TY 2015 Form 990

(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)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) Ammons Carl E Eric...................................................................... President, Mercy Hospital Jefferson & Board member	54.50 ................. 5.50	X				562,345	0	211,670
(2) Breeze Tonda...................................................................... Board member	0.50 ................. 0.50	X				0	0	0
(3) Carron RSM Sr Judith Ann...................................................................... Board member	1.00 ................. 1.00	X				0	0	0
(4) Enger MD Kevin...................................................................... Board member	0.50 ................. 0.00	X				0	0	0
(5) Gannon Dennis...................................................................... Board member	0.50 ................. 0.50	X				0	0	0
(6) Kennen E William...................................................................... Physician & board member	40.00 ................. 0.00	X				567,293	0	24,167
(7) King BA M Div Rev Jack...................................................................... Board member	0.50 ................. 0.50	X				0	0	0
(8) Patel MD Ash...................................................................... Board member	4.00 ................. 0.50	X				0	36,000	0
(9) Rehm MD Charles...................................................................... Chief Admin Officer & Board member	4.00 ................. 56.00	X				0	717,088	48,718
(10) Hannasch Susan...................................................................... Regional VP-General Counsel	10.00 ................. 50.00		X			0	373,926	58,299
(11) Matejka Cheryl L...................................................................... Chief Financial Officer	10.00 ................. 47.00		X			0	552,339	82,953
(12) Sorensen Donn...................................................................... President-East Communities	5.00 ................. 59.00		X			0	1,021,817	325,703
(13) Bryson Jared...................................................................... VP Mission	29.00 ................. 31.00			X		210,730	0	24,340
(14) Eckenfels Daniel...................................................................... VP Finance	58.50 ................. 1.50			X		281,402	0	26,135
(15) Julien Sheila...................................................................... CNO	40.00 ................. 0.00			X		219,573	0	19,842
(16) Meyer Michele...................................................................... VP Operations	60.00 ................. 0.00			X		282,476	0	26,840
(17) Al Furgani Mahmud M...................................................................... Physician	54.00 ................. 6.00				X	731,132	0	27,944

(A) Name and business address	(B) Description of services	(C) Compensation
McCarthy Building Co 1341 North Rock Hill Road St Louis,MO63124	Construction	5,261,753
Bates and Associates 433 W Walnut Springfield,MO65806	Architectural Services	4,423,273
Acuity Anesthesiology LLC 1734 Clarkson Road Suite 147 Chesterfield,MO63017	Anesthesia Services	3,608,744
Rehabcare Group Inc 7733 Forsyth Blvd Ste 1700 St Louis,MO63105	IP Acute Rehab and OP Rehab Services	3,002,350
Northstar Management Company LLC 10820 Sunset Office Drive Suite 20 St Louis,MO63127	Project Management Services	440,363
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 34

- TIN:

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

Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

Mercy Hospital Jefferson

Employer identification number

43-0687077

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.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ))

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross 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.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 11a through 11d that describes the type of supporting organization and complete lines 11e, 11f, and 11g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ..............

Provide the following information about the supported organization(s).

(i)Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i)Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2015

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)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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 VI.)..
11	Total support. Add lines 7 through 10.

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2014 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2015. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2014. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2015. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the facts-and-circumstances test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2014. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

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) 2015

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)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513...
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2014 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2015 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2014 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2015. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2014. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2015

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2015

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2015

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2015

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2015 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2015	(iii) Distributable Amount for 2015
1 Distributable amount for 2015 from Section C, line 6
2 Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions)
3 Excess distributions carryover, if any, to 2015:
a
b
c
d From 2013.......
e From 2014.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2015 distributable amount
i Carryover from 2010 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2015 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2015 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions)
6 Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2016. Add lines 3j and 4c.
8 Breakdown of line 7:
a
b
c Excess from 2013.......
d From 2014.......
e From 2015.......

Schedule A (Form 990 or 990-EZ) (2015)

Schedule A (Form 990 or 990-EZ) 2015

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Name of the organization

Mercy Hospital Jefferson

Employer identification number

43-0687077

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015) Page 2

Name of organization Mercy Hospital Jefferson

Part I	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 3

Name of organization Mercy Hospital Jefferson		Employer identification number 43-0687077

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 4


Name of organization Mercy Hospital Jefferson			Employer identification number 43-0687077
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

Mercy Hospital Jefferson

Employer identification number

43-0687077

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures ...................................................................................................................... SchCMd Bullet

Volunteer hours .............................................................................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2015

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ...............................................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ...........................................
c	Total lobbying expenditures (add lines 1a and 1b) .......................................................................
d	Other exempt purpose expenditures .........................................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ....................................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) ..........................................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ..........................................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ...........................................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ..............................................................................................................	Yes No

4-Year Averaging Period Under section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2012	(b) 2013	(c) 2014	(d) 2015	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2015

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Yes

24,240

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Total. Add lines 1c through 1i ....................................................................................................

24,240

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures (see instructions) .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
Part II-B, Line 1:	The filing organization is a member of and pays dues to the following hospital associations: Catholic Hospital Association, American Hospital Association and the Missouri Hospital Association. For the year ended June 30, 2016, dues were $18,362, $15,553, and $56,192, respectively. Approximately 3.11% of the Catholic Hospital Association dues, 22.12% of the American Hospital Association dues, and 36.00% of Missouri Hospital Association dues were attributable to lobbying activities performed by this association.

Return Reference

Explanation

Part II-B, Line 1:

The filing organization is a member of and pays dues to the following hospital associations: Catholic Hospital Association, American Hospital Association and the Missouri Hospital Association. For the year ended June 30, 2016, dues were $18,362, $15,553, and $56,192, respectively. Approximately 3.11% of the Catholic Hospital Association dues, 22.12% of the American Hospital Association dues, and 36.00% of Missouri Hospital Association dues were attributable to lobbying activities performed by this association.

Schedule C (Form 990 or 990EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on 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.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

Mercy Hospital Jefferson

Employer identification number

43-0687077

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

			(a) Donor advised funds	(b) Funds and other accounts

1	Total number at end of year ....
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ....

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? ...........

Yes No

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? ............................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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.


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

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

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)? .............................

Yes No

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" on Form 990, Part IV, line 8.

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.

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)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

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:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

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) 2015

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

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):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

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?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


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

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?

Yes No

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" on Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	(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 ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations .................

3a(i)

(ii) related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11a. 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 ...	3,509,000		3,509,000
b	Buildings	43,627,143	6,192,154	37,434,989
c	Leasehold improvements	10,317	860	9,457
d	Equipment ...	41,576,254	16,511,489	25,064,765
e	Other ...	29,294,529	690,614	28,603,915
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				94,622,126

Schedule D (Form 990) 2015

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11b. 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
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
Other Liabilities	403,313
DUE TO AFFILIATES	322,333
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	725,646
2. Liability for uncertain tax positions. 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) 2015

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
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 (losses) 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. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
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

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.

Return Reference

Explanation

Part X, Line 2

FEDERAL INCOME TAX PRIMARILY ALL OF THE MERCY HEALTH ENTITIES ARE RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(A) OF THE INTERNAL REVENUE CODE AS CHARITABLE ORGANIZATIONS QUALIFYING UNDER INTERNAL REVENUE CODE SECTION 501(C)(3), BY VIRTUE OF IRS DETERMINATION LETTERS OR INCLUSION IN THE OFFICIAL CATHOLIC DIRECTORY. MERCY COMPLETED AN ANALYSIS OF ITS TAX POSITIONS IN ACCORDANCE WITH APPLICABLE ACCOUNTING GUIDANCE AND DETERMINED THAT NO AMOUNTS WERE REQUIRED TO BE RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS AT JUNE 30, 2016 OR 2015.

Schedule D (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

Mercy Hospital Jefferson

Employer identification number

43-0687077

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	6,054,550		6,054,550	4.130 %
b	Medicaid (from Worksheet 3, column a) . . . . .	18,304,091	17,498,465	805,626	0.550 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	24,358,641	17,498,465	6,860,176	4.680 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	290,460	27,860	262,600	0.180 %
f	Health professions education (from Worksheet 5) . . .	306,060		306,060	0.210 %
g	Subsidized health services (from Worksheet 6) . . . .	2,844,789	2,668,892	175,897	0.120 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	15,087	4,081	11,006	0.010 %
j	Total. Other Benefits . .	3,456,396	2,700,833	755,563	0.520 %
k	Total. Add lines 7d and 7j .	27,815,037	20,199,298	7,615,739	5.200 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2015

Schedule H (Form 990) 2015

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development	6,045	338	5,707	0 %
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development	7,192		7,192	0 %
9	Other	55,232	15,323	39,909	0.030 %
10	Total	68,469	15,661	52,808	0.030 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

805,626

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

56,809,578

Enter Medicare allowable costs of care relating to payments on line 5.....

66,959,739

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-10,150,161

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2015

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?1 Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	Mercy Hospital Jefferson PO Box 350 Crystal City,MO63019 www.mercy.net/crystalcitymo 529-2	X

Schedule H (Form 990) 2015

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	Mercy Hospital Jefferson
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 15

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): www.mercy.net/about/community/benefits

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 15

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): www.mercy.net/about/community-benefits

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2015

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	Mercy Hospital Jefferson
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 100.000000000000% and FPG family income limit for eligibility for discounted care of 400.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Included measures to publicize the policy within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

www.mercy.net

The FAP application form was widely available on a website (list url):

www.mercy.net

A plain language summary of the FAP was widely available on a website (list url):
www.mercy.net

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notice of availability of the FAP was conspicuously displayed throughout the hospital facility

Notified members of the community who are most likely to require financial assistance about availability of the FAP

Other (describe in Section C)

Billing and Collections

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon non-payment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2015

Page 6

Part VFacility Information (continued)

	Mercy Hospital Jefferson
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that
can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Section C)

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2015

Page 7

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
Mercy Hospital Jefferson	Part V, Section B, Line 5: When conducting its most recent CHNA and developing the Community Health Improvement Plan (CHIP), Mercy Hospital Jefferson worked with the Jefferson County Health Department (JCHD) as a primary community partner. JCHD utilizes the Mobilizing Action through Planning and Partnerships (MAPP) model, bringing agencies across Jefferson County together in a collaborative process. MHJ is currently engaged in the MAPP process through the Jefferson County Community Health Network (JCCHN). Below are a few examples of JCCHN agencies with coworkers who have special knowledge and expertise in the field of public health:- Jefferson County Health Department (JCHD): (Kelley Vollmar, Director of JCHD; Chrissy Oberle, Health Education Supervisor)- Community Treatment (COMTREA): (Dr. Nathan Suter, Dentist and Oral Health Director; Margo Pigg, Executive Vice President of Adult Behavioral Health)- Jefferson Franklin Community Action: (Paulette Hensley, Chief Program Officer) Additionally, a Mercy Hospital Jefferson Community Outreach Coordinator focuses on identifying unmet needs and gaps in services, making connections and referrals, developing partnerships, improving community health, and advocating for the most vulnerable. Partnering task forces with agency coworkers who have special knowledge and expertise in the field of public health include: - Methamphetamine Action Coalition (Cassie Miller, Tobacco Control Coordinator for JCHD; Kristen Bengston, Manager of Community Strategy for NCADA; Jillian Bissell, Project Coordinator for Jefferson County Drug Prevention Coalition (JCDPC))- Smoke Free Jefferson County (Adam Hunn, Health educator for JCDH; Linda Hardgrave, Program Coordinator Jefferson County Drug Prevention Coalition (JCDPC))In order to better understand the broad interests of the community, a Mercy Community Health Qualtrics (a top data collection software application) survey (available in both hard-copy and on-line format) was designed to assess the perceptions and thoughts of community members about the health needs of their community (Appendix F). A total of 84 individuals completed the survey over a 15-month time frame (from the fall of 2014 to the end of 2015). A significant effort was made to bring hard-copy surveys to local food pantries in order to include the voices of populations less likely to access the survey via the internet. A total of 39 survey responses were received as a result of direct distribution in areas with high populations of underserved, low-income individuals. Additionally, in collaboration with MHJ, a community health survey was created by Victory Health Ministry, the health and wellness arm of Victory Church (Appendix G). The survey was distributed to the church's parishioners, and a total of 154 responses were collected and reviewed.
Mercy Hospital Jefferson	Part V, Section B, Line 11: Based on the findings of its most recently conducted CHNA, Mercy Hospital Jefferson has chosen to address the following three significant health needs identified in Jefferson County: - Access to care- Mental health- Substance useThese needs are being addressed in the hospital's Community Health Improvement Plan (CHIP), which can be accessed here: https://www.mercy.net/sites/default/files/vendor-resources/mhj_chip_161003.pdf. Additional needs being addressed by the hospital include: - Violence: Domestic, Elderly, Child Abuse, and TraffickingMercy will continue its collaboration and involvement with A Safe Place, a local domestic violence shelter, as well as the awareness and education campaigns it has begun with restroom resource posters, a training video, and the incorporation of a screening question/referral process in Mercy's Electronic Medical Record (EMR). MHSL and Alternatives to Living in Violent Environments (ALIVE), a St. Louis based domestic violence agency, have implemented Project HOPE, the only program in the St. Louis area that allows domestic violence survivors to file for, and potentially have granted, orders of protection while still in a hospital setting. Inpatient care management is currently looking into expanding this resource to MHJ.- Cancer: Lung/Tobacco UseEfforts to address tobacco cessation will continue through Mercy's Certified Health and Wellness Coach/Mercy Road to Freedom program though Mercy's Cardiopulmonary Rehab area. Additionally, Mercy will continue to advocate around measures that promote tobacco cessation. For example, Tobacco 21, a bill introduced by a MHSL physician in 2016 to raise the tobacco products purchase age to 21 in St. Louis County, was recently passed and will go into effect on December 1, 2016. MHJ will look for opportunities to collaborate with MHSL and potentially expand legislation to Jefferson County. - Obesity/Poor Nutrition/Physical InactivityAlthough MHJ did not choose healthy lifestyles as a priority community health need to be addressed, Mercy has focused on its own coworkers, 10,000+ in the St Louis region, as a start to addressing this need. A robust initiative, Mercy's Healthification program, provides comprehensive health evaluation, screening, education, and incentives to increase healthy behaviors and improve health among Mercy coworkers. - Chronic Conditions: Heart Disease, Diabetes, or Asthma and AllergiesMHJ continues to provide education and support to those patients and community members with chronic conditions. In addition to having a Deaconess Faith Community Nurse and Mercy home health team, who provide patients with chronic disease management and education, a specialized congestive heart failure clinic was just established within the cardiology clinic in Jefferson. Clinic operations are also currently partnering with Novo Nordisk to provide Diabetic Academy, a 6 week free course focused on diabetes management. The following need is not being addressed by the hospital:- Environmental: Air/Water Quality MHJ will continue its partnership with the Jefferson County Health Department (JCHD) and will collaborate with any environmental initiatives they develop.However, it was felt by Mercy's Community Health Council (CHC) that while continued attention to this issue was important, Mercy's focus remains on providing quality healthcare. Therefore, the issues of access, and the community's crisis with behavioral health and addiction demanded Mercy's focus at this time.
Mercy Hospital Jefferson	Part V, Section B, Line 22d: ELIGIBILITY GUIDELINES FOR CHARITY CARE DISCOUNTS THE FEDERAL POVERTY GUIDELINES FOR INCOME ARE THE BASIS FOR DETERMINING ELIGIBILITY FOR CHARITY CARE DISCOUNTS. FOR EXAMPLE, INDIVIDUALS WITH INCOMES BELOW 100% OF THE FEDERAL POVERTY GUIDELINES WILL BE ELIGIBLE FOR FREE CARE. INDIVIDUALS WITH INCOMES GREATER THAN 100% OF THE FEDERAL POVERTY GUIDELINES MAY BE ELIGIBLE FOR CARE AT DISCOUNTED RATES DEPENDING ON THEIR INCOME LEVEL AND/OR THE AMOUNT DUE TO THE HOSPITAL. TO DETERMINE THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE, THE HOSPITAL FACILITY USES AMOUNTS GENERALLY BILLED TO INDIVIDUALS WHO HAVE INSURANCE COVERING SUCH CARE. THE HOSPITAL USES A LOOK BACK METHOD THAT CONSIDERS DISCOUNTS ALLOWED TO MEDICARE AND ALL PRIVATE HEALTH INSURERS.ADDITIONAL FINANCIAL ASSISTANCE AFTER APPROPRIATE DISCOUNTS HAVE BEEN APPLIED, ARRANGEMENTS MAY BE MADE FOR AN INTEREST-FREE MONTHLY PAYMENT PLAN. GENERALLY, NO PATIENT'S FINANCIAL RESPONSIBILITY WILL BE GREATER THAN 20% OF ANNUAL HOUSEHOLD INCOME. IT IS OUR GOAL TO WORK WITH OUR PATIENTS ON THEIR REMAINING LIABILITY.

Schedule H (Form 990) 2015

Page 8

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?8
Name and address		Type of Facility (describe)
1	1 - Mercy Home Health-Jefferson 5 Industrial Drive Festus,MO62028	Hospital based outpatient depts: Home care services
2	2 - Mercy Hospice-Jefferson 5 Industrial Drive Festus,MO62028	Hospital based outpatient depts: Hospice services
3	3 - Mercy Imaging Services-Calvary Church Ro 1500 Calvary Church Rd Festus,MO62028	Hospital based outpatient depts: Lab & Imaging
4	4 - Mercy Surgery Center-Jefferson 1377 Highway 61 South Festus,MO62028	Hospital based outpatient depts: Surgery
5	5 - Mercy Home Health-Farmington 620 Maple Valley Dr Ste A Farmington,MO63640	Hospital based outpatient depts: Home health
6	6 - Mercy Hospice-Farmington 620 Maple Valley Dr Ste A Farmington,MO63640	Hospital based outpatient depts: Hospice services
7	7 - Mercy Therapy Services-Imperial 1250 Main Street Imperial,MO63012	Hospital based outpatient depts: physical therapy
8	8 - Mercy Therapy Services 702 N Main St DeSoto,MO63020	Hospital based outpatient depts: physical therapy
9
10

Schedule H (Form 990) 2015

Page 9

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
Part I, Line 7g:	SUBSIDIZED HEALTH SERVICESTHE ORGANIZATION DID NOT INCLUDE ANY PHYSICIAN CLINIC COSTS ON LINE 7G.
Part I, Ln 7 Col(f):	TOTAL EXPENSES FROM FORM 990, PART IX, LINE 25, COLUMN (A) ARE $159,896,597. INCLUDED IN THIS AMOUNT WAS BAD DEBT EXPENSE (CHARGES) OF $9,858,149. EXPENSES FOR THE PURPOSE OF CALCULATING LINE 7, COLUMN (F) ARE $805,626.
PART I, LINE 6A	COMMUNITY BENEFIT REPORTTHE ORGANIZATION'S COMMUNITY BENEFIT REPORT IS PREPARED BY ITS ULTIMATE PARENT ENTITY, MERCY HEALTH (EIN: 43-1423050).
Part II, Community Building Activities:	MERCY HOSPITAL JEFFERSON'S (MHJ) COMMUNITY BUILDING ACTIVITIES PROMOTE THE HEALTH, WELLNESS, AND SAFETY OF THE COMMUNITY IT SERVES. THROUGH ACTIVE PARTICIPATION ON COMMUNITY BOARDS, NEIGHBORHOOD/COMMUNITY COALITIONS, AND INVOLVEMENT IN COMMUNITY-BASED EVENTS, MERCY BUILDS PARTNERSHIPS TO DEVELOP COLLABORATIVE SOLUTIONS TO ADDRESS COMMUNITY NEEDS. SOME OF THESE COMMUNITY BUILDING PARTNERSHIPS AND COMMUNITY ENGAGEMENT ACTIVITIES INCLUDE: - JEFFERSON COUNTY HEALTH DEPARTMENT- JEFFERSON COUNTY GROWTH ASSOCIATION- JEFFERSON COLLEGE BOARD- PARTICIPATION IN THE DESOTO, HILLSBORO, TWIN CITY AREA, AND STE. GENEVIEVE CHAMBERS OF COMMERCE ACTIVITIES- KIWANIS CLUB- YMCA BOARD- COMTREA (COMMUNITY TREATMENT, INC.)IN ADDITION, MHJ ACTIVELY PARTICIPATES IN SEVERAL COALITIONS THAT ALIGN WITH THE HOSPITAL'S CHNA TOP HEALTH PRIORITY OF SUBSTANCE ABUSE, INCLUDING:- JEFFERSON COUNTY DRUG PREVENTION COALITION- JEFFERSON COUNTY METHAMPHETAMINE ACTION COALITION- SMOKE FREE JEFFERSON COUNTY. EXAMPLES OF ONGOING PROJECTS LED BY THE COALITIONS LISTED ABOVE INCLUDE:- CLEARING THE AIR, A MULTI-MEDIA CONTEST FOR YOUTH TO ADDRESS THE HARM OF SMOKING- SUBSTANCE ABUSE AWARENESS DAY, A ONE DAY ANNUAL CONFERENCE THAT FOCUSES ON DRUG USE TRENDS IN THE JEFFERSON COUNTY COMMUNITY, THE EFFECTS OF SUBSTANCE ABUSE ON THE INDIVIDUAL AND THE COMMUNITY AND THE CONNECTION BETWEEN SUBSTANCE ABUSE AND MENTAL HEALTH. EFFORTS WITH THESE COALITIONS WILL CONTINUE AS MHJ DETERMINED SUBSTANCE ABUSE TO BE A TOP HEALTH PRIORITY THROUGH THE 2016-2019 CHNA CYCLE. CASH/IN-KIND DONATIONSMERCY PROVIDES CASH AND IN-KIND DONATIONS THROUGH THE SUPPORT OF CO-WORKER ENGAGEMENT AND COMMUNITY SERVICE ACTIVITIES. THESE COMMUNITY BUILDING ACTIVITIES ALLOW MERCY CO-WORKERS TO LOOK BEYOND THE WALLS OF THE FACILITIES IN WHICH THEY SERVE TO BETTER UNDERSTAND AND ADDRESS THE NEEDS OF THE COMMUNITY.DURING FY16, CASH DONATIONS WERE GIVEN TO ORGANIZATIONS THROUGHOUT THE COMMUNITY THAT INCLUDED:- JEFFERSON COUNTY YMCA- ST. PIUS X CATHOLIC HIGH SCHOOL- JEFFERSON COLLEGE- FOX C-6 SCHOOL DISTRICT- PONY BIRDA FULL DESCRIPTION OF OUR COMMUNITY BUILDING ACTIVITIES CAN BE FOUND AT WWW.MERCY.NET/ABOUT/COMMUNITYBENEFITS.
Part III, Line 2:	TO DETERMINE THE AMOUNT OF BAD DEBT EXPENSE, AT COST, BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENT ACCOUNTS WAS MULTIPLIED BY A RATIO OF COST TO CHARGES. THE RATIO OF COST TO CHARGES USED WAS BASED ON DETAILED COST ACCOUNT, WHERE AVAILABLE. WHERE COST ACCOUNTING IS NOT AVAILABLE, COST REPORT COST TO CHARGE RATIOS WERE UTILIZED.
Part III, Line 3:	THE FILING ORGANIZATION DETERMINED THAT THE ESTIMATED AMOUNT OF BAD DEBT EXPENSE (AT COST) ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS $0. ALTHOUGH THE CHARITY CARE POLICY REQUIRES THE PARTICIPATION OF THE PATIENT REQUESTING ASSISTANCE, WE HAVE A PROCESS UNDER PRESUMPTIVE CHARITY TO ADDRESS ACCOUNTS FOR PATIENTS WHO DO NOT PROVIDE THE INFORMATION. WE BELIEVE THAT OUR CHARITY POLICY IS COMPREHENSIVE ENOUGH TO CAPTURE ALMOST ALL PATIENTS WHO QUALIFY FOR CHARITY CARE.
Part III, Line 4:	THE TEXT OF THE FOOTNOTE THAT IS INCLUDED IN MERCY HEALTH AND SUBSIDIARIES AUDITED FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE IS AS FOLLOWS: "PATIENT ACCOUNTS THAT ARE UNCOLLECTED, INCLUDING THOSE PLACED WITH COLLECTION AGENCIES, ARE INITIALLY CHARGED AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IN ACCORDANCE WITH COLLECTIONS POLICIES OF THE HEALTH SYSTEM AND, IN CERTAIN CASES, ARE RECLASSIFIED TO CHARITY CARE IF DEEMED TO OTHERWISE MEET THE HEALTH SYSTEM'S CHARITY CARE POLICY. THE PROVISION FOR UNCOLLECTIBLE RECEIVABLES IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. PERIODICALLY THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES BASED UPON THE PAYOR COMPOSITION AND AGING OF RECEIVABLES AS OF THE REPORTING DATE WITH CONSIDERATION OF THE HISTORICAL PAYMENT AND WRITE-OFF EXPERIENCE BY PAYOR CATEGORY. THE RESULTS OF THESE REVIEWS ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR UNCOLLECTIBLE RECEIVABLES TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES. AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE, THE HEALTH SYSTEM FOLLOWS ESTABLISHED GUIDELINES FOR PLACING PAST-DUE PATIENT BALANCES WITH COLLECTION AGENCIES."
Part III, Line 8:	IT IS THE POSITION OF MERCY HOSPITAL JEFFERSON THAT 100% OF ANY SHORT FALL SHOULD BE TREATED AS COMMUNITY BENEFIT. THIS AMOUNT REPRESENTS COST OF PROVIDING SERVICES THAT REMAIN UNCOMPENSATED TO THE PROVIDER. THE UNREIMBURSED COSTS OF MEDICARE IS CALCULATED BY THE GROSS CHARGES NET OF THE COST TO CHARGE RATIO LESS ANY PAYMENTS, DEDUCTIONS OR REIMBURSEMENTS USING THE ANNUAL MEDICARE COST REPORT (CMS FORM 2552-96).
Part III, Line 9b:	MERCY'S COLLECTION POLICY PROVIDES THAT MERCY WILL PERFORM A REASONABLE COMMUNICATION AND/OR REVIEW OF PATIENT ACCOUNTS AS IT RELATES TO ANY SERVICE PROVIDED AT OUR FACILITIES BEFORE TURNING THE ACCOUNT TO BAD DEBT OR TAKING LEGAL ACTION FOR NONPAYMENT. MERCY ACTIVELY SCRUBS ACCOUNTS FOR PAYOR PLAN COVERAGE'S; INCLUDING MEDICAID. IN THE EVENT AN ACCOUNT IS TURNED TO COLLECTIONS, AND IS IDENTIFIED IN NEED OF FINANCIAL ASSISTANCE DUE TO CIRCUMSTANCE CHANGES, OR NOW REQUESTING ASSISTANCE, THE ACCOUNTS ARE RETURNED BY THE AGENCY AND CONSIDERED FOR CHARITY IF THE PATIENT PROVIDES THE REQUESTED INFORMATION. IF THE PATIENT FAILS TO RETURN THE INFORMATION, THE ACCOUNT WILL QUALIFY FOR COLLECTIONS.MERCY UTILIZES THE EXPERIAN TOOL TO ENHANCE THE ABILITY TO DETERMINE THE CHARITY QUALIFICATION PRIOR TO TURNING TO BAD DEBT; KNOWN AS PRESUMPTIVE CHARITY. MERCY WILL GRANT CHARITY IN SITUATIONS WHERE THERE HAS BEEN AN INABILITY TO OBTAIN INFORMATION FROM PATIENTS OR THE INFORMATION PROVIDED IS NOT COMPLETE ENOUGH TO MAKE A CHARITY DETERMINATION WHEN A PATIENT HAS SUBMITTED AN APPLICATION. IN ADDITION, MERCY UTILIZES THE SAME TOOL TO QUALIFY ACCOUNTS PER THE PRACTICE OF PRESUMPTIVE CHARITY PRIOR TO BAD DEBT PLACEMENT FOR BALANCES IN EXCESS OF $6500. ALL ACCOUNT BALANCES RELATING TO ACCOUNTS IDENTIFIED BY THE HIGHER BALANCES WILL BE CONSIDERED AND FLAGGED FOR CHARITY IF THERE IS AN INABILITY TO PAY AFTER A RETURN FROM THE COLLECTION AGENCY AT APPROXIMATELY 120 DAYS. MERCY WILL PURSUE APPROPRIATE MEANS IN THE COLLECTION OF DELINQUENT ACCOUNTS FROM PATIENTS WITH AN ESTABLISHED ABILITY TO PAY OR AN UNWILLINGNESS TO COOPERATE IN VALIDATING ELIGIBILITY FOR FINANCIAL ASSISTANCE. THESE APPROPRIATE MEANS MAY INCLUDE LEGAL ACTION CONSISTENT WITH MERCY MISSION AND VALUES AFTER A SENDING 3 MONTHLY STATEMENTS WITH THE FINAL INCLUDING NOTIFICATION; IF NO RESOLUTION THEY WILL BE TURNED TO COLLECTIONS. ADDITIONALLY, THEY MAY INCLUDE LIENS UPON REAL PROPERTY AND REASONABLE WAGE GARNISHMENTS. LEGAL ACTIONS WILL GENERALLY NOT INCLUDE BANK GARNISHMENTS, REPOSSESSION OF ASSETS OR FORECLOSURES TO ENSURE SATISFACTION OF A LIEN. MERCY HAS POLICIES AND PROCEDURES ESTABLISHED TO ADDRESS THE INITIATION OF LEGAL ACTION AND ANNUALLY REVIEW COMPLIANCE WITH POLICIES BUT ENSURE 120 DAYS OF BILLING AND COLLECTIONS OCCURS PRIOR TO ANY EXTRAORDINARY COLLECTIONS ARE PURSUED.
Part VI, Line 2:	COMMUNITY HEALTH NEEDS ASSESSMENT PROCESSIN JANUARY OF 2015, MERCY HOSPITAL JEFFERSON (MHJ) BEGAN PLANNING FOR ITS 2016-2019 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THE JEFFERSON COUNTY HEALTH DEPARTMENT (JCHD) SERVES AS THE PRIMARY COMMUNITY PARTNER FOR MERCY HOSPITAL JEFFERSON IN BOTH THE CHNA AND COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) PROCESSES. JCHD UTILIZES THE MOBILIZING ACTION THROUGH PLANNING AND PARTNERSHIPS (MAPP) MODEL, BRINGING AGENCIES ACROSS JEFFERSON COUNTY TOGETHER IN A COLLABORATIVE PROCESS. MHJ IS CURRENTLY ENGAGED IN THE MAPP PROCESS THROUGH THE JEFFERSON COUNTY COMMUNITY HEALTH NETWORK. A COMMUNITY HEALTH COUNCIL, LED BY ERIC AMMONS, PRESIDENT OF MERCY HOSPITAL JEFFERSON, GUIDED THE NEEDS ASSESSMENT PROCESS. THE COUNCIL CONVENES QUARTERLY AND IS ACCOUNTABLE FOR ENSURING THAT COMMUNITY BENEFIT ACTIVITIES MEET MISSION COMPLIANCE AND IRS GUIDELINES. IT CONSISTS OF MERCY LEADERS FROM VARIOUS DEPARTMENTS, SUCH AS BEHAVIORAL HEALTH, FINANCE, CARE MANAGEMENT, PHILANTHROPY, ETC., AND A HOSPITAL BOARD MEMBER. THE COUNCIL DETERMINES WHICH HEALTH INITIATIVES WILL BE PUT FORTH IN THE HOSPITAL'S THREE-YEAR COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP). CO-WORKERS IN MERCY'S COMMUNITY HEALTH & ACCESS DEPARTMENT SERVED ON THE COUNCIL AND WERE THE PRIMARY LEADS OF THE 2016 CHNA. A SAINT LOUIS UNIVERSITY MASTER OF HEALTH ADMINISTRATION STUDENT PROVIDED SUPPORT BY COLLECTING AND REVIEWING DATA FROM VARIOUS SOURCES. THESE INCLUDED: SURVEYS, FOCUS GROUPS, PUBLISHED DATA, AND HOSPITAL SPECIFIC DATA.THE VOICES OF THE PEOPLE OF JEFFERSON COUNTY WERE CENTRAL TO THE HEALTH NEEDS ASSESSMENT PROCESS. MHJ GATHERED COMMUNITY INPUT THROUGH: - SURVEYS - ONLINE AND PRINTED (FOR THOSE WITH NO COMPUTER ACCESS) - MERCY COMMUNITY ADVISORY PANELS- COMMUNITY COALITIONS AND STAKEHOLDER MEETINGS EXTERNAL SOURCES OF PUBLISHED DATA ARE AS FOLLOWS:- JEFFERSON COUNTY HEALTH DEPARTMENT ANNUAL SUMMARY REPORT - 2014 HTTP://WWW.JEFFCOHEALTH.ORG/IMAGES/STORIES/ADMINSERVICES/2014%20JCHD%20ANNUAL%20REPORT.PDF - JEFFERSON MEMORIAL COMMUNITY FOUNDATION - 2014 REPORTHTTP://JMCFMO.ORG/MEDIA/NEEDS_ASSESSMENT.PDF - COUNTY HEALTH RANKINGS 2016WWW.COUNTYHEALTHRANKINGS.ORG- COMMUNITY DATA PROFILES & MISSOURI INFORMATION FOR COMMUNITY ASSESSMENT (MICA)HTTP://HEALTH.MO.GOV/DATA/COMMUNITYDATAPROFILES/INDEX.HTML- COMMUNITY COMMONSWWW.COMMUNITYCOMMONS.ORGPRIORITIZED SIGNIFICANT COMMUNITY HEALTH NEEDSTHE NOMINAL GROUP TECHNIQUE WAS USED IN THE PRIORITY SETTING PROCESS. THE MERCY HOSPITAL JEFFERSON COMMUNITY HEALTH COUNCIL WAS PRESENTED WITH THE QUANTITATIVE AND QUALITATIVE COMMUNITY HEALTH DATA AND MEMBERS WERE ASKED TO RANK THESE HEALTH ISSUES BY LEVEL OF CONCERN AND ABILITY TO COLLABORATE ON THE ISSUE TO PRODUCE RESULTS. THE STRENGTHS AND SERVICES OF MHJ ALONG WITH THE STRATEGIC PLAN WERE ALSO CONSIDERED. UPON REVIEW AND DISCUSSION OF THE PRIMARY AND SECONDARY DATA GATHERED, THE HOSPITAL'S STRATEGIC PLAN, AND THE RESOURCES AVAILABLE AT THE HOSPITAL AND IN THE COMMUNITY, THE FOLLOWING PRIORITIES WERE SELECTED:- MENTAL HEALTH- SUBSTANCE USE - ACCESS TO CARETHE COMMUNITY HEALTH COUNCIL THEN CREATED A COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) FOR MHJ, IDENTIFYING SPECIFIC INITIATIVES RELATED TO IMPROVING EACH OF THESE HEALTH PRIORITIES. THE CHIP WAS DESIGNED WITH REALISTIC, MEASUREABLE, AND ATTAINABLE GOALS THAT ALIGN WITH THE MISSION AND STRATEGY OF THE ORGANIZATION. MERCY HOSPITAL JEFFERSON ALSO ASSESSES THE NEEDS OF THE COMMUNITY THROUGH REQUESTS BY LOCAL AGENCIES. ACCORDING TO THE CATHOLIC HEALTH ASSOCIATION, A REQUEST FROM A PUBLIC AGENCY OR COMMUNITY GROUP TO INITIATE OR CONTINUE AN ACTIVITY OR PROGRAM MEETS THE REQUIREMENTS FOR A DOCUMENTED COMMUNITY NEED. MERCY'S INVOLVEMENT WITH COMMUNITY ORGANIZATIONS LIKE MEALS ON WHEELS IS BASED ON THE ORGANIZATION'S REQUEST FOR SUPPORT.
Part VI, Line 3:	Mercy informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization's financial assistance policy through several means. If at any time a patient expresses hardship and inability to pay, the accounts is placed for review. In addition, patient have signage about the policy at the access points, and all staff working with the patient at Point of Service, Scheduling, Customer Service, and even through the Medicaid Eligibility Screening, have the means to send the account for review. There is the plain language summary that is being provided to all whom express hardship, in addition to the web address providing the application, policies, and even how uninsured accounts are handled. Lastly, the statements message to the patient that Mercy does have a Financial Assistance Program and to call to see if they are eligible. Mercy staffs internal resources certified to assist patients with Medicaid Applications as well.
Part VI, Line 4:	MERCY HOSPITAL JEFFERSON INCLUDES FOUR COUNTIES IN MISSOURI - JEFFERSON,WASHINGTON, STE. GENEVIEVE AND ST. FRANCOIS. THE FOLLOWING INFORMATION IS DERIVED FROM 2016 SG2 ANALYTICS DATA AND SG2 INSURANCE COVERAGE ESTIMATES. THE AREA'S POPULATION IS 304,996. 29% OF THE POPULATION HAS INCOME OVER$75,000. 43% OF THE POPULATION IS AGE 45 AND OLDER. 22% OF THE POPULATION IS ON MEDICARE, 16% ON MEDICAID, AND 11% UNINSURED.
Part VI, Line 5:	OPEN MEDICAL STAFF MEDICAL STAFF PRIVILEGES ARE EXTENDED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY FOR NEARLY ALL OF OUR DEPARTMENTS. MERCY HOSPITAL JEFFERSON HAS EXCLUSIVE CONTRACTS WITH PHYSICIAN GROUPS FOR THE FOLLOWING SERVICES: RADIOLOGY, PATHOLOGY, ANESTHESIA AND EMERGENCY MEDICINE. THIS MEANS THAT THE MAJORITY OF THE PHYSICIANS ON STAFF ARE IN CATEGORIES THAT ARE OPEN TO QUALIFIED PHYSICIANS IN THE COMMUNITY.COMMUNITY BOARD - FY16 MERCY HEALTH EAST COMMUNITIES FY16 BOARD MEMBERSCRAIG ASHMOREJON BAUERPATRICIA BOLSTER, MDCRAIG BOYD, MDSTEVEN BUSCHSR. JUDY CAREY, RSMSR. KATHERINE GLOSENGER, RSM - EX-OFFICIOARTHUR JOHNSONWILLIAM MCKENNATERI MURRAY, RN, PHDDON MUSICK, IIISR. SUSAN O'CONNOR, RSMCHARLES REHM, MDGEORGE ROMANSTEPHEN SANDERS, MDDONN SORENSEN - EX-OFFICIOSTEVE SWYERS -CHAIRTESSA TRELZSR. MARIA LUISA VERA, RSMRAY WEICK, MDMERCY HOSPITAL JEFFERSON FY16 BOARD MEMBERSERIC AMMONS - EX-OFFICIOTONDA BREEZE - CHAIRDR. BRICCIO CADIZSR. JUDY CARRON, RSMKEVIN ENGER, MDDENNIS GANNONOSLER GUZON, MD - EX-OFFICIO JACK KINGERIC KNOLLCHARLES REHM, MDBASSAM ROUKOZ, MDUSE OF SURPLUS FUNDS SURPLUS FUNDS AND UNRESTRICTED ASSETS HELD BY MERCY HOSPITAL JEFFERSON ARE REINVESTED IN PATIENT CARE, MEDICAL EDUCATION AND RESEARCH INITIATIVES WHICH SUPPORT THE ORGANIZATION'S MISSION TO DELIVER COMPASSIONATE CARE AND EXCEPTIONAL HEALTH CARE SERVICES TO THE COMMUNITIES IT SERVES. EXAMPLES INCLUDE THE FOLLOWING:- NEW PATIENT TOWER PLANNED TO CONVERT MERCY HOSPITAL JEFFERSON TO A PRIVATE ROOM CAMPUS AS WELL AS TO EXPAND WOMEN'S HEALTH SERVICES IN THE REGION, REGARDLESS OF ABILITY TO PAY.- EXPANSION OF PRIMARY CARE AND SPECIALTY CARE PHYSICIANS TO THE MERCY HOSPITAL JEFFERSON SERVICE AREA WITH A FOCUS TO REACH THE UNDERSERVED POPULATIONS CLOSER TO THEIR HOMES.- CONTINUED PARTNERING WITH AREA EDUCATION PROGRAMS TO HELP PROMOTE THE TRAINING OF CRITICALLY NEEDED SERVICES FOR THE COMMUNITY INCLUDING SCHOOLS OF NURSING, RADIOLOGY AND PHARMACY.- EXPANSION OF BEHAVIORAL HEALTH CARE TO PROVIDE ADOLESCENT CARE FOR THE FIRST TIME IN JEFFERSON COUNTY. INITIALLY ADDING CLINIC PHYSICIANS FOR OP COVERAGE AND WILL EXPAND TO IOP (INTENSIVE OUTPATIENT THERAPY) THE FOLLOWING YEAR.- A NEW CANCER CENTER IS UNDER CONSTRUCTION TO BRING CARE CLOSER TO HOME FOR THE COMMUNITY. ADDITIONAL COMMUNITY HEALTH INITIATIVES/INFORMATIONCURRENTLY NOT INCLUDED THROUGH THE REPORTING OF COMMUNITY BENEFIT OR COMMUNITY BUILDING ACTIVITIES ARE:IN KEEPING WITH MHJ'S COMMITMENT TO SERVE ALL MEMBERS OF THE COMMUNITY, MHJ PROVIDES:- FREE CARE AND/OR SUBSIDIZED CARE- CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST- HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY- HEALTH EDUCATION PROGRAMS, AND- A VARIETY OF BROAD COMMUNITY SUPPORT ACTIVITIES.MANY OF THE PROGRAMS MENTIONED BELOW ARE PART OF OUR CURRENT COMMUNITY HEALTH IMPACT PLAN (CHIP). THESE ARE INDICATED BY ASTERISKS.MERCY NEIGHBORHOOD MINISTRY (MNM)MERCY NEIGHBORHOOD MINISTRY IS A DEPARTMENT THAT SUPPORTS THE SERVICE AREAS OF MERCY HOSPITAL JEFFERSON, MERCY HOSPITAL ST. LOUIS AND THE SURROUNDING COUNTIES. IT FOCUSES ON CONNECTING THE ECONOMICALLY UNDERSERVED WITH APPROPRIATE HEALTH AND SOCIAL SERVICES AS WELL AS OVERALL COMMUNITY HEALTH AND ACCESS. MNM PARTNERS WITH OVER 100 COMMUNITY HEALTH AND SOCIAL SERVICE AGENCIES, CLINICS, CHURCHES AND SCHOOLS. NEARLY HALF OF ITS ANNUAL EXPENSES ARE OFFSET THROUGH MERCY FOUNDATION. ACCESS TO CARECERTIFIED APPLICATION COUNSELORSSINCE THE BEGINNING OF OPEN ENROLLMENT THROUGH THE AFFORDABLE CARE ACT IN AUGUST 2013, MERCY HAS HELPED THOSE IN NEED OF AFFORDABLE HEALTH INSURANCE TO ENROLL IN PLANS AND/OR EDUCATE THEM ABOUT THEIR OPTIONS. THIS COVERAGE ASSISTANCE PROGRAM HAS BEEN ENTIRELY FUNDED THROUGH MISSOURI FOUNDATION FOR HEALTH GRANTS AND WAS AVAILABLE IN THE SERVICE AREAS OF MHJ, MHSL, MHW AND BEYOND. ENROLLMENTS TO-DATE TOTAL OVER 800 AND THE CACS HAVE ATTENDED HUNDREDS OF EVENTS RESULTING IN EDUCATIONAL OPPORTUNITIES IN UNDERSTANDING THE TERMINOLOGY AND USAGE OF HEALTH INSURANCE.HEALTH LEADSHEALTH LEADS IS A SOCIAL ENTERPRISE THAT ENVISIONS A HEALTHCARE SYSTEM THAT ADDRESSES ALL PATIENTS' BASIC RESOURCE NEEDS AS A STANDARD PART OF QUALITY CARE. IN THE SPRING OF 2016, MERCY HEALTH JOINED THE HEALTH LEADS LEARNING COLLABORATIVE TO BEGIN INTEGRATING THE HEALTH LEADS PROGRAM IN ORDER TO ASSIST PATIENTS WITH HEALTH-RELATED SOCIAL NEEDS THROUGH RESOURCE REFERRAL. THIS PROGRAM IS DESIGNED FOR MERCY CLINIC JEFFERSON PATIENTS AND IS BEING FUNDED THROUGH MERCY CLINICS; THEREFORE THE TOTAL COMMUNITY BENEFIT OF THIS PROGRAM CANNOT BE REPORTED UNDER THE EIN FOR MERCY HOSPITAL JEFFERSON.MENTAL HEALTHALIVE AND WELL IN STL*ALIVE AND WELL STL IS A COMMUNITY-WIDE EFFORT STARTED BY THE REGIONAL HEALTH COMMISSION THAT FOCUSES ON REDUCING THE IMPACT OF TOXIC STRESS AND TRAUMA ON A PERSON'S HEALTH AND WELL-BEING. MERCY ACTS AS A COMMUNITY PARTNER FOR THIS INITIATIVE AND WORKS TO CREATE A MORE TRAUMA AWARE/INFORMED COMMUNITY THROUGH TRAINING OPPORTUNITIES AND ANALYZING BEST PRACTICES IN THE FIELD OF BEHAVIORAL HEALTH. IN FY16 TRAUMA AWARENESS TRAININGS, OPEN TO THE COMMUNITY, WERE HELD AT EACH MERCY EAST COMMUNITY HOSPITAL.SUBSTANCE USEMERCY ROAD TO FREEDOMTHIS PROGRAM WAS OFFERED TO THE COMMUNITY AND MERCY CO-WORKERS AS A TELEPHONIC, ONE-ON-ONE SUPPORT SYSTEM WITH A SPECIALTY TRAINED COUNSELOR. SINCE 2013, OVER 80 PEOPLE HAVE KICKED THE HABIT.PHYSICIANSMERCY HEALTH SYSTEM HAS A LARGE NUMBER OF CLINICS, PHYSICIAN OFFICES AND OTHER HEALTHCARE FACILITIES LOCATED IN THE EAST COMMUNITY THAT ARE NOT ASSOCIATED WITH A HOSPITAL EIN. THESE CLINICS AND FACILITIES PROVIDE FINANCIAL ASSISTANCE, PARTICIPATE IN HEALTH PROFESSIONS EDUCATION (I.E. STUDENT SHADOWING) AND PROVIDE IN-KIND CONTRIBUTIONS TO THEIR COMMUNITIES. THE TOTAL COMMUNITY BENEFIT THAT CANNOT BE REPORTED FOR THESE ACTIVITIES IN FY16 IS $13,384,370.
Part VI, Line 6:	AFFILIATED HEALTH CARE SYSTEM: THE FILING ORGANIZATION IS PART OF MERCY HEALTH ("MERCY"). MERCY IS A MISSOURI NON-PROFIT CORPORATION WITH ITS HEADQUARTERS ("MINISTRY OFFICE") IN ST. LOUIS, MISSOURI. MERCY PROVIDES HEALTH CARE SERVICES IN FOUR STATES - ARKANSAS, KANSAS, MISSOURI, AND OKLAHOMA - AND HAS OUTREACH MINISTRIES LOCATED IN LOUISIANA, MISSISSIPPI, AND TEXAS. MERCY'S MISSION IS "AS THE SISTERS OF MERCY BEFORE US, WE BRING LIFE TO THE HEALING MINISTRY OF JESUS THROUGH OUR COMPASSIONATE CARE AND EXCEPTIONAL SERVICE." AS OF JUNE 30, 2016, MERCY FACILITIES INCLUDED 33 ACUTE CARE HOSPITALS, 3 MANAGED HOSPITALS, 4 HEART HOSPITALS, 2 CHILDREN'S HOSPITALS, 2 ORTHOPEDIC HOSPITALS AND 3 REHAB HOSPITALS. FOR THE FISCAL YEAR ENDED JUNE 30, 2016, MERCY HAD MORE THAN 9.2 MILLION OUTPATIENT AND PHYSICIAN OFFICE VISITS, APPROXIMATELY 2,100 EMPLOYED PHYSICIANS, AND APPROXIMATELY 40,000 FULL-TIME EQUIVALENT EMPLOYEES, MAKING MERCY THE FIFTH LARGEST CATHOLIC HEALTH SYSTEM IN THE UNITED STATES. MERCY IS SPONSORED BY MERCY HEALTH MINISTRY, WHICH IS GOVERNED BY MEMBERS THAT INCLUDE SISTERS OF MERCY. MANY SERVICES THAT ARE ESSENTIAL TO FULFILLING MERCY'S MISSION ARE CENTRALIZED AT THE MINISTRY OFFICE. SUCH CENTRALIZED SERVICES INCLUDE TREASURY, INFORMATION TECHNOLOGY, CLINICAL QUALITY MANAGEMENT, LEGAL AND COMPLIANCE COUNSEL, COMPENSATION AND BENEFITS, CONSULTING, PERFORMANCE MANAGEMENT, REVENUE MANAGEMENT, INTERNAL AUDIT, ACCOUNTING AND REPORTING, CAPITAL MANAGEMENT, CLINICAL ENGINEERING, AND CLINICAL SAFETY. THE CENTRALIZATION OF SUCH SUPPORT SERVICES ENABLES MERCY TO ENSURE THAT EACH OF ITS COMMUNITIES, WHETHER LARGE OR SMALL, HAS THE SERVICES IT NEEDS.
Part VI, Line 7, Reports Filed With States	MO

Schedule H (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization
Mercy Hospital Jefferson

Employer identification number
43-0687077

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section if applicable	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of non-cash assistance	(h) Purpose of grant or assistance

(1) AMERICAN HEART ASSOCIATION 7272 GREENVILLE AVE DALLAS,TX75231	13-5613797	501(C)(3)	7,500		FMV		GENERAL SUPPORT
(2) ARCHDIOCESE OF ST LOUIS 20 ARCHBISHOP MAY DRIVE ST LOUIS,MO63119	43-0653244	501(C)(3)	10,000		FMV		GENERAL SUPPORT

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2015

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of non-cash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of non-cash assistance

(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.

Return Reference	Explanation
Schedule I, Part I, Line 2	The organization awards assistance to preapproved local charity-based organizations, the amounts of $5,000 to $20,000 are approved by the CFO and amounts over $20,000 are approved by the CEO.

Schedule I (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

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" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

Mercy Hospital Jefferson

Employer identification number

43-0687077

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

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 .........

Yes

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..

Yes

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.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ................

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

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), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization?

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization?

Any related organization? .........................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on 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 ............

Were any amounts reported on 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 .............................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2015

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 on 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 in column(B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1Ammons Carl E EricPresident, Mercy Hospital Jefferson	(i) (ii)	328,268 ------------- 0	191,001 ------------- 0	43,076 ------------- 0	197,182 ------------- 0	14,488 ------------- 0	774,015 ------------- 0	0 ------------- 0
2Kennen E WilliamPhysician & board member	(i) (ii)	500,656 ------------- 0	22,832 ------------- 0	43,805 ------------- 0	9,100 ------------- 0	15,067 ------------- 0	591,460 ------------- 0	0 ------------- 0
3Rehm MD CharlesChief Admin Officer & Board member	(i) (ii)	0 ------------- 485,066	0 ------------- 178,689	0 ------------- 53,333	0 ------------- 34,034	0 ------------- 14,684	0 ------------- 765,806	0 ------------- 0
4Hannasch SusanRegional VP-General Counsel	(i) (ii)	0 ------------- 234,457	0 ------------- 102,417	0 ------------- 37,052	0 ------------- 44,292	0 ------------- 14,007	0 ------------- 432,225	0 ------------- 0
5Matejka Cheryl LChief Financial Officer	(i) (ii)	0 ------------- 348,636	0 ------------- 151,352	0 ------------- 52,351	0 ------------- 64,123	0 ------------- 18,830	0 ------------- 635,292	0 ------------- 0
6Sorensen DonnPresident-East Communities	(i) (ii)	0 ------------- 647,761	0 ------------- 345,241	0 ------------- 28,815	0 ------------- 312,651	0 ------------- 13,052	0 ------------- 1,347,520	0 ------------- 0
7Bryson JaredVP Mission	(i) (ii)	121,934 ------------- 0	39,231 ------------- 0	49,565 ------------- 0	7,591 ------------- 0	16,749 ------------- 0	235,070 ------------- 0	0 ------------- 0
8Eckenfels DanielVP Finance	(i) (ii)	205,146 ------------- 0	61,539 ------------- 0	14,717 ------------- 0	9,100 ------------- 0	17,035 ------------- 0	307,537 ------------- 0	0 ------------- 0
9Julien SheilaCNO	(i) (ii)	155,938 ------------- 0	45,604 ------------- 0	18,031 ------------- 0	11,943 ------------- 0	7,899 ------------- 0	239,415 ------------- 0	0 ------------- 0
10Meyer MicheleVP Operations	(i) (ii)	194,388 ------------- 0	61,482 ------------- 0	26,606 ------------- 0	8,945 ------------- 0	17,895 ------------- 0	309,316 ------------- 0	0 ------------- 0
11Al Furgani Mahmud MPhysician	(i) (ii)	271,148 ------------- 0	430,089 ------------- 0	29,895 ------------- 0	9,100 ------------- 0	18,844 ------------- 0	759,076 ------------- 0	0 ------------- 0
12Alam TariqPhysician	(i) (ii)	366,749 ------------- 0	416,578 ------------- 0	12,252 ------------- 0	9,100 ------------- 0	19,366 ------------- 0	824,045 ------------- 0	0 ------------- 0
13Albano Benjamin YPhysician	(i) (ii)	297,683 ------------- 0	216,666 ------------- 0	30,502 ------------- 0	9,100 ------------- 0	18,937 ------------- 0	572,888 ------------- 0	0 ------------- 0
14Barakat AmmarPhysician	(i) (ii)	259,346 ------------- 0	279,125 ------------- 0	29,838 ------------- 0	9,100 ------------- 0	17,634 ------------- 0	595,043 ------------- 0	0 ------------- 0
15Misra AayushmanPhysician	(i) (ii)	219,467 ------------- 0	117,609 ------------- 0	34,439 ------------- 0	9,100 ------------- 0	13,944 ------------- 0	394,559 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2015

Page 3

Part III

Supplemental Information

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.

Return Reference	Explanation
Part I, Line 1a	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 FOR NONBUSINESS REASONS IS PROVIDED IN CERTAIN 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. SPOUSAL TRAVEL WAS PROVIDED FOR THE FOLLOWING EMPLOYEES OF A RELATED ORGANIZATION: CHARLES REHM. LIMITED INSTANCES OF TAX GROSS-UPS MAY HAVE OCCURRED WITH RESPECT TO EXECUTIVES. HOUSING BENEFITS ARE PROVIDED THROUGH A RELOCATION PROGRAM IN ACCORDANCE WITH COMPANY POLICY. SUCH BENEFITS WERE SUBJECT TO TAX TO THE EMPLOYEE OF A RELATED ORGANIZATION, JARED BRYSON. SUCH BENEFITS WERE SUBJECT TO TAX OF AN EMPLOYEE, AAYUSHMAN MISRA. PAYMENT BY THE COMPANY OF COSTS FOR TEMPORARY HOUSING BY EMPLOYEES FOR THE CONVENIENCE OF THE COMPANY IS MADE IN ACCORDANCE WITH THE CO-WORKER TRAVEL AND OTHER EXPENSE POLICY AND PROCEDURES. AS A REIMBURSABLE EXPENSE, THIS TYPE OF LODGING IS NOT TAXABLE TO THE EMPLOYEE.
Part I, Line 4b	Part I, Line 4B: Mercy Health, the ultimate parent company, offers supplemental retirement plans to certain executives which provide benefits upon vesting date 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 plans are closed to new entrants. The following individuals participated in the following plans. There were no payments for the fiscal year ended 6/30/2016: Supplemental Executive Retirement Plan (SERP) Sorensen, Donn (DC); Ammons,Carl (DC) Supplemental Management Retirement Plan (SMRP) Sorensen, Donn; Hannasch, Susan; Matejka,Cheryl L; Rehm MD, Charles The amount of all accrued benefits is included in compensation amounts provided in Schedule J, Part II, Column (C).
Part I, Line 3	Mercy Health (parent company) is responsible for establishing the compensation of the organization's CEO/Executive Director. The following methods were used by Mercy Health to establish compensation: -Independent compensation consultant -written employment contract -compensation survey or study -approval by the board or compensation committee

Schedule J (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

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 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

Mercy Hospital Jefferson

Employer identification number

43-0687077

Return Reference	Explanation
Form 990, Part VI, Section A, line 6	THE FILING ORGANIZATION HAS A SOLE CORPORATE MEMBER, MERCY HEALTH EAST COMMUNITIES - SOUTHERN REGION, a supporting organization under Section 509(a)(3). The member of MERCY HEALTH EAST COMMUNITIES - SOUTHERN REGION is Mercy Health East Communities, a supporting organization under Section 509(a)(3). The member of Mercy Health East Communities is Mercy Health.
Form 990, Part VI, Section A, line 7a	Mercy Health, the member of Mercy Health East Communities, has reserve powers to appoint and remove all directors and officers for Mercy Hospital Jefferson.
Form 990, Part VI, Section A, line 7b	THE FOLLOWING CORPORATE POWERS AND RESPONSIBILITIES SHALL BE RESERVED TO THE CORPORATE MEMBER (AND WITH REGARD TO CERTAIN POWERS AND RESPONSIBILITIES, TO MERCY HEALTH EAST COMMUNITIES AS THE CORPORATE MEMBER OF THE CORPORATE MEMBER): A. APPROVAL OF REVISIONS TO THE MISSION, VISION AND OPERATING VALUES PURSUANT TO WHICH THE CORPORATION OPERATES; B. APPROVAL OF ANY AMENDMENTS TO THE ARTICLES OF INCORPORATION AND THESE BYLAWS AND ANY AMENDMENTS TO THE ORGANIZATIONAL DOCUMENTS OF ANY AFFILIATE OF THE CORPORATION; C. APPOINTMENT AND REMOVAL OF MEMBERS OF THE BOARD; D. APPROVAL OF THE APPOINTMENT AND REMOVAL OF THE PRESIDENT OF THE HOSPITAL SUBJECT TO THE CONSENT OF MERCY HEALTH EAST COMMUNITIES; E. ADOPTION OF THE STRATEGIC PLAN, GOALS, AND OBJECTIVES OF THE CORPORATION; F. ADOPTION OF THE OPERATING, CAPITAL AND ALL OTHER BUDGETS FOR THE CORPORATION; G. APPROVAL OF THE ASSIGNMENT, TRANSFER, SALE OR LEASE OF ANY OF THE ASSETS OF THE CORPORATION OR ANY AFFILIATE OF THE CORPORATION IN EXCESS OF ONE MILLION DOLLARS ($1,000,000) IN ANY ONE OR SERIES OF RELATED TRANSACTIONS OCCURRING WITHIN ANY TWELVE (12) MONTH PERIOD; H. AUTHORIZATION AND APPROVAL OF THE INCURRENCE OF DEBT BY THE CORPORATION OR ANY AFFILIATE OF 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; I. APPROVAL OF A PLAN OF MERGER, CONSOLIDATION OR DISSOLUTION OF THE CORPORATION OR ANY AFFILIATE; J. APPROVAL OF THE LEASE, MANAGEMENT OR PURCHASE OF, OR AFFILIATION WITH, ANOTHER HOSPITAL OR HOSPITAL SYSTEM, OR HEALTH CARE FACILITY OR HEALTH CARE SYSTEM BY THE CORPORATION; AND, K. TO APPROVE THE CREATION, OWNERSHIP OR ACQUISITION OF, OR AFFILIATION WITH, ANY OTHER ORGANIZATION BY THE CORPORATION. L. OVERSEE, APPROVE AND MONITOR HUMAN RESOURCE PROGRAMS, WHICH SHALL PROMORTE AN ORGANIZATIONAL ENVIRONMENT THAT: 1. PROVIDES FOR THE RECRUITMENT AND RENTION OF CO-WORKERS WHO ARE SERVICE ORIENTED, COMPASSIONATE, ENGAGED, AND WHO FIND MEANING AND PURPOSE IN WORKING IN A FAITH-BASED ORGANIZATION; 2. ENABLES PEOPLE TO RELATE TO ONE ANOTHER WITH RESPECT AND ACCEPTANCE IN A SPIRIT OF COMMUNITY; 3. PROMOTES CO-WORKER PARTIICPATION AND VOICE IN THEIR WORK LIVES; 4. GIVES CO-WORKERS A FAIR OPPORTUNITY TO DEVLEOP THEIR SKILLS AND TALENTS, AND A MEANS BY WHICH THEIR CONTRIBUTIONS ARE RECOGNIZED; 5. PROVIDES CO-WORKERS WITH THE MATERIALS AND EQUIPMENT TO PROPERLY DO THEIR WORK;AND, 6. ENSURES CO-WORKER SAFETY AND WELL-BEING.
Form 990, Part VI, Section B, line 11	THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM, USING INFORMATION PROVIDED BY THE FILING ORGANIZATION. A DRAFT FORM 990 IS REVIEWED BY THE FILING ORGANIZATION'S FINANCE TEAM, 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, Section B, line 12c	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, 2016. 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, Section B, line 15	FOR THOSE CLASSIFIED AS OFFICERS (AND THUS DISQUALIFIED PERSONS), MERCY HEALTH (ultimate parent company) 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 COMPENSATION COMMITTEE OF THE MERCY HEALTH BOARD. FOR THOSE CLASSIFIED AS KEY EMPLOYEES, THE ORGANIZATION USES THE FOLLOWING TO ESTABLISH THE COMPENSATION: EXTERNAL MARKET SALARY SURVEYS, EXTERNAL MARKET SALARY STUDIES, AND REVIEW/APPROVAL OF EXECUTIVE MANAGEMENT. COMPENSATION REVIEWS ARE COMPLETED ON AN ANNUAL BASIS, AND A REVIEW WAS COMPLETED DURING THE REPORTING YEAR.
Form 990, Part VI, Section C, line 19	Governing documents and financial statements are made available from time to time but are not published publicly; we are not required to make these documents available to the public. Financial results are available via request of copy of Form 990.
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, line 9:	Transfer FROM (TO) AFFILIATES -9,039,635. NET ASSETS RELEASED FROM RESTRICTIONS 10,225. RESTRICTED FUND DONATIONS 55,559. RESTRICTED FUND EXPENSES -39,213.
Part XII, Line 2C	THE FILING ORGANIZATION'S FINANCIAL STATEMENTS WERE INCLUDED IN MERCY HEALTH AND SUBSIDIARIES ANNUAL FINANCIAL STATEMENT AUDIT. MERCY HEALTH AND SUBSIDIARIES RECEIVED AN UNQUALIFIED OPINION FROM THE EXTERNAL AUDITORS FOR FISCAL 2015 (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.
Form 990, Part XII, Line 3	Single Audit Act and OMB Circular A-133 MERCY HEALTH UNDERGOES A CONSOLIDATED A-133 AUDIT EVERY YEAR AND DID SO FOR THE FISCAL YEAR ENDING JUNE 30, 2016. EACH ENTITY THAT RECEIVES FEDERAL FUNDS DURING THE YEAR IS INCLUDED ON THE SCHEDULE OF EXPENDITURES OF FEDERAL AWARDS (SEFA) AND IS ALSO INCLUDED IN THE POPULATION AVAILABLE FOR AUDIT. THE FILING ENTITY RECEIVED FEDERAL FUNDS DURING THE YEAR ENDED JUNE 30, 2016, WAS INCLUDED ON THE MERCY HEALTH CONSOLIDATED SEFA, AND THEREFORE, WAS ALSO INCLUDED IN THE POPULATION AVAILABLE FOR AUDIT.
FORM 990, SCHEDULE R, PART V	SYSTEM LIMITATIONS MERCY HEALTH (MERCY) HAS A COMPLEX LEGAL STRUCTURE WITH OVER 60 LEGAL ENTITIES. LAWSON ERP SOFTWARE IS THE PRIMARY ACCOUNTING SOFTWARE USED BY MERCY AND THE MAJORITY OF THE INTERCOMPANY/RELATED ORGANIZATION TRANSACTIONS ARE PROCESSED THROUGH LAWSON. WITH THE CURRENT DESIGN OF THE ERP SYSTEM, THERE ARE VARIOUS LIMITATIONS ON EXTRACTING THE INTERCOMPANY/RELATED ORGANIZATION INFORMATION FROM LAWSON. DUE TO THESE LIMITATIONS, MOST OF THE RELATED ORGANIZATION ACTIVITY FOR THE FILING ORGANIZATION HAS BEEN CLASSIFIED ON SCHEDULE R, PART V, IN LINES P AND Q. WE HAVE CAPTURED AND REPORTED THE KNOWN MATERIAL TRANSACTIONS BETWEEN ENTITIES. THERE MAY BE MINOR AMOUNTS OF RELATED ORGANIZATION TRANSACTION ACTIVITY WHICH IS NOT REFLECTED IN THIS SCHEDULE.
Form 990, Part V, Question 1a	Independent Contractors Independent contractors 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 health system (with limited exceptions) under the Mercy Health EIN.
Form 990, Part V, Question 2a	W-3 FILING SALARIES AND WAGES WITH LIMITED EXCEPTIONS, THE SALARIES AND WAGES REPORTED ON FORM 990, PART IX, LINE 7 REPRESENT AN ALLOCATION OF SALARIES AND WAGES FROM A RELATED ORGANIZATION. MOST EMPLOYEES ARE PAID BY A RELATED ORGANIZATION UNDER A COMMON PAYMASTER ARRANGEMENT. AS SUCH, ALL REQUIRED PAYROLL FILING FOR THESE EMPLOYEES (INCLUDING W-2 AND W-3'S) IS REPORTED UNDER THE RELATED ORGANIZATION, MHM SUPPORT SERVICES,EIN 20-2553101.
FORM 990, SCHEDULE R, PART II	MERCY HOSPITALS EAST COMMUNITIES MERCY HOSPITALS EAST COMMUNITIES CONSISTS OF MERCY HOSPITALS EAST COMMUNITIES ST. LOUIS, EIN 43-0653493, AND MERCY HOSPITALS EAST COMMUNITIES WASHINGTON, EIN 43-1066883.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

Mercy Hospital Jefferson

Employer identification number

43-0687077

Part I

Identification of Disregarded Entities Complete if the organization answered "Yes" on 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)	(f) Direct controlling entity
(1) Jefferson Cardiovascular and Thoracic Services LLC 14528 S Outer Forty Suite 100 Chesterfield,MO63017 45-4423688	Healthcare services	MO	Mercy Hospital Jefferson
(2) Mercy Clinic Adult Hospitalists - Jefferson LLC 14528 S Outer Forty Suite 100 Chesterfield,MO63017 46-2913068	Managed care contracting	MO	Mercy Hospital Jefferson
(3) Mercy Labs Jefferson LLC 14528 S Outer Forty Suite 100 Chesterfield,MO63017 46-3478362	Laboratory Services	MO	Mercy Hospital Jefferson

Part II

Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on 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?
(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	Yes	No
(1)Casa de Misericordia 1602 McClelland Street Laredo,TX78044 74-2912461	Women's domestic violence shelter	TX	501c3	7	Mercy Ministries of Laredo	Yes
(2)Jefferson Land Company Inc 14528 S Outer Forty St 100 Chesterfield,MO63017 43-1330360	Holding Company	MO	501c2		Mercy Hospital Jefferson	Yes
(3)McAuley Portfolio Mgmt Co 14528 S Outer Forty St 100 Chesterfield,MO63017 26-1708048	Portfolio management	MO	501c3	11-II	Mercy Health	Yes
(4)Mercy ACO Clinical Services Inc 14528 S Outer Forty St 100 Chesterfield,MO63017 46-4504901	Virtual Care Center	MO	501c3	3	Mercy Health	Yes
(5)Mercy Clinic East Communities 645 Maryville Ctr Dr Ste 100 St Louis,MO63141 43-1771217	Physician Group	MO	501c3	9	Mercy Health East Communities	Yes
(6)Mercy Clinic Fort Smith Comm 7301 Rogers Avenue Fort Smith,AR72917 26-1318597	Physician Clinic	AR	501c3	9	Mercy Health Fort Smith Comm	Yes
(7)Mercy Clinic Oklahoma Comm 4300 W Memorial Road Oklahoma City,OK73120 27-0473057	Physician Group	OK	501c3	3	Mercy Health OK Communities	Yes
(8)Mercy Clinic Springfield Comm 1965 Fremont Street Suite 2950 Springfield,MO65804 43-1560263	Physician Group	MO	501c3	3	Mercy Health Springfield Comm	Yes
(9)Mercy Family Center 14528 S Outer Forty St 100 Chesterfield,MO63017 72-1069468	Family counseling services	MO	501c3	7	Mercy Health	Yes
(10)Mercy Health Foundation 14528 S Outer Forty St 100 Chesterfield,MO63017 20-0901499	Foundation	MO	501c3	11-II	Mercy Health	Yes
(11)Mercy Health 14528 S Outer Forty St 100 Chesterfield,MO63017 43-1423050	Corporate Office	MO	501c3	1	N/A		No
(12)Mercy Health East Communities 645 Maryville Ctr Dr Ste 100 St Louis,MO63141 43-1718408	Health System	MO	501c3	11-II	Mercy Health	Yes
(13)Mercy Health East Communities - SR 645 Maryville Ctr Dr Ste 100 St Louis,MO63141 46-1412322	Health System	MO	501c3	11-II	Mercy Health East Communities	Yes
(14)Mercy Health Fort Smith Comm 7301 Rogers Avenue Fort Smith,AR72917 26-1318515	Holding Company	AR	501c3	11-II	Mercy Health	Yes
(15)Mercy Health Foundation Ada 430 N Monte Vista Street Ada,OK74820 46-3596274	Foundation	OK	501c3	11-I	Mercy Hospital Ada	Yes
(16)Mercy Health Foundation Ardmore 1011 14th Avenue NW Ardmore,OK73401 71-0962525	Foundation	OK	501c3	11-I	Mercy Hospital Ardmore	Yes
(17)Mercy Health Foundation Berryville 214 Carter Street Berryville,AR72616 71-0759301	Foundation	AR	501c3	11-I	Mercy Hospital Berryville	Yes
(18)Mercy Health Foundation Ft Scott 401 Woodland Hills Blvd Fort Scott,KS66701 48-1077073	Foundation	KS	501c3	11-III	Mercy Kansas Communities Inc	Yes
(19)Mercy Health Foundation Hot Springs 300 Werner Street Hot Springs,AR71913 71-0804718	Foundation	AR	501c3	11-II	Mission Clinical Services	Yes
(20)Mercy Health Foundation Independence 800 W Myrtle Independence,KS67301 48-1079981	Foundation	KS	501c3	11-I	Mercy Kansas Communities Inc	Yes
(21)Mercy Health Foundation Jefferson 1400 US Highway 61 South Festus,MO63028 46-2797051	Foundation	MO	501c3	11-II	Mercy Health East Communities - SR	Yes
(22)Mercy Health Foundation Joplin 100 Mercy Way Joplin,MO64804 27-0906136	Foundation	MO	501c3	11-I	Mercy Health SW MOKS Comm	Yes
(23)Mercy Health Foundation Lincoln 1000 East Cherry Street Troy,MO63379 81-1477159	Foundation	MO	501c3	11-II	Mercy Health East Communities	Yes
(24)Mercy Health Foundation NW Ark 2710 Rife Medical Ln Rogers,AR72858 71-0601687	Foundation	AR	501c3	11-III	Mercy Hospital Rogers	Yes
(25)Mercy Health Foundation of OK 4300 W Memorial Road Oklahoma City,OK73120 45-4732301	Foundation	OK	501c3	11-I	Mercy Health OK Communities	Yes
(26)Mercy Health Foundation OK City 4300 W Memorial Road Oklahoma City,OK73120 46-3184231	Foundation	OK	501c3	11-I	Mercy Health OK Communities	Yes
(27)Mercy Health Foundation Springfield 1235 E Cherokee Street Springfield,MO65804 32-0195818	Foundation	MO	501c3	11-II	Mercy Health Springfield Comm	Yes
(28)Mercy Health Foundation STL 615 South New Ballas Road St Louis,MO63141 56-2410020	Foundation	MO	501c3	11-II	Mercy Health East Communities	Yes
(29)Mercy Health Foundation Washington 901 E Fifth Street Washington,MO63090 56-2410022	Foundation	MO	501c3	11-II	Mercy Health East Communities	Yes
(30)Mercy Health NW Ark Communities 2710 Rife Medical Ln Rogers,AR72758 62-1684203	Physician Group	AR	501c3	11-II	Mercy Health	Yes
(31)Mercy Health OK Communities 4300 W Memorial Road Oklahoma City,OK73120 73-1453048	Health System	OK	501c3	11-II	Mercy Health	Yes
(32)Mercy Health Plans of MissouriInc 3265 S National Avenue Springfield,MO65807 32-0481419	HMO	MO	501c4		Mercy Health	Yes
(33)Mercy Health PlansInc 3265 S National Avenue Springfield,MO65807 32-0486150	PPO	MO	501c4		Mercy Health Plans of MissouriInc	Yes
(34)Mercy Health SW MOKS Comm 100 Mercy Way Joplin,MO64804 30-0584463	Health System	MO	501c3	11-II	Mercy Health	Yes
(35)Mercy Health Springfield Comm 1235 E Cherokee Street Springfield,MO65804 43-1856028	Health System	MO	501c3	11-II	Mercy Health	Yes
(36)Mercy Home Health Berryville 804 W Freeman Suite 4 Berryville,AR72616 87-0781247	Home Health and Hospice operations	AR	501c3	11-III	Mercy Hospital Springfield	Yes
(37)Mercy Hospital Ada Inc 430 N Monte Vista Street Ada,OK74820 46-2288155	Hospital	OK	501c3	3	Mercy Health OK Communities	Yes
(38)Mercy Hospital Ardmore 1011 14th Avenue NW Ardmore,OK73401 73-1500629	Hospital	OK	501c3	3	Mercy Health OK Communities	Yes
(39)Mercy Hospital Aurora 500 Porter Avenue Aurora,MO65605 43-1936696	Hospital	MO	501c3	3	Mercy Health Springfield Comm	Yes
(40)Mercy Hospital Berryville 214 Carter Street Berryville,AR72616 71-0759299	Hospital	AR	501c3	3	Mercy Health Springfield Comm	Yes
(41)Mercy Hospital Booneville 880 West Main Street Booneville,AR72927 46-3851119	Hospital	AR	501c3	3	Mercy Hospital Fort Smith	Yes
(42)Mercy Hospital Carthage 3125 Dr Russell Smith Way Carthage,MO64836 45-3808607	Hospital	MO	501c3	3	Mercy Health SW MOKS Comm	Yes
(43)Mercy Hospital Cassville 94 Main Street Cassville,MO65625 43-1936699	Hospital	MO	501c3	3	Mercy Health Springfield Comm	Yes
(44)Mercy Hospital Columbus 220 Pennsylvania Avenue Columbus,KS66725 27-0842031	Hospital	MO	501c3	3	Mercy Health SW MOKS Comm	Yes
(45)Mercy Hospital El Reno 2115 Parkview Drive El Reno,OK73036 27-2716065	Hospital	OK	501c3	3	Mercy Hospital Oklahoma City	Yes
(46)Mercy Hospital Fort Smith 7301 Rogers Avenue Fort Smith,AR72917 71-0240352	Hospital	AR	501c3	3	Mercy Health Fort Smith Comm	Yes
(47)Mercy Hospital Healdton Inc 3462 Hospital Rd Healdton,OK73438 26-3173902	Hospital	OK	501c3	3	Mercy Hospital Ardmore Inc	Yes
(48)Mercy Hospital Joplin 100 Mercy Way Joplin,MO64804 27-0814858	Hospital	MO	501c3	3	Mercy Health SW MOKS Comm	Yes
(49)Mercy Hospital Kingfisher Inc 1000 Hospital Circle Kingfisher,OK73750 46-3433074	Hospital	OK	501c3	3	Mercy Hospital Oklahoma City	Yes
(50)Mercy Hospital Lebanon 100 Hospital Drive Lebanon,MO65536 43-1767432	Hospital	MO	501c3	3	Mercy Health Springfield Comm	Yes
(51)Mercy Hospital Lincoln 1000 East Cherry Street Troy,MO63379 47-2219204	Hospital	MO	501c3	3	Mercy Health East Communities	Yes
(52)Mercy Hospital Logan County Inc 200 South Academy Guthrie,OK73044 45-2998842	Hospital	OK	501c3	3	Mercy Hospital Oklahoma City	Yes
(53)Mercy Hospital Oklahoma City 4300 W Memorial Road Oklahoma City,OK73120 73-0579285	Hospital	OK	501c3	3	Mercy Health OK Communities	Yes
(54)Mercy Hospital Ozark 801 W River Street Ozark,AR72949 71-0689680	Hospital	AR	501c3	3	Mercy Hospital Fort Smith	Yes
(55)Mercy Hospital Paris 500 E Academy Paris,AR72855 71-0655753	Hospital	AR	501c3	3	Mercy Hospital Fort Smith	Yes
(56)Mercy Hospital Rogers 2710 Rife Medical Ln Rogers,AR72758 71-0294390	Hospital	AR	501c3	3	Mercy Health NW Ark Communities	Yes
(57)Mercy Hospital Springfield 1235 E Cherokee Street Springfield,MO65804 44-0552485	Hospital	MO	501c3	3	Mercy Health Springfield Comm	Yes
(58)Mercy Hospital Tishomingo 1000 South Byrd Tishomingo,OK73460 27-4433830	Hospital	OK	501c3	3	Mercy Hospital Ardmore	Yes
(59)Mercy Hospital Waldron 1341 W 6th Street Waldron,AR72958 71-0557895	Hospital	AR	501c3	3	Mercy Hospital Fort Smith	Yes
(60)Mercy Hospital Watonga Inc 500 Clarence Nash Blvd Watonga,OK73772 45-5199762	Hospital	OK	501c3	3	Mercy Hospital Oklahoma City	Yes
(61)Mercy Hospitals East Comm 645 Maryville Ctr Dr Ste 100 St Louis,MO63141 43-0653493	Hospital	MO	501c3	3	Mercy Health East Communities	Yes
(62)Mercy Kansas Communities Inc 401 Woodland Hills Blvd Ft Scott,KS66701 48-0956045	Hospital	KS	501c3	3	Mercy Health SW MOKS Comm	Yes
(63)Mercy Research 1235 E Cherokee Street Springfield,MO65804 87-0796305	Research - Clinical Trials	MO	501c3	4	Mercy Health Springfield Comm	Yes
(64)Mercy Ministries of Laredo 2500 Zacatecas Laredo,TX78043 20-0198462	Outreach	TX	501c3	7	Mercy Health	Yes
(65)Mercy St Francis Hospital 100 W Highway 60 Mountain View,MO65548 44-0607149	Hospital	MO	501c3	3	Mercy Health Springfield Comm	Yes
(66)MHM Support Services 14528 S Outer Forty St 100 Chesterfield,MO63017 20-2553101	Centralized Health System Functions	MO	501c3	11-II	Mercy Health	Yes
(67)Mission Clinical Services 300 Werner Street Hot Springs,AR71913 13-4239691	Child Advocacy Center	AR	501c3	9	Mercy Health	Yes
(68)St Edward Mercy Foundation 7301 Rogers Avenue Fort Smith,AR72917 23-7330425	Foundation	AR	501c3	7	Mercy Hospital Fort Smith	Yes
(69)St Marys Hosp Enid Ok 14528 S Outer Forty St 100 Chesterfield,MO63017 73-0614655	Inactive	OK	501c3	3	Mercy Health OK Communities	Yes
(70)The Sr M Cornelia Blasko Fn 100 W Highway 60 Mountain View,MO65548 43-1873914	Foundation	MO	501c3	11-I	Mercy St Francis Hospital	Yes
(71)Unity Ambulatory Care 14528 S Outer Forty St 100 Chesterfield,MO63017 43-1861745	Inactive	MO	501c3	11-III	Mercy Health East Communities	Yes

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2015

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on 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?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) Southern Oklahoma Diag Ctr LLC 1011 Fourteenth Avenue NW Ardmore,OK73401 43-1971232	MRI Services - Dissolved 12/2015	OK	Mercy Hospital Ardmore Inc	N/A				No			No
(2) Resource Optimiz & InnovLLC 645 Maryville Ctr DrSte 200 St Louis,MO63141 46-0468368	Central Distribution Center	MO	MHN INC - MHNSR INC	N/A				No			No
(3) Mercy Ambulatory Surgery Center LLC 7301 Rogers Avenue Fort Smith,AR72917 71-0827721	Ambulatory Surgery Center	AR	Mercy Hospital Fort Smith	N/A				No			No
(4) Fort Smith Emergency Medical Services 1701 South Greenwood Fort Smith,AR72901 71-0416615	Emergency Medical Services	AR	Mercy Hospital Fort Smith	N/A				No			No
(5) St Edward Mercy Med Ctr M-P Off Bldg 7301 Rogers Avenue Fort Smith,AR72903 71-0554050	Office building	AR	Mercy Hospital Fort Smith	N/A				No			No

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on 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	(i) Section 512(b)(13) controlled entity?
(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	Yes	No
(1) Mercy Comm Services Inc 401 Woodland Hills Blvd Fort Scott,KS66701 48-1078101	Retail pharmacy	KS	MERCY KANSAS COMM INC	C				No
(2) Frontenac Properties Inc 14528 S Outer Forty Suite 100 Chesterfield,MO63017 52-1914421	Holds ancillary assets & owns aircraft	DE	MERCY HEALTH	C				No
(3) Inveno Health Inc 1235 E Cherokee Street Springfield,MO65804 26-4509571	Technology transfer company	MO	MERCY HEALTH SPRINGFIELD COMM	C				No
(4) Unity Support Services Inc 645 Maryville Centre Drive Suite 10 St Louis,MO63141 43-1797042	Inactive	MO	MERCY HEALTH EAST COMMUNITIES	C				No
(5) UH L Corp Inc 645 Maryville Centre Drive Suite 10 St Louis,MO63141 74-2499535	Holding company	MO	MERCY HEALTH SERVICES LLC	C				No
(6) MHN of the Southern Region Inc 1011 14th Avenue NW Ardmore,OK73401 73-1580607	holding company	OK	MERCY MANAGED CARE CORP	C				No
(7) Mercy Health Center Condominium Inc 4300 W Memorial Rd Oklahoma City,OK73120 68-0640970	Administrator of certain real property and improvements	OK	MERCY HOSPITAL OKLAHOMA CITYINC	C				No
(8) Mercy Managed Care Corporation 4300 W Memorial Road Oklahoma City,OK73120 73-1441665	Holding company	OK	MERCY HEALTH	C				No
(9) Mercy Health Network Inc 4300 W Memorial Road Oklahoma City,OK73120 73-1381689	holding company	OK	MERCY MANAGED CARE CORP	C				No
(10) Mercy Commercial Services Inc 14528 South Outer Forty Suite 100 Chesterfield,MO63017 46-4953543	Corp Parent of VCC taxable commercializ svcs	OK	MHN Inc and MHNSR INC	C				No

Schedule R (Form 990) 2015

Page 3

Part V

Transactions With Related Organizations Complete if the organization answered "Yes" on 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

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 .....................

b Gift, grant, or capital contribution to related organization(s) ............................

c Gift, grant, or capital contribution from related organization(s) ............................

Yes

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

Yes

k Lease of facilities, equipment, or other assets from related organization(s) ......................

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

m Performance of services or membership or fundraising solicitations by related organization(s) .................

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

s Other transfer of cash or property from related organization(s) ............................

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 related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) Mercy Clinic East Communities	P	915,306	FMV
(2) Mercy Health East Communities	Q	8,844,136	FMV
(3) Mercy Hospitals East Communities	P	8,751,816	FMV
(4) Mercy Hospital Springfield	Q	185,789	FMV
(5) MHM Support Services	P	8,807,808	FMV
(6) Resource Optimization & Innovation LLC	P	5,726,731	FMV
(7) Mercy Health Foundation Jefferson	C	48,156	FMV

Schedule R (Form 990) 2015

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on 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)	(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?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2015

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2015

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: A community based integrated healthcare system consisting of a 251 bed licensed facility which provides a full range of diagnostic, preventative and healthcare services along with 24 hour emergency room care.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	9
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	5
5	Total number of individuals employed in calendar year 2015 (Part V, line 2a) ......	5	176
6	Total number of volunteers (estimate if necessary) .............	6	125
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	162,108
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	51,657

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	45,310	48,156
9	Program service revenue (Part VIII, line 2g) .........	163,550,035	170,193,604
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	4,244	-3,295,488
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	739,244	1,402,017
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	164,338,833	168,348,289
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	38,937	23,338
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)	67,993,543	71,655,440
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	88,899,557	84,920,710
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	156,932,037	156,599,488
19	Revenue less expenses. Subtract line 18 from line 12.......	7,406,796	11,748,801
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	173,921,716	179,763,466
21	Total liabilities (Part X, line 26).............	8,067,825	11,173,838
22	Net assets or fund balances. Subtract line 21 from line 20.....	165,853,891	168,589,628

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 142,227,854 including grants of $ 23,338 ) (Revenue $ 171,114,214 )
	Mercy Hospital Jefferson consists of a 251 bed licensed facility which provides a wide range of services. In fiscal year 2016, the following services were provided - 45,236 patient days, 406 deliveries, 32,835 emergency visits, 1,808 inpatient surgeries and 2,663 outpatient surgery procedures. It is the policy of Mercy Hospital Jefferson to provide uncompensated care to patients in need of financial assistance in accordance with the hospital's established guidelines and without regard to race, religion, sex, age,or national origin. Charity and uncompensated care for the year totaled $36,072,977. Mercy Hospital Jefferson is committed to providing educational programs to the community. Free seminars and presentations are provided on a wide variety of health issues which impact patients and their families. Free services are also offered to the community such as lipid, cholesterol, bone density and glucose screenings as well as hearing and memory screenings.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses142,227,854

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)		(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
(A) Name and Title
(18) Alam Tariq........................................................................ Physician	34.00 .......................6.00	X	795,579	0	28,466
(19) Albano Benjamin Y........................................................................ Physician	40.00 .......................0.00	X	544,851	0	28,037
(20) Barakat Ammar........................................................................ Physician	39.00 .......................1.00	X	568,309	0	26,734
(21) Misra Aayushman........................................................................ Physician	60.00 .......................0.00	X	371,515	0	23,044

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	5,135,205	2,701,170	982,892

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	48,156
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f

g	Noncash contributions included in lines 1a-1f:$
h Total.Add lines 1a-1f.......		48,156

			Business Code
2a	Net Patient Service Re	621110	169,399,135	169,399,135
b	Rental From Affiliated	531120	621,509	621,509
c	Lab Services	621500	172,960	17,769	155,191
d
e
f	All other program service revenue.
g Total.Add lines 2a–2f.....			170,193,604

3 Investment income (including dividends, interest, and othersimilar amounts) ..........			1,621			1,621
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		613,230
b	Less: rental expenses		1,558,764
c	Rental income or (loss)		-945,534
d	Net rental income or (loss)......			-945,534			-945,534
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory
b	Less: cost or other basis and sales expenses	3,297,109
c	Gain or (loss)	-3,297,109
d	Net gain or (loss).....			-3,297,109			-3,297,109
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
c	Net income or (loss) from fundraising events..
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..
10a	Gross sales of inventory, less returns and allowances ..
	a		76,092
b	Less: cost of goods sold ..b		69,175
c	Net income or (loss) from sales of inventory..			6,917		6,917
Business Code			Miscellaneous Revenue
11a	Cafe & vending		722210	986,970			986,970
b	Gift shop sales		900099	439,971			439,971
c	Pharmacy Revenue		624100	76,092	76,092
d	All other revenue ....			837,601	837,601
e	Total. Add lines 11a–11d ......			2,340,634
12	Total revenue. See Instructions......			168,348,289	170,952,106	162,108	-2,814,081

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	23,338	23,338
2	Grants and other assistance to individuals in the United States. See Part IV, line 22
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....	2,259,767	2,259,767
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....
7	Other salaries and wages	54,993,237	52,918,458	2,074,779
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	2,655,198	2,558,402	96,796
9	Other employee benefits .......	7,946,713	7,655,682	291,031
10	Payroll taxes ...........	3,800,525	3,662,596	137,929
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	12,822		12,822
c	Accounting ...........	17,549		17,549
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	9,872,139	9,446,086	426,053
12	Advertising and promotion ....	151,458	10,500	140,958
13	Office expenses .......	4,489,251	4,332,583	156,668
14	Information technology ......	20,697	20,697
15	Royalties ..
16	Occupancy ...........	1,106,123	984,449	121,674
17	Travel ............	418,864	397,532	21,332
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	600	600
20	Interest ...........	3,295	3,295
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	8,586,463	4,511,177	4,075,286
23	Insurance ...	919,622	919,622
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	Drugs & medical expense	34,515,794	34,304,632	211,162
b	Shared service fees	12,907,203	6,711,746	6,195,457
c	Bad debt expense	9,858,149	9,858,149	0
d	Repairs and maintenance	1,293,425	1,147,081	146,344
e	All other expenses	747,256	501,462	245,794
25	Total functional expenses. Add lines 1 through 24e	156,599,488	142,227,854	14,371,634	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 if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			4,379,330	1	4,778,989
2	Savings and temporary cash investments .........				2
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			21,935,190	4	19,460,498
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L
					5
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
					6
7	Notes and loans receivable, net ....				7
8	Inventories for sale or use ........			3,034,853	8	3,166,970
9	Prepaid expenses and deferred charges ......			190,400	9	113,210
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	118,017,243
b	Less: accumulated depreciation	10b	23,395,117	76,628,804	10c	94,622,126
11	Investments—publicly traded securities .				11
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............			52,924,664	14	52,924,664
15	Other assets. See Part IV, line 11 ...........			14,828,475	15	4,697,009
16	Total assets. Add lines 1 through 15 (must equal line 34)...			173,921,716	16	179,763,466

17	Accounts payable and accrued expenses .....	7,591,937	17	10,334,897
18	Grants payable ...	1,253	18	113,295
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
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..		22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ..		24
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	474,635	25	725,646
26	Total liabilities. Add lines 17 through 25..	8,067,825	26	11,173,838

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	165,831,886	27	168,551,277
28	Temporarily restricted net assets ...........	22,005	28	38,351
29	Permanently restricted net assets		29
	Organizations that do not follow SFAS 117 (ASC 958), check here 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 ...........	165,853,891	33	168,589,628
34	Total liabilities and net assets/fund balances ........	173,921,716	34	179,763,466