 22183 822 367088 0.84450 0.15550 0 0 23262 23262 0 0 Gift Annuity 2903 2903 Part V, Line 4: The funds are used for scholarship distributions. Gala (Red Dress) 72100 66900 5200 25 7485 15702 Golf Tournament 59011 45371 13640 8500 5585 16761 1 1075 1075 400 132186 112271 19915 8525 13070 32863 54458 -34543 1 United Way of Riley County PO Box 922 Manhattan KS 66505 480847598 Section 501(c)(3) 11964 Employee Campaign Contributions Mercy Regional Health Center Inc 1823 College Avenue Manhattan KS 66502 481186704 Section 501(c)(3) 79122 Support for Medical Equipment, Supplies and Employee Education Heart and Vascular Clinic LLC 2900 Amherst Avenue Ste B Manhattan KS 66503 455420179 6000 Physician Cardiovascular Training 2 1 Mercy Regional Health Center Employee Education Assistance 13 7821 Mercy Regional Health Center Employee General Assistance 21 5565 Part I, Line 2: Mercy Community Health Foundation, Inc. does not solicit grant applications from organizations to which it provides assistance. The Foundation provides assistance to certain organizations listed in Schedule I based on employee payroll contributions; the individual contributions are forwarded to the organization as soon as the funds are received. 0 1 0 0 0 0 0 0 0 James Barber end 913 Trustee 0 163265 0 5461 0 46456 0 10309 0 12449 0 237940 0 0 John Broberg ex-officio Senior Administrator 0 271118 0 4886 0 6892 0 21228 0 8541 0 312665 0 0 Part I, Line 3 The organization does not compensate the top management official for their role as Senior Administrator of the organization. However, if they did, this person's salary would be set using the following policies established by Via Christi Health, Inc., a related organization: - Compensation Committee, - Independent Compensation Consultant, - Compensation Survey or Study, and - Approval by the Board or Compensation Committee. Part I, Line 4b Eligible executives participate in a program that provides for supplemental retirement benefits. The payment of benefits under the program, if any, is entirely dependent upon the facts and circumstances under which the executive terminates employment with the organization. Benefits under the program are funded annually based on participation and are not vested until the 5 year service requirement is reached. Due to the substantial risk of forfeiture provision, there is no guarantee that these executives will ever receive any benefit under the program. The amount funded annually under the program to the executives is reported as compensation on Form 990 Schedule J, Part II, Column B in the year funded. The amount ultimately paid under the program to executives is reported on Form 990 Schedule J, Part II, Column F. There were no distributions from a supplemental nonqualified retirement plan during the year. Form 990, Part VI, Section A, line 2 Many of the persons listed on Part VII have a "business relationship" with each other by virtue of sitting on related Via Christi Health, Inc. entity boards. Form 990, Part VI, Section A, line 6 Mercy Community Health Foundation, Inc. has a single corporate member, Mercy Regional Health Center, Inc. Form 990, Part VI, Section A, line 7a Mercy Community Health Foundation, Inc. has a single corporate member, Mercy Regional Health Center, Inc., who has the reserve power to approve two of the nominees and remove these two members of the board of trustees of Mercy Community Health Foundation, Inc. Form 990, Part VI, Section B, line 11 Management, including certain officers, work diligently to complete the Form 990 and attached schedules in through manner. Prior to filing the return, all board members are provided the Form 990 and management team members are available to answer any board members' questions. Form 990, Part VI, Section B, line 12c The organization's Conflict of Interest Policy is monitored as part of the system-wide procedures of Via Christi Health, Inc. and not at the organizational level. The system-wide procedures are as follows: 1 - At time of appointment and annually thereafter, all interested persons, including board and committee members, complete a disclosure statement which addresses actual or potential conflicts of interest; 2 - The disclosure statement is done electronically and the return of the completed statement is a condition of continued appointment, employment, or participation with the organization; 3 - All actual or potential conflicts are reviewed, investigated, and resolved by the chief governance officer and the corporate responsibility officer, with the results shared with the chief executive of the organization; and 4 - Periodic reviews are conducted by governance, compliance, and internal audit to ensure the organization is operating consistent with the policy and enforcing the policy's terms. Form 990, Part VI, Section B, line 15 Mercy Community Health Foundation uses the policies established by Via Christi Health, Inc. (VCH). VCH has established a common philosophy, strategy, and processes for executive compensation. Through the oversight of the VCH Executive Compensation Committee, executive compensation is competitively positioned at its stated market position when compared to the compensation paid by relevant organizations (comparably-sized health systems, hospitals, and long-term care providers). VCH recognizes its responsibility to ensure that its executive compensation program is appropriate in view of its mission and tax-exempt status and that its compensation levels and expenditures are reasonable and not excessive. To ensure these ends, the VCH Executive Compensation Committee has established and approved the executive compensation philosophy for VCH and all related entities. It will also approve all changes in the compensation package for VCH executives in advance. On an annual basis, the Committee conducts a comprehensive review of total compensation for all executives. It also reviews and approves "off-cycle" compensation transactions as needed. In their review, the Committee considers the following factors: - Market data from independent compensation surveys and sources that reflect comparable positions in organizations of similar size and scope; - Difficulties in recruiting and retaining executives; - Skills, experience and performance history of individual executives; - Critical business or strategic issues that the organization may face; and - Market position for total compensation. The adequacy, competitiveness, and cost of the VCH total executive compensation program are reviewed on an ongoing basis and changes are made as the Committee determines appropriate. The executive compensation program will be maintained such that it will fall within the safe harbor guidelines established by the intermediate sanctions regulations. The Committee also employs the services of an independent compensation consultant to prepare market analysis to aid and support the Committee's actions, provide documentation of market trends for budget setting purposes, review annual compensation changes to ensure "reasonableness" and provide attestation, and provide consultation on all executive compensation issues. The Committee also relies on third-party validation of performance measures used in the determination of compensation. Form 990, Part VI, Section C, line 19 The financial statements are mailed in the form of an annual report to all contributors to the Foundation. They are also available on the Foundation's website. Other public documents are available upon request. Form 990, Part XI, line 9: Transfer to Mercy Regional Health Center, Inc. for Reimbursement for the Purchase of Medical Equipment -101,527. Ambulatory Surgery Center LP 8200 E Thorn Drive Suite 300 Wichita KS 67226 481114690 Surgery Center KS N/A AMS Diagnostics LLC 8200 E Thorn Drive Suite 300 Wichita KS 67226 481223653 Radiology Services KS N/A Kansas Surgery and Recovery Center LLC 2770 North Webb Road Wichita KS 67226 481148580 Surgery Center KS N/A MR Imaging Center LLC 8200 E Thorn Drive Suite 300 Wichita KS 67226 481000538 Imaging Center KS N/A St Joseph MRI LLC 8200 E Thorn Drive Suite 300 Wichita KS 67226 481007220 Imaging Center KS N/A Mercy Imaging LLC 1823 College Avenue Manhattan KS 66502 481251984 Radiology Services KS N/A Affiliated Medical Services Laboratory Inc 2916 E Central Wichita KS 67214 481239522 Medical Laboratory KS N/A C 0 Integrated Healthcare Systems Inc 3311 East Murdock Wichita KS 67208 480941549 Clinic Services KS N/A C 0 VCH Iowa PC Trust 8200 E Thorn Drive Suite 300 Wichita KS 67226 276937322 Beneficiary Trust IA N/A T 0 VCH Iowa PC 8200 E Thorn Drive Suite 300 Wichita KS 67226 273983977 Professional Association IA N/A C 0 Via Christi Clinic PA 3311 East Murdock Wichita KS 67208 480993446 Professional Association KS N/A C 0 Via Christi Clinic Services Inc 8200 E Thorn Drive Suite 300 Wichita KS 67226 273984287 Clinic Services KS N/A C 0 Sunflower Assurance Ltd PO Box 1085 Grand Cayman CJ KY1-1102 980223159 Insurance Company CJ N/A C 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 Mercy Regional Health Center Inc B 180724 FMV Mercy Regional Health Center Inc S 181724 FMV