MERCY HOSPITAL ROGERS: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
MERCY HOSPITAL ROGERS (EIN 71-0294390)
Tax period
2011-07-01 to 2012-06-30
Filed
2013-05-30
IRS object ID
201301509349300005
Schema version
2011v1.5
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-05-30T09:10:37-05:00Timestamp
Tax Period End Date2012-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1ERNST & YOUNG US LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1190 CARONDELET PLAZA SUITE 1300AddressLine1
CityCLAYTONCity
StateMOState
ZIP Code63105ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN710294390EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Mercy Hospital RogersBusinessNameLine1
FieldValueIRS element (for citing)
In Care Of Name% BENNY J STOVER CPAInCareOfName
Name ControlMERCNameControl
Phone3145796100Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12710 Rife Medical LaneAddressLine1
CityRogersCity
StateARState
ZIP Code72758ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameBenny StoverName
TitleVP-FinanceTitle
Date Signed2013-05-10DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
Phone3142901000Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonSCOTT STREETNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line12710 Rife Medical LaneAddressLine1
CityRogersCity
StateARState
ZIP Code72758ZIPCode
FieldValueIRS element (for citing)
Gross Receipts155206674GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Group Exemption Number0928GroupExemptionNumber
Organization501c3XOrganization501c3
Web SiteWWW.MERCY.NETWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1995YearFormation
State Legal DomicileARStateLegalDomicile
Activity Or Mission DescriptionAS THE SISTERS OF MERCY BEFORE US, WE BRING TO LIFE THE HEALING MINISTRY OF JESUS THROUGH OUR COMPASSIONATE CARE AND EXCEPTIONAL SERVICE.ActivityOrMissionDescription
Nbr Voting Members Governing Body5NbrVotingMembersGoverningBody
Nbr Independent Voting Members3NbrIndependentVotingMembers
Total Nbr Employees1077TotalNbrEmployees
Total Nbr Volunteers313TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year21710ContributionsGrantsCurrentYear
Program Service Revenue Prior Year147186014ProgramServiceRevenuePriorYear
Program Service Revenue CY154212501ProgramServiceRevenueCY
Investment Income Prior Year25349InvestmentIncomePriorYear
Investment Income Current Year24594InvestmentIncomeCurrentYear
Other Revenue Prior Year1585074OtherRevenuePriorYear
Other Revenue Current Year947869OtherRevenueCurrentYear
Total Revenue Prior Year148796437TotalRevenuePriorYear
Total Revenue Current Year155206674TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY3492GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year45554216SalariesEtcPriorYear
Salaries Etc Current Year48870622SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year91494783OtherExpensePriorYear
Other Expenses Current Year90862854OtherExpensesCurrentYear
Total Expenses Prior Year137048999TotalExpensesPriorYear
Total Expenses Current Year139736968TotalExpensesCurrentYear
Revenues Less Expenses Prior Year11747438RevenuesLessExpensesPriorYear
Revenues Less Expenses CY15469706RevenuesLessExpensesCY
Total Assets BOY189509685TotalAssetsBOY
Total Assets EOY203796910TotalAssetsEOY
Total Liabilities BOY7295708TotalLiabilitiesBOY
Total Liabilities EOY6288024TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY182213977NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY197508886NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionAS THE SISTERS OF MERCY BEFORE US, WE BRING TO LIFE THE HEALING MINISTRY OF JESUS THROUGH OUR COMPASSIONATE CARE AND EXCEPTIONAL SERVICE.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense44495895Expense
Revenue53859481Revenue
DescriptionINPATIENT HEALTHCARE: THE HOSPITAL IS A FULL SERVICE MEDICAL FACILITY THAT PROVIDES QUALITY INPATIENT HEALTHCARE TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THE INPATIENT HOSPITAL IS LICENSED FOR 147 ACUTE BEDS AND 18 NEWBORN BEDS, FOR A TOTAL OF 165 BEDS. DURING THE FISCAL YEAR ENDED JUNE 30, 2012, ACUTE DISCHARGES WERE 8,682 AND ACUTE PATIENT DAYS WERE 28,672. NEWBORN DISCHARGES WERE 1,303 AND NEWBORN PATIENT DAYS WERE 2,235.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense20965081Expense
Revenue25376911Revenue
DescriptionSURGICAL SERVICES: THE HOSPITAL PROVIDES A BROAD SCOPE OF SURGICAL SERVICES, ON BOTH AN INPATIENT AND AN OUTPATIENT BASIS. DURING THE FISCAL YEAR ENDED JUNE 30, 2012, THE HOSPITAL PERFORMED 2,706 INPATIENT SURGERIES AND 6,234 OUTPATIENT SURGERIES.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense7395797Expense
Revenue8952147Revenue
DescriptionEMERGENCY SERVICES: THE HOSPITAL PROVIDES 24 HOUR EMERGENCY SERVICES, AND PROVIDES SUCH SERVICES REGARDLESS OF ABILITY TO PAY. DURING THE FISCAL YEAR ENDED JUNE 30, 2012, THE HOSPITAL PROVIDED FOR 44,207 EMERGENCY VISITS. OF THIS AMOUNT, 37,833 WERE TREATED AND SENT HOME, WHILE 6,374 BECAME INPATIENT ADMISSIONS.Description
FieldValueIRS element (for citing)
Total Of Other Program Service Exp54142126TotalOfOtherProgramServiceExp
Total Of Other Program Service Grnt3492TotalOfOtherProgramServiceGrnt
Total Of Other Program Service Rev66573107TotalOfOtherProgramServiceRev
Total Program Service Expense126998899TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredfalseScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetstrueReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transaction Related EntitytrueTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Info In Schedule O Part VXInfoInScheduleOPartV
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees1077NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members5NbrVotingGoverningBodyMembers
Number Independent Voting Members3NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOfalseCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonBENNY J STOVER CPANamePerson
Telephone Number4793382903TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12710 RIFE MEDICAL LANEAddressLine1
CityROGERSCity
StateARState
ZIP Code72758ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (24 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
Paul Bergant
Board member1.0X000
Wayne Callahan
Board member1.0X000
Hugh Donnell
Physician & Board member60.0X032468737798
Sr Chabanel Finnegan RSM
Board member1.0X000
Scott Street
Chief executive officer60.0X0547813113902X
Jonathan Vitiello
Chief financial officer60.0043976761898X
Bradley KIM Day
President, central communities60.00833159436266X
Tanya Marion
Regional VP-Human resources60.0016039116041X
Michael Merrigan
Regional VP-General Counsel60.0032092365228X
Michele Stewart
Chief operating officer60.0029103067596X
Benny Stover
VP-Finance60.0017148119523X
Douglas Treptow MD
Chief of staff60.0052918434524X
William Hennessey III
Regional VP- Marketing/Comm60.0028054447347X
Eric Gibbs
CLINICAL PHARMACIST40.0160731013295X
James Johnson
Director, pharmacy services40.0148656029147X
Richard Moore
Clinical pharmacist40.0153312013761X
Charlotte Rankin
Executive director, imaging40.0149784012436X
Sean Slaba
Perfusionist40.0144067019677X
Susan Barrett
Former president40.003000000X
George Flynn
SR VP-Former CEO60.00571155192126X
Robert Donnell
Physician40.0025523539798X
James Merritt
Physician40.0026380023185X
Ralph Ritz
Physician40.0025122324683X
Cynthia Wilson
Physician40.0029520629557X
FieldValueIRS element (for citing)
Total Reportable Comp From Org756550TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs5835598TotalReportableCompFrmRltdOrgs
Total Other Compensation1297788TotalOtherCompensation
Number Individuals GT100 K19NumberIndividualsGT100K
Formers ListedtrueFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
MCCARTHY BUILDING CO
1341 North Rock Hill RoadST LOUISMO63124Construction4365680
PINNACLE RADIOLOGY PLLC
4500 S Garnett Ste 919TULSAOK74146RADIOLOGY SERVICES684925
WOUND CARE CENTERS INC
PO Box 637114CINCINNATIOH45263PATIENT SVC MGMT412224
LINEN KING
14780 S MemorialBIXBYOK74008LINEN SERVICES386822
WHITE RIVER LITHOTRIPSY
6333 N State Hwy 161 Ste 200IRVINGTX75038MEDICAL SERVICES354400
FieldValueIRS element (for citing)
Number Of Contractors GT100 K19NumberOfContractorsGT100K
All Other Contributions21710AllOtherContributions
Total Contributions21710TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
IP HEALTHCARE6221105385948153859481
SURGICAL SERVICES6221102537691125376911
EMERGENCY SERVICES62211089521478952147
OTHER PATIENT SERVICES REVENUE6221106553563765535637
OTHER OPERATING REVENUE900099488325488325
FieldValueIRS element (for citing)
Total Program Service Revenue154212501TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column18744TotalRevenueColumn
Exclusion$18,744ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real398724Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real0Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real398724Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column398724TotalRevenueColumn
Exclusion$398,724ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other5850Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other0Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other5850Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column5850TotalRevenueColumn
Exclusion$5,850ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionCAFTERIA AND VENDINGDescription
Business Code900099BusinessCode
Total Revenue Column549145TotalRevenueColumn
Related Or Exempt Function Income549145RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue549145TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column155206674TotalRevenueColumn
Related Or Exempt Function Income154761646RelatedOrExemptFunctionIncome
Exclusion$423,318ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total3492Total
Program Services3492ProgramServices

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total0Total

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total38982584Total
Program Services34634305ProgramServices
Management And General4348279ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1833545Total
Program Services1629024ProgramServices
Management And General204521ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total5174663Total
Program Services4597460ProgramServices
Management And General577203ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total2879830Total
Program Services2558602ProgramServices
Management And General321228ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total0Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total0Total

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total5400450Total
Program Services4327850ProgramServices
Management And General1072600ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total73337Total
Program Services65157ProgramServices
Management And General8180ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total2857760Total
Program Services1233298ProgramServices
Management And General1624462ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total51164Total
Program Services42348ProgramServices
Management And General8816ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total2520556Total
Program Services2239403ProgramServices
Management And General281153ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total260604Total
Program Services204773ProgramServices
Management And General55831ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total57406Total
Program Services51003ProgramServices
Management And General6403ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total0Total

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total11598114Total
Program Services10304412ProgramServices
Management And General1293702ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total0Total

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
SHARED SERVICE FEES22007171195524002454771
BAD DEBT EXPENSE1089039410890394
REPAIRS & MAINTENANCE1010198897516112682
MEDICAL SUPPLIES3367833733678337

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total457363Total
Program Services89125ProgramServices
Management And General368238ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total139736968Total
Program Services126998899ProgramServices
Management And General12738069ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY6543661BOY
EOY17341202EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY18297535BOY
EOY21548184EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY1818559BOY
EOY1558765EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY3075521BOY
EOY3299090EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY64034BOY
EOY53410EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis197619376LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec74328617LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY127980256BOY
EOY123290759EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY31730119BOY
EOY36705500EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY189509685BOY
EOY203796910EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY7289208BOY
EOY6269290EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY5000BOY
EOY18734EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY1500BOY
EOY0EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY7295708BOY
EOY6288024EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY182213977BOY
EOY197508886EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY182213977BOY
EOY197508886EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY189509685BOY
EOY203796910EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses15469706ReconcilationRevenueExpenses
Reconcilation Other Changes-174797ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredtrueFederalGrantAuditRequired
Federal Grant Audit PerformedtrueFederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbying
Total Direct LobbyingTotalDirectLobbying
Total Lobbying ExpendituresTotalLobbyingExpenditures
Other Exempt Purpose ExpendituresOtherExemptPurposeExpenditures
Total Exempt Purpose ExpendituresTotalExemptPurposeExpenditures
Lobbying NontaxableLobbyingNontaxableAmount
Grassroots NontaxableGrassrootsNontaxableAmount
Tot Lobbying Grassroot Minus Non TxTotLobbyingGrassrootMinusNonTx
Tot Lobby Expend Mns Lobbying NontxTotLobbyExpendMnsLobbyingNontx
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationsfalseGrantsOtherOrganizations
Direct Contact LegislatorsfalseDirectContactLegislators
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiestrueOtherActivities
Other Activities$12,474OtherActivitiesAmount
Total Lobbying Expenditures IIB12474TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierFORM 990, SCHEDULE C, PART II-B, LINE 1(I)Identifier
Return ReferenceLOBBYING PORTION OF DUESReturnReference
ExplanationTHE FILING ORGANIZATION IS A MEMBER OF AND PAYS DUES TO THE FOLLOWING HOSPITAL ASSOCIATIONS: ARKANSAS HOSPITAL ASSOCIATION, AMERICAN HOSPITAL ASSOCIATION AND CATHOLIC HEALTH ASSOCIATION. FOR THE YEAR ENDED JUNE 30, 2012, DUE WERE $44,013, $13,900 AND $30,545, RESPECTIVELY. APPROXIMATELY 17% OF ARKANSAS HOSPITAL ASSOCIATION DUES, 24.6% OF AMERICAN HOSPITAL ASSOCIATION DUES AND 5.15% OF CATHOLIC HEALTH ASSOCIATION DUES WERE ATTRIBUTABLE TO LOBBYING ACTIVITIES PERFORMED BY THESE ASSOCIATIONS.Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts
Current Year Minus3 YearsCurrentYearMinus3Years

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis5485447OtherCostOrOtherBasis
Book Value5485447BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis136987321OtherCostOrOtherBasis
Depreciation36420316Depreciation
Book Value100567005BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis1477392OtherCostOrOtherBasis
Depreciation631300Depreciation
Book Value846092BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis52780766OtherCostOrOtherBasis
Depreciation37090746Depreciation
Book Value15690020BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis888450OtherCostOrOtherBasis
Depreciation186255Depreciation
Book Value702195BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings123290759TotalOfBookValueLandBuildings

Other Assets OtherAssets (2 entries)

DescriptionDescriptionBook ValueBookValue
DUE FROM AFFILIATES36612141
INVESTMENT IN UNITY93359
FieldValueIRS element (for citing)
Total Book Value Other Assets36705500TotalBookValueOtherAssets
Federal Income Tax Liability0FederalIncomeTaxLiability
Total Of Amounts0TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierFORM 990, SCHEDULE D, PART X, LINE 2Identifier
Return ReferenceASC 740 FOOTNOTEReturnReference
ExplanationTHE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF MERCY HEALTH AND SUBSIDIARIES DO NOT INCLUDE A FOOTNOTE TO REPORT THE ORGANIZATION'S LIABILITY FOR UNCERTAIN TAX PROVISIONS UNDER ASC 740, AS THEY ARE DEEMED IMMATERIAL FOR DISCLOSURE.Explanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent100XPcent100
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare
Pcent400XPcent400
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgettrueExpensesExceededBudget
Unable To Provide CarefalseUnableToProvideCare
Annual Community Benefit ReportfalseAnnualCommunityBenefitReport

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense7194375TotalCommunityBenefitExpense
Net Community Benefit Expense7194375NetCommunityBenefitExpense
Percent Of Total Expense0.05580PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense12340915TotalCommunityBenefitExpense
Direct Offsetting Revenue7482588DirectOffsettingRevenue
Net Community Benefit Expense4858327NetCommunityBenefitExpense
Percent Of Total Expense0.03770PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense19535290TotalCommunityBenefitExpense
Direct Offsetting Revenue7482588DirectOffsettingRevenue
Net Community Benefit Expense12052702NetCommunityBenefitExpense
Percent Of Total Expense0.09350PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense298079TotalCommunityBenefitExpense
Net Community Benefit Expense298079NetCommunityBenefitExpense
Percent Of Total Expense0.00230PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense349444TotalCommunityBenefitExpense
Net Community Benefit Expense349444NetCommunityBenefitExpense
Percent Of Total Expense0.00270PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense81558TotalCommunityBenefitExpense
Net Community Benefit Expense81558NetCommunityBenefitExpense
Percent Of Total Expense0.00060PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense729081TotalCommunityBenefitExpense
Net Community Benefit Expense729081NetCommunityBenefitExpense
Percent Of Total Expense0.00560PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense20264371TotalCommunityBenefitExpense
Direct Offsetting Revenue7482588DirectOffsettingRevenue
Net Community Benefit Expense12781783NetCommunityBenefitExpense
Percent Of Total Expense0.09910PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Total Community Building Expense55410TotalCommunityBuildingExpense
Net Community Building Expense55410NetCommunityBuildingExpense
Percent Of Total Expense0.00040PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense55410TotalCommunityBuildingExpense
Net Community Building Expense55410NetCommunityBuildingExpense
Percent Of Total Expense0.00040PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$3,442,453BadDebtExpenseAmount
Amount Reimbursed By Medicare41612745AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare43686384CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-2073639MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1Mercy Hospital RogersBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line12710 Rife Medical LaneAddressLine1
CityRogersCity
StateARState
ZIP Code72758ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Childrens HospitalXChildrensHospital
Teaching HospitalXTeachingHospital
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Mercy Hospital RogersBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria ExplainedtrueEligibilityCriteriaExplained
Uses FPG FreetrueUsesFPGFree
FPG Free Percent100FPGFreePercent
Uses FPG DiscountedtrueUsesFPGDiscounted
FPG Discount Percent400.FPGDiscountPercent
Explains BasistrueExplainsBasis
Income LevelXIncomeLevel
Asset LevelXAssetLevel
Medical IndigencyXMedicalIndigency
Explains Application MethodtrueExplainsApplicationMethod
Includes Publicity MeasurestrueIncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Available On RequestXAvailableOnRequest
Actions On NonpaymenttrueActionsOnNonpayment
Collection ActivitiesfalseCollectionActivities
Nondiscrim Emergency Care PolicytrueNondiscrimEmergencyCarePolicy
Used Other MethodXUsedOtherMethod
Amounts Generally BilledfalseAmountsGenerallyBilled
Gross ChargesfalseGrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities17NumberOfOtherFacilities

Other Facilities OtherFacilities (17 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
Mercy Bella Vista Lancashire
600 Memorial DriveBella VistaAR72714Primary Care Medium
Mercy Bella Vista
2790 Bella Vista WayBella VistaAR72715Physician Clinic/Practice
Sugar Creek Center
24 Sugar Creek CenterBella VistaAR72714Physician Clinic/Practice
Mercy J Street
1000 SE 13th CourtBentonvilleAR72712Primary Care Medium
Mercy Moberly Lane
2900 Moberly LaneBentonvilleAR72712Primary Care Medium
Mercy Highway 102
3101 SE 14thBentonvilleAR72712Physician Clinic/Practice
Mercy Centerton
805 W Centerton BoulevardCentertonAR72719Primary Care Small
Mercy Lowell
325 S 6thLowellAR72745Physician Clinic/Practice
Mercy Monroe Avenue
116 W Monroe AvenueLowellAR72745Physician Clinic/Practice
Mercy Noel
125 Main StreetNoelMO64854Primary Care Small
Mercy Horsebarn Road
1001 Horsebarn RoadRogersAR72758Physician Clinic/Practice
Mercy Redbud
5204 W RedbudRogersAR72758Physician Clinic/Practice
Mercy W Elm
1110 W ElmRogersAR72756Primary Care Small
Mercy Physician Plaza
2708 Rife Medical LaneRogersAR72758Physician Clinic/Practice
Center for Non-Profits
1200 W WalnutRogersAR72756Home Care
JB Hunt Parkway Tower
3333 Pinnacle Hills ParkwayRogersAR72758Physician Clinic/Practice
Mercy Wound Care
1194 W WalnutRogersAR72756Wound Care

Form990 Schedule H Part VI Form990ScheduleHPartVI

FieldValueIRS element (for citing)
IdentifierForm 990, Schedule H, PART I, LINE 7, Column FIdentifier
ExplanationTOTAL EXPENSES FROM FORM 990, PART IX, LINE 25 WAS $139,736,968. THE BAD DEBT EXPENSE (CHARGES) INCLUDED IN THIS AMOUNT WAS $10,890,394. THE REMAINING EXPENSE OF $128,846,574 WAS UTILIZED FOR THE PURPOSE OF CALCULATING LINE 7, COLUMN (F). FORM 990, SCHEDULE H, 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 ACCOUNTING, WHERE AVAILABLE. WHERE COST ACCOUNTING IS NOT AVAILABLE, COST REPORT COST TO CHARGE RATIOS WERE UTILIZED. FORM 990, SCHEDULE H, 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 (REFER TO DISCLOSURE FOR PART III, #9B) 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. FORM 990, SCHEDULE H, PART III, LINE 8 IT IS THE POSITION OF MERCY HOSPITAL ROGERS 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). FORM 990, SCHEDULE H, PART III, LINE 9B MERCY HOSPITAL ROGERS ("MERCY") DEBT COLLECTION POLICY PROVIDES THAT MERCY WILL PERFORM A REASONABLE REVIEW OF EACH INPATIENT ACCOUNT BEFORE TURNING AN ACCOUNT OVER TO A THIRD-PARTY COLLECTION AGENT AND PRIOR TO INSTITUTING ANY LEGAL ACTION FOR NON-PAYMENT, TO ASSURE THAT THE PATIENT AND PATIENT GUARANTOR ARE NOT ELIGIBLE FOR ANY ASSISTANCE PROGRAM (E.G., MEDICAID) AND DO NOT QUALIFY FOR COVERAGE THROUGH MERCY'S COMMUNITY ASSISTANCE POLICY. AFTER HAVING BEEN TURNED OVER TO A THIRD-PARTY COLLECTION AGENT, ANY PATIENT ACCOUNT THAT IS SUBSEQUENTLY DETERMINED TO HAVE MET THE MERCY HOSPITAL COMMUNITY ASSISTANCE POLICY IS REQUIRED TO BE RETURNED IMMEDIATELY BY THE THIRD-PARTY COLLECTION AGENT TO MERCY FOR APPROPRIATE FOLLOW-UP. MERCY REQUIRES ITS THIRD-PARTY COLLECTION AGENTS TO INCLUDE A MESSAGE ON ALL STATEMENTS INDICATING THAT IF A PATIENT OR PATIENT GUARANTOR MEETS CERTAIN STIPULATED INCOME REQUIREMENTS, THE PATIENT OR PATIENT GUARANTOR MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE. MERCY UTILIZES THE "SEARCH AMERICA" TOOL TO ENHANCE THE ABILITY TO DETERMINE CHARITY QUALIFICATION. PRESUMPTIVE CHARITY WILL BE GRANTED IN SITUATIONS WHERE MERCY HOSPITAL HAS BEEN UNABLE TO OBTAIN INFORMATION FROM PATIENTS OR THE INFORMATION PROVIDED IS NOT COMPLETE ENOUGH TO MAKE A CHARITY DETERMINATION. MERCY UTILIZES PRESUMPTIVE CHARITY PRIOR TO BAD DEBT PLACEMENT FOR CHARITY ADJUSTMENTS IN EXCESS OF $6,500. IN THESE CASES, MERCY UTILIZES THE SEARCH AMERICA REPORT STATUS OF "PROBABLE CHARITY" AS THE BASIS FOR ASSIGNING THE CHARITY LEVEL. 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. ADDITIONALLY THEY MAY INCLUDE LIENS UPON REAL PROPERTY AND REASONABLE WAGE GARNISHMENTS. LEGAL ACTIONS WILL GENERALLY NOT INCLUDE BANK GARNISHMENT, REPOSSESSION OF ASSETS OR FORECLOSURES TO ENFORCE SATISFACTION OF A LIEN. MERCY HAS POLICIES AND PROCEDURES ESTABLISHED TO ADDRESS THE INITIATION OF LEGAL ACTION AND ANNUALLY REVIEWS COMPLIANCE WITH ALL POLICIES FORM 990, SCHEDULE H, PART V, LINE 19D EACH HOSPITAL FACILITY USED THE AVERAGE DISCOUNT OF THE HIGHEST (BEST PAYING) THREE COMMERCIAL MANAGED CARE PAYERS AS THE BASIS FOR ESTABLISHING UNINSURED DISCOUNT RATES FOR FAP ELIGIBLE INDIVIDUALS. UNDER NO CIRCUMSTANCES, WILL THIS UNINSURED DISCOUNT BE LESS THAN 15%. FORM 990, SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT MERCY HOSPITAL ROGERS' OBJECTIVES OF COMMUNITY NEEDS ASSESSMENT ARE TO IDENTIFY HEALTH NEEDS IN ROGERS, ARKANSAS AND THE SURROUNDING COMMUNITIES, AND TO INVOLVE THE COMMUNITY IN THE HEALTH PLANNING EFFORTS. THE INFORMATION GATHERED IS USED TO PLAN STRATEGICALLY, AND BETTER MEET THE HEALTH AND HUMAN SERVICE NEEDS OF THESE COMMUNITIES. MERCY HOSPITAL ROGERS LOOKS AT COMMUNITY NEEDS ASSESSMENT AS AN OPPORTUNITY TO BUILD RELATIONSHIPS, EDUCATE THE COMMUNITY AND IDENTIFY RESOURCES THAT ARE AVAILABLE TO MEET IDENTIFIED NEEDS. BASIC DISCUSSION FORUMS HAVE BEEN UTILIZED TO FOSTER CONVERSATION WITH KEY STAKEHOLDERS. EXAMPLES OF FORUMS INCLUDE AN ADVISORY BOARD, FOCUS GROUPS, OPINION SURVEYS, AND COMMUNITY ROUND TABLE DISCUSSIONS. STAKEHOLDER PARTICIPANTS INCLUDE BOARD MEMBERS, COMMUNITY/CIVIC LEADERS, LOCAL EMPLOYERS, OTHER HEALTH CARE PROVIDERS, FORMER PATIENTS, AND CO-WORKERS. FORM 990, SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE MERCY HOSPITAL ROGERS HAS PRINTED MATERIAL AVAILABLE AT EACH POINT OF REGISTRATION IN OUR FACILITY, IN ADDITION TO ELECTRONICALLY AVAILABILITY AT OUR WEB SITE WWW.MERCY4U.COM. SPECIFIC INFORMATION PROVIDED: FINANCIAL ASSISTANCE INFORMATION AS A PART OF OUR HEALING MINISTRY, MERCY HOSPITAL ROGERS IS COMMITTED TO PROVIDING QUALITY HEALTHCARE SERVICES TO PATIENTS REGARDLESS OF THEIR FINANCIAL SITUATION. WE OFFER PAYMENT ASSISTANCE FOR THOSE WHO DO NOT HAVE INSURANCE OR WHO ARE IN FINANCIAL NEED. UNINSURED PATIENT DISCOUNTS A DISCOUNT FROM THE HOSPITAL'S REGULAR BILLED CHARGES WILL BE PROVIDED TO PATIENTS WHO DO NOT HAVE INSURANCE. THIS INCLUDES PATIENTS WHOSE FINANCIAL SITUATION NORMALLY WOULD NOT OTHERWISE QUALIFY THEM FOR CHARITY CARE DISCOUNTS. PATIENTS WITHOUT INSURANCE WHOSE FINANCIAL SITUATION QUALIFIES THEM FOR CHARITY CARE DISCOUNTS (SEE ELIGIBILITY GUIDELINES BELOW) MUST FIRST FIND OUT IF THEY ARE ELIGIBLE FOR MEDICAID BEFORE APPLYING FOR FINANCIAL ASSISTANCE. PATIENTS DENIED MEDICAID ELIGIBILITY THEN MUST PROVIDE CERTAIN INFORMATION TO SHOW FINANCIAL NEED. APPLICATIONS FOR CHARITY CARE DISCOUNTS WILL BE REVIEWED FOR ELIGIBILITY BASED ON THE APPLICANT'S INCOME, FAMILY SIZE, AMOUNT OF PAYMENT DUE AND AVAILABILITY OF OTHER ASSETS OR RESOURCES. PLEASE NOTE THAT CARE MUST BE MEDICALLY NECESSARY TO BE CONSIDERED ELIGIBLE FOR UNINSURED PATIENT DISCOUNTS. 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. 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, ADJUSTED TO CONSIDER AVAILABILITY OF OTHER ASSETS THAT COULD BE USED TOWARD MAKING PAYMENTS. FORM 990, SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION: THE SERVICE AREA IS MADE UP OF FOUR COUNTIES IN ARKANSAS AND TWO COUNTIES IN MISSOURI. THE TOTAL POPULATION SERVICED IS APPROXIMATELY 549,229, BASED ON 2011 THOMSON REUTERS DATA. KEY DEMOGRAPHIC INDICATORS FOR THE POPULATION: 12% ARE INDIVIDUALS IN EXCESS OF 65 YEARS OF AGE, 78% WHITE, 2% BLACK, AND 15% HISPANIC. THE UNEMPLOYMENT RATE AS OF MARCH 2012, BASED ON US DEPARTMENT OF LABOR WAS 5.7%. FORM 990, SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH: COMMUNITY BUILDING ACTIVITIES: MERCY HOSPITAL ROGERS CONTINUED ITS COLLABORATION WITH THE JONES TRUST IN THE CONVERSION OF THE OLD ST. MARY'S HOSPITAL INTO "THE CENTER FOR NON PROFITS AT ST. MARY'S." MERCY HOSPITAL ROGERS INVESTED IN SEVERAL RENOVATIONS OF THE CENTER AND ENGAGED IN RENTING SIGNIFICANT SQUARE FOOTAGE FOR OUR HOME HEALTH AND WOUND CARE CENTERS. LOCAL ORGANIZATIONS SUCH AS THE AMERICAN HEART ASSOCIATION AND SUSAN G KOMEN BENEFITED FROM ACTIVITIES INCLUDING STAFF TIME IN SUPPORT OF SPECIFIC HEALTH RELATED ACTIVITIES, INCLUDING BUT NOT LIMITED TO BOARD MEMBERSHIP, GRANT WRITING, ADMINISTRATIVE SUPPORT, PHYSICIAN RECRUITMENT, AND WORK FORCE DEVELOPMENT. OTHER INFORMATION: MERCY HOSPITAL ROGERS' CO-WORKERS ARE SERVICE ORIENTED AND RESPONSIVE COMMUNITY MEMBERS. IN ADDITION TO OUR TRADITIONAL ACUTE CARE SERVICE ROLE, MERCY HOSPITAL ROGERS' CO-WORKERS PROVIDED MORE THAN 3,000 VOLUNTEER HOURS, SUPPORTING VARIOUS COMMUNITY EVENTS. EVENTS SUCH AS HEALTH SCREENING, COMMUNITY EDUCATION SEMINARS, FOOD AND CLOTHING COLLECTION FOR WOMEN'S CRISIS CENExplanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
First Class Or Charter TravelXFirstClassOrCharterTravel
Travel For CompanionsXTravelForCompanions
Idemnification Gross Up PaymentsXIdemnificationGrossUpPayments
Written Policy Re T And E ExpensestrueWrittenPolicyReTAndEExpenses
Substantiation RequiredtrueSubstantiationRequired
Severance PaymenttrueSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentstrueAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (21 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Hugh Donnell
029617200028515017639020159036248500
Scott Street
03734340154052020327097848016054066171500
Jonathan Vitiello
0278936069300091531046475015423050166500
Bradley KIM Day
0598570020388703070204228390134270126942500
Tanya Marion
011156003003001880103958012083017643200
Michael Merrigan
0214349066366040208049457015771038615100
Michele Stewart
0205916065038020076052390015206035862600
Benny Stover
013250502725601172004751014772019100400
Douglas Treptow MD
045248100076703018787015737056370800
Eric Gibbs
1386130002211804684086110174026000
James Johnson
107984093120313600181750109720177803000
Richard Moore
1358630001744904503092580167073000
Charlotte Rankin
11825401609401543606561058750162220000
Sean Slaba
11944400024623051140145630163744000
Susan Barrett
030000000000000030000000
Robert Donnell
0199699020000035536024912014886029503300
George Flynn
041052001338600267750176339015787076328100
James Merritt
021979002000002401003769019416028698500
Ralph Ritz
018656402000004465907768016915027590600
Cynthia Wilson
025817802000001702809557020000032476300
William Hennessey III
0132990095312052242032357014990032789100

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierFORM 990, Schedule J, Part I, Question 1Identifier
ExplanationCharter 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 is provided in rare 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. FORM 990, Schedule J, Part I, Question 3 Mercy Hospital Rogers relies on a related organization; refer to Schedule O, Part VI, Question 15a and 15b for the process the related organization follows. FORM 990, Schedule J, Part I, Question 4a The following individual received a severance payment during calendar 2011: Jerri (Lynne) Mitchell, $106,757. FORM 990, Schedule J, Part I, Question 4b Mercy Hospital Rogers offers supplemental retirement plans to certain executives which provide benefits upon retirement 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 individuals reportable on this return who participate in the supplemental retirement plans include: Scott Street, Jonathan Vitiello, Bradley Day, Michael Merrigan, Michele Stewart, WILLIAM HENNESSEY, and George Flynn. The amount of all accrued benefits is included in compensation amounts provided in Schedule J, Part II, Column (C). FORM 990, Schedule J, Part I, Question 7 Mercy Hospital Rogers provides a non-fixed bonus plan for which certain tiers of its employees are eligible. For fiscal year 2012 (July 1, 2011 - June 30, 2012), payment of all or part of the bonus was contingent upon attainment of certain financial targets. Payments are made annually in October following (I) the conclusion of the fiscal year and (II) determination of goal achievement. Bonus opportunities are tiered percentages and are dependent upon the leadership level and attainment percentage. Mercy's attainment of financial goals is reviewed by the Executive Compensation Committee of Mercy Health and is then taken into account when analyzing executive compensation for reasonableness.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation

FieldValueIRS element (for citing)
IdentifierFORM 990, PART III, LINE 4DIdentifier
Return ReferenceDESCRIPTION OF OTHER PROGRAM SERVICESReturnReference
ExplanationMERCY HOSPITAL ROGERS (MHR) AND ITS MEMBER HEALTH CARE FACILITIES PROVIDE QUALITY CARE REGARDLESS OF RACE, CREED, GENDER, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. MHR PROVIDED 28,672 INPATIENT SERVICE DAYS OF ACUTE OR SUB-ACUTE CARE. MHR PERFORMED 1,318 DELIVERIES, RESPONDED TO APPROX. 44,207 EMERGENCY ROOM ENCOUNTERS, MADE APPROX. 28,640 HOME HEALTH CARE VISITS AND COMPLETED 127,550 OUTPATIENT VISITS. COMMUNITY OUTREACH/BENEFIT PROGRAMS INCLUDE SUPPORT GROUPS FOR CURRENT AND PAST PATIENTS (DIABETIC, CARDIAC, ETC), EXPECTING/NEW PARENTS (CHILD BIRTH CLASSES, VARIOUS SUPPORT GROUPS, ETC), EMPLOYEES (EDUCATIONAL ASSISTANCE PROGRAMS, ETC), AND LOCAL/SURROUNDING COMMUNITY (HEALTH AND WELLNESS PROGRAMS, HEALTH FAIRS, HOME HEALTH PROGRAMS, ETC). RELIEF FROM THE FINANCIAL BURDEN OF HEALTH CARE SERVICES TO THE INDIGENT CONSISTS OF CHARGES OF $23,786,262 FOR CHARITY CARE PROVIDED. FORM 990, PART V, QUESTION 1A 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 MH EIN. FORM 990, PART VI, QUESTION 6, 7A, & 7B DESCR OF CLSES OF MMBRS OR STCKHDS, DEC REQ APPR & TYPE OF VOTING RGTS THE FILING ORGANIZATION HAS A SOLE CORPORATE MEMBER, MERCY HEALTH NORTHWEST ARKANSAS COMMUNITIES. THE FOLLOWING CORPORATE POWERS AND RESPONSIBILITIES SHALL BE RESERVED SOLELY UNTO THE CORPORATE MEMBER: A. TO APPROVE THE MISSION AND ESTABLISH THE PHILOSOPHY ACCORDING TO WHICH THE CORPORATION AND ANY ORGANIZATION CONTROLLED BY THE CORPORATION SHALL OPERATE; B. TO AMEND THE ARTICLES OF INCORPORATION AND BYLAWS; C. TO APPOINT AND REMOVE MEMBERS OF THE BOARD; D. TO APPOINT AND REMOVE THE CHIEF EXECUTIVE OFFICER OF THE CORPORATION; E. TO APPROVE OR AMEND THE STRATEGIC PLAN, GOALS, AND OBJECTIVES OF THE CORPORATION OR ANY ORGANIZATION CONTROLLED BY THE CORPORATION; F. TO APPROVE OR AMEND THE OPERATING, CAPITAL AND CONSTRUCTION BUDGETS FOR THE CORPORATION OR ANY ORGANIZATION CONTROLLED BY THE CORPORATION; G. TO LEASE OR SELL ANY OF THE ASSETS OF THE CORPORATION OR ANY ORGANIZATION CONTROLLED BY THE CORPORATION IN EXCESS OF ONE MILLION DOLLARS ($1,000,000); H. TO ENCUMBER ANY OR ALL OF THE ASSETS OF THE CORPORATION OR ANY ORGANIZATION CONTROLLED BY THE CORPORATION; I. TO AUTHORIZE AND APPROVE THE INCURRENCE OF DEBT BY THE CORPORATION OR ANY ORGANIZATION CONTROLLED 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; J. TO MERGE, DISSOLVE, OR ABANDON THE CORPORATION; AND, K. TO APPROVE THE CREATION, OWNERSHIP OR ACQUISITION OF, OR AFFILIATION WITH, ANY OTHER ORGANIZATION BY THE CORPORATION. FORM 990, PART VI, QUESTION 11B DESCRIBE PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990 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 990. 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, QUESTION 12C DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST 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, 2012. 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 FINANCE, AUDIT AND COMPLIANCE COMMITTEE OF THE BOARD OF DIRECTORS. FORM 990, PART VI, LINE 15B OFFICES & POSITIONS FOR WHICH PROCESS WAS USED, & YEAR PROCESS WAS BEGUN FOR THOSE CLASSIFIED AS OFFICERS (AND THUS DISQUALIFIED PERSONS), THE ORGANIZATION RELIES UPON MERCY HEALTH, WHICH 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 EXECUTIVE 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, QUESTION 19 AVAIL GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMTS TO GEN PUBLIC GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST BUT ARE NOT PUBLISHED PUBLICLY. FORM 990, PART VII, SECTION A, COLUMN B AVERAGE HOURS PER WEEK SEVERAL INDIVIDUALS LISTED IN PART VII ARE DISCLOSED AS TRUSTEES, DIRECTORS, OFFICERS, AND KEY EMPLOYEES ON MULTIPLE FORM 990S OF ENTITIES INCLUDED WITHIN MERCY HEALTH. THE AVERAGE HOURS PER WEEK DISCLOSED IN PART VII IS AN ESTIMATE OF THE HOURS PER WEEK THAT THE LISTED INDIVIDUAL SPENDS ON BOTH THE FILING ORGANIZATION AND ALL RELATED ORGANIZATIONS. FORM 990, PART XI, LINE 5 RECONCILIATION OF NET ASSETS PRIOR PERIOD ADJUSTMENT = ($174,797) TOTAL OTHER CHANGES IN NET ASSETS = ($174,797) FORM 990, PART XII, QUESTION 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 2012 (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 FINANCE, AUDIT, AND COMPLIANCE COMMITTEE OF MERCY HEALTH BOARD OF DIRECTORS. AUDIT RESULTS ARE COMMUNICATED TO THIS COMMITTEE.Explanation

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (67 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
Advance Care Hospital
300 Werner StreetHot SpringsAR71913710816634HospitalAR501(C)(3)3Mercy Healthtrue
Casa de Misericordia
1602 MCCLELLAND STREETLaredoTX78044742912461ShelterTX501(C)(3)7MM Laredotrue
Laredo Medical Group
14528 S Outer Forty Ste 100ChesterfieldMO63017742764726InactiveTX501(C)(3)9MHS-TXtrue
McAuley Portfolio Management Company
14528 S Outer Forty Ste 100ChesterfieldMO63017261708048Port MgmtMO501(C)(3)11bMercy Healthtrue
Mercy Clinic East Communites
14528 S Outer Forty Ste 100ChesterfieldMO63017431771217Phys GroupMO501(C)(3)9MHECtrue
Mercy Clinic Fort Smith Communitites
7301 Rogers AvenueFort SmithAR72917261318597Phys ClinicAR501(C)(3)9MHFSCtrue
Mercy Clinic Hot Springs Communitites
1 Mercy LaneHot SpringsAR71913261125131Phys ClinicAR501(C)(3)9MHHSCtrue
Mercy Clinic Oklahoma Communities
4300 W Memorial RoadOklahoma CityOK73120270473057Phys GroupOK501(C)(3)9MHOCtrue
Mercy Clinic Springfield Communities
1965 Fremont Street Ste 2950SpringfieldMO65804431560263Phys GroupMO501(C)(3)9MHSCtrue
Mercy Family Center
14528 S Outer Forty Ste 100ChesterfieldMO63017721069468counselingMO501(C)(3)7Mercy Healthtrue
Mercy Foundation for Health Innovation
14528 S Outer Forty Ste 100ChesterfieldMO63017200901499FoundationMO501(C)(3)11bMercy Healthtrue
Mercy Health
14528 S Outer Forty Ste 100ChesterfieldMO63017431423050Sup Hlth SysMO501(C)(3)1NAfalse
Mercy Health East Communities
14528 S Outer Forty Ste 100ChesterfieldMO63017431718408Hlth SystemMO501(C)(3)11bMercy Healthtrue
Mercy Health Fort Smith Communities
7301 Rogers AvenueFort SmithAR72917261318515Holding CoAR501(C)(3)11bMercy Healthtrue
Mercy Health Foundation Ardmore
1011 14th Avenue NWArdmoreOK73401710962525FoundationOK501(C)(3)11aMH Ardmoretrue
Mercy Health Foundation Berryville
214 Carter StreetBerryvilleAR72616710759301FoundationAR501(C)(3)11aMH Berryvilltrue
Mercy Health Foundation Fort Scott
401 Woodland Hills BlvdFort ScottKS66701481077073FoundationKS501(C)(3)11cMercy KS Comtrue
Mercy Health Foundation Hot Springs
300 Werner StreetHot SpringsAR71913710804718FoundationAR501(C)(3)11bMHHStrue
Mercy Health Foundation Independence
800 W MyrtleIndependenceKS67301481079981FoundationKS501(C)(3)11aMercy KS Comtrue
Mercy Health Foundation Joplin
2817 St Johns BlvdJoplinMO64804270906136FoundationMO501(C)(3)11aMHSMKCtrue
Mercy Health Foundation NW Arkansas
2710 Rife Medical LaneRogersAR72758710601687FoundationAR501(C)(3)11cMH Rogerstrue
Mercy Health Foundation OF Oklahoma
4300 W Memorial RoadOklahoma CityOK73120454732301FoundationOK501(C)(3)11aMHOCtrue
Mercy Health Foundation OK City
4300 W Memorial RoadOklahoma CityOK73120731593024FoundationOK501(C)(3)11aMHOCtrue
Mercy Health Foundation Springfield
1235 E Cherokee StreetSpringfieldMO65804320195818FoundationMO501(C)(3)11bMHSCtrue
Mercy Health Foundation St Louis
14528 S Outer Forty Ste 100ChesterfieldMO63017562410020FoundationMO501(C)(3)11bMHECtrue
Mercy Health Foundation Washington
901 E Fifth StreetWashingtonMO63090562410022FoundationMO501(C)(3)11bMHECtrue
Mercy Health Hot Springs Communities
300 Werner StreetHot SpringsAR71913261125064Holding CoAR501(C)(3)11bMercy Healthtrue
Mercy Health NW Arkansas Communities
2710 Rife Medical DriveRogersAR72758621684203Phys GroupAR501(C)(3)11bMercy Healthfalse
Mercy Health Oklahoma Communities
4300 W Memorial RoadOklahoma CityOK73120731453048Holding coOK501(C)(3)11bMercy Healthtrue
Mercy Health Springfield Communitites
1235 E Cherokee StreetSpringfieldMO65804431856028Holding CoMO501(C)(3)11bMercy Healthtrue
Mercy Health SW MOKS Communitites
2817 St Johns BlvdJoplinMO64804300584463Hlth SystemMO501(C)(3)11bMercy Healthtrue
Mercy Health System of Texas Inc
14528 S Outer Forty Ste 100ChesterfieldMO63017742764727InactiveTX501(C)(3)11bMercy Healthtrue
Mercy Home Health Berryville
804 W Freeman Suite 4BerryvilleAR72616870781247Home HealthAR501(C)(3)11cMH Sprngfldtrue
Mercy Hospital Ardmore
1011 14th Avenue NWArdmoreOK73401731500629HospitalOK501(C)(3)3MHOCtrue
Mercy Hospital Aurora
500 Porter AvenueAuroraMO65605431936696HospitalMO501(C)(3)3MHSCtrue
Mercy Hospital Berryville
214 Carter StreetBerryvilleAR72616710759299HospitalAR501(C)(3)3MHSCtrue
Mercy Hospital Carthage
3125 Dr Russell Smith WayCarthageMO64836453808607HospitalMO501(C)(3)3MHSMKCtrue
Mercy Hospital Cassville
94 Main StreetCassvilleMO65625431936699HospitalMO501(C)(3)3MHSCtrue
Mercy Hospital Columbus
220 Pennsylvania AvenueColumbusKS66725270842031HospitalMO501(C)(3)3MHSMKCtrue
Mercy Hospital El Reno
2115 Parkview DriveEl RenoOK73036272716065HospitalOK501(C)(3)3MHOCtrue
Mercy Hospital Fort Smith
7301 Rogers AvenueFort SmithAR72917710240352HospitalAR501(C)(3)3MHFSCtrue
Mercy Hospital Healdton
918 South 8TH StreetHealdtonOK73438263173902HospitalOK501(C)(3)3MH Ardmoretrue
Mercy Hospital Hot Springs
300 Werner StreetHot SpringsAR71913710236913HospitalAR501(C)(3)3MHHSCtrue
Mercy Hospital Joplin
2817 St Johns BlvdJoplinMO64804270814858HospitalMO501(C)(3)3MHSMKCtrue
Mercy Hospital Lebanon
100 Hospital DriveLebanonMO65536431767432HospitalMO501(C)(3)3MHSCtrue
Mercy Hospital Logan County Inc
200 South AcademyGuthrieOK73044452998842HospitalOK501(C)(3)3MHOCtrue
Mercy Hospital of Laredo
14528 S Outer Forty Ste 100ChesterfieldMO63017741189682InactiveTX501(C)(3)3MHS-TXtrue
Mercy Hospital Oklahoma City
4300 W Memorial RoadOklahoma CityOK73120730579285HospitalOK501(C)(3)3MHOCtrue
Mercy Hospital Ozark
801 W River StreetOzarkAR72949710689680HospitalAR501(C)(3)3MHFStrue
Mercy Hospital Paris
500 E AcademyParisAR72855710655753HospitalAR501(C)(3)3MHFStrue
Mercy Hospital Springfield
1235 E Cherokee StreetSpringfieldMO65804440552485HospitalMO501(C)(3)3MHSCtrue
Mercy Hospital Tishomingo
1000 South ByrdTishomingoOK73460274433830HospitalOK501(C)(3)3MH Ardmoretrue
Mercy Hospital Waldron
1341 W 6th StreetWaldronAR72958710557895HospitalAR501(C)(3)3MHFStrue
Mercy Hospital Watonga Inc
500 Clarence Nash BlvdWatongaOK73772455199762HospitalOK501(C)(3)3MHOCtrue
Mercy Hospitals East Communities
14528 S Outer Forty Ste 100ChesterfieldMO63017430653493HospitalMO501(C)(3)3MHECtrue
Mercy Kansas Communities Inc
401 Woodland Hills BlvdFt ScottKS66701480956045HospitalKS501(C)(3)3MHSMKCtrue
Mercy Medical Research Institute
1235 E Cherokee StreetSpringfieldMO65804870796305ResearchMO501(C)(3)4MHSCtrue
Mercy Ministries of Laredo
2500 ZacatecasLaredoTX78046200198462outreachTX501(C)(3)7Mercy Healthtrue
Mercy St Francis Hospital
100 W Highway 60Mountain ViewMO65548440607149HospitalMO501(C)(3)3MHSCtrue
Mercy Support Services
14528 S OUTER FORTY STE 100CHESTERFIELDMO63017431677952InactiveMO501(C)(3)11cMHECtrue
MHM SUPPORT SERVICES
14528 S OUTER FORTY STE 100CHESTERFIELDMO63017202553101Hlth SystemMO501(C)(3)11BMERCY HEALTHtrue
Mission Clinical Services
300 Werner StreetHot SpringsAR71913134239691nursing homeAR501(C)(3)9MHHSCtrue
St Edward Mercy Foundation
PO Box 17000Fort SmithAR72917237330425FoundationAR501(C)(3)7MHFStrue
St John's Children's Hospital Inc
1235 E Cherokee StreetSpringfieldMO65804InactiveMO501(C)(3)3MHSCtrue
St Mary's Hospital of Enid Oklahoma
14528 S Outer Forty Ste 100ChesterfieldMO63017730614655InactiveOK501(C)(3)3MHOCtrue
The Sister M Cornelia Blasko Foundation
100 W Highway 60Mountain ViewMO65548431873914FoundationMO501(C)(3)11aMSFHtrue
Unity Ambulatory Care
14528 S OUTER FORTY STE 100CHESTERFIELDMO63017431861745InactiveMO501(C)(3)11cMHECtrue

Form990 Schedule R Part III Form990ScheduleRPartIII (5 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
Merc Ambu Surg CTR
7301 Rogers AvFort SmithAR72903710827721AMBUL SURG CENTERARNA
RES OPT & INNOV
645 Maryville Centre Dr 200St LouisMO63141460468368CENTRAL DIST.MONA
SO OK DIAG CTR
1011 14TH Ave NWArdmoreOK73401431971232MRI ServicesOKNA
Fort Smith EMS
1701 S GreenwoodFort SmithAR72901710416615Emergency MedARNA
St Ed Mer Med MOB
7301 Rogers AveFort SmithAR72903710554050Office BuildingARNA

Form990 Schedule R Part IV Form990ScheduleRPartIV (9 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntity
Frontenac Properties Inc
14528 S Outer Forty Suite 100ChesterfieldMO63017521914421HOLDING COMPDENAC-Corp
Inveno Health Inc
1235 E Cherokee StreetSpringfieldMO65804264509571IT SERVICESMONAC-Corp
Mercy Community Services Inc
401 Woodland Hills BlvdFort ScottKS66701481078101RETAIL PHARMACYKSNAC-Corp
Mercy Health Center Condominium Inc
4300 W Memorial RdOklahoma CityOK73120680640970REAL ESTATEOKNAC-Corp
Mercy Health Network of the Southern Reg
1011 14th Avenue NWArdmoreOK73401731580607HEALTH CAREOKNAC-Corp
Mercy Health Network Inc
4300 W Memorial RoadOklahoma CityOK73120731381689HEALTH CAREOKNAC-Corp
Mercy Managed Care Corporation
4300 W Memorial RoadOklahoma CityOK73120731441665HOLDING COMPOKNAC-Corp
UH L Corp Inc
645 Maryville Centre Drive Suite 1St LouisMO63141742499535HOLDING COMPMONAC-Corp
Unity Support Services Inc
645 Maryville Centre Drive Suite 1St LouisMO63141431797042PRACTICE MGTMONAC-Corp
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (7 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
Mercy Hospital Fort Smith
o54223FMV
Mercy Hospital Joplin
o139453FMV
Mercy Hospital Oklahoma City Inc
o121848FMV
Mercy Hospitals East Communities
o469437FMV
Mercy Kansas Communities Inc
p242158FMV
MHM Support Services
p27710092FMV
Resource Optimization & Innovation LLC
o6123162FMV

Form990 Schedule R Part VII Form990ScheduleRPartVII

FieldValueIRS element (for citing)
IdentifierFORM 990, SCHEDULE R, PART VIIdentifier
Return ReferenceSUPPLEMENTAL INFORMATION FOR SCHEDULE RReturnReference
ExplanationLAWSON ERP SOFTWARE IS THE PRIMARY ACCOUNTING SOFTWARE USED BY MERCY HEALTH AND AFFILIATES. THE MAJORITY OF THE INTERCOMPANY/RELATED ORGANIZATION TRANSACTIONS ARE PROCESSED THROUGH LAWSON VIA INTERCOMPANY JOURNAL ENTRIES. WITH THE CURRENT DESIGN OF THE ERP SYSTEM, THERE ARE VARIOUS LIMITATIONS ON THE RELATED ORGANIZATION INFORMATION THAT CAN BE EXTRACTED FROM LAWSON. DUE TO THESE LIMITATIONS, MOST OF THE RELATED ORGANIZATIONS ACTIVITY FOR THE FILING ORGANIZATION HAS BEEN CLASSIFIED ON SCHEDULE R, PART V, IN LINES O AND P.Explanation

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