Attach to Form 990 or Form 990-EZ.
See separate instructions.| (i) Name of supported organization |
(ii) EIN |
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) |
(iv) Is the organization in col. (i) listed in your governing document? |
(v) Did you notify the organization in col. (i) of your support? |
(vi) Is the organization in col. (i) organized in the U.S.? |
(vii) Amount of support? |
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| Yes | No | Yes | No | Yes | No | ||||
| Total | |||||||||
| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .... | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3.. | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | ||||||
| 6 | Public Support. Subtract line 5 from line 4. | ||||||
| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets.. | ||||||
| 11 | Total support (Add lines 7 through 10). | ||||||






| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose...... | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513.. | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 6 | Total. Add lines 1 through 5. | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public Support (Subtract line 7c from line 6.) | ||||||
| Calendar year (or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) | ||||||
| 13 | Total support (Add lines 9, 10c, 11 and 12.). | ||||||




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Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
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| FORM 990 REVIEW | PART VI, SECTION A, QUESTION 11A | THE AUDIT COMMITTEE REVIEWS AND APPROVES THE FORM 990 PRIOR TO THE DATE OF FILING. THE AUDIT COMMITTEE REPORTS ON THE REVIEW TO THE BOARD OF TRUSTEES AND ASSURES THAT THE BOARD HAS THE OPPORTUNITY TO REVIEW THE FINAL FORM 990 AS FILED. A COPY OF FORM 990 IS PROVIDED TO THE BOARD OF TRUSTEES VIA A SECURE EMAIL PRIOR TO FILING WITH THE IRS. |
| CONFLICT OF INTEREST POLICY | PART VI, SECTION B, QUESTION 12C | MERCY REGIONAL HEALTH CENTER, INC. FOLLOWS VIA CHRISTI HEALTH, INC.'S CONFLICT OF INTEREST POLICY. IT IS MONITORED AND ENFORCED AS PART OF THE SYSTEM-WIDE PROCEDURES AND IS NOT HANDLED AT THE ORGANIZATION LEVEL. THE SYSTEM MONITORS AND ENFORCES THE CONFLICT OF INTEREST POLICY AS FOLLOWS: 1) AT TIME OF APPOINTMENT AND ANNUALLY THEREAFTER, ALL INTERESTED PERSONS, INCLUDING BOARD AND COMMITTEE MEMBERS COMPLETE A DISCLOSURE STATEMENT WHICH ADDRESSES ACTUAL OR POTENTIAL CONFLICTS OF INTEREST. 2) THE DISCLOSURE STATEMENT IS DONE ELECTRONICALLY AND THE RETURN OF THE COMPLETED STATEMENT IS A CONDITION OF CONTINUED APPOINTMENT, EMPLOYMENT OR PARTICIPATION WITH THE ORGANIZATION. 3) ALL ACTUAL OR POTENTIAL CONFLICTS ARE REVIEWED, INVESTIGATED AND RESOLVED BY THE CHIEF GOVERNANCE OFFICER AND THE CORPORATE RESPONSIBILITY OFFICER, WITH THE RESULTS SHARED WITH THE CHIEF EXECUTIVE OF THE ORGANIZATION. 4) PERIODIC REVIEWS ARE CONDUCTED BY GOVERNANCE, COMPLIANCE AND INTERNAL AUDIT TO ENSURE THE ORGANZIATION IS OPERATING CONSISTENT WITH THE POLICY AND ENFORCING THE POLICY'S TERMS. |
| COMPENSATION REVIEW | PART VI, SECTION B, QUESTION 15 | Mercy Regional Health Center, Inc. uses the policies established by Via Christi Health, Inc. (VCH). VCH has established a common philosophy, strategy, and processes for executive compensation to be used throughout the Via Christi Health System. VCH's philosophy, strategy and process for executive compensation are described next. Through the oversight of the VCH Executive Compensation Committee, executive compensation is competitively positioned at its stated market position when compared to the compensation paid by relevant organizations (comparably-sized health systems, hospitals, and long-term care providers). VCH recognizes its responsibility to ensure that its executive compensation program is appropriate in view of its mission and tax-exempt status and that its compensation levels and expenditures are reasonable and not excessive. To ensure these ends, the VCH Executive Compensation Committee has established and approved the executive compensation philosophy for VCH and all related entities. It will also approve all changes in the compensation package for VCH executives in advance. On an annual basis, the Committee conducts a comprehensive review of total compensation for all executives. It also reviews and approves "off-cycle" compensation transactions as needed. In their review, the Committee considers the following factors: * Market data from independent compensation surveys and sources that reflect comparable positions in organizations of similar size and scope * Difficulties in recruiting and retaining executives * Skills, experience and performance history of individual executives * Critical business or strategic issues that the organization may face * Market position for total compensation The adequacy, competitiveness, and cost of the VCH total executive compensation program are reviewed on an ongoing basis and changes are made as the Committee determines appropriate. The executive compensation program will be maintained such that it will fall within the safe harbor guidelines established by the Intermediate Sanctions regulations. The Committee also employs the services of an independent compensation consultant to prepare market analysis to aid and support the Committee's actions, provide documentation of market trends for budget setting purposes, review annual compensation changes to ensure "reasonableness" and provide attestation, and provide consultation on all executive compensation issues. The Committee also relies on third-party validation of performance measures used in the determination of compensation. |
| GOVERNING DOCUMENTS | PART VI, SECTION C, QUESTION 19 | MERCY REGIONAL HEALTH CENTER, INC.'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| RELATED TAX-EXEMPT ORGANIZATIONS | SCHEDULE R, PART II | MERCY REGIONAL HEALTH CENTER, INC. IS CONTROLLED BY VIA CHRISTI HEALTH, INC. VIA CHRISTI HEALTH, INC. IS JOINTLY SPONSORED AND CONTROLLED BY ASCENSION HEALTH AND MARIAN HEALTH SYSTEM, WHICH IN TURN ARE SPONSORED BY THE SISTERS OF THE SORROWFUL MOTHER, FOUR PROVINCES OF THE DAUGHTERS OF CHARITY, THE CONGREGATION OF ST. JOSEPH, AND THE SISTERS OF ST. JOSEPH OF CARONDELET. DUE TO SUCH SPONSORSHIP AND CONTROL, AND IN THE INTEREST OF INCREASED CLARITY AND TRANSPARENCY, BOTH ASCENSION HEALTH AND MARIAN HEALTH SYSTEM ARE BEING LISTED AS RELATED ORGANIZATIONS ON SCHEDULE R. |
| MEMBERS | PART VI, SECTION A, Q6, 7A, AND 7B | VIA CHRISTI HEALTH, INC. AND MEMORIAL HOSPITAL ASSOCIATION, INC. ARE THE MEMBERS. THE MEMBERS MAY APPROVE AND REMOVE INDIVIDUALS ON THE BOARD OF TRUSTEES. ARTICLE 2 OF THE BYLAWS PROVIDE THE MEMBERS WITH THE FOLLOWING POWERS: *Approve, before they may become effective, all mission, philosophy, and value statements of the corporation and all amendments thereto. *Monitor compliance with the mission and philosophy of the corporation through receipt of annual reports, financial statements and other pertinent information. *Approve Articles of Incorporation and Bylaws of the corporation or amendments thereto. *Approve appointment and removal of all Directors of the corporation. *Approve, before it may become effective, any merger or consolidation involving the corporation. *Approve any partial or total dissolution of the corporation. *Approve the issuance of any debt by the corporation in excess of $1 million or the amount specified in writing from time to time by the Corporate Members. *Approve all transfers, leases, encumbrances or other conveyances of the property of all assets of the corporation in excess of $1 million or the amount specified in writing from time to time by the Corporate Members. *Approve, before it may become effective, the creation of any subsidiary organization to the corporation. *Receive reports on all operating and capital budgets of the corporation. *Receive reports on all unbudgeted expenses in excess of $50,000 or the amount specified in writing from time to time by the Members. *Receive information and reports on all long-range strategic and financial plans of the corporation. *Receive reports on all alliances and affiliations entered into by the corporation. |
| OTHER CHANGES IN NET ASSETS | PART XI LINE 5 | UNREALIZED LOSS (2,386,191) NET PENSION ADJUSTMENT (115,715) RELEASED FROM RESTRICTION (50,000) K-1 ADJUSTMENTS: PFI LLC (1,711) MERCY IMAGING LLC 783,288 781,577 ----------- PART XI LINE 5 (1,770,329) |
| COMMUNITY BENEFIT REPORT | PART III | Part I - Summary As a part of Via Christi Health, we share this Mission: Inspired by the Gospel and our Catholic tradition, we serve as a healing presence with special concern for our neighbors who are vulnerable. Part III - Statement of Program Service Accomplishments Mercy Regional Health Center (MRHC) is a member of Via Christi Health, Inc. (VCH). As a Catholic health system, VCH has its origins in faith-based responses to health needs of our communities, with a particular concern for those living in poverty and who are vulnerable. In addition to typical inpatient and outpatient services, VCH operates primary care clinics, a low income neighborhood outreach clinic, specialty hospitals and centers, home medical services, therapy centers and long-term care villages. The obligation to reach out to those in need and to improve community health flows directly from VCH's identity as a faith-based healing ministry. VCH continues its tradition in providing community benefit because we are committed to: - Promoting and defending human dignity - Caring for persons living in poverty and other vulnerable populations - Promoting the common good - Stewarding resources responsibly According to the VCH mission statement, "As a part of Via Christi Health, we share this Mission: Inspired by the Gospel and our Catholic tradition, we serve as a healing presence with special concern for our neighbors who are vulnerable." The financial information in this report was prepared in accordance with the Catholic Health Association's (CHA) A Guide for Planning and Reporting Community Benefit Guidelines. Per these Guidelines, we report the net expense for community benefit services (i.e., the total community benefit expense minus any associated revenue from patients, residents, payers, and other external sources). The CHA Guidelines reflect a conservative approach to reporting quantifiable community benefit. The goal of the Guidelines is to produce community benefit financial reports that reflect true costs and that describe community benefit activities that increase access to health care and improve community health for all. The following are MRHC's definitions for quantifiable community benefits. Charity Care - Free or discounted health services provided to persons who cannot afford to pay and who meet VCH's criteria for financial assistance. Charity care is reported in terms of costs, not charges. Charity care does not include bad debt. Government Sponsored Means-Tested Health Care - Includes unpaid costs of public programs for low-income persons - the shortfall created when VCH receives payments that are less than the cost of caring for public program beneficiaries. This payment shortfall is not the same as a contractual allowance, which is the full difference between charges and government payments. Health Professions Education - Helping to prepare future health care professionals is a distinguishing characteristic of not-for-profit health care and constitutes a significant community benefit. This category includes programs and financial assistance for physicians and medical students, nurses and nursing students, interns and other health professionals. For fiscal year ended September 30, 2011 Community Benefit (MRHC, Inc and Subsidiaries): 1. Charity care - at cost $3.1 million 2. Government sponsored health care - net expense $2.0 million Unpaid cost of public indigent care programs (includes Medicaid, SCHIP, other safety net programs; does not include Medicare shortfall) 3. Community Benefit Programs - net expense $0.8 million 4. Total Quantifiable Community Benefit $5.9 million Listed below are just a few of the community benefit programs offered by Mercy Regional Health Center (MRHC) and Wamego City Hospital (WCH) during FY2011. This is not a complete listing but a sampling of how the hospital gives back to the community while meeting current needs. |
| COMMUNITY BENEFIT REPORT | PART III CONTINUED | Car Seat Clinics - MRHC conducts various car seat inspection clinics that the general public is invited to participate in to assess and educate parents on how to properly use the car seat and to ensure its base is securely installed in the parent's vehicle. Nearly 150 car seats were checked for a cost of $1,095 in community benefit. Heart Education Health News - Numerous newsletters were printed and distributed on cardiac related issues and shared with patients who have had a history of heart disease but who are now under physician care to improve their cardiac efficiency. Approximately $1,800 was spent to print and distribute their heart education newsletter. Targeted Population Health Fairs are conducted annually for children, seniors and the broader community. During this tax year, 290 people were served for a cost of $1,505 by having their blood pressure checked, eye exams, hearing tests and recommendations for establishing a medical home with either a physician and/or the free clinic. Several Support Groups are hosted (e.g. cardiac, bereavement) and numerous educational presentations (e.g. Bereaved Parents, Cardiac, etc) are given in the Manhattan/Wamego area. In FY2011, over 125 attendees participated in these educational events at a cost of nearly $500. Community Education is a program shared with the community to improve their understanding of specific diseases or improve their skills in taking care of others. MRHC offered educational forums on advance directives, babysitter's basics, breastfeeding and child birth basics, CPR, depression/anxiety, EMS, fitness/wellness and a host of other topics for the general public during FY2011. Nearly 3,000 attendees took advantage of these educational opportunities at a cost of just below $5,000. SANE/SART is a program in response to all victims of sexual assault who present themselves to MRHC hospital by providing immediate and follow-up medical, advocacy and criminal justice services in an ethical and compassionate manner. Over 106 individuals were assisted by the SANE/SART team of nurses at a cost of $17,626. Flint Hills Community Clinic, in partnership with MRHC, oversees uninsured and underinsured individuals. MRHC provides staff support, as well as free diagnostic testing (e.g. lab, x-rays, etc) for the clinic. During this fiscal year, nearly 2,100 instances of service were provided by MRHC at a cost of $231,282. Similarly, Wamego City Hospital provided 245 free labs for individuals helped by the Community Health Ministries Clinic in Wamego for a cost of $23,939. Health Profession Education of area physicians, nurses, physician assistants, nursing students and other health care professionals who are either looking for continuing education credits, wanting more hands-on training, or are in need of field practicum placements, etc are welcomed at MRHC and WCH for additional training opportunities. Nearly 660 health care professionals and/or students hoping to enter the health care field were offered training opportunities through the various programs offered by MRHC and WCH at a cost of $255,781. Security Transport is a support service provided by MRHC when patients are brought to the hospital emergency department but are in need of psychiatric placement but are unable to pay for transportation to get access to the facilities, which are located outside of the Manhattan area. Most of these patients are transferred to Larned, Osawatomie, Kansas University Medical Center in Kansas City or other locations. In FY2011, MRHC supplied security transport 140 times at a cost of $27,189. In-Kind Donations through service on community boards that are health related (e.g. American Red Cross, United Way, Flint Hills Community Clinic), and sharing of hospital space to conduct health related not-for-profit business is another area in which MRHC and WCH gives back to the community. In fiscal year 2011, MRHC and WCH contributed just over $129,052 through financial and in-kind contributions. Nearly $31,000 was expended in tracking community benefit activities offered by MRHC and WCH for fiscal year 2011. This includes the gearing up for a community-wide health needs assessment that was scheduled for FY2011. Community benefit staff uses and trains others to use the Community Benefit Inventory Social Accountability (CBISA) software, developed by Lyon Software and used by over 1,700 hospitals throughout the country. CBISA software follows the reporting guidelines adopted by Catholic Health Association and does not include bad debt or unpaid Medicare reimbursements as community benefit. Community Benefit Operations - Community benefit staff uses and trains others to use the Community Benefit Inventory Social Accountability (CBISA) software, developed by Lyon Software and used by over 1,700 hospitals throughout the country. CBISA software follows the reporting guidelines adopted by Catholic Health Association and does not include bad debt or unpaid Medicare reimbursements as community benefit. Overall, MRCH and WCH combined community benefit programs (not counting traditional charity care, unpaid reimbursement of Medicaid, and/or Community-Building activities) accounted for $758,452 to the geographical area of Manhattan and Wamego, Kansas during FY2011. |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:DAVID HADLEY TITLE:TRUSTEE HOURS:49 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:RANDALL PETERSON TITLE:TRUSTEE HOURS:49 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:JOHN BROBERG TITLE:EX-OFFICIO(CEO) HOURS:1 |
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