2011-05-13T13:02:48-05:00 2010-06-30 Pleus and Company LLC 14323 S Outer Forty Ste 310N Chesterfield MO 63017 990 2009-07-01 731500629 MERCY MEMORIAL HEALTH CENTER INC MERC 4057523655 1011 14th Avenue NW Ardmore OK 73401 Jon Vitiello 4057523724 2011-05-10 1 3143179916 2009 2016-02-24 21:20:13Z Malinda Burdick 1011 14th Avenue NW Ardmore OK 73401 134933878 0 0928 X www.mercyok.net X 1996 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. 17 15 1368 8 0 0 9315142 6376712 111121449 125972889 151457 -134101 1935697 2493332 122523745 134708832 33136 123334 0 48238395 51535535 0 0 51881374 69879666 100152905 121538535 22370840 13170297 94590457 117006157 14489943 23193513 80100514 93812644 MERCY MEMORIAL HEALTH CENTER 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.MERCY MEMORIAL HEALTH CENTER IMPLEMENTS AND ADVOCATES FOR INNOVATIVE HEALTH AND SOCIAL SERVICES TO IMPROVE THE HEALTH AND QUALITY OF LIFE OF COMMUNITIES SERVED, WITH PARTICULAR CONCERN FOR PEOPLE WHO ARE ECONOMICALLY POOR.IN SERVING OTHERS WE MAKE A DIFFERENCE BY TOUCHING THEIR LIVES WITH COMPASSION AND EXCEPTIONAL MERCY SERVICE. 0 0 90903221 123334 126858118 Mercy Memorial Health Center, Inc. ("Mercy") provides quality medical health care regardless of race, creed, sex, national origin, handicap, age, or ability to pay. During FY2010, Mercy provided services to 8,430 inpatients, 39,412 emergency department patients, and 143,072 outpatients. Services are provided through a community-based, acute care hospital, a skilled nursing center, and a rehabilitation center and a behavioral medicine center. Our outpatient services include a home health agency, outpatient surgery and diagnostics and various primary physician clinics/services. The institution continues to focus on the provision of primary health services through the purchase of primary clinics and education to the community, regardless of their means to pay for these services. Mercy recognizes that not all individuals possess the ability to purchase essential medical services and, further, that part of our mission is to provide health care services and health care education to the communities in which our facilities are located. In keeping with Mercy's commitment to serve all members of the community, Mercy provides; (i) free care and/or subsidized care, (ii) care to persons covered by governmental programs at below cost, (iii) health activities and programs to support the community, (iv) health education programs, and (v) a variety of broad community support activities. Among the community support activities offered by Mercy are the following:1) health education and Wellness programs and other support group meetings offered to the community.2) health services such as health fairs and screenings, free clinics, pre-natal and well baby care. 3) health professionals are provided education, including opportunities for clinical internships.4) subsidized health services including hospice, home health services, and disaster readiness.5) Community Health Research6) Cash and in-kind donations for events and fund-raising7) Community building activities, in partnership with other community organizations Mercy provides care to patients who lack financial resources and are deemed to be medically indigent and does not pursue collection of amounts determined to qualify as charity care. In addition, Mercy provides services to other patients under the Medicare Program and various state Medicaid programs. Such programs pay providers amounts that are less than billed charges of the services provided to the recipients. Care is provided to those with limited or no ability to pay. Relief for the financial burden of health care services rendered to the indigent totaled $6,073,037 in FY2010.The above amount does not reflect the cost of Health activities and programs to support the community health education programs and other community support activities. The services provided by Mercy, as well as the amount of charity care provided, demonstrates the ongoing commitment of the organization to serve in a leadership role as an advocate for responsive healthcare services for the community, with a deep commitment and sensitivity to meeting the needs of the poor. 90903221 1 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 1 0 0 1368 1 0 0 0 0 0 0 0 0 0 17 15 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 1 1 OK X Jon Vitiello 4057523724 4300 WEST MEMORIAL ROAD OKLAHOMA CITY OK 73120 Allen Dubea 1.00 X 0 0 0 JASON T SMOTHERMAN 1.00 X 0 0 0 SISTER RICHARD MARY BURKE 1.00 X 0 0 0 CURTIS J DAVIDSON 1.00 X 0 0 0 THOMAS F DUNLAP 1.00 X 0 0 0 SISTER REBECCA ANN HENDRICKS RSM 1.00 X 0 0 0 Clayton Lodes 1.00 X 0 0 0 BARBARA E HISEY 1.00 X 0 0 0 PAMELA L KIMBROUGH 1.00 X 0 0 0 DAN PARROTT 1.00 X 0 0 0 David A Woerz 1.00 X 0 0 0 MALINDA BURDICK 40.00 X X 0 367853 13153 DIANA SMALLEY 6.00 X X 0 541413 166553 DAVID J BRENNER 1.00 X 0 0 0 DOUGLAS BRITT MORRISDO 1.00 X 0 0 0 FREDERICK A DORROHMD 1.00 X 0 0 0 JOHN L MOORE 1.00 X 0 0 0 JAMES NEWMAN 24.00 X 0 337999 87400 WILLIAM PARSONS 40.00 X 312444 0 0 THOMAS EDELSTEIN 1.00 X 0 166922 24748 RYAN BARNARD 40.00 X 166232 0 19490 CINDY CARMICHAEL 30.00 X 50635 167063 9733 RHONDA J HANAN 40.00 X 129530 49454 16652 JAY JOHNSON 40.00 X 0 226436 36933 RICHARD BARKER 40.00 X 148201 0 15541 TAD HALL 40.00 X 219134 0 21637 JOHN T O'CONNOR 40.00 X 245030 0 25587 LARRY D POWELL 40.00 X 161773 0 12579 VERGIL D SMITH 40.00 X 139888 0 13434 1572867 1857140 463440 33 0 1 0 NABHOLZ CONSTRUCTION 1120 E Reno Avenue Oklahoma City OK 73117 construction 18961020 ARDMORE ANESTHESIA INC PO BOX 1983 Ardmore OK 73402 MEDICAL SERVICES 629964 ARDMORE SURGICAL MANAGEMENT 1011 14TH NW Ardmore OK 73401 MEDICAL SERVICES 520750 HEALTHCARE FINANCIAL RESOURCES 830 North Meacham Rd Schaumburg IL 60173 COLLECTION SERVICES 445731 RCOA IMAGING SERVICES 16110 JOG RD STE 200 Delray Beach FL 33446 MEDICAL SERVICES 441010 22 6376712 6376712 NET PATIENT REVENUE 621300 125972889 125972889 125972889 90945 90945 798650 798650 798650 798650 225046 -225046 -225046 -225046 OTHER REVENUE 900099 1118383 1118383 CAFETERIA 722210 584407 584407 JOINT VENTURE (LOSS) 900099 -8108 -8108 1694682 134708832 126858118 0 1474002 123334 123334 662843 662843 40763781 28461272 12302509 1569153 1095583 473570 5962123 4162754 1799369 2577635 1799705 777930 6133432 6133432 45937 45937 534863 534863 5176235 3614047 1562188 53984 37692 16292 244384 170629 73755 5031992 3513337 1518655 3079556 2150146 929410 263463 183950 79513 4931916 3443464 1488452 928380 648195 280185 BAD DEBT 17218448 17218448 MEDICAL SUPPLIES 15650500 15650500 PHARMACEUTICALS 4104103 4104103 RECRUITING EXPENSE 1556971 1087077 469894 4925502 3438985 1486517 121538535 90903221 30635314 0 448967 17674 16862302 16966167 1984901 631843 1951435 1851328 144312 238996 183487499 86324600 72437150 97162899 362296 137250 399094 0 94590457 117006157 12766831 10456027 201164 201164 1521948 12536322 14489943 23193513 X 80100514 93812644 80100514 93812644 94590457 117006157 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 3551 0 0 0 3551 0 Part IV, Supplemental Information: The organization is a member of and pays dues to the Oklahoma Hospital Association. For the year ended June 30, 2010, dues were $37,418. Approximately 9.49% of Oklahoma Hospital Association dues were attributable to lobbying activities performed. 2417794 2417794 39670475 24842251 14828224 77784300 60481064 17303236 63614930 1001285 62613645 97162899 MEDICARE SETTLEMENTS 729432 Due to Affiliates 11806890 12536322 Part X: Description of Uncertain Tax Positions Under FIN 48: The consolidated audited financial statements of the Sisters of Mercy Health System, Inc. and Subsidiaries do not include a footnote to report the organization's liability for uncertain tax provisions under FIN 48, as they are deemed immaterial for disclosure. 1 1 X 1 X 1 X 1 1 1 0 1 1 5033584 5033584 0.04830 1039453 1039453 0.01000 6073037 6073037 0.05830 6 1987 559890 559890 0.00540 1 96 377550 377550 0.00360 1 100 61025 61025 0.00060 3 13141 398742 398742 0.00380 11 15324 1397207 1397207 0.01340 11 15324 7470244 7470244 0.07170 1 2120 73834 73834 0.00070 1 9368 31678 31678 0.00030 1 0 12759 12759 0.00010 1 0 6950 6950 0.00010 1 1792 105907 105907 0.00100 5 13280 231128 231128 0.00220 1 5397760 0 48040366 49745642 -1705276 X 1 1 MERCY MEMORIAL HEALTH CENTER

1011 14TH AVENUE NW ARDMORE OK 73401

X X X Part III, Line 4: The text of the footnote that is included in the Sisters of Mercy Health System, Inc. and Subsidiaries audited financial statements that describes bad debt expense 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 on management's assessment of historical and expected net collections considering business and economic conditions, trends in healthcare coverage, and other collection indicators. Periodically throughout the year, management assess 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 balances with collection agencies."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.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. Part III, Line 8: The Medicare shortfall was computed using the annual Medicare cost report (CMS Form 2552-96). It is the position of Mercy Memorial Health Center, Inc. that 100% of the shortfall should be treated as community benefit. This amount represents the costs of providing services that remain uncompensated to the provider. Part III, Line 9b: Mercy will exhaust all other payment options and avenues to obtain financial assistance and third party payments including, but not limited to, local, state, and federal assistance programs before considering an applicant for Charity/Medical Indigence. Charity/Medical Indigence will only apply to the remaining balance after all third party payments are applied. Applicants are identified as potentially eligible for Medicaid benefits must first make application to Medicaid. Financially Indigent means an uninsured or underinsured patient who is accepted for care with no obligation, or with a discounted obligation, to pay for the services rendered based on a demonstrated inability by, income and family size, to meet their financial obligations. A patient is Medically Indigent when his/her financial responsibility is so significant in relation to their total income and/or assets that payment in full is not likely or equitable. Generally no patient's financial responsibility shall be greater than 20% of the household income, subject to an asset test. Mercy will use financial counseling and point of service activities to identify Charity/Medical Indigence as soon as practical in the intake process toincrease customer satisfaction and reduce costs of operations. In addition to financial counseling, Mercy will provide patient financial services and financial assistance options through signage and brochures at all patient access points and explanations of financial assistance on patient statements. Part VI, Line 2: One step in the needs assessment process included receiving and assessing information from the Turning Point Coalition which represents Carter County and the surrounding counties as well. Through this coalition Mercy Memorial stays apprised of current needs and works both independently and collaboratively to meet these needs.Additionally, Community Roundtable meetings were held in Ardmore, which are located in the Mercy Memorial Health Center, Inc. service area. Participants shared their views on both the current and future state of health in their communities. Part VI, Line 3: The filing organization has printed material available at each point of registration in our facility, in addition to electronically availability at our web site. Specific information provided: Financial Assistance Information As a part of our healing ministry, the filing organization 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 10% of annual household income, adjusted to consider availability of other assets that could be used toward making payments. Part VI, Line 4: Mercy Memorial Health Center, Inc. is located in Ardmore, Oklahoma. Mercy Memorial Health Center, Inc. primarily serves those in urban/suburban Ardmore and the Carter County area. Ardmore is a community of approximately 30,000 people, and is the center of business and trade for Southern Oklahoma. Surrounding towns and rural homes bring the total population of Carter County including Ardmore close to 50,000.- A review of the community health status for Carter County found issues related to poverty and the uninsured rate; drug and alcohol abuse; child neglect and abuse; injuries relating to falls and work-related activities are all present.- Risk factors that contribute to premature death are high blood pressure, smoking, and adult obesity.- Identified health needs: Tobacco use is high, increasing population is overweight, health insurance coverage is low, chronic disease rates are high and cancer screening rates are low. Part VI, Line 5: Mercy Memorial Health Center, Inc. (MMHC) 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, MMHC 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. Mercy co-workers participate as board members, volunteers giving hours of hands-on assistance, program development and fund raising. Some of the community building activities in which MMHC serves are:- Gloria Ainsworth Day Care, Soup Kitchen, Good Shepherd Clinic.- YMCA, Grace Center, Boys and Girls Club. - United Way, Cross Timbers Hospice, March of Dimes, Turning Point and Tobacco Coalition.Through these programs those in need receive day care at reduced rates, those without healthcare insurance or governmental support receive care and adults and children receive education and mentoring to achieve health and improved life quality. Programs are funded which promote positive lifestyle choices. Part VI, Line 6: Mercy Memorial Health Center, Inc. (MMHC) 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 service communities. In keeping with MMHC's commitment to serve allmembers of the communities it serves, MMHC provides care to patients regardless of ability to pay. As defined by the institution's charity policy, MMHC does not pursue collection of amounts determined to qualify for charity care. In addition, MMHC provides services to other patients under the Medicare Program and various state Medicaid programs. Such programs pay providers amounts that are substantially less than billed charges, and frequently less than the cost, of the services provided to the recipients.MMHC is governed by a Board of Directors which includes representation from community leaders in the organization's primary service areas. All board members are required to complete an annual Conflict of Interest survey. Any potential conflicts of interest disclosed by board members are screened by general counsel and reviewed by the board chairperson and CEO. This process ensures that public, rather than private interests areserved by MMHC.Surplus funds and unrestricted assets held by MMHC are reinvested in patient care, medical education and research initiatives which support the organization's mission to deliver compassionate care and exceptional health care services to the communities it serves. Examples include the following: - Conversion to the EPIC Electronic Health Record system. This platform allows continuity of patient medical record access by providers throughout the Mercy system and also allows the patient to access information from their own records, allowing more complete and meaningful communication, information and health education for the community. - Opening of Mercy Memorial's new 180,000-square-foot patient tower with 158 private rooms which doubled the number and size of the current private rooms. The $60 million patient tower houses private rooms, a women's health center and an improved intensive care unit. Part VI, Line 7: The filing organization is part of the Sisters of Mercy Health System ("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, 2010, Mercy facilities included 28 hospitals with 3,718 acute licensed beds (3,300 acute available beds). For the fiscal year ended June 30, 2010, Mercy had more than 6.3 million outpatient visits, more than 1,200 employed physicians, and approximately 28,000 employees, making Mercy the eighth largest Catholic health system in the United States based on net patient service revenue. 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, 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. OK 1 CHAMBER OF COMMERCE FOUNDATION PO BOX 1585 Ardmore OK 73402 731372214 501(c)(3) 20000 GENERAL OPERATIONS ARDMORE CHAMBER OF COMMERCE PO BOX 1585 Ardmore OK 73402 730130860 501(c)(6) 12800 GENERAL OPERATIONS 1 1 Other Information: Part IV: 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. 1 1 0 0 0 0 0 1 0 MALINDA BURDICK 0 275216 0 57725 0 34912 0 8404 0 4749 0 381006 0 0 DIANA SMALLEY 0 397309 0 115774 0 28330 0 151301 0 15252 0 707966 0 0 JAMES NEWMAN 0 258143 0 60157 0 19699 0 72747 0 14653 0 425399 0 0 WILLIAM PARSONS 234316 0 34449 0 43679 0 0 0 0 0 312444 0 0 0 THOMAS EDELSTEIN 0 95054 0 7112 0 64756 0 15285 0 9463 0 191670 0 0 RYAN BARNARD 135559 0 16128 0 14545 0 7911 0 11579 0 185722 0 0 0 CINDY CARMICHAEL 49623 125529 0 27642 1012 13892 0 4626 1625 3482 52260 175171 0 0 RHONDA J HANAN 83212 44165 21088 2500 25230 2789 3753 0 7218 5681 140501 55135 0 0 JAY JOHNSON 0 167195 0 37565 0 21676 0 25040 0 11893 0 263369 0 0 RICHARD BARKER 117398 0 20326 0 10477 0 14419 0 1122 0 163742 0 0 0 TAD HALL 203584 0 0 0 15550 0 14771 0 6866 0 240771 0 0 0 JOHN T O'CONNOR 102618 0 109744 0 32668 0 16840 0 8747 0 270617 0 0 0 LARRY D POWELL 107045 0 25000 0 29728 0 7864 0 4715 0 174352 0 0 0 VERGIL D SMITH 87570 0 0 0 52318 0 9469 0 3965 0 153322 0 0 0 Part I, Line 4a Thomas Edelstein received $38,848 in severance pay from St. Johns Mercy Health Care in St. Louis, a related entity. Part I, Line 4B: Sisters of Mercy Health System, the parent company, 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 FOLLOWING INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL MANAGEMENT RETIREMENT PLAN: MINDY BURDICK JAMES NEWMAN JAY JOHNSON 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 INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN: DIANA SMALLEY 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 7 The related organization which employs those individuals listed on Part VII, and the filing organization when applicable, provides a non-fixed bonus plan for which certain tiers of its employees are eligible. For fiscal year 2009 (July 1, 2008-June 30, 2009), payment of all or part of the bonus is contingent upon percentage attainment of (I) personal goals and (II) certain financial targets. For fiscal year 2010 (July 1, 2009-June 30, 2010), payment of all or part of the bonus is 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 (applicable only for fiscal year 2009). Bonus opportunities are tiered percentages and are dependent upon the leadership level and attainment percentage. Mercy's attainment of financial goals are validated by an external consulting firm and are then taken into account by the executive compensation committee of Mercy when analyzing executive compensation for reasonableness. Supplemental Information Part III 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. Ardmore Surgical Management (ASM) Pamela L. Kimbrough is a board member of the organization and ASM 498355 Independent contractor - amount is based on Form 1099 amount and not fiscal year 0 Form 990, Part VI, Section A, line 6 MERCY HEALTH SYSTEM, INC. IS THE SOLE MEMBER OF THE ORGANIZATION. Form 990, Part VI, Section A, line 7a MERCY HEALTH SYSTEM, INC. (THE MEMBER) MAY APPOINT OR REMOVE MEMBERS OF THE BOARD OF DIRECTORS AT ANY TIME AT THE MEMBER'S DISCRETION. Form 990, Part VI, Section A, line 7b MERCY HEALTH SYSTEM, INC. has the following powers and responsibilities: -TO APPROVE THE MISSION AND ESTABLISH THE PHILOSOPHY ACCORDING TO WHICH THE CORPORATION SHALL OPERATE; -TO AMEND AND APPROVE THE ARTICLES OF INCORPORATION AND BYLAWS OF THE CORPORATION AND TO AMEND AND APPROVE THE ARTICLES OF INCORPORATION AND BYLAWS OF ANY CORPORATION CONTROLLED BY THE CORPORATION; -TO APPOINT AND REMOVE THE CHIEF EXECUTIVE OFFICER OF THE CORPORATION; -TO APPROVE OR AMEND THE STRATEGIC PLAN, GOALS AND OBJECTIVES OF THE CORPORATION; -TO APPROVE OR AMEND THE OPERATING, CAPITAL, AND CONSTRUCTION BUDGETS FOR THE CORPORATION; -TO LEASE OR SELL ANY OF THE ASSETS OF THE CORPORATION OR ANY CORPORATION CONTROLLED BY THE CORPORATION IN EXCESS OF ONE MILLION DOLLARS ($1,000,000); -TO ENCUMBER ANY OR ALL OF THE ASSETS OF THE CORPORATION OR ANY CORPORATION CONTROLLED BY THE CORPORATION; -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 EXECUTY ANY DOCUMENTS AND TAKE ANY ACTIONS NECESSARY OR APPROPRIATE IN CONNECTION WITH THE INCURRENCE OF SUCH DEBT; -TO MERGE, DISSOLVE, OR ABANDON THE CORPORATION; AND, -TO APPROVE THE CREATION, OWNERSHIP OR ACQUISITION OF, OR AFFILIATION WITH, ANY OTHER ORGANIZATION 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. The draft Form 990 is also reviewed by the Sisters of Mercy Health System'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 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 THE BOARD ANNUALLY RECEIVES A CONFLICT OF INTEREST QUESTIONAIRE. THE ORGANIZATION HAS A COMPLIANCE DEPARTMENT TO MONITOR AND ENFORCE COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. Form 990, Part VI, Section B, line 15a 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 executive compensation committee of the Board of the Sister of Mercy Health System. 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 have been made available from time to time but are not published publicly. Part XI, Line 2 Audited Financial Statements The filing organization's financial statements were included in the Sisters of Mercy Health System, Inc. and Subsidiaries annual financial statement audit. The Sisters of Mercy Health System, Inc. and Subsidiaries received an unqualified opinion from the external auditors for fiscal 2010 (the tax year currently being reported). However, no separate audit opinion is 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 the Sisters of Mercy Health System Board of Directors. Audit results are communicated to this committee. Part XI, Line 3 Single Audit Act and OMB Circular A-133 The Consolidated Group of Sisters of Mercy Health System is required to undergo an audit as set forth in the single audit act and OMB Circular A-133. The single audit was conducted on a consolidated basis. FORM 990, SCHEDULE R, PART II ST JOHNS MERCY HEALTH SYSTEM ST. JOHN'S MERCY HEALTH SYSTEM CONSISTS OF ST. JOHN'S MERCY MEDICAL CENTER, EIN 43-065393, AND ST. JOHN'S MERCY HOSPITAL, EIN 43-1066883. FORM 990, SCHEDULE R, PART V SYSTEM LIMITATIONS LAWSON ERP SOFTWARE IS THE PRIMARY ACCOUNTING SOFTWARE USED BY SISTERS OF MERCY HEALTH SYSTEM, INC. AND SUBSIDIARIES. 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 ORGANIZATION ACTIVITY FOR THE FILING ORGANIZATION HAS BEEN CLASSIFIED ON SCHEDULE R,PART V, IN LINES O & P. FORM 990, PART VII HOURS PER WEEK JAMES NEWMAN DEVOTED AN AVERAGE OF 37 HOURS PER WEEK TO RELATED ORGANIZATIONS. DIANA SMALLEY DEVOTED AN AVERAGE OF 34 HOURS PER WEEK TO RELATED ORGANIZATIONS. CINDY CARMICHAEL DEVOTED AN AVERAGE OF 10 HOURS PER WEEK TO RELATED ORGANIZATIONS. THOMAS EDELSTEIN DEVOTED AN AVERAGE OF 50 HOURS PER WEEK TO RELATED ORGANIZATIONS. FORM 990, PART V, LINE 2A SALARIES AND WAGES THE SALARIES AND WAGES REPORTED ON FORM 990, PART IX, LINE 7 REPRESENT AN ALLOCATION OF SALARIES AND WAGES FROM A RELATED ORGANIZATION. Employees are paid by a related organization under a common paymaster arrangement. As such, all required payroll filing (including W-2 and W-3's) was reported under the related organization's EIN. FORM 990, PART V, LINE 1A Independent Contractors Independent contractors for the filing organization are paid by the Sisters of Mercy Health System (EIN 43-1423050). As such, all required Form 1099 and Form 1096 reporting is made for the entire Health System (with limited exceptions) under the SMHS EIN. Advance Care Hospital 300 Werner St 3rd Floor Hot Springs AR 71913 710816634 Long term acute-care hospital AR 501c3 3 SMHS Breech Regional Med Ctr 100 Hospital Drive Lebanon MO 65536 431767432 Hospital MO 501c3 3 ST JOHn's Health System Inc Carroll Health Foundation 214 Carter Street Berryville AR 72616 710759301 Foundation AR 501c3 11-I Ozark Regions Health Systems Casa de Misericordia 1602 McClelland Street Laredo TX 78044 742912461 Women's domestic violence shelter TX 501c3 9 Mercy Ministries of Laredo Healdton Mercy Hosp Corp 918 South Street Healdton OK 73438 263173902 Operating co for leased hosp OK 501c3 3 Mercy Memorial Health Ctr Inc Laredo Medical Group 14528 S Outer Forty St 100 Chesterfield MO 63017 742764726 Inactive TX 501c3 9 MHSystem of Texas Inc McAuley Portfolio Mgmt Co 14528 S Outer Forty St 100 Chesterfield MO 63017 261708048 Portfolio management. MO 501c3 11-II SMHS Mercy El Reno Hosp Corporation 2115 Parkview Drive El Reno OK 73036 736617948 Operating co for leased hosp OK 501c3 3 SMHS Mercy Emergency Med Srvs 4300 W Memorial Road Oklahoma City OK 73120 810627035 Inactive OK 501c3 9 Mercy Health Center Inc Mercy Fdtn Health Innov 14528 S Outer Forty St 100 Chesterfield MO 63017 200901499 Foundation MO 501c3 11-II SMHS Mercy Health Ctr Fdtn 401 Woodland Hills Blvd Fort Scott KS 66701 481077073 Foundation KS 501c3 11-III MHS of Kansas Inc Mercy Health Ctr Fdtn Inc 4300 W Memorial Road Oklahoma City OK 73120 731593024 Foundation OK 501c3 11-I Mercy Health Center Inc Mercy Health Center Inc 4300 W Memorial Road Oklahoma City OK 73120 730579285 Hospital OK 501c3 3 Mercy Health System Inc Mercy Health MNMCH Inc 220 Pennsylvania Avenue Columbus KS 66725 270842031 Critical Access Hospital MO 501c3 9 Mercy Health System-Joplin Inc Mercy Health of Joplin Found 2727 McClelland Blvd Joplin MO 64804 270906136 Foundation MO 501c3 11-I Mercy Health System-Joplin Inc Mercy Health of Joplin Inc 2727 McClelland Blvd Joplin MO 64804 270814858 Hospital MO 501c3 9 Mercy Health System-Joplin Inc Mercy Health Services 4300 W Memorial Road Oklahoma City OK 73120 141838609 Urgent Care Clinics OK 501c3 3 Mercy Health Center Inc Mercy Health System Joplin Inc 2727 McClelland Blvd Joplin MO 64804 300584463 Health System MO 501c3 11-II SMHS Mercy Health System KS 401 Woodland Hills Blvd Ft Scott KS 66701 480956045 Hospital;rural health clinics KS 501c3 3 SMHS Mercy Health System NW Ark Inc 2710 Rife Medical Ln Rogers AR 72758 621684203 Physician Group AR 501c3 11-II SMHS Mercy Health System TX 14528 S Outer Forty St 100 Chesterfield MO 63017 742764727 Inactive TX 501c3 11-II SMHS Mercy Health System Inc 4300 W Memorial Road Oklahoma City OK 73120 731453048 Holding company OK 501c3 11-II SMHS Mercy Hospital Fdtn Indep 800 W Myrtle Independence KS 67301 481079981 Foundation KS 501c3 11-I MHS of Kansas Inc Mercy Hospital of Laredo 14528 S Outer Forty St 100 Chesterfield MO 63017 741189682 Inactive TX 501c3 3 MHSystem of Texas Inc Mercy Medical Group 645 Maryville Ctr Dr Ste 100 St Louis MO 63141 431771217 Physician Group MO 501c3 9 St John's Mercy Health Care Mercy Memorial Health Ctr Fdtn 1011 14th Avenue NW Ardmore OK 73401 710962525 Foundation OK 501c3 11-I Mercy Memorial Health Ctr Inc Mercy Ministries of Laredo 2500 Zacatecas Laredo TX 78043 200198462 healthcare, outreach,food pantry. TX 501c3 3 SMHS Mercy Physicians Ok 4300 W Memorial Road Oklahoma City OK 73120 270473057 Physician Group/Clinic OK 501c3 9 Mercy Health System Inc MHM Support Services 14528 S Outer Forty St 100 Chesterfield MO 63017 202553101 Centralized Health System Functions MO 501c3 11-II SMHS Mission Clinical Services 300 Werner Street Hot Springs AR 71913 134239691 Physician Clinics AR 501c3 11-II St Joseph's MHS Inc Ozarks Regions HS 214 Carter Street Berryville AR 72616 710759299 Hospital AR 501c3 3 St John's Health System Inc Sisters of Mercy Hlth Sys 14528 S Outer Forty St 100 Chesterfield MO 63017 431423050 Health System - Corporate Office MO 501c3 11-II N/A Sisters of Mercy Ministries 14528 S Outer Forty St 100 Chesterfield MO 63017 721069468 Family counseling;social justice advocacy MO 501c3 9 SMHS St Edward Health Frank Cty 801 W River Street Ozark AR 72949 710689680 Hospital AR 501c3 3 St Edward Mercy Medical Ctr St Edward Health Log Cty 500 E Academy Paris AR 72855 710655753 Hospital AR 501c3 3 St Edward Mercy Medical Ctr St Edward Health Scott Cty 1341 W 6th Street Waldron AR 72958 710557895 Hospital AR 501c3 3 St Edward Mercy Medical Ctr St Edward Mercy Clin 7301 Rogers Avenue Fort Smith AR 72917 261318597 Physician Clinic AR 501c3 3 St Edward MHS Inc St Edward Mercy Foundation PO Box 17000 Fort Smith AR 72917 237330425 Foundation AR 501c3 3 St Edward Mercy Medical Ctr St Edward Mercy HS Inc 7301 Rogers Avenue Fort Smith AR 72917 261318515 Holding Company AR 501c3 11-II SMHS St Edward Mercy Med Ctr 7301 Rogers Avenue Fort Smith AR 72917 710240352 Hospital AR 501c3 3 St Edward MHS Inc St Francis Hosp MtView MO 100 W Highway 60 Mountain View MO 65548 440607149 Hospital MO 501c3 3 ST John's Health System Inc St Johns Aurora Inc 500 Porter Avenue Aurora MO 65605 431936696 Operating co for leased hosp MO 501c3 3 St John's Health System Inc St Johns Cassville Inc 94 Main Street Cassville MO 65625 431936699 Operating co for leased hosp MO 501c3 3 St John's Health System Inc St Johns Childrens Hosp 1235 E Cherokee Street Springfield MO 65804 INactive MO 501c3 3 ST JOhn's Health System Inc St Johns Clinic Inc 1965 Fremont Street Suite 2950 Springfield MO 65804 431560263 Physician Group MO 501c3 3 St John's Health System Inc St Johns Fdtn Comm Hlth 1235 E Cherokee Street Springfield MO 65804 320195818 Foundation MO 501c3 11-II St John's Health System Inc St Johns Health System In 1235 E Cherokee Street Springfield MO 65804 431856028 Holding Company MO 501c3 11-II SMHS St Johns Home Care Berryville 214 Carter Street Berryville AR 72616 870781247 Home Health and Hospice operations. AR 501c3 11-III St John's Regional Health Ctr St Johns Medical Rsch Inst 1235 E Cherokee Street Springfield MO 65804 870796305 Research - Clinical Trials MO 501c3 3 St John's Health System Inc St Johns Mercy Fdtn 645 Maryville Ctr Dr Ste 100 St Louis MO 63141 562410020 Foundation MO 501c3 11-II St John's Mercy Health Care St Johns Mercy Health Care 645 Maryville Ctr Dr Ste 100 St Louis MO 63141 431718408 Health System MO 501c3 11-II SMHS St Johns Mercy Health System 645 Maryville Ctr Dr Ste 100 St Louis MO 63141 430653493 Hospital MO 501c3 3 St John's Mercy Health Care St Johns Mercy Hospital Fdtn 901 E Fifth Street Washington MO 63090 562410022 Foundation MO 501c3 11-II St John's Mercy Health Care St Johns Mercy Supp Srv 615 S New Ballas Road St Louis MO 63141 431677952 Inactive MO 501c3 11-III St John's Mercy Health System St Johns Reg Hlth Ctr 1235 E Cherokee Street Springfield MO 65804 440552485 Hospital MO 501c3 3 St John's Health System Inc St Josephs Mercy Clin 1 Mercy Lane Hot Springs AR 71913 261125131 Physician Clinic AR 501c3 9 St Joseph's MHS Inc St Josephs Mercy Health Center 300 Werner Street Hot Springs AR 71913 710236913 Hospital AR 501c3 3 St Joseph's MHS Inc St Josephs Mercy Health Fdtn 300 Werner Street Hot Springs AR 71913 710804718 Foundation AR 501c3 11-II St Joseph's Mercy Health Ctr St Josephs Mercy Health Sys 300 Werner Street Hot Springs AR 71913 261125064 Holding Company AR 501c3 11-II SMHS St Mary-Rogers Mem Hos 2710 Rife Medical Ln Rogers AR 72758 710294390 Hospital AR 501c3 3 MH S NW Arkansas Inc St Marys Hospital Foundation 2710 Rife Medical Ln Rogers AR 72858 710601687 Foundation AR 501c3 11-III St Mary-Rogers Mem Hosp Inc St Marys Hosp Enid Ok 14528 S Outer Forty St 100 Chesterfield MO 63017 730614655 Inactive OK 501c3 3 Mercy Health System Inc The Sr M Cornelia Blasko Fn 100 W Highway 60 Mountain View MO 65548 431873914 Foundation MO 501c3 11-I St Francis Hosp Mount View MO Unity Ambulatory Care 645 Maryville Ctr Dr Ste 100 St Louis MO 63141 431861745 Inactive MO 501c3 11-III St John's Mercy Health Care Southern Oklahoma Diag Ctr LLC 1011 Fourteenth Avenue NW ARDMORE OK 73401 431971232 MRI Services OK N/A Related 9288 816299 0 0 Resource Optimiz & InnovLLC 645 Maryville Ctr DrSte 200 ST LOUIS MO 63141 460468368 Central Distribution Center MO N/A N/A 0 0 Mercy Ambulatory Surgery Center LLC 7301 Rogers Avenue FORT SMITH AR 72917 710827721 Ambulatory Surgery Center AR N/A N/A 0 0 Hot Springs Equip Leasing LLC 300 Werner Street HOT SPRINGS AR 71913 204340915 Inactive, dissolved 9/30/09 AR N/A N/A 0 0 Hot Springs MRI Partnership 100 Ridgeway Place HOT SPRINGS AR 72901 710675196 Inactive, dissolved 8/5/09 AR N/A N/A 0 0 FORT SMITH EMERGENCY MEDICAL SERVICES 1701 SOUTH GREENWOOD FORT SMITH AR 72901 710416615 Emergency Medical Services AR N/A N/A 0 0 Southern Oklahoma PHO LLC 1011 Fourteenth Avenue NW ARDMORE OK 73401 731462104 Inactive, dissolved 12/31/09 OK N/A RElated 0 1 St Edward Mercy MC M-P Office Bldg 7301 Rogers Avenue FORT SMITH AR 72903 710554050 Office Building AR N/A N/A 0 0 St Edward Medical Services Inc 7301 Rogers Avenue Fort Smith AR 72903 202965518 Inactive dissolved 5/5/10 AR N/A C Consolidated Logistics Inc 2710 Rife Medical Lane Rogers AR 72758 710474406 Inactive dissolved 8/4/09 AR N/A C Mercy Comm Services Inc 401 Woodland Hills Blvd Fort Scott KS 66701 481078101 Catering operations KS N/A C Frontenac Properties Inc 14528 S Outer Forty Suite 100 Chesterfield MO 63017 521914421 Holds ancillary assets & owns aircraft DE N/A C MHP Inc 14528 S Outer Forty Suite 300 Chesterfield MO 63017 431697084 Holding company sold 10/1/10 DE N/A C Mercy Medical Services Inc 14528 S Outer Forty Suite 100 Chesterfield MO 63017 710641246 Inactive dissolved 7/1/09 MO N/A C Inveno Health Inc 1235 E Cherokee Street Springfield MO 65804 264509571 Technology transfer company MO N/A C Unity Support Services Inc 645 Maryville Centre Drive Suite 10 St Louis MO 63141 431797042 Inactive MO N/A C UH L Corp Inc 645 Maryville Centre Drive Suite 10 St Louis MO 63141 742499535 Holding company MO N/A C MHN of the Southern Region Inc 1011 14th Avenue NW Ardmore OK 73401 731580607 Employed physicians, physician assistants, and nurse practitioners OK N/A C Mercy Health Center Condominium Inc 4300 W Memorial Rd Oklahoma City OK 73120 680640970 Administrator of certain real property and improvements OK N/A C Mercy Managed Care Corporation 4300 W Memorial Road Oklahoma City OK 73120 731441665 Holding company OK N/A C Mercy Health Network Inc 4300 W Memorial Road Oklahoma City OK 73120 731381689 Employed physicians, physician assistants, and nurse practitioners OK N/A C 0 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 Healdton Mercy Hospital Corporation P 109080 Mercy Health Center Inc O 10380376 Mercy Health Center Inc P 116450882 Mercy Health Network of the Southern Region Inc N 86617 Mercy Health Network of the Southern Region Inc P 171540 Mercy Health Network Inc O 107510 Mercy Health network Inc P 421785 Mercy Memorial Health Center Foundation O 139802 MHM Support Services O 13581755 MHP Inc P 1883362 Resource Optimization & Innovation LLC O 6017514 Sisters of Mercy Health System O 618477 Southern Oklahoma PHO LLC O 196972 St John's Mercy Health System O 130308 Mercy Memorial Health Center Foundation C 6376712