Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2012
Open to Public Inspection
A For the 2012 calendar year, or tax year beginning 07-01-2012 , 2012, and ending 06-30-2013
BCheck if applicable:
CName of organization
MERCY HEALTH NORTHWEST ARKANSAS COMMUNITIES
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
2710 Rife Medical Lane
Suite
Room/suite
City or town, state or country, and ZIP + 4
Rogers, AR72758
D Employer identification number

62-1684203
E Telephone number

G Gross receipts $ 66,196,353
F Name and address of principal officer:
ERIC PIANALTO
2710 Rife Medical Lane
Rogers,AR72758
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.mercy.net
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet0928
K Form of organization:
 
L Year of formation: 1997
M State of legal domicile: AR
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: AS THE SISTERS OF MERCY BEFORE US, WE BRING TO LIFE THE HEALING MINISTRY OF JESUS THROUGH OUR COMPASSIONATE CARE AND EXCEPTIONAL service.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 15
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 11
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...... 5 719
6 Total number of volunteers (estimate if necessary) ............. 6 0
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b  
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 0 0
9 Program service revenue (Part VIII, line 2g) ......... 62,087,740 64,912,062
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 15,342 64,245
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 182,341 1,220,046
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 62,285,423 66,196,353
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 500 1,750
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 58,414,319 60,769,442
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 20,486,652 22,827,920
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 78,901,471 83,599,112
19 Revenue less expenses. Subtract line 18 from line 12....... -16,616,048 -17,402,759
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 12,569,127 12,912,480
21 Total liabilities (Part X, line 26)............. 78,478,829 95,414,940
22 Net assets or fund balances. Subtract line 21 from line 20..... -65,909,702 -82,502,460
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2012)
Form 990 (2012)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III ...............
1
Briefly describe the organization’s mission: AS THE SISTERS OF MERCY BEFORE US, WE BRING TO LIFE THE HEALING MINISTRY OF JESUS THROUGH OUR COMPASSIONATE CARE AND EXCEPTIONAL SERVICE.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ......................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ............................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 26,728,662 including grants of $   ) (Revenue $ 24,703,885 )
FAMILY MEDICINE PHYSICIAN SERVICES: MERCY HEALTH SYSTEM OF NWA'S FAMILY MEDICINE PHYSICIAN SERVICES ARE COMPRISED OF 34 BOARD CERTIFIED FAMILY MEDICINE PHYSICIANS AND 9 MID-LEVELS, WHO PROVIDED PRIMARY MEDICINE SERVICES TO PATIENTS RANGING FROM ONE YEAR OLD THROUGH ADULTHOOD. THESE SERVICES ARE OFFERED IN APPROXIMATELY 11 LOCATIONS THROUGHOUT BENTON COUNTY ARKANSAS AND THE SURROUNDING SERVICE AREA. DURING THE YEAR, 187,218 OFFICE VISITS WERE PROVIDED TO PATIENTS.
4b (Code:   ) (Expenses $ 11,600,625 including grants of $   ) (Revenue $ 6,617,774 )
CARDIOVASCULAR SERVICES: MERCY HEALTH SYSTEM OF NWA'S CARDIOVASCULAR PHYSICIAN SERVICES ARE COMPRISED OF 7 CARDIOLOGISTS, 2 CARDIOVASCULAR SURGEONS, AND 9 MID-LEVEL PROVIDERS. THESE PROVIDERS SERVE PATIENTS THROUGHOUT BENTON COUNTY ARKANSAS AND THE SURROUNDING SERVICE AREA, WHO HAVE HEART RELATED MEDICAL NEEDS. DURING THE YEAR, 22,231 OFFICE VISITS WERE PROVIDED TO PATIENTS.
4c (Code:   ) (Expenses $ 4,757,930 including grants of $   ) (Revenue $ 4,499,701 )
PEDIATRIC PHYSICIAN SERVICES: MERCY HEALTH SYSTEM OF NWA'S PEDIATRIC PHYSICIAN SERVICES ARE COMPRISED OF 6 BOARD CERTIFIED PEDIATRICIANS AND 1.5 MID LEVELS, WHO PROVIDED PRIMARY MEDICINE SERVICES TO PATIENTS RANGING IN AGE FROM INFANTS THROUGH EIGHTEEN YEARS. SERVICES ARE PROVIDED TO PATIENTS THROUGHOUT BENTON COUNTY ARKANSAS AND THE SURROUNDING SERVICE AREA. DURING THE YEAR, 32,657 OFFICE VISITS WERE PROVIDED TO PATIENTS.
4d Other program services (Describe in Schedule O.)
(Expenses $ 32,773,346 including grants of $ 1,750 ) (Revenue $ 30,310,748 )
4e Total program service expensesMediumBullet75,860,563
Form 990 (2012)
Form 990 (2012)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment........................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? ...
2
 
No
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part I..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If “Yes,” complete Schedule C, Part II........
4
 
No
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C,
Part III............................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part IClick to see attachment........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,” complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment......
10
 
No
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If “Yes,” complete Schedule D, Part VI.Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIIClick to see attachment.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IXClick to see attachment............
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part XClick to see attachment.........................
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI and XII Click to see attachment.................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E....
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?.....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the United States? If “Yes,” complete Schedule F, Parts II and IV
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the United States? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I (see instructions)....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If “Yes,” complete Schedule H....
20a
 
No
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statements to this return?
20b
 
 
Form 990 (2012)
Form 990 (2012)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II...
21
 
No
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
 
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I........ Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................... Click to see attachment
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highest compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II.......................... Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III......... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV .......................... Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV..................... Click to see attachment
28b
Yes
 
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If “Yes,” complete Schedule L, Part IV... Click to see attachment
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M.............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Part II, III, or IV, and Part V, line 1........................ Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2012)
Form 990 (2012)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V ...............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
0
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
 
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
719
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?..........................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes,” to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions?...
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?............................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?............................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?............
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?..........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?.......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year. ....................
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2012)
Form 990 (2012)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI ...............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year .....................
1a
15
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
11
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done.......................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
 
No
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization:
MediumBulletBENNY J STOVER CPA VP OF F2710 RIFE MEDICAL LANEROGERSAR72758 (479) 338-2903
Form 990 (2012)
Form 990 (2012)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII ...............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) Bergant Paul........................................................................
Board member
 1.0
.......................1.0 		X           0 0 0
(2) Callahan Wayne........................................................................
Board member
 1.0
.......................1.0 		X           0 0 0
(3) Donnell Hugh G........................................................................
Physician & Board member
 59.0
.......................1.0 		X           328,514 0 39,685
(4) Evans RSM Sr Gayle........................................................................
Board member
 1.0
.......................35.0 		X           0 0 0
(5) Faddis MD Lance........................................................................
Physician & Board member
 60.0
.......................0.0 		X           264,805 0 25,457
(6) Finnegan RSM Sr Chabanel........................................................................
Board member
 1.0
.......................34.0 		X           0 0 0
(7) Ford Rollin........................................................................
Board member
 1.0
.......................0.0 		X           0 0 0
(8) Kelone RSM Sr Teresa........................................................................
Board member
 1.0
.......................0.0 		X           0 0 0
(9) Lawson Randy........................................................................
Board member
 1.0
.......................0.0 		X           0 0 0
(10) Lipscomb Tabitha........................................................................
Board member
 1.0
.......................0.0 		X           0 0 0
(11) Mahan Paul........................................................................
Board member
 1.0
.......................0.0 		X           0 0 0
(12) Rogers Chris........................................................................
Board member
 1.0
.......................0.0 		X           0 0 0
(13) Stuppy Robert J........................................................................
Physician & Board member
 60.0
.......................0.0 		X           799,645 0 30,010
(14) Trammel Dick........................................................................
Board member
 1.0
.......................1.0 		X           0 0 0
(15) Street Scott........................................................................
Chief executive officer
 20.0
.......................40.0 		X   X       0 529,683 115,769
(16) Vitiello Jonathan........................................................................
Chief financial officer
 2.0
.......................58.0 		    X       0 493,118 64,006
(17) Day Bradley Kim........................................................................
Pres Central Comm- thru 3/1/13
 1.0
.......................59.0 		      X     0 987,614 348,680
Form 990 (2012)
Form 990 (2012)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) Goss Stephen........................................................................
Physician executive
 60.0
.......................0.0 		      X     322,299 0 72,481
(19) Halstead John........................................................................
VP-Mission
 20.0
.......................40.0 		      X     152,406 0 15,864
(20) Hughes Steven L........................................................................
Chief administrative officer
 60.0
.......................0.0 		      X     218,261 0 18,465
(21) Marion Tanya........................................................................
Regional VP-Human resources
 3.0
.......................57.0 		      X     0 232,635 43,308
(22) Merrigan Michael........................................................................
Regional VP-General Counsel
 2.0
.......................58.0 		      X     0 378,450 56,809
(23) Stover Benny J........................................................................
VP-Finance
 20.0
.......................40.0 		      X     175,634 0 20,594
(24) Swope Jon........................................................................
Pres Central Comm-Start 3/1/13
 2.0
.......................58.0 		      X     0 758,712 230,689
(25) El-Shafei Amr........................................................................
Physician
 60.0
.......................0.0 		        X   1,389,303 0 18,240
(26) Riley Philip........................................................................
Physician
 60.0
.......................0.0 		        X   827,153 0 16,837
(27) Simpson Christopher........................................................................
Physician
 60.0
.......................0.0 		        X   827,431 0 28,916
(28) Weathers Larry W........................................................................
Physician
 60.0
.......................0.0 		        X   774,491 0 24,028
(29) Wigington William C........................................................................
Physician
 60.0
.......................0.0 		        X   777,921 0 19,845
(30) Barrett Susan........................................................................
Former president
 0.0
.......................40.0 		          X 0 216,667 0
(31) Flynn George........................................................................
Former CEO
 0.0
.......................0.0 		          X 0 3,297,507 140,483
(32) Little-Smith Karen........................................................................
Former key employee
 60.0
.......................0.0 		          X 124,596 0 12,375
(33) Stewart Michele........................................................................
Former key employee
 0.0
.......................60.0 		          X 223,325 109,236 67,910
(34) Barclay RicK........................................................................
Former key employee
 0.0
.......................60.0 		          X 199,052 0 21,415
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 7,404,836 7,003,622 1,431,866
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet114
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual ..............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
QUEST DIAGNOSTICS, PO BOX 740709ATLANTAGA30374 LAB DIAGNOSTICS 355,507
M MODAL, 9009 CAROTHERS PARKWAY SUITE C2FRANKLINTN37067 TRANSCRIPTION SERV 194,246
MERCY MEDICAL CENTER, PO BOX 504664ST LOUISMO63150 LAB SERVICES 169,941
TIMELINE RECRUITING LLC, 13841 COLLECTIONS CENTER DRIVECHICAGOIL60693 RECRUITING 136,253
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet4
Form 990 (2012)
Form 990 (2012)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response to any question in this Part VIII ..............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c 0
d Related organizations...1d  
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		 
g Noncash contributions included in lines
1a-1f:$ 		0
h Total. Add lines 1a-1f.......MediumBullet 0
Program Service Revenue Business Code
2a Net Patient Service Reven 621111 64,599,930 64,599,930 0 0
b PCIP/HPSA Revenue 900099 312,132 312,132 0 0
c
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 64,912,062
Other Revenue 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 64,245     64,245
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties...........MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents    
b Less: rental expenses    
c Rental income or (loss) 0 0
d Net rental income or (loss).......MediumBullet 0      
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory    
b Less: cost or other basis and sales expenses    
c Gain or (loss)    
d Net gain or (loss)..........MediumBullet 0      
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ..
a  
b Less: direct expenses ...b 0
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a DIALYSIS CENTER REVENUE 900099 330,962 330,962 0 0
b COMP PRIM CARE PILOT PROG 900099 452,497 452,497 0 0
c HUMAN PRACTICE REWARDS 900099 271,956 271,956 0 0
d All other revenue .... 164,631 164,631 0 0
e Total. Add lines 11a–11d ...... MediumBullet 1,220,046
12 Total revenue. See Instructions......MediumBullet 66,196,353 66,132,108 0 64,245
Form 990 (2012)
Form 990 (2012)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response to any question in this Part IX ...............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 1,750 1,750
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 0 0
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16 0 0
4 Benefits paid to or for members 0 0
5 Compensation of current officers, directors, trustees, and key employees .... 3,704,729 3,704,729 0 0
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 114,941 114,941 0 0
7 Other salaries and wages 46,904,591 42,305,399 4,599,192 0
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 1,833,933 1,653,928 180,005 0
9 Other employee benefits ....... 5,638,624 5,107,147 531,477 0
10 Payroll taxes ........... 2,572,624 2,337,863 234,761 0
11 Fees for services (non-employees):        
a Management ...... 0 0 0 0
b Legal ......... 144,874   144,874 0
c Accounting ........... 0 0 0 0
d Lobbying ........... 0 0 0 0
e Professional fundraising services. See Part IV, line 17 0 0
f Investment management fees ...... 0 0 0 0
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 1,518,527 1,013,823 504,704 0
12 Advertising and promotion .... 246,755 111,348 135,407 0
13 Office expenses ....... 956,186 868,930 87,256 0
14 Information technology ...... 40,235 36,563 3,672 0
15 Royalties .. 0 0 0 0
16 Occupancy ........... 4,160,313 3,795,477 364,836 0
17 Travel ............ 230,099 129,787 100,312 0
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0 0 0 0
19 Conferences, conventions, and meetings .... 774 0 774 0
20 Interest ........... 28,756 26,132 2,624 0
21 Payments to affiliates ....... 0 0 0 0
22 Depreciation, depletion, and amortization ..... 883,182 535,904 347,278 0
23 Insurance .............. 1,445,150 1,313,275 131,875 0
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a Repairs & Maintenance 193,585 157,905 35,680 0
b Shared Service fees 2,066,496 1,877,921 188,575 0
c Drugs & Medical Supplies 6,497,012 6,459,949 37,063 0
d Bad Debt 3,379,837 3,379,837 0 0
e All other expenses 1,036,139 927,955 108,184  
25 Total functional expenses. Add lines 1 through 24e 83,599,112 75,860,563 7,738,549 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720). 0      
Form 990 (2012)
Form 990 (2012)
Page 11
Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing ............. 481,493 1 482,034
2 Savings and temporary cash investments ......... 0 2 0
3 Pledges and grants receivable, net ........... 0 3 0
4 Accounts receivable, net ............. 6,027,356 4 5,299,779
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
0 5 0
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
0 6 0
7 Notes and loans receivable, net ............. 1,236,480 7 897,017
8 Inventories for sale or use .............. 453,516 8 447,585
9 Prepaid expenses and deferred charges .......... 13,086 9 92,262
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 13,058,544
b Less: accumulated depreciation ..... 10b 7,368,058 4,357,196 10c 5,690,486
11 Investments—publicly traded securities .......... 0 11 0
12 Investments—other securities. See Part IV, line 11 ..... 0 12 0
13 Investments—program-related. See Part IV, line 11 ..... 0 13 0
14 Intangible assets ............... 0 14 0
15 Other assets. See Part IV, line 11 ........... 0 15 3,317
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 12,569,127 16 12,912,480
Liabilities 17 Accounts payable and accrued expenses ......... 9,496,494 17 8,423,859
18 Grants payable ................. 0 18 0
19 Deferred revenue ................ 0 19 0
20 Tax-exempt bond liabilities ............. 0 20 0
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
22 Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L.......... 0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 0 23 0
24 Unsecured notes and loans payable to unrelated third parties .... 1,998,906 24 1,625,001
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.................... 66,983,429 25 85,366,080
26 Total liabilities. Add lines 17 through 25......... 78,478,829 26 95,414,940
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. -65,909,702 27 -82,502,460
28 Temporarily restricted net assets ........... 0 28 0
29 Permanently restricted net assets ........... 0 29 0
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds ........   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ........... -65,909,702 33 -82,502,460
34 Total liabilities and net assets/fund balances ........ 12,569,127 34 12,912,480
Form 990 (2012)
Form 990 (2012)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI ...............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
66,196,353
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
83,599,112
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
-17,402,759
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
-65,909,702
5
Net unrealized gains (losses) on investments ...............
5
 
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
810,001
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
-82,502,460
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII ..............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If “Yes,” to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits
3b
 
 
Form 990 (2012)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


Software ID:  
Software Version:  
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
MERCY HEALTH NORTHWEST ARKANSAS COMMUNITIES
 
Employer identification number

62-1684203
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization? ................
11g(i)
 
 
(ii) A family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) A 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
Provide the following information about the supported organization(s).
(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 monetary support
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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.            
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . 0 0 0 0 0 0
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...... 95,352,882 54,103,144 58,695,633 61,696,202 64,599,930 334,447,791
3 Gross receipts from activities that are not an unrelated trade or business under section 513..           0
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...           0
5 The value of services or facilities furnished by a governmental unit to the organization without charge..           0
6 Total. Add lines 1 through 5. 95,352,882 54,103,144 58,695,633 61,696,202 64,599,930 334,447,791
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...         0 0
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.         0 0
c Add lines 7a and 7b..         0 0
8 Public support (Subtract line 7c from line 6.)           334,447,791
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
9 Amounts from line 6... 95,352,882 54,103,144 58,695,633 61,696,202 64,599,930 334,447,791
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. 41,511 27,879 -18,223 15,342 64,245 130,754
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.           0
c Add lines 10a and 10b. 41,511 27,879 -18,223 15,342 64,245 130,754
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.           0
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) .. 1,237,480 533,693 417,373 573,879 1,532,178 4,294,603
13 Total support. (Add lines 9, 10c, 11, and 12.).. 96,631,873 54,664,716 59,094,783 62,285,423 66,196,353 338,873,148
14
Section C. Computation of Public Support Percentage
15
15
98.694 %
16
16
98.491 %
Section D. Computation of Investment Income Percentage
17
17
0.039 %
18
18
0.260 %
19a
b
20
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information. Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
OTHER INCOME INCLUDED SERVICES PROVIDED TO SUPPORT THE HOSPITAL, SUCH AS CAFETERIA INCOME AND OTHER SERVICE REVENUE.
 
 
 
Schedule A (Form 990 or 990-EZ) 2012

Additional Data


Software ID:  
Software Version:  
SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
MERCY HEALTH NORTHWEST ARKANSAS COMMUNITIES
 
Employer identification number

62-1684203
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) .....    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIII and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance ....          
b Contributions ........          
c Net investment earnings, gains, and losses          
d Grants or scholarships .....          
e Other expenditures for facilities
and programs ........ 		         
f Administrative expenses ....          
g End of year balance ......          
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Temporarily restricted endowment SchDMd Bullet  
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
 
(ii) related organizations ........................
3a(ii)
 
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   935,000 935,000
b Buildings ................   1,453,944 1,166,123 287,821
c Leasehold improvements ............   4,358,031 2,454,590 1,903,441
d Equipment ................   5,705,575 3,677,749 2,027,826
e Other .................   605,994 69,596 536,398
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 5,690,486
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes 0
DEPOSITORY ACCOUNTS-BOA 35,924,204
DUE TO AFFILIATES 49,441,876







Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 85,366,080
2. Fin 48 (ASC 740) Footnote. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII .....................................................
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIII.) ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ........... 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIII.) ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIII
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
Form 990, Schedule D, Part X, Line 2 ASC 740 FOOTNOTE THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF MERCY HEALTH AND AFFILIATES 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.
Schedule D (Form 990) 2012

Additional Data


Software ID:  
Software Version:  




Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
MERCY HEALTH NORTHWEST ARKANSAS COMMUNITIES
 
Employer identification number

62-1684203
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....
1b
Yes
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all officers,
directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? .......
2
Yes
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ................
4a
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
Yes
 
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1)Donnell Hugh GPhysician & Board member (i)
(ii)		 281,391
0 		27,018
0 		20,105
0 		18,710
0 		20,975
0 		368,199
0 		0
0
(2)Faddis MD LancePhysician & Board member (i)
(ii)		 228,615
0 		21,498
0 		14,692
0 		5,081
0 		20,376
0 		290,262
0 		0
0
(3)Stuppy Robert JPhysician & Board member (i)
(ii)		 580,290
0 		175,000
0 		44,355
0 		8,801
0 		21,209
0 		829,655
0 		0
0
(4)Street ScottChief executive officer (i)
(ii)		 0
388,618 		0
120,181 		0
20,884 		0
98,296 		0
17,473 		0
645,452 		0
0
(5)Vitiello JonathanChief financial officer (i)
(ii)		 0
294,647 		0
102,118 		0
96,353 		0
47,736 		0
16,270 		0
557,124 		0
0
(6)Day Bradley KimPres Central Comm- thru 3/1/13 (i)
(ii)		 0
630,366 		0
322,225 		0
35,023 		0
334,446 		0
14,234 		0
1,336,294 		0
0
(7)Goss StephenPhysician executive (i)
(ii)		 233,046
0 		45,473
0 		43,780
0 		53,115
0 		19,366
0 		394,780
0 		0
0
(8)Halstead JohnVP-Mission (i)
(ii)		 129,542
0 		21,848
0 		1,016
0 		1,158
0 		14,706
0 		168,270
0 		0
0
(9)Hughes Steven LChief administrative officer (i)
(ii)		 171,465
0 		21,144
0 		25,652
0 		6,829
0 		11,636
0 		236,726
0 		0
0
(10)Marion TanyaRegional VP-Human resources (i)
(ii)		 0
137,188 		0
70,088 		0
25,359 		0
28,325 		0
14,983 		0
275,943 		0
0
(11)Merrigan MichaelRegional VP-General Counsel (i)
(ii)		 0
227,959 		0
96,337 		0
54,154 		0
49,389 		0
7,420 		0
435,259 		0
0
(12)Stover Benny JVP-Finance (i)
(ii)		 130,156
0 		25,143
0 		20,335
0 		5,691
0 		14,903
0 		196,228
0 		0
0
(13)Swope JonPres Central Comm-Start 3/1/13 (i)
(ii)		 0
481,585 		0
249,457 		0
27,670 		0
212,960 		0
17,729 		0
989,401 		0
0
(14)El-Shafei AmrPhysician (i)
(ii)		 1,222,473
0 		129,260
0 		37,570
0 		6,863
0 		11,377
0 		1,407,543
0 		0
0
(15)Riley PhilipPhysician (i)
(ii)		 715,688
0 		75,000
0 		36,465
0 		6,930
0 		9,907
0 		843,990
0 		0
0
(16)Simpson ChristopherPhysician (i)
(ii)		 715,790
0 		75,000
0 		36,641
0 		7,643
0 		21,273
0 		856,347
0 		0
0
(17)Weathers Larry WPhysician (i)
(ii)		 607,187
0 		75,000
0 		92,304
0 		7,429
0 		16,599
0 		798,519
0 		0
0
(18)Wigington William CPhysician (i)
(ii)		 655,017
0 		58,450
0 		64,454
0 		6,030
0 		13,815
0 		797,766
0 		0
0
(19)Barclay RicKFormer key employee (i)
(ii)		 151,314
0 		27,703
0 		20,035
0 		9,853
0 		11,562
0 		220,467
0 		0
0
(20)Barrett SusanFormer president (i)
(ii)		 0
216,667 		0
0 		0
0 		0
0 		0
0 		0
216,667 		0
0
(21)Flynn GeorgeFormer CEO (i)
(ii)		 0
24,154 		0
136,500 		0
3,136,853 		0
139,018 		0
1,465 		0
3,437,990 		0
2,299,930
(22)Little-Smith KarenFormer key employee (i)
(ii)		 94,859
0 		6,229
0 		23,508
0 		6,340
0 		6,035
0 		136,971
0 		0
0
(23)Stewart MicheleFormer key employee (i)
(ii)		 135,431
86,463 		50,220
0 		37,674
22,773 		52,172
0 		10,406
5,332 		285,903
114,568 		0
0
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Identifier Return Reference Explanation
FORM 990, SCHEDULE J, PART I, LINE 1   CHARTER TRAVEL IS PROVIDED TO CERTAIN EMPLOYEES AS AND WHEN APPROPRIATE, AND AS DEEMED NECESSARY FOR BUSINESS TRAVEL. AFTER CHARTER TRAVEL APPROVAL HAS BEEN GRANTED IN ACCORDANCE WITH THE FINANCIAL JUSTIFICATION PROCESS, THE APPROVED CHARTER TRAVEL FOR BUSINESS IS A REIMBURSABLE EXPENSE WHICH IS NOT TAXABLE TO THE EMPLOYEES. TRAVEL FOR COMPANIONS 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 HEALTH NORTHWEST ARKANSAS COMMUNITIES 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 YEAR 2012: GEORGE FLYNN, $720,175 FORM 990, SCHEDULE J, PART I, QUESTION 4B MERCY HEALTH 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, STEPHEN GOSS, TANYA MARION, MICHAEL MERRIGAN, JON SWOPE, MICHELE STEWART, 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 HEALTH NORTHWEST ARKANSAS COMMUNITIES PROVIDES A NON-FIXED BONUS PLAN FOR WHICH CERTAIN TIERS OF ITS EMPLOYEES ARE ELIGIBLE. FOR FISCAL YEAR 2013 (JULY 1, 2012 - JUNE 30, 2013), 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. FORM 990, SCHEDULE J, PART II THE AMOUNT FOR GEORGE FLYNN IN COLUMN (F) IS INCLUDED IN COLUMN BIII AS OTHER REPORTABLE COMPENSATION. THIS IS A PAYOUT OF THE SUPPLEMENTAL RETIREMENT PLAN AND WAS INCLUDED IN COLUMN (C) OF PREVIOUSLY FILED FORMS 990.
Schedule J (Form 990) 2012

Additional Data


Software ID:  
Software Version:  
Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
MERCY HEALTH NORTHWEST ARKANSAS COMMUNITIES
 
Employer identification number

62-1684203
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501(c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No





2
Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22
(a) Name of interested person (b) Relationship with organization (c) Purpose of loan (d) Loan to or from the organization? (e)Original principal amount (f)Balance due (g) In default? (h) Approved by board or committee? (i)Written agreement?
To From Yes No Yes No Yes No
Total ......Small Bullet $  
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of assistance (d) Type of assistance (e) Purpose of assistance
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2012
Schedule L (Form 990 or 990-EZ) 2012
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) Ashley Goss Family of key employee 114,941 Employment   No
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
Schedule L (Form 990 or 990-EZ) 2012

Additional Data


Software ID:  
Software Version:  




SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
MERCY HEALTH NORTHWEST ARKANSAS COMMUNITIES
 
Employer identification number

62-1684203
Identifier Return Reference Explanation
FORM 990, PART III, QUESTION 4D DESCRIPTION OF OTHER PROGRAM SERVICES MERCY HEALTH NORTHWEST ARKANSAS COMMUNITIES (MHNWAC) AND ITS MEMBER HEALTH CARE FACILITIES PROVIDE QUALITY CARE REGARDLESS OF RACE, CREED, GENDER, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. IN ACTIVE PURSUIT OF THE ABOVE STATED MISSION, MHNWAC PROVIDED 32,078 INPATIENT SERVICE DAYS OF ACUTE OR SUB-ACUTE CARE. MHNWAC HAD ACUTE NEWBORN DISCHARGES OF 1,302, NEWBORN PATIENT DAYS WERE 2,286, RESPONDED TO APPROXIMATELY 44,700 EMERGENCY ROOM ENCOUNTERS, MADE OVER 34,100 HOME HEALTH CARE VISITS AND COMPLETED 153,456 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.), AND EMPLOYEES (EDUCATIONAL ASSISTANCE PROGRAMS, ETC.), LOCAL/SURROUNDING COMMUNITY (WELLNESS PROGRAMS, HEALTH FAIRS, HOME HEALTH PROGRAMS, ETC.) RELIEF FROM FINANCIAL BURDEN OF HEALTH CARE SERVICES TO THE INDIGENT CONSISTS OF CHARGES OF $23,474,932 FOR CHARITY CARE PROVIDED WITH A COST OF RELATED SERVICES. FORM 990, PART V, QUESTION 1A FORM 1099/1096 FILING VENDORS FOR THE FILING ORGANIZATION ARE PAID BY MERCY HEALTH (EIN 43-1423050). AS SUCH, ALL REQUIRED FORM 1099 AND FORM 1096 REPORTING IS MADE FOR THE ENTIRE MERCY HEALTH SYSTEM (WITH LIMITED EXCEPTIONS) UNDER THE MERCY HEALTH EIN. FORM 990, PART VI, LINE 6A, LINE 7A, 7B CLASSES OF MEMBERS OR STOCKHOLDERS THE FILING ORGANIZATION HAS A SOLE CORPORATE MEMBER, MERCY HEALTH. THE FOLLOWING CORPORATE POWERS AND RESPONSIBILITIES SHALL BE RESERVED SOLELY UNTO THE CORPORATE MEMBER: -TO APPROVE AND ESTABLISH THE MISSION AND PHILOSOPHY ACCORDING TO WHICH THE CORPORATION AND ALL CORPORATIONS CONTROLLED BY THE CORPORATION SHALL OPERATE; -TO ADOPT OR AMEND THE ARTICLES OF INCORPORATION AND BYLAWS OF MERCY HOSPITAL ROGERS; -TO ADOPT OR AMEND THE ARTICLES OF INCORPORATION AND BYLAWS OF THE CORPORATION, EXCEPT THAT: -ANY AND ALL AMENDMENTS TO THE BYLAWS OF THE CORPORATION THAT MATERIALLY AFFECT THE EXISTENCE OR OPERATIONS OF THE MEDICAL GROUP BOARD, AS PROVIDED IN SECTION 8.2, MUST BE APPROVED BY THE MEDICAL GROUP BOARD, AND ANY AND ALL AMENDMENTS TO THE BYLAWS OF THE CORPORATION THAT MATERIALLY AFFECT THOSE POWERS RESERVED SOLELY TO THE MEDICAL GROUP, AS DESCRIBED IN SECTION 8.3, MUST BE APPROVED BY THE MEDICAL GROUP BOARD; -TO APPROVE AND APPOINT THE THREE (3) MEDICAL GROUP PHYSICIAN DIRECTORS AND ALL COMMUNITY REPRESENTATIVE DIRECTORS ON THE BOARD FROM NOMINATIONS SUBMITTED BY THE NOMINATING COMMITTEE; -TO APPOINT THE (2) MERCY HEALTH DIRECTORS ON THE BOARD; -TO APPOINT THE PRESIDENT/CEO OF THE CORPORATION, WHO SHALL SERVE AS AN EX-OFFICIO DIRECTOR ON THE BOARD WITH VOTE; -TO REMOVE ALL DIRECTORS ON THE BOARD WITH OR WITHOUT CAUSE; -TO APPROVE OR AMEND THE OVERALL STRATEGIC, LONG RANGE, AND HEALTH MANPOWER DEVELOPMENT PLANS, GOALS, AND OBJECTIVES OF THE CORPORATION OR ANY CORPORATION CONTROLLED BY THE CORPORATION; -TO APPROVE THE CONSOLIDATED OPERATING, CAPITAL, AND CONSTRUCTION BUDGETS (INCLUDING AGGREGATE PHYSICIAN COMPENSATION LEVELS) FOR THE CORPORATION OR ANY CORPORATION CONTROLLED BY THE CORPORATION AND CHANGES IN THE BUDGETS IN EXCESS OF AN AMOUNT ESTABLISHED FROM TIME TO TIME BY THE CORPORATE MEMBER; -TO LEASE OR SELL ANY OF THE ASSETS OF THE CORPORATION OR ANY CORPORATION CONTROLLED BY THE CORPORATION IN EXCESS OF AN AMOUNT ESTABLISHED FROM TIME TO TIME BY THE CORPORATE MEMBER; -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 CORPORATION 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; -TO MERGE, DISSOLVE, OR ABANDON THE CORPORATION OR ANY CORPORATION CONTROLLED BY THE CORPORATION; AND, -TO APPROVE THE CREATION, OWNERSHIP OR ACQUISITION OF, OR AFFILIATION WITH, ANY OTHER ORGANIZATION BY THE CORPORATION. FORM 990, PART VI, QUESTION 11B DSCR THE 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 990S. AFTER QUESTIONS ARISING FROM THE VARIOUS REVIEWS ARE ADDRESSED AND INCORPORATED INTO THE FORM 990, A REVISED DRAFT IS PROVIDED TO THE FILING ORGANIZATION'S LEADERSHIP TEAM, INCLUDING THE CFO AND CEO, FOR REVIEW. ONCE REVIEWED AND APPROVED BY THE FILING ORGANIZATION'S LEADERSHIP TEAM, THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS FOR REVIEW; IT IS THEN SIGNED AND FILED WITH THE IRS. FORM 990, PART VI, 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, 2013. THIS PROCESS IS ADMINISTERED AT THE MERCY HEALTH LEVEL BY MERCY'S BUSINESS RISK (INTERNAL AUDIT) DEPARTMENT. THE QUESTIONNAIRES ARE REVIEWED WITH LEADERSHIP AT THE LOCAL LEVEL AND POTENTIAL CONFLICTS DISCUSSED AND RESOLVED. THE CONFLICTS AND THEIR RESPECTIVE RESOLUTIONS ARE SHARED AT THE MERCY LEVEL WITH A TEAM INCLUDING MERCY'S CHIEF FINANCIAL OFFICER, CHIEF COMPLIANCE OFFICER AND OTHER MEMBERS OF FINANCE, LEGAL AND HR. SUMMARY RESULTS ARE REVIEWED WITH MERCY'S STEWARDSHIP COMMITTEE (FORMERLY FINANCE, AUDIT AND COMPLIANCE COMMITTEE) OF THE BOARD OF DIRECTORS. FORM 990, PART VI, QUESTIONS 15A & 15B OFFICERS & 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 OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMT 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 THE HOURS PER WEEK DISCLOSED IN PART VII IS THE AVERAGE HOURS THE LISTED PERSON WORKED OR DEVOTED PER WEEK WHILE EMPLOYED OR ASSOCIATED WITH THE FILING ORGANIZATION AND RELATED ORGANIZATIONS (IF APPLICABLE). FORM 990, PART XI, QUESTION 9 OTHER CHANGES IN NET ASSETS OR FUND BALANCE TRANSFER TO/FROM AFFILIATES- $810,001 FORM 990, PART XII, QUESTION 2C AUDIT OF FINANCIAL STATEMENTS THE FILING ORGANIZATION'S FINANCIAL STATEMENTS WERE INCLUDED IN MERCY HEALTH AND SUBSIDIARIES ANNUAL FINANCIAL STATEMENT AUDIT. MERCY HEALTH AND SUBSIDIARIES RECEIVED AN UNQUALIFIED OPINION FROM THE EXTERNAL AUDITORS FOR FISCAL 2013 (THE TAX YEAR CURRENTLY BEING REPORTED). HOWEVER, NO SEPARATE AUDIT OPINION WAS ISSUED ON THE FINANCIAL STATEMENTS OF THE FILING ORGANIZATION. THE ULTIMATE RESPONSIBILITY FOR OVERSIGHT OF THE FINANCIAL STATEMENT AUDIT AND SELECTION OF THE EXTERNAL AUDITOR LIES WITH THE STEWARDSHIP COMMITTEE (FORMERLY FINANCE, AUDIT, AND COMPLIANCE COMMITTEE) OF THE MERCY HEALTH BOARD OF DIRECTORS. AUDIT RESULTS ARE COMMUNICATED TO THIS COMMITTEE.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2012

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
MERCY HEALTH NORTHWEST ARKANSAS COMMUNITIES
 
Employer identification number

62-1684203
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" to Form 990, Part IV, line 33.)
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income


 		(e)
End-of-year assets


 		(f)
Direct controlling
entity










Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section


 		(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled entity?
Yes No
(1) Casa de Misericordia

1602 McClelland Street

Laredo,TX78044
74-2912461 		SHELTER TX 501(C)(3) 7 MM LAREDO
 
Yes
 
(2) Laredo Medical Group

14528 S Outer Forty Ste 100

Chesterfield,MO63017
74-2764726 		INACTIVE TX 501(C)(3) 9 MHS TEXAS
 
Yes
 
(3) McAuley Portfolio Management Company

14528 S Outer Forty Ste 100

Chesterfield,MO63017
26-1708048 		PORT MGMT MO 501(C)(3) 11b MERCY HEALTH
 
Yes
 
(4) Mercy Clinic East Communities

14528 S Outer Forty Ste 100

Chesterfield,MO63017
43-1771217 		PHYS GROUP MO 501(C)(3) 9 MH EAST COMM
 
Yes
 
(5) Mercy Clinic Fort Smith Communities

7301 Rogers Avenue

Fort Smith,AR72903
26-1318597 		PHYS CLINIC AR 501(C)(3) 9 MH FS COMM
 
Yes
 
(6) Mercy Clinic Hot Springs Communities

1 Mercy Lane

Hot Springs,AR71913
26-1125131 		PHYS CLINIC AR 501(C)(3) 9 MH HS COMM
 
Yes
 
(7) Mercy Clinic Oklahoma Communities Inc

4300 W Memorial Road

Oklahoma City,OK73120
27-0473057 		PHYS GROUP OK 501(C)(3) 9 MH OK COMM
 
Yes
 
(8) Mercy Clinic Springfield Communities

1965 Fremont Street Ste 2950

Springfield,MO65804
43-1560263 		PHYS GROUP MO 501(C)(3) 9 MH SF COMM
 
Yes
 
(9) Mercy Family Center

14528 S Outer Forty Ste 100

Chesterfield,MO63017
72-1069468 		COUNSELING MO 501(C)(3) 7 MERCY HEALTH
 
Yes
 
(10) Mercy Foundation for Health Innovation

14528 S Outer Forty Ste 100

Chesterfield,MO63017
20-0901499 		FOUNDATION MO 501(C)(3) 11b MERCY HEALTH
 
Yes
 
(11) Mercy Health

14528 S Outer Forty Ste 100

Chesterfield,MO63017
43-1423050 		CORP OFFICE MO 501(C)(3) 1 NA
 
 
No
(12) Mercy Health East Communities

14528 S Outer Forty Ste 100

Chesterfield,MO63017
43-1718408 		HLTH SYSTEM MO 501(C)(3) 11b MERCY HEALTH
 
Yes
 
(13) Mercy Health East Communities South Reg

14528 S Outer Forty Ste 100

Chesterfield,MO63017
46-1412322 		HLTH SYSTEM MO 501(C)(3) 11b MH EAST COMM
 
Yes
 
(14) Mercy Health Fort Smith Communities

7301 Rogers Avenue

Fort Smith,AR72917
26-1318515 		HOLDING CO AR 501(C)(3) 11b MERCY HEALTH
 
Yes
 
(15) Mercy Health Foundation Ardmore

1011 14th Avenue NW

Ardmore,OK73401
71-0962525 		FOUNDATION OK 501(C)(3) 11a MH ARDMORE
 
Yes
 
(16) Mercy Health Foundation Berryville

214 Carter Street

Berryville,AR72616
71-0759301 		FOUNDATION AR 501(C)(3) 11a MH BRYVILLE
 
Yes
 
(17) Mercy Health Foundation Fort Scott

401 Woodland Hills Blvd

Fort Scott,KS66701
48-1077073 		FOUNDATION KS 501(C)(3) 11c M KS COMM
 
Yes
 
(18) St Edward Mercy Foundation

7301 Rogers Avenue

Fort Smith,AR72917
23-7330425 		FOUNDATION AR 501(C)(3) 7 MH FT SMITH
 
Yes
 
(19) Mercy Health Foundation Hot Springs

300 Werner Street

Hot Springs,AR71913
71-0804718 		FOUNDATION AR 501(C)(3) 11b MH H SPRINGS
 
Yes
 
(20) Mercy Health Foundation Independence

800 W Myrtle

Independence,KS67301
48-1079981 		FOUNDATION KS 501(C)(3) 11a M KS COMM
 
Yes
 
(21) Mercy Health Foundation Jefferson

1400 US Highway 61 South

Festus,MO63028
46-2797051 		FOUNDATION MO 501(C)(3) 11b MH E COMM SR
 
Yes
 
(22) Mercy Health Foundation Joplin

2817 St Johns Blvd

Joplin,MO64804
27-0906136 		FOUNDATION MO 501(C)(3) 11a MH SWMK COMM
 
Yes
 
(23) Mercy Health Foundation NW Arkansas

2710 Rife Medical Lane

Rogers,AR72758
71-0601687 		FOUNDATION AR 501(C)(3) 11c MH ROGERS
 
Yes
 
(24) Mercy Health Foundation Oklahoma City

4300 W Memorial Road

Oklahoma City,OK73120
73-1593024 		FOUNDATION OK 501(C)(3) 11a MH OK CITY
 
Yes
 
(25) Mercy Health Foundation of Oklahoma

4300 W Memorial Road

Oklahoma City,OK73120
45-4732301 		FOUNDATION OK 501(C)(3) 11a MH OK COMM
 
Yes
 
(26) Mercy Health Foundation Springfield

1235 E Cherokee Street

Springfield,MO65804
32-0195818 		FOUNDATION MO 501(C)(3) 11b MH SF COMM
 
Yes
 
(27) Mercy Health Foundation St Louis

14528 S Outer Forty Ste 100

Chesterfield,MO63017
56-2410020 		FOUNDATION MO 501(C)(3) 11b MH EAST COMM
 
Yes
 
(28) Mercy Health Foundation Washington

901 E Fifth Street

Washington,MO63090
56-2410022 		FOUNDATION MO 501(C)(3) 11b MH EAST COMM
 
Yes
 
(29) Mercy Health Hot Springs Communities

300 Werner Street

Hot Springs,AR71913
26-1125064 		HOLDING CO AR 501(C)(3) 11b MERCY HEALTH
 
Yes
 
(30) Mercy Health Oklahoma Communities Inc

4300 W Memorial Road

Oklahoma City,OK73120
73-1453048 		HOLDING CO OK 501(C)(3) 11b MERCY HEALTH
 
Yes
 
(31) Mercy Health Southwest MOKS Communities

2817 St Johns Blvd

Joplin,MO64804
30-0584463 		HLTH SYSTEM MO 501(C)(3) 11b MERCY HEALTH
 
Yes
 
(32) Mercy Health Springfield Communities

1235 E Cherokee Street

Springfield,MO65804
43-1856028 		HLTH SYSTEM MO 501(C)(3) 11b MERCY HEALTH
 
Yes
 
(33) Mercy Health System of Texas Inc

14528 S Outer Forty Ste 100

Chesterfield,MO63017
74-2764727 		INACTIVE TX 501(C)(3) 11b MERCY HEALTH
 
Yes
 
(34) Mercy Home Health Berryville

804 W Freeman Suite 4

Berryville,AR72616
87-0781247 		HOME HEALTH AR 501(C)(3) 11c MH SF
 
Yes
 
(35) Mercy Hospital Ada Inc

430 N Monte Vista Street

Ada,OK74820
46-2288155 		HOSPITAL OK 501(C)(3) 3 MH OK COMM
 
Yes
 
(36) Mercy Hospital Ardmore Inc

1011 14th Avenue NW

Ardmore,OK73401
73-1500629 		HOSPITAL OK 501(C)(3) 3 MH OK COMM
 
Yes
 
(37) Mercy Hospital Aurora

500 Porter Avenue

Aurora,MO65605
43-1936696 		HOSPITAL MO 501(C)(3) 3 MH SF COMM
 
Yes
 
(38) Mercy Hospital Berryville

214 Carter Street

Berryville,AR72616
71-0759299 		HOSPITAL AR 501(C)(3) 3 MH SF COMM
 
Yes
 
(39) Mercy Hospital Carthage

3125 Dr Russell Smith Way

Carthage,MO64836
45-3808607 		HOSPITAL MO 501(C)(3) 3 MH SWMK COMM
 
Yes
 
(40) Mercy Hospital Cassville

94 Main Street

Cassville,MO65625
43-1936699 		HOSPITAL MO 501(C)(3) 3 MH SF COMM
 
Yes
 
(41) Mercy Hospital Columbus

220 Pennsylvania Avenue

Columbus,KS66725
27-0842031 		HOSPITAL MO 501(C)(3) 3 MH SWMK COMM
 
Yes
 
(42) Mercy Hospital El Reno Inc

2115 Parkview Drive

El Reno,OK73036
27-2716065 		HOSPITAL OK 501(C)(3) 3 MH OK COMM
 
Yes
 
(43) Mercy Hospital Fort Smith

7301 Rogers Avenue

Fort Smith,AR72917
71-0240352 		HOSPITAL AR 501(C)(3) 3 MH FS COMM
 
Yes
 
(44) Mercy Hospital Healdton Inc

918 South 8th Street

Healdton,OK73438
26-3173902 		HOSPITAL OK 501(C)(3) 3 MH ARDMORE
 
Yes
 
(45) Mercy Hospital Hot Springs

300 Werner Street

Hot Springs,AR71913
71-0236913 		HOSPITAL AR 501(C)(3) 3 MH HS COMM
 
Yes
 
(46) Mercy Hospital Jefferson

1400 Highway 61 South

Festus,MO63028
43-0687077 		HOSPITAL MO 501(C)(3) 3 MH E COMM SR
 
Yes
 
(47) Mercy Hospital Joplin

2817 St Johns Blvd

Joplin,MO64804
27-0814858 		HOSPITAL MO 501(C)(3) 3 MH SWMK COMM
 
Yes
 
(48) Mercy Hospital Lebanon

100 Hospital Drive

Lebanon,MO65536
43-1767432 		HOSPITAL MO 501(C)(3) 3 MH SF COMM
 
Yes
 
(49) Mercy Hospital Logan County Inc

200 South Academy

Guthrie,OK73044
45-2998842 		HOSPITAL OK 501(C)(3) 3 MH OK COMM
 
Yes
 
(50) Mercy Hospital of Laredo

14528 S Outer Forty Ste 100

Chesterfield,MO63017
74-1189682 		INACTIVE TX 501(C)(3) 3 MHS TEXAS
 
Yes
 
(51) Mercy Hospital Oklahoma City Inc

4300 W Memorial Road

Oklahoma City,OK73120
73-0579285 		HOSPITAL OK 501(C)(3) 3 MH OK COMM
 
Yes
 
(52) Mercy Hospital Ozark

801 W River Street

Ozark,AR72949
71-0689680 		HOSPITAL AR 501(C)(3) 3 MH FT SMITH
 
Yes
 
(53) Mercy Hospital Paris

500 E Academy

Paris,AR72855
71-0655753 		HOSPITAL AR 501(C)(3) 3 MH FT SMITH
 
Yes
 
(54) Mercy Hospital Rogers

2710 Rife Medical Lane

Rogers,AR72758
71-0294390 		HOSPITAL AR 501(C)(3) 3 MH NWAR COMM
 
Yes
 
(55) Mercy Hospital Springfield

1235 E Cherokee Street

Springfield,MO65804
44-0552485 		HOSPITAL MO 501(C)(3) 3 MH SF COMM
 
Yes
 
(56) Mercy Hospital Tishomingo Inc

1000 South Byrd

Tishomingo,OK73460
27-4433830 		HOSPITAL OK 501(C)(3) 3 MH ARDMORE
 
Yes
 
(57) Mercy Hospital Waldron

1341 W 6th Street

Waldron,AR72958
71-0557895 		HOSPITAL AR 501(C)(3) 3 MH FT SMITH
 
Yes
 
(58) Mercy Hospital Watonga Inc

500 Clarence Nash Blvd

Watonga,OK73772
45-5199762 		HOSPITAL OK 501(C)(3) 3 MH OK COMM
 
Yes
 
(59) Mercy Hospitals East Communities

14528 S Outer Forty Ste 100

Chesterfield,MO63017
43-0653493 		HOSPITAL MO 501(C)(3) 3 MH EAST COMM
 
Yes
 
(60) Mercy Kansas Communities Inc

401 Woodland Hills Blvd

Ft Scott,KS66701
48-0956045 		HOSPITAL KS 501(C)(3) 3 MH SWMK COMM
 
Yes
 
(61) Mercy Medical Research Institute

1235 E Cherokee Street

Springfield,MO65804
87-0796305 		RESEARCH MO 501(C)(3) 4 MH SF COMM
 
Yes
 
(62) Mercy Ministries of Laredo

2500 Zacatecas

Laredo,TX78046
20-0198462 		OUTREACH TX 501(C)(3) 7 MERCY HEALTH
 
Yes
 
(63) Mercy St Francis Hospital

100 W Highway 60

Mountain View,MO65548
44-0607149 		HOSPITAL MO 501(C)(3) 3 MH SF COMM
 
Yes
 
(64) Mercy Support Services

14528 S Outer Forty Ste 100

Chesterfield,MO63017
43-1677952 		INACTIVE MO 501(C)(3) 11c MH EAST COMM
 
Yes
 
(65) MHM Support Services

14528 S Outer Forty Ste 100

Chesterfield,MO63017
20-2553101 		HLTH SYSTEM MO 501(C)(3) 11b MERCY HEALTH
 
Yes
 
(66) Mission Clinical Services

300 Werner Street

Hot Springs,AR71913
13-4239691 		NURSING HOME AR 501(C)(3) 9 MH HS COMM
 
Yes
 
(67) St John's Children's Hospital Inc

1235 E Cherokee Street

Springfield,MO65804
 INACTIVE MO 501(C)(3) 3 MH SF COMM
 
Yes
 
(68) St Mary's Hospital of Enid Oklahoma

14528 S Outer Forty Ste 100

Chesterfield,MO63017
73-0614655 		INACTIVE OK 501(C)(3) 3 MH OK COMM
 
Yes
 
(69) The Sister M Cornelia Blasko Foundation

100 W Highway 60

Mountain View,MO65548
43-1873914 		FOUNDATION MO 501(C)(3) 11a M ST FRANCIS
 
Yes
 
(70) Unity Ambulatory Care

14528 S Outer Forty Ste 100

Chesterfield,MO63017
43-1861745 		INACTIVE MO 501(C)(3) 11c MH EAST COMM
 
Yes
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) Merc Ambu Surg CTR

7301 Rogers Av
Fort Smith,AR72903
71-0827721 		AMBUL SURG CTR AR NA
  		                 
(2) RES OPT & INNOV

645 Maryville Centre Dr 200
St Louis,MO63141
46-0468368 		CENTRAL DIST. MO NA
  		                 
(3) SO OK DIAG CTR

1011 14TH Ave NW
Ardmore,OK73401
43-1971232 		MRI Services OK NA
  		                 
(4) Fort Smith EMS

1701 S Greenwood
Fort Smith,AR72901
71-0416615 		Emergency Med AR NA
  		                 
(5) St Ed Mer Med MOB

7301 Rogers Ave
Fort Smith,AR72903
71-0554050 		Office Building AR NA
  		                 




Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of
related organization
 		(b)
Primary activity
 		(c)
Legal
domicile
(state or foreign
country)
 		(d)
Direct controlling
entity
 		(e)
Type of entity
(C corp, S corp,
or trust) 		(f)
Share of total income
 		(g)
Share of end-of-year
assets
 		(h)
Percentage
ownership
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) Frontenac Properties Inc

14528 S Outer Forty Suite 100
Chesterfield,MO63017
52-1914421 		HOLDING COMP DE NA
  		C-Corp       Yes  
(2) Inveno Health Inc

1235 E Cherokee Street
Springfield,MO65804
26-4509571 		RESEARCH MO NA
  		C-Corp       Yes  
(3) Mercy Community Services Inc

401 Woodland Hills Blvd
Fort Scott,KS66701
48-1078101 		RETAIL PHARMACY KS NA
  		C-Corp       Yes  
(4) Mercy Health Center Condominium Inc

4300 W Memorial Rd
Oklahoma City,OK73120
68-0640970 		REAL ESTATE OK NA
  		C-Corp       Yes  
(5) Mercy Health Network of the Southern Reg

1011 14th Avenue NW
Ardmore,OK73401
73-1580607 		HEALTH CARE OK NA
  		C-Corp       Yes  
(6) Mercy Health Network Inc

4300 W Memorial Road
Oklahoma City,OK73120
73-1381689 		HEALTH CARE OK NA
  		C-Corp       Yes  
(7) Mercy Managed Care Corporation

4300 W Memorial Road
Oklahoma City,OK73120
73-1441665 		HOLDING COMP OK NA
  		C-Corp       Yes  
(8) UH L Corp Inc

645 Maryville Centre Drive Suite 1
St Louis,MO63141
74-2499535 		HOLDING COMP MO NA
  		C-Corp       Yes  
(9) Unity Support Services Inc

645 Maryville Centre Drive Suite 1
St Louis,MO63141
43-1797042 		PRACTICE MGT MO NA
  		C-Corp       Yes  
(10) Jefferson Land Company Inc

14528 South Outer Forty Suite 100
Chesterfield,MO63017
43-1330360 		HOLDING COMP MO NA
  		C-Corp       Yes  
(11) The Apothecary Services Inc

PO Box 350
Crystal City,MO63019
43-1627267 		RETAIL PHARMACY MO NA
  		C-Corp       Yes  
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34, 35b, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
 
No
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
 
No
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) Mercy Clinic Springfield Communities

 p 171,474 FMV
(2) Mercy Health East Communities

 p 92,351 FMV
(3) Mercy Health Springfield Communities

 p 83,523 FMV
(4) Mercy Hospital Joplin

 p 97,071 FMV
(5) Mercy Hospital Logan County Inc

 p 64,150 FMV
(6) Mercy Hospital Rogers

 p 288,354 FMV
(7) Mercy Hospital Rogers

 q 18,933,625 FMV
(8) MHM Support Services

 p 29,629,527 FMV
(9) Resource Optimization & Innovation LLC

 p 372,597 FMV
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income (related, unrelated, excluded from tax under section 512-514)

(e)
Are all partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V—UBI
amount in box 20
of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation
FORM 990, SCHEDULE R, PART VI SUPPLEMENTAL INFORMATION FOR SCHEDULE R LAWSON 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 P AND Q.

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