TY 2017 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)
(1) Angst Randall...................................................................... Board member	1.0 ................. 0.0	X		0	0
(2) Barbe MD David O...................................................................... Physician & Board member	10.0 ................. 50.0	X		431,415	82,950
(3) Chase Scott...................................................................... Board member & President	1.0 ................. 1.0	X	X	0	0
(4) Childers Scott...................................................................... Admins & Board member	60.0 ................. 0.0	X		89,909	69
(5) Dent MD Aaron...................................................................... Physician & Board member	60.0 ................. 0.0	X		816,903	19,116
(6) Donald John...................................................................... Board member	1.0 ................. 0.0	X		0	0
(7) Edwards Doyle...................................................................... Board member	1.0 ................. 0.0	X		0	0
(8) Howe Kenneth...................................................................... Board member	1.0 ................. 0.0	X		0	0
(9) Roecker Marc...................................................................... Board member	1.0 ................. 0.0	X		0	0
(10) Tegtmeyer MD Chris...................................................................... Physician & Board member	60.0 ................. 0.0	X		291,737	60,494
(11) Vincent Jenine...................................................................... VP-Operations & Board member	2.0 ................. 58.0	X		245,394	21,087
(12) Vincent Marsha...................................................................... Board member	1.0 ................. 0.0	X		0	0
(13) Willard Brennon...................................................................... Board member	1.0 ................. 0.0	X		0	0
(14) Willard Sandy...................................................................... Board member	1.0 ................. 0.0	X		0	0
(15) Burke James...................................................................... Regional VP Legal Thru 4/18	2.0 ................. 58.0		X	355,737	21,532
(16) Hoban Douglas...................................................................... CFO- MERCY HOSPITAL LEBANON	60.0 ................. 0.0		X	172,973	26,683
(17) Reynolds Scott R...................................................................... CFO-central commun (thru 5/18)	1.0 ................. 59.0		X	532,268	106,770

(A) Name and business address	(B) Description of services	(C) Compensation
360 DEGREE MEDICINE, 800 HWY 248 STE 2E BRANSON,MO65616	AGENCY PHYS WAGES	1,369,769
CONEXUS SOLUTIONS, PO BOX 334 TONTITOWN,AR72770	AGENCY PHYS WAGES	725,169
RHINO MEDICAL SERVICES, 2000 E LAMAR BLVD STE 250 ARLINGTON,TX76006	AGENCY PHYS WAGES	423,414
MIDWEST CARDIOVASC, 1700 S CAMPBELL STE J SPRINGFIELD,MO65807	ECHOCARDIOGRAM	400,225
TRAVEL NURSE ACROSS AMERICA, 5020 NORTHSHORE DR STE 2 NORTH LITTLE ROCK,AR72118	STAFF CONTRACT WAGES	231,135
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 9

- 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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

MERCY HOSPITAL LEBANON

Employer identification number

43-1767432

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 12, 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 agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

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 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

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) 2019

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 failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
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) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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 2019 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2018 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2019. 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—2018. 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—2019. 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—2018. 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) 2019

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 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) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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 2019 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2018 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2019 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2018 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2019. 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—2018. 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) 2019

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d 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 12a or 12b 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) 2019

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) 2019

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 (explain in Part VI). 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) 2019

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 2019 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-2019	(iii) Distributable Amount for 2019
1 Distributable amount for 2019 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2019:
a From 2014.......
b From 2015.......
c From 2016.......
d From 2017.......
e From 2018.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2019 distributable amount
i Carryover from 2014 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2019 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2019 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2020. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2015.....
b Excess from 2016.....
c Excess from 2017.....
d Excess from 2018.....
e Excess from 2019.....

Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019

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) 2019

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.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Name of the organization

MERCY HOSPITAL LEBANON

Employer identification number

43-1767432

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. Don't 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 isn't covered by the General Rule and/or the Special Rules doesn't 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 doesn't 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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019) Page 2

Name of organization MERCY HOSPITAL LEBANON

Part I Contributors	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
		$	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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 3

Name of organization MERCY HOSPITAL LEBANON		Employer identification number 43-1767432

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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 4


Name of organization MERCY HOSPITAL LEBANON			Employer identification number 43-1767432
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) (2019)

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

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 LEBANON

Employer identification number

43-1767432

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 (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

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) 2019

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) 2016	(b) 2017	(c) 2018	(d) 2019	(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) 2019

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|No

(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? ..........................................................

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

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

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

Yes

10,697

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

10,697

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
FORM 990, SCH. C, PART II-B, LINE 1 (I)	LOBBYING PORTION OF DUES THE FILING ORGANIZATION IS A MEMBER OF AND PAYS DUES TO THE FOLLOWING HOSPITAL ASSOCIATIONS: MISSOURI HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION. FOR THE YEAR ENDED JUNE 30, 2018, DUES WERE $33,712 AND $11,046, RESPECTIVELY. APPROXIMATELY 24.2% OF MISSOURI HOSPITAL ASSOCIATION DUES AND 22.98% OF AMERICAN HOSPITAL ASSOCIATION DUES WERE ATTRIBUTABLE TO LOBBYING ACTIVITIES PERFORMED BY THESE ASSOCIATIONS.

Return Reference

Explanation

FORM 990, SCH. C, PART II-B, LINE 1 (I)

LOBBYING PORTION OF DUES THE FILING ORGANIZATION IS A MEMBER OF AND PAYS DUES TO THE FOLLOWING HOSPITAL ASSOCIATIONS: MISSOURI HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION. FOR THE YEAR ENDED JUNE 30, 2018, DUES WERE $33,712 AND $11,046, RESPECTIVELY. APPROXIMATELY 24.2% OF MISSOURI HOSPITAL ASSOCIATION DUES AND 22.98% OF AMERICAN HOSPITAL ASSOCIATION DUES WERE ATTRIBUTABLE TO LOBBYING ACTIVITIES PERFORMED BY THESE ASSOCIATIONS.

Schedule C (Form 990 or 990EZ) 2019

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.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

MERCY HOSPITAL LEBANON

Employer identification number

43-1767432

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 7/25/06, 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 FASB 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 FASB 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 FASB 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) 2019

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

Term 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 .....	1,616,425		1,616,425
b	Buildings ....	26,623,140	12,928,315	13,694,825
c	Leasehold improvements	1,035,364	796,496	238,868
d	Equipment ....	21,821,508	18,837,264	2,984,244
e	Other .....	375,237	153,847	221,390
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				18,755,752

Schedule D (Form 990) 2019

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
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
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

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
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)DUE FROM AFFILIATES				2,509,278
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				2,509,278

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

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)
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) 2019

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

FORM 990, SCHEDULE D, PART X, LINE 2

ASC 740 FOOTNOTE PRIMARILY ALL OF THE MERCY HEALTH ENTITIES ARE RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) 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 ON THE CONSOLIDATED FINANCIAL STATEMENTS AT JUNE 30, 2018 OR 2017.

Schedule D (Form 990) 2019

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

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

MERCY HOSPITAL LEBANON

Employer identification number

43-1767432

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? . . . . . .

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) . . .	1,510,007		1,510,007	2.130 %
b	Medicaid (from Worksheet 3, column a) . . . . .	12,546,027	13,155,318
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	14,056,034	13,155,318	1,510,007	2.130 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	37,575		37,575	0.050 %
f	Health professions education (from Worksheet 5) . . .	20,301		20,301	0.030 %
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	64,709		64,709	0.090 %
j	Total. Other Benefits . .	122,585		122,585	0.170 %
k	Total. Add lines 7d and 7j .	14,178,619	13,155,318	1,632,592	1.450 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2019

Schedule H (Form 990) 2019

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	(e) Net community building expense
1	Physical improvements and housing
2	Economic development
3	Community support	1,640	1,640
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development	709	709
9	Other	3,057	3,057
10	Total	5,406	5,406

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare 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. ......

3,874,940

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).....

20,294,677

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

19,648,928

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

645,749

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) 2019

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?1Name, 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 Lebanon 100 Hospital Drive Lebanon,MO65536 www.mercy.net 450-17	X	X	X

Schedule H (Form 990) 2019

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 LEBANON
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

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

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

Yes

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

Yes

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): SEE SUPPLEMENTAL INFORMATION

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 16

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) 2019

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	MERCY HOSPITAL LEBANON
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%
and FPG family income limit for eligibility for discounted care of 400.%

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)

Was widely publicized 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):

SEE PART V, SECTION C

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

SEE PART V, SECTION C

A plain language summary of the FAP was widely available on a website (list url):
SEE PART V, SECTION C

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)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

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

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 6

Part VFacility Information (continued)

Billing and Collections

	MERCY HOSPITAL LEBANON
Name of hospital facility or letter of facility reporting group

Yes

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 nonpayment?..................................

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

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

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

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

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

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):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

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)

Schedule H (Form 990) 2019

Page 7

Part VFacility Information (continued)

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

	MERCY HOSPITAL LEBANON
Name of hospital facility or letter of facility reporting group

Yes

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 a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

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) 2019

Page 8

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, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 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
FORM 990, SCHEDULE H, PART V, SECTION B, LINE 3e	Yes, the hospital facility did include a prioritized list of the communitys significant health needs in its CHNA report. FORM 990, SCHEDULE H, PART V, SECTION B, LINE 5 IN THE MOST RECENT CHNA, MERCY HOSPITAL LEBANON DID 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. MERCY HOSPITAL LEBANON HOSTED ROUND TABLE EVENTS IN WHICH LOCAL PUBLIC HEALTH, BEHAVIORAL HEALTH, AND AREA NONPROFIT LEADERS REPRESENTING HEALTH-RELATED SERVICES WERE INVITED TO PARTICIPATE IN COMPREHENSIVE CONVERSATIONS WITH MERCY HOSPITAL LEBANON ABOUT OUR COMMUNITY HEALTH NEEDS, RESOURCE GAPS AND OPPORTUNITIES TO COLLABORATE AND IMPROVE OUR COMMUNITYS HEALTH AND INCREASE ACCESS TO SERVICES. THE PRIORITIES FOR EACH COMMUNITY EMERGED AS A RESULT OF DATA AND FEEDBACK COLLECTION FROM A VARIETY OF SOURCES INCLUDING: -A SURVEY OPEN TO MEMBERS OF THE PUBLIC AND PARTNER AGENCIES IN ALL COMMUNITIES; -SECONDARY DATA COLLECTED FROM COMMUNITYCOMMONS.ORG AND OTHER SOURCES; -FOCUS GROUPS TARGETING UNDERSERVED, CHRONICALLY ILL AND LOW-INCOME POPULATIONS IN EACH COMMUNITY; AND; -EMERGENCY DEPARTMENT DATA FROM HOSPITAL PARTNERS. THESE SOURCES WERE COMBINED AND COMPARED TO DEVELOP COMMUNITY PRIORITIES WHICH WEIGHED MORBIDITY, MORTALITY AND A VARIETY OF OTHER FACTORS.
FORM 990, SCHEUDLE H, PART V, SECTION B, LINE 6A	THE CHNA WAS CONDUCTED IN CONJUNCTION WITH THE FOLLOWING HOSPITAL FACILITIES: MERCY HOSPITAL AURORA, MERCY HOSPITAL CASSVILLE, CITIZENS MEMORIAL HEALTHCARE, COXHEALTH, FREEMAN HEALTH SYSTEM AND POLK COUNTY HEALTH CENTER.
FORM 990, SCHEDULE, H, PART V, SECTION B, LINE 6B	THE CHNA WAS CONDUCTED IN CONJUNCTION WITH THE FOLLOWING NON-HOSPITAL FACILITIES: BURRELL BEHAVIORAL HEALTH, JASPER COUNTY HEALTH DEPARTMENT, JOPLIN HEALTH DEPARTMENT, SPRINGFIELD-GREEN COUNTY HEALTH DEPARTMENT AND TANEY COUNTY HEALTH DEPARTMENT.
FORM 990, SCHEDULE H, PART V, SECTION B, LINE 7B	HTTP://OZARKSHEALTHCOMMISSION.ORG/SPRINGFIELD/
FORM 990, SCHEDULE H, PART V, SECTION B, LINE 11	MERCY IS ADDRESSING THE SIGNIFICANT NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA BY FOCUSING PROGRAMMING, SERVICES AND EDUCATION OR AWARENESS AROUND: (1) EXPANDED CAPACITY TO PRIMARY CARE THROUGH A MANPOWER PLANNING PROCESS AND LINKAGE INTO COMMUNITY PARTNERS, (2) ACCESS TO BEHAVIORAL HEALTH EDUCATION AND SERVICES, INCLUDING ADDICTION MANAGEMENT NEEDS, AND (3) GROWING IMPORTANT COMMUNITY PARTNERSHIPS THAT FURTHER THE EFFORTS TO IMPROVE THE COMMUNITY'S HEALTH. FOR ALL OF THESE IDENTIFIED NEEDS AND PRIORITIES, MERCY LEBANON Mercy Hospital Lebanon is addressing the significant needs identified in its most recently conducted CHNA by focusing programming, services and education or awareness around: (1) Reduce the incidence of Cardiovascular disease (2) Reduce the incidence of Lung disease (3) Awareness of Mental Health issues. The first identified need or priority is to reduce the incidence of cardiovascular disease (1) Increasing the number of uninsured adults who are managing their high blood pressure or Hypertension by finding them primary health care. (2) Increasing the amount of adults educated about risk factors for cardiovascular disease. The second identified need or priority is to reduce the incidence of lung disease. Mercy Lebanon adopted implementation strategies for (1) increasing the amount of adults educated about symptoms of mild or undiagnosed lung disease. (2) Promote evidence based care to manage chronic disease. The third identified need or priority is to increase awareness for mental health issues. Mercy Lebanon adopted implementation strategies for (1) provide community education on substance abuse. (2) Provide education to the community regarding resources in the geographic area that assist with mental and behavioral health issue. For all of these identified needs and priorities, Mercy Lebanon continues to work closely with its local public school system, nonprofit organizations, the Chamber of Commerce, and public officials to ensure we are collaboratively addressing the needs of our community in a measurable way. Mercy Lebanon remains actively engaged in its representation on The Health Commission as a way to stay attached to key leaders in our community aiming to achieve similar work and outcomes, particularly for patients and our vulnerable populations. DURING THIS CYCLE OF THE COMMUNITY HEALTH IMPROVEMENT PLAN, MERCY HOSPITAL LEBANON WILL NOT BE ADDRESSING THE FOLLOWING IDENTIFIED HEALTH NEEDS: CANCER, DIABETES, MATERNAL AND INFANT HEALTH, AND ORAL HEALTH. ALTHOUGH EACH IS A SIGNIFICANT NEED IN OUR COMMUNITY, THERE ARE MANY FACTORS THAT WILL BE ADDRESSED THROUGH LOCAL HOSPITAL DEPARTMENTS AND COMMUNITY COLLABORATIONS.
SCHEDULE H, PART V, LINES 16A, 16B, AND 16C	THE FINANCIAL ASSISTANCE POLICY, APPLICATION AND A PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY ARE AVAILABLE ONLINE AT HTTPS://WWW.MERCY.NET/OPEN-PAGES/MERCY-FINANCIAL-ASSISTANCE/

Schedule H (Form 990) 2019

Page 9

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?
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2019

Page 10

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
FORM 990, SCHEDULE H, PART I, LINE 6A	COMMUNITY BENEFIT REPORT THE ORGANIZATION'S COMMUNITY BENEFIT REPORT IS PREPARED BY ITS PARENT ENTITY, MERCY HEALTH (EIN: 43-1423050).
FORM 990, SCHEDULE H, PART I, LINE 7, COLUMN F	TOTAL EXPENSES FROM FORM 990, PART IX, LINE 25, COLUMN (A) ARE $87,007,239. INCLUDED IN THIS AMOUNT WAS BAD DEBT EXPENSE (CHARGES) OF $16,219,925. EXPENSES FOR THE PURPOSE OF CALCULATING LINE 7, COLUMN (F) ARE $70,787,314.
FORM 990, SCHEDULE H, PART II	COMMUNITY BUILDING ACTIVITIES WORK TOWARD IMPROVING THE HEALTH, WELLNESS AND SAFETY OF THE COMMUNITY. MERCY HOSPITAL LEBANON'S EFFORTS TO ENHANCE THE OPERATIONAL STRUCTURES OF THE COMMUNITY INCLUDE COLLABORATIONS WITH MANY COMMUNITY ORGANIZATIONS; FOR EXAMPLE: LACLEDE COUNTY HEALTH DEPARTMENT, LEBANON PUBLIC SCHOOLS, OZARKS TECHNICAL COMMUNITY COLLEGE, AND MANY ORGANIZATIONS IN CLOSE PROXIMITY IN LEBANON, MO. COMMUNITY BUILDING ACTIVITIES PROMOTE THE HEALTH OF THE COMMUNITIES THEY SERVE THROUGH COMMUNITY-BASED PARTNERSHIPS, MEETINGS AND EVENTS, AND SERVICE ON COMMUNITY BOARDS. ONE EXAMPLE OF MERCY HOSPITAL LEBANON'S PARTICIPATION IN COALITION BUILDING AND COMMUNITY HEALTH PROMOTION IS DENTAL PROGRAMS THAT HAVE BEEN DISCOUNTED IN THE SCHOOL SYSTEM. PATIENTS WHO PRESENT IN THE EMERGENCY ROOM WITH DENTAL PAIN ARE REFERRED TO JORDAN VALLEY CLINIC. MERCY HOSPITAL LEBANON'S COMMUNITY INVOLVEMENT INCLUDES VARIOUS BUSINESS AND PUBLIC ORGANIZATIONS SUCH AS THE ONES NAMED ABOVE AS WELL AS THE AMERICAN CANCER SOCIETY, CHAMBER OF COMMERCE, CITY OF LEBANON, LEBANON AREA FOUNDATION/COMMUNITY CARES, L-LIFE FOOD BANK, EMERGENCY SERVICES, FAITH BASED ORGANIZATION, AND MANY OTHER LOCAL NONPROFIT SERVICE ORGANIZATIONS IN THE GREATER LEBANON AREA TO EDUCATE AND IMPROVE THE HEALTH OF THE COMMUNITY. HEALTH EDUCATION OPPORTUNITIES ARE PROVIDED TO THE COMMUNITY IN COLLABORATION WITH OTHER COMMUNITY PARTNERS. SPECIFICALLY, MERCY HOSPITAL LEBANON MAINTAINS CLOSE COLLABORATION WITH THE REDI TO ASSIST IN LEBANON/LACLEDE COUNTY ECONOMIC DEVELOPMENT AND TO MAXIMIZE RESOURCES FOR NEEDED PROJECTS/PROGRAM IN THE COMMUNITY. MERCY HOSPITAL LEBANON ALSO WORKS CLOSELY WITH FORT LEONARD WOOD AND AUSA TO ASSIST THE MILITARY COMMUNITY. WORKFORCE DEVELOPMENT IS ENHANCED BY BEING A CLINICAL EDUCATION SITE FOR NURSING, RADIOLOGY, LAB, SURGICAL TECHNICIAN, AND ULTRASOUND STUDENTS. MERCY HOSPITAL LEBANON IS THE ONLY HOSPITAL IN THIS COMMUNITY AND SERVES A LARGE RURAL GEOGRAPHIC AREA. MERCY HOSPITAL LEBANON IS BEGINNING TO WORK CLOSELY WITH A NEW SATELLITE CLINIC OF THE FEDERALLY QUALIFIED HEALTH CENTER, JORDAN VALLEY COMMUNITY HEALTH CENTER, LOCATED IN SPRINGFIELD, MO AS WELL AS SATELLITE LOCATIONS IN MARSHFIELD, MO AND LEBANON, MO. EARLY COLLABORATION POINTS TO OPPORTUNITIES THAT ENSURE ACCESS TO SERVICES FOR PREGNANT WOMEN AND THEIR INFANTS.
FORM 990, SCHEDULE H, PART III, SECTION A, LINE 2	TO DETERMINE THE AMOUNT OF BAD DEBT EXPENSE, AT COST, BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENT ACCOUNTS WAS MULTIPLIED BY A RATIO OF COST TO CHARGES. THE RATIO OF COST TO CHARGES USED WAS BASED ON DETAILED COST ACCOUNTING, WHERE AVAILABLE. WHERE COST ACCOUNTING IS NOT AVAILABLE, COST REPORT COST TO CHARGE RATIOS WERE UTILIZED.
FORM 990, SCHEDULE H, PART III, SECTION A, 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 ELIGIBILITY TO ADDRESS ACCOUNTS FOR PATIENTS WHO DO NOT PROVIDE THE INFORMATION. WE BELIEVE THAT OUR CHARITY POLICY IS COMPREHENSIVE ENOUGH TO CAPTURE ALMOST ALL PATIENTS WHO QUALIFY FOR CHARITY CARE.
FORM 990, SCHEDULE H, PART III, SECTION A, 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 RECEIVABLE THAT ARE DEEMED UNCOLLECTIBLE, INCLUDING THOSE PLACED WITH COLLECTION AGENCIES, ARE INITIALLY CHARGED AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IN ACCORDANCE WITH COLLECTION POLICIES OF THE HEALTH SYSTEM AND, IN CERTAIN CASES, ARE RECLASSIFIED TO CHARITY CARE IF DEEMED TO OTHERWISE MEET THE HEALTH SYSTEMS CHARITY CARE POLICY. THE PROVISION FOR UNCOLLECTIBLE RECEIVABLES IS BASED UPON MANAGEMENTS 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 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."
FORM 990, SCHEDULE H, PART III, SECTION B, LINE 8	IT IS THE POSITION OF MERCY HOSPITAL LEBANON THAT 100% OF ANY SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT. THIS AMOUNT REPRESENTS COST OF PROVIDING SERVICES THAT REMAIN UNCOMPENSATED TO THE PROVIDER. THE UNREIMBURSED COSTS OF MEDICARE IS CALCULATED BY THE GROSS CHARGES NET OF THE COST TO CHARGE RATIO LESS ANY PAYMENTS, DEDUCTIONS OR REIMBURSEMENTS USING THE ANNUAL MEDICARE COST REPORT (CMS FORM 2552-96).
FORM 990, SCHEDULE H, PART III, SECTION C, LINE 9B	MERCYS 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, INCLUDING MEDICAID. IN THE EVENT AN ACCOUNT IS TURNED TO COLLECTIONS AND IS IDENTIFIED IN NEED OF FINANCIAL ASSISTANCE DUE TO CIRCUMSTANCE CHANGES, OR IS 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, A PROCESS 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 $6,500. 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.
FORM 990, SCHEDULE H, PART VI, LINE 2	MERCY HOSPITAL LEBANON BELIEVES THAT ITS COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS IS COMPREHENSIVE ENOUGH TO CAPTURE SUBSTANTIALLY ALL OF THE COMMUNITYS NEEDS. THEREFORE, NO FURTHER STEPS WERE TAKEN TO IDENTIFY ADDITIONAL NEEDS. MERCY HOSPITAL LEBANON MEASURES ALL COMMUNITY HEALTH INDICATORS AS SET FORTH BY THE CENTERS FOR DISEASE CONTROL AND PREVENTION, AND MEASURES ALL UTILIZATION ACTIVITY (PARTICULARLY FOR VULNERABLE POPULATIONS) TO FIRST UNDERSTAND THE STATUS OF THE COMMUNITYS HEALTH ON AN ANNUAL BASIS. BASED ON THESE FINDINGS, MERCY REFINES ITS IMPLEMENTATION STRATEGIES TO MEET THE NEEDS OF THE COMMUNITY AND MONITORS PROGRESS THROUGH A COMMUNITY BENEFIT COMMITTEE OF THE BOARD OF DIRECTORS. THE DIRECTOR OF COMMUNITY BENEFIT ALSO SERVES ON A COMMUNITY HEALTH COLLABORATION BOARD WITH OTHER AREA NONPROFIT HEALTH SYSTEM AND ORGANIZATIONAL LEADERS TO MAKE SURE OUR UNDERSTANDING OF COMMUNITY NEEDS ARE CORRECT AND TO DEVELOP ALIGNED STRATEGIES TO ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITIES AND SUBSEQUENT IMPROVEMENT STRATEGIES.
FORM 990, SCHEDULE H, 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 organizations 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.
FORM 990, SCHEDULE H, PART VI, LINE 4	MERCY HOSPITAL LEBANON'S PRIMARY SERVICE AREA INCLUDES LACLEDE AND PULASKI COUNTIES IN MISSOURI. THE FOLLOWING INFORMATION IS DERIVED FROM 2018 IBM/WATSONS DEMOGRAPHICS AND FY2018 DECISION RESOURCE GROUPS INSURANCE COVERAGE ESTIMATES. THE AREAS POPULATION IS 91,232. 25% OF THE POPULATIONS AVERAGE HOUSEHOLD INCOME IS OVER $75,000. 34% OF THE POPULATION IS 45 AND OLDER. 20% OF THE HOUSEHOLDS ARE ON MEDICARE, 15% ON MEDICAID, AND 11% UNINSURED.
FORM 990, SCHEDULE H, PART VI, LINE 5	MERCY HOSPITAL LEBANON PROVIDES QUALITY MEDICAL HEALTH CARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY. MERCY IS A CATHOLIC HEALTH CARE CORPORATION THAT, PURSUANT TO THE ORGANIZATIONAL CORE BELIEF THAT HEALTH CARE SERVICES ARE A VITAL AND INTEGRAL PART OF THE CHURCH'S HEALING MISSION, ENGAGES IN A MINISTRY WHICH PROVIDES GENERAL ACUTE CARE, AMBULATORY, LONG-TERM AND HOME CARE HEALTH SERVICES TO INDIVIDUALS AND FAMILIES IN ITS COMMUNITIES. MERCY OFFERS SERVICES AND PROGRAMS WHICH FURTHER HEALTH PROMOTION, MAINTENANCE AND CARE TO THE COMMUNITY. PROGRAMS PROVIDED TO MEET THE COMMUNITY INCLUDE SUPPORT GROUPS FOR VARIOUS SITUATIONS, OUTREACH PROGRAMS, EDUCATIONAL PROGRAMS, HEALTH RESOURCE COORDINATION, COMMUNITY BLOOD DRIVES AND HEALTH FAIRS, ETC. MERCY HOSPITAL LEBANON IS GOVERNED BY A BOARD OF DIRECTORS WHICH INCLUDES REPRESENTATION FROM COMMUNITY LEADERS IN THE ORGANIZATION'S PRIMARY SERVICE AREAS. ALL BOARD MEMBERS ARE REQUIRED TO COMPLETE AN ANNUAL CONFLICT OF INTEREST SURVEY. ANY POTENTIAL CONFLICTS OF INTEREST DISCLOSED BY BOARD MEMBERS ARE REVIEWED AND RESOLVED. THIS PROCESS ENSURES THAT PUBLIC, RATHER THAN PRIVATE, INTERESTS ARE SERVED BY MERCY. SURPLUS FUNDS AND UNRESTRICTED ASSETS HELD BY MERCY LEBANON 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.
FORM 990, SCHEDULE H, 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 TO LIFE THE HEALING MINISTRY OF JESUS THROUGH OUR COMPASSIONATE CARE AND EXCEPTIONAL SERVICE." AS OF JUNE 30, 2018, MERCY FACILITIES INCLUDED 30 ACUTE CARE HOSPITALS, 5 MANAGED HOSPITALS, 4 HEART HOSPITALS, 2 CHILDREN'S HOSPITALS, 2 ORTHOPEDIC HOSPITALS AND 3 REHAB HOSPITALS. FOR THE FISCAL YEAR ENDED JUNE 30, 2018, MERCY HAD MORE THAN 10.3 MILLION OUTPATIENT AND PHYSICIAN OFFICE VISITS, APPROXIMATELY 2,400 EMPLOYED PHYSICIANS, AND APPROXIMATELY 45,000 FULL-TIME EQUIVALENT EMPLOYEES, MAKING MERCY THE SIXTH 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: FINANCE (INCLUDING TREASURY, FINANCIAL ACCOUNTING AND REPORTING, REVENUE MANAGEMENT, INTERNAL AUDIT, ACCOUNTS PAYABLE AND PAYROLL OPERATIONS, ANALYTICS AND DECISION SUPPORT); ENVIRONMENTAL SERVICES SUPPORT; CLINICAL INTEGRATION; CARE MANAGEMENT; CLINICAL PERFORMANCE ACCELERATION; CLINICAL ENGINEERING; CLINICAL QUALITY MANAGEMENT; COMPLIANCE; GRANTS AND RESEARCH SERVICES; LEGAL AND COMPLIANCE COUNSEL; MARKETING AND COMMUNICATIONS; PLANNING, DESIGN AND CONSTRUCTION; PRODUCT DEVELOPMENT INFORMATICS; REAL ESTATE; SUPPLY CHAIN MANAGEMENT; MANAGED CARE STRATEGY SUPPORT; HUMAN RESOURCES (INCLUDING COMPENSATION, BENEFITS AND RECRUITING); MISSION SERVICES AND ETHICS; PHILANTHROPY SUPPORT; INFORMATION TECHNOLOGY; AND, COMMUNITY RELATIONS. THE CENTRALIZATION OF SUCH SUPPORT SERVICES ENABLES MERCY TO ENSURE THAT EACH OF ITS COMMUNITIES, WHETHER LARGE OR SMALL, HAS THE SERVICES IT NEEDS.
FORM 990, SCHEDULE H, PART VI, LINE 7	STATE FILING OF COMMUNITY BENEFIT REPORT: MO

Schedule H (Form 990) 2019

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

MERCY HOSPITAL LEBANON

Employer identification number

43-1767432

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 on 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 .........

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 on Line 1a? ..

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 nonfixed
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) 2019

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)
1Barbe MD David O Physician & Board member	(i) (ii)	0 ------------- 334,777	0 ------------- 72,173	0 ------------- 24,465	0 ------------- 70,886	0 ------------- 12,064	0 ------------- 514,365	0 ------------- 0
2Dent MD Aaron Physician & Board member	(i) (ii)	0 ------------- 715,804	0 ------------- 100,613	0 ------------- 486	0 ------------- 2,650	0 ------------- 16,466	0 ------------- 836,019	0 ------------- 0
3Tegtmeyer MD Chris Physician & Board member	(i) (ii)	0 ------------- 215,979	0 ------------- 31,999	0 ------------- 43,759	0 ------------- 48,496	0 ------------- 11,998	0 ------------- 352,231	0 ------------- 0
4Vincent Jenine VP-Operations & Board member	(i) (ii)	0 ------------- 200,610	0 ------------- 29,711	0 ------------- 15,073	0 ------------- 5,218	0 ------------- 15,869	0 ------------- 266,481	0 ------------- 0
5Burke James Regional VP Legal Thru 4/18	(i) (ii)	0 ------------- 232,090	0 ------------- 82,178	0 ------------- 41,469	0 ------------- 9,275	0 ------------- 12,257	0 ------------- 377,269	0 ------------- 0
6Hoban Douglas CFO- MERCY HOSPITAL LEBANON	(i) (ii)	0 ------------- 132,125	0 ------------- 9,204	0 ------------- 31,644	0 ------------- 14,556	0 ------------- 12,127	0 ------------- 199,656	0 ------------- 0
7Reynolds Scott R CFO-central commun (thru 5/18)	(i) (ii)	0 ------------- 358,736	0 ------------- 114,156	0 ------------- 59,376	0 ------------- 94,698	0 ------------- 12,072	0 ------------- 639,038	0 ------------- 0
8Swope Jon President, central communities	(i) (ii)	0 ------------- 703,153	0 ------------- 408,199	0 ------------- 96,148	0 ------------- 154,702	0 ------------- 16,505	0 ------------- 1,378,707	0 ------------- 0
9Marion Tanya Regional VP-Human resources	(i) (ii)	0 ------------- 220,314	0 ------------- 71,776	0 ------------- 37,257	0 ------------- 43,163	0 ------------- 16,268	0 ------------- 388,778	0 ------------- 0
10O'Connor Judy VP-Nursing	(i) (ii)	144,079 ------------- 0	11,493 ------------- 0	22,763 ------------- 0	14,416 ------------- 0	16,463 ------------- 0	209,214 ------------- 0	0 ------------- 0
11Bond MD Jeffrey B Physician	(i) (ii)	348,196 ------------- 0	------------- 0	44,819 ------------- 0	28,889 ------------- 0	16,411 ------------- 0	438,315 ------------- 0	0 ------------- 0
12Bray Dennis Chief CRNA	(i) (ii)	214,867 ------------- 0	12,017 ------------- 0	25,258 ------------- 0	21,794 ------------- 0	12,004 ------------- 0	285,940 ------------- 0	0 ------------- 0
13Oleniacz Sharron Nurse anesthetist	(i) (ii)	224,817 ------------- 0	40 ------------- 0	15,084 ------------- 0	7,171 ------------- 0	192 ------------- 0	247,304 ------------- 0	0 ------------- 0
14Mauppins Desiree L NURSE ANESTHETIST	(i) (ii)	212,722 ------------- 0	40 ------------- 0	12,198 ------------- 0	1,126 ------------- 0	5,086 ------------- 0	231,172 ------------- 0	0 ------------- 0
15Wong John S Nurse anesthetist	(i) (ii)	190,171 ------------- 0	40 ------------- 0	25,196 ------------- 0	7,112 ------------- 0	201 ------------- 0	222,720 ------------- 0	0 ------------- 0
16Scarrow MD Alan Pres.,Sprg comm thru (9/17)	(i) (ii)	0 ------------- 635,731	0 ------------- 357,357	0 ------------- 1,225	0 ------------- 18,579	0 ------------- 16,505	0 ------------- 1,029,397	0 ------------- 0
17DAVISON JUSTIN VICE PRESIDENT FINANCE	(i) (ii)	0 ------------- 190,745	0 ------------- 26,858	0 ------------- 159	0 ------------- 0	0 ------------- 15,731	0 ------------- 233,493	0 ------------- 0
18HANNASCH SUSAN VP-REGIONAL GENERAL COUNSEL	(i) (ii)	0 ------------- 258,747	0 ------------- 84,442	0 ------------- 25,878	0 ------------- 46,417	0 ------------- 13,311	0 ------------- 428,795	0 ------------- 0

Schedule J (Form 990) 2019

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

FORM 990, SCHEDULE J, PART I, QUESTION 3

MERCY HOSPITAL LEBANON RELIES ON A RELATED ORGANIZATION; REFER TO SCHEDULE O, PART VI, QUESTION 15A AND 15B FOR THE PROCESS THE RELATED ORGANIZATION FOLLOWS.

FORM 990, SCHEDULE J, PART I, QUESTION 4B

MERCY HEALTH 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 INDIVIDUALS REPORTABLE ON THIS RETURN WHO PARTICIPATE IN THE SUPPLEMENTAL RETIREMENT PLANS INCLUDE: DAVID BARBE, JON SWOPE, SCOTT REYNOLDS, JAMES BURKE, ALAN SCARROW, TANYA MARION AND SUSAN HANNASCH. THE AMOUNT OF ALL ACCRUED BENEFITS IS INCLUDED IN COMPENSATION AMOUNTS PROVIDED IN SCHEDULE J, PART II, COLUMN (C).

Schedule J (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered "Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

MERCY HOSPITAL LEBANON

Employer identification number

43-1767432

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and section 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by the organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e) Original principal amount	(f) Balance due	(g) In default?		(h) Approved by board or committee?		(i) Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e) Original principal amount	(f) Balance due	Yes	No	Yes	No	Yes	No






Total ............... $

Part III

Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

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

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2019

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) Gerry C Hoke Nutter	Family member of board member	48,515	Employment		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference	Explanation

Schedule L (Form 990 or 990-EZ) 2019

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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

MERCY HOSPITAL LEBANON

Employer identification number

43-1767432

Return Reference	Explanation
FORM 990, PART V, QUESTION 1A	FORM 1099/1096 FILING VENDORS FOR THE FILING ORGANIZATION ARE PAID BY MERCY HEALTH (EIN 43-1423050). AS SUCH, ALL REQUIRED FORM 1099 AND FORM 1096 REPORTING IS MADE FOR THE ENTIRE MERCY HEALTH SYSTEM (WITH LIMITED EXCEPTIONS) UNDER THE MERCY HEALTH EIN. FORM 990, PART V, QUESTION 2A W-3 FILING MOST EMPLOYEES ARE PAID BY A RELATED ORGANIZATION UNDER A COMMON PAYMASTER ARRANGEMENT. AS SUCH, REQUIRED PAYROLL FILING (INCLUDING W-2 AND W-3S) WAS REPORTED UNDER THE RELATED ORGANIZATION, MHM SUPPORT SERVICES, EIN 20-2553101.
FORM 990, PART VI, LINES 6A, 7A, & 7B	CLASSES OF MEMBERS OR STOCKHOLDERS THE FILING ORGANIZATION HAS A SOLE CORPORATE MEMBER, MERCY HEALTH SPRINGFIELD COMMUNITIES. THE CORPORATE MEMBER SHALL HAVE THE FOLLOWING POWERS AND RESPONSIBILITIES, SUBJECT TO THE RESTRICTIONS SET FORTH UNDER THESE BYLAWS: -TO APPROVE THE MISSION AND PHILOSOPHY OF THE CORPORATION; -TO AMEND THE ARTICLES OF INCORPORATION AND BYLAWS, SUBJECT TO ARTICLES XI AND XII HEREIN; -TO APPOINT OR REMOVE MEMBERS OF THE BOARD, SUBJECT TO THE RESTRICTIONS SET FORTH IN ARTICLE V HEREIN; -TO APPOINT OR REMOVE THE PRESIDENT OF THE CORPORATION, SUBJECT TO THE RESTRICTIONS SET FORTH IN ARTICLE VII HEREIN; -TO REVIEW, AMEND, AND APPROVE THE STRATEGIC PLAN, GOALS AND OBJECTIVES OF THE CORPORATION; -TO REVIEW, AMEND, AND APPROVE THE OPERATING, CAPITAL, AND CONSTRUCTION BUDGETS FOR THE CORPORATION; -TO REVIEW OR APPROVE ANY CAPITAL EXPENDITURES OR RECOMMENDATIONS NOT PREVIOUSLY APPROVED AS PART OF THE CORPORATION'S BUDGETS AND/OR STRATEGIC PLAN; -TO LEASE OR SELL ANY OF THE ASSETS OF THE CORPORATION OR ANY ORGANIZATION CONTROLLED BY THE CORPORATION SUBJECT TO THRESHOLDS ESTABLISHED FROM TIME TO TIME BY MERCY HEALTH; -TO ENCUMBER THE ASSETS OF THE CORPORATION OR ANY CORPORATION CONTROLLED BY THE CORPORATION; -TO AUTHORIZE AND APPROVE THE INCURRENCE OF DEBT BY THE CORPORATION OR ANY ORGANIZATION CONTROLLED BY THE CORPORATION (OTHER THAN DEBT INCURRED FOR THE ACQUISITION OF GOODS THAT ARE ACQUIRED IN THE ORDINARY COURSE OF BUSINESS) AND TO GRANT ANY SECURITY INTERESTS, PLACE ANY ENCUMBRANCES, ENTER INTO ANY COVENANTS, AND EXECUTE ANY DOCUMENTS AND TAKE ANY ACTIONS NECESSARY OR APPROPRIATE IN CONNECTION WITH THE INCURRENCE OF SUCH DEBT; AND, -TO MERGE, DISSOLVE, OR CHANGE THE SPONSORSHIP OF THE CORPORATE MEMBER.
FORM 990, PART VI, QUESTION 11B	DSCR OF PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990 THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM USING INFORMATION PROVIDED BY THE FILING ORGANIZATION. A DRAFT FORM 990 IS REVIEWED BY THE FILING ORGANIZATION'S FINANCE TEAM, INCLUDING THE DIRECTOR OF FINANCE 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' FORMS 990. AFTER QUESTIONS ARISING FROM THE VARIOUS REVIEWS ARE ADDRESSED AND INCORPORATED INTO THE FORM 990, A REVISED DRAFT IS MADE AVAILABLE TO THE FILING ORGANIZATION'S LEADERSHIP TEAM FOR THEIR REVIEW. THE FORM 990 IS THEN SIGNED AND FILED WITH THE IRS.
FORM 990, PART VI, QUESTION 12C	DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST OFFICERS, DIRECTORS, KEY EMPLOYEES AND OTHER DISQUALIFIED PERSONS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE ANNUALLY AND DID SO IN THE NORMAL COURSE FOR THE YEAR ENDED JUNE 30, 2018. THIS PROCESS IS ADMINISTERED AT THE MERCY HEALTH LEVEL BY MERCY'S CORPORATE COMPLIANCE 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 OF THE BOARD OF DIRECTORS.
FORM 990, PART VI, QUESTIONS 15A & 15B	FOR THOSE CLASSIFIED AS OFFICERS (AND THUS DISQUALIFIED PERSONS), THE ORGANIZATION RELIES UPON MERCY HEALTH, WHICH USES THE FOLLOWING TO ESTABLISH THE COMPENSATION: EXTERNAL MARKET SALARY SURVEYS, EXTERNAL MARKET SALARY STUDIES, ENGAGEMENT OF AN INDEPENDENT COMPENSATION CONSULTANT, AND REVIEW/APPROVAL OF COMPENSATION BY THE COMPENSATION COMMITTEE OF THE BOARD OF MERCY HEALTH. FOR THOSE CLASSIFIED AS KEY EMPLOYEES, THE ORGANIZATION RELIES UPON MERCY HEALTH, WHICH USES THE FOLLOWING TO ESTABLISH THE COMPENSATION: EXTERNAL MARKET SALARY SURVEYS, EXTERNAL MARKET SALARY STUDIES, AND REVIEW/APPROVAL OF EXECUTIVE MANAGEMENT. COMPENSATION REVIEWS ARE COMPLETED ON AN ANNUAL BASIS AND A REVIEW WAS COMPLETED DURING THE REPORTING YEAR.
FORM 990, PART VI, QUESTION 19	AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMT TO GEN PUBLIC GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST BUT ARE NOT PUBLISHED PUBLICLY.
FORM 990 PART XI LINE 9	OTHER CHANGES IN NET ASSETS NET TRANSFERS TO/FROM AFFILIATES:($27,037,618)
FORM 990, PART XII, QUESTION 2C	AUDIT OF FINANCIAL STATEMENTS THE FILING ORGANIZATION'S FINANCIAL STATEMENTS WERE INCLUDED IN MERCY HEALTH AND SUBSIDIARIES ANNUAL FINANCIAL STATEMENT AUDIT. MERCY HEALTH AND SUBSIDIARIES RECEIVED AN UNQUALIFIED OPINION FROM THE EXTERNAL AUDITORS FOR FISCAL 2018 (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 OF THE MERCY HEALTH BOARD OF DIRECTORS. AUDIT RESULTS ARE COMMUNICATED TO THIS COMMITTEE.

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2019

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

MERCY HOSPITAL LEBANON

Employer identification number

43-1767432

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)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" 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	Shelter	TX	501c3	7	MM LAREDO	Yes
(2)McAuley Portfolio Management Company 14528 S Outer Forty Suite 100 Chesterfield,MO63017 26-1708048	PORT MGMT	MO	501c3	12b	Mercy Health	Yes
(3)Mercy ACO Clinical Services Inc 14528 S Outer Forty Suite 100 Chesterfield,MO63017 46-4504901	Virtual Care	MO	501c3	3	Mercy Health	Yes
(4)Mercy Clinic East Communities 645 Maryville Center Drive Suite 1 St Louis,MO63141 43-1771217	PHYS GROUP	MO	501c3	10	MH EAST COMM	Yes
(5)Mercy Clinic Fort Smith Communities 7301 Rogers Avenue Fort Smith,AR72903 26-1318597	PHYS CLINIC	AR	501c3	3	MH FS COMM	Yes
(6)Mercy Clinic Oklahoma Communities Inc 4300 W Memorial Road Oklahoma City,OK73120 27-0473057	PHYS GROUP	OK	501c3	3	MH OK COMM	Yes
(7)Mercy Clinic Springfield Communities 1965 Fremont Street Suite 2950 Springfield,MO65804 43-1560263	PHYS GROUP	MO	501c3	3	MH SF COMM	Yes
(8)Mercy Family Center 14528 S Outer Forty Suite 100 Chesterfield,MO63017 72-1069468	COUNSELING	LA	501c3	7	Mercy Health	Yes
(9)Mercy Health 14528 S Outer Forty Suite 100 Chesterfield,MO63017 43-1423050	CORP OFFICE	MO	501c3	1	NA		No
(10)Mercy Health East Communities 14528 S Outer Forty Suite 100 Chesterfield,MO63017 43-1718408	HLTH SYSTEM	MO	501c3	12a	Mercy Health	Yes
(11)Mercy Health East Communities - Southern 14528 S Outer Forty Suite 100 Chesterfield,MO63017 46-1412322	DSLVD 5/18	MO	501c3	12a	MH EAST COMM	Yes
(12)Mercy Health Fort Smith Communities 7301 Rogers Avenue Fort Smith,AR72917 26-1318515	Holding Co	AR	501c3	12b	Mercy Health	Yes
(13)Mercy Health Foundation 14528 S Outer Forty Suite 100 Chesterfield,MO63017 20-0901499	Foundation	MO	501c3	12b	Mercy Health	Yes
(14)Mercy Health Foundation Ada 430 N Monte Vista Street Ada,OK74820 46-3596274	Foundation	OK	501c3	12a	MH ADA Inc	Yes
(15)Mercy Health Foundation Ardmore 1011 14th Avenue NW Ardmore,OK73401 71-0962525	Foundation	OK	501c3	12a	MH ARDMORE	Yes
(16)Mercy Health Foundation Berryville 214 Carter Street Berryville,AR72616 71-0759301	Foundation	AR	501c3	12a	MH Berryvill	Yes
(17)Mercy Health Foundation Fort Scott 401 Woodland Hills Blvd Fort Scott,KS66701 48-1077073	Foundation	KS	501c3	7	M KS COMM	Yes
(18)Mercy Health Foundation Fort Smith 7301 Rogers Avenue Fort Smith,AR72917 23-7330425	Foundation	AR	501c3	7	MH FT SMITH	Yes
(19)Mercy Health Foundation Hot Springs 300 Werner Street Hot Springs,AR71913 71-0804718	DSLVD 6/18	AR	501c3	12a	MC SRVCS	Yes
(20)Mercy Health Foundation Jefferson 1400 US Highway 61 South Festus,MO63028 46-2797051	Foundation	MO	501c3	12b	MH E COMM SR	Yes
(21)Mercy Health Foundation Joplin 100 Mercy Way Joplin,MO64804 27-0906136	Foundation	MO	501c3	7	MH SWMK COMM	Yes
(22)Mercy Health Foundation Lebanon 100 Hospital Drive Lebanon,MO65536 82-2514567	Foundation	MO	501c3	12b	MH Lebanon	Yes
(23)Mercy Health Foundation Lincoln 1000 East Cherry Street Troy,MO63379 81-1477159	Foundation	MO	501c3	12b	MH EAST COMM	Yes
(24)Mercy Health Foundation NW Arkansas 2710 Rife Medical Lane Rogers,AR72758 71-0601687	Foundation	AR	501c3	7	MH Rogers	Yes
(25)Mercy Health Foundation of Oklahoma 4300 W Memorial Road Oklahoma City,OK73120 45-4732301	Foundation	OK	501c3	12a	MH OK COMM	Yes
(26)Mercy Health Foundation Oklahoma City 4300 W Memorial Road Oklahoma City,OK73120 46-3184231	Foundation	OK	501c3	12a	MH OK City	Yes
(27)Mercy Health Foundation Springfield 1235 E Cherokee Street Springfield,MO65804 32-0195818	Foundation	MO	501c3	12b	MH SF COMM	Yes
(28)Mercy Health Foundation St Francis 100 W Highway 60 Mountain View,MO65548 43-1873914	Foundation	MO	501c3	12a	M St Francis	Yes
(29)Mercy Health Foundation St Louis 14528 S Outer Forty Suite 100 Chesterfield,MO63017 56-2410020	Foundation	MO	501c3	12b	MH EAST COMM	Yes
(30)Mercy Health Foundation Washington 901 E Fifth Street Washington,MO63090 56-2410022	Foundation	MO	501c3	12b	MH EAST COMM	Yes
(31)Mercy Health NW Arkansas Communities 2710 Rife Medical Lane Rogers,AR72758 62-1684203	PHYS GROUP	AR	501c3	10	Mercy Health	Yes
(32)Mercy Health Oklahoma Communities Inc 4300 W Memorial Road Oklahoma City,OK73120 73-1453048	HLTH SYSTEM	OK	501c3	12a	Mercy Health	Yes
(33)Mercy Health Plans of Missouri Inc 3265 S National Avenue Springfield,MO65807 32-0481419	HMO	MO	501c4	N/A	Mercy Health	Yes
(34)Mercy Health Plans Inc 3265 S National Avenue Springfield,MO65807 32-0486150	PPO	MO	501c4	N/A	MH PLANS MO	Yes
(35)Mercy Health SW MOKS Communities 100 Mercy Way Joplin,MO64804 30-0584463	HLTH SYSTEM	MO	501c3	12b	Mercy Health	Yes
(36)Mercy Health Springfield Communities 1235 E Cherokee Street Springfield,MO65804 43-1856028	HLTH SYSTEM	MO	501c3	12b	Mercy Health	Yes
(37)Mercy Home Health Berryville 804 W Freeman Suite 4 Berryville,AR72616 87-0781247	Inactive	AR	501c3	12a	MH Springfie	Yes
(38)Mercy Hospital Ada Inc 430 N Monte Vista Street Ada,OK74820 46-2288155	Hospital	OK	501c3	3	MH OK COMM	Yes
(39)Mercy Hospital Ardmore Inc 1011 14th Avenue NW Ardmore,OK73401 73-1500629	Hospital	OK	501c3	3	MH OK COMM	Yes
(40)Mercy Hospital Aurora 500 Porter Avenue Aurora,MO65605 43-1936696	Hospital	MO	501c3	3	MH SF COMM	Yes
(41)Mercy Hospital Berryville 214 Carter Street Berryville,AR72616 71-0759299	Hospital	AR	501c3	3	MH SF COMM	Yes
(42)Mercy Hospital Booneville 880 West Main Street Booneville,AR72927 46-3851119	Hospital	AR	501c3	3	MH FT Smith	Yes
(43)Mercy Hospital Carthage 3125 Dr Russell Smith Way Carthage,MO64836 45-3808607	Hospital	MO	501c3	3	MH SWMK COMM	Yes
(44)Mercy Hospital Cassville 94 Main Street Cassville,MO65625 43-1936699	Hospital	MO	501c3	3	MH SF COMM	Yes
(45)Mercy Hospital Columbus 220 Pennsylvania Avenue Columbus,KS66725 27-0842031	Hospital	KS	501c3	3	MH SWMK COMM	Yes
(46)Mercy Hospital El Reno Inc 2115 Parkview Drive El Reno,OK73036 27-2716065	Hospital	OK	501c3	3	MH OK City	Yes
(47)Mercy Hospital Fort Smith 7301 Rogers Avenue Fort Smith,AR72903 71-0240352	Hospital	AR	501c3	3	MH FS Comm	Yes
(48)Mercy Hospital Healdton Inc 3462 Hospital Rd Healdton,OK73438 26-3173902	Hospital	OK	501c3	3	MH ADA Inc	Yes
(49)Mercy Hospital Jefferson 1400 Highway 61 South Festus,MO63028 43-0687077	Hospital	MO	501c3	3	MH EAST COMM	Yes
(50)Mercy Hospital Joplin 100 Mercy Way Joplin,MO64804 27-0814858	Hospital	MO	501c3	3	MH SWMK COMM	Yes
(51)Mercy Hospital Kingfisher Inc 1000 Kingfisher Regional Hospital C Kingfisher,OK73750 46-3433074	Hospital	OK	501c3	3	MH OK City	Yes
(52)Mercy Hospital Lincoln 1000 East Cherry Street Troy,MO63379 47-2219204	Hospital	MO	501c3	3	MH EAST COMM	Yes
(53)Mercy Hospital Logan County Inc 200 South Academy Guthrie,OK73044 45-2998842	Hospital	OK	501c3	3	MH OK City	Yes
(54)Mercy Hospital Oklahoma City Inc 4300 W Memorial Road Oklahoma City,OK73120 73-0579285	Hospital	OK	501c3	3	MH OK COMM	Yes
(55)Mercy Hospital Ozark 801 W River Street Ozark,AR72949 71-0689680	Hospital	AR	501c3	3	MH FT Smith	Yes
(56)Mercy Hospital Paris 500 E Academy Paris,AR72855 71-0655753	Hospital	AR	501c3	3	MH FT Smith	Yes
(57)Mercy Hospital Rogers 2710 Rife Medical Lane Rogers,AR72758 71-0294390	Hospital	AR	501c3	3	MH NWAR COMM	Yes
(58)Mercy Hospital Springfield 1235 E Cherokee Street Springfield,MO65804 44-0552485	Hospital	MO	501c3	3	MH SF COMM	Yes
(59)Mercy Hospital Tishomingo Inc 1000 South Byrd Tishomingo,OK73460 27-4433830	Hospital	OK	501c3	3	MH ADA Inc	Yes
(60)Mercy Hospital Waldron 1341 W 6th Street Waldron,AR72958 71-0557895	Hospital	AR	501c3	3	MH FT Smith	Yes
(61)Mercy Hospital Watonga Inc 500 Clarence Nash Blvd Watonga,OK73772 45-5199762	Hospital	OK	501c3	3	MH OK City	Yes
(62)Mercy Hospitals East Communities 615 S New Ballas Road St Louis,MO63141 43-0653493	Hospital	MO	501c3	3	MH EAST COMM	Yes
(63)Mercy Kansas Communities Inc 401 Woodland Hills Blvd Ft Scott,KS66701 48-0956045	Hospital	KS	501c3	3	MH SWMK COMM	Yes
(64)Mercy Ministries of Laredo 2500 Zacatecas Laredo,TX78046 20-0198462	Outreach	TX	501c3	7	Mercy Health	Yes
(65)Mercy Research 524 North Booneville Avenue Springfield,MO65802 87-0796305	Research	MO	501c3	4	Mercy Health	Yes
(66)Mercy St Francis Hopsital 100 W Highway 60 Mountain View,MO65548 44-0607149	Hospital	MO	501c3	3	MH SF COMM	Yes
(67)MHM Support Services 14528 S Outer Forty Suite 100 Chesterfield,MO63017 20-2553101	CTRL SYS FUNC	MO	501c3	12a	Mercy Health	Yes
(68)Mission Clinical Services 300 Werner Street Hot Springs,AR71913 13-4239691	CHILD ADVOC	AR	501c3	3	Mercy Health	Yes
(69)St Anthony's Charitable Foundation 10010 Kennerly Road St Louis,MO63128 26-1516789	Fundraising	MO	501c3	12a	ST ANTHONY	Yes
(70)St Anthony's Medical Center 10010 Kennerly Road St Louis,MO63128 43-0980256	Hospital	MO	501c3	3	MH EAST COMM	Yes
(71)St Anthony's Physician Organization 10010 Kennerly Road St Louis,MO63128 43-1784536	Health care	MO	501c3	3	ST ANTHONY	Yes
(72)St Mary's Hospital of Enid Oklahoma I 14528 S Outer Forty Suite 100 Chesterfield,MO63017 73-0614655	Inactive	OK	501c3	3	MH OK COMM	Yes
(73)Unity Ambulatory Care 14528 S Outer Forty Suite 100 Chesterfield,MO63017 43-1861745	Inactive	MO	501c3	12c	MH EAST COMM	Yes

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

Cat. No. 50135Y

Schedule R (Form 990) 2019

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	(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) Fort Smith Ems 1701 S Greenwood FT SMITH,AR72901 71-0416615	Emergency Medical	AR	NA
(2) Mercy Ambu Surg Ctr 7301 Rogers FT SMITH,AR72917 71-0827721	AMBUL SURG CT	AR	NA
(3) Plaza Surg SVCS CO 12700 Southfork RD St Louis,MO63128 20-4709312	INACTIVE	MO	NA
(4) RES OPT & INNOV 645 Maryville St Louis,MO63141 46-0468368	CENTRAL DIST.	MO	NA
(5) ST ED MER MED MOB 7301 Rogers FT SMITH,AR72903 71-0554050	OFFICE BUILDING	AR	NA

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" 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) Frontenac Properties Inc 14528 S Outer Forty Suite 100 Chesterfield,MO63017 52-1914421	Holding company	DE	NA	C-Corp
(2) Inveno Health Inc 1235 E Cherokee Street Springfield,MO65804 26-4509571	Product Commer	MO	NA	C-Corp
(3) Mercy Commercial Services Inc 14528 South Outer Forty Suite 100 Chesterfield,MO63017 46-4953543	Parent of VCC	MO	NA	C-Corp
(4) Mercy Community Services Inc 401 Woodland Hills Blvd Fort Scott,KS66701 48-1078101	Retail pharmacy	KS	NA	C-Corp
(5) Mercy Health Center Condominium Inc 4300 W Memorial Rd Oklahoma City,OK73120 68-0640970	Real estate	OK	NA	C-Corp
(6) Mercy Health Network of the Southern Reg 14528 S Outer Forty Suite 100 Chesterfield,MO63017 73-1580607	Holding company	OK	NA	C-Corp
(7) Mercy Health Network Inc 14528 S Outer Forty Suite 100 Chesterfield,MO63017 73-1381689	Holding company	OK	NA	C-Corp
(8) Mercy Managed Care Corporation 14528 S Outer Forty Suite 100 Chesterfield,MO63017 73-1441665	Holding company	OK	NA	C-Corp
(9) UHL Corp Inc 645 Maryville Centre Drive Suite 1 St Louis,MO63141 74-2499535	Holding company	MO	NA	C-Corp
(10) Unity Support Services Inc 645 Maryville Centre Drive Suite 1 St Louis,MO63141 43-1797042	Inactive	MO	NA	C-Corp
(11) St Anthony's Physician Organization of 10010 Kennerly Road St Louis,MO63128 32-0457168	Health Care	MO	NA	C-Corp

Schedule R (Form 990) 2019

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) ............................

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) .......................

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) ............................

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 ACO Clinical Services Inc	P	635,637	FMV
(2) Mercy Clinic Springfield Communities	P	63,058	FMV
(3) Mercy Hospital Springfield	Q	232,283	FMV
(4) MHM Support Services	P	35,081,680	FMV
(5) Mercy Health Springfield Communities	Q	3,191,952	FMV
(6) Mercy Health Foundation Lebanon	q	132,649	FMV
(7) Mercy Health Foundation Lebanon	b	218,939	FMV

Schedule R (Form 990) 2019

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) 2019

Page 5

Part VII

Supplemental Information

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

Return Reference

Explanation

Form 990, Schedule R, Part II

Mercy Hospitals East Communities Mercy Hospitals East Communities consists of Mercy Hospital St. Louis, EIN 43-0653493, and Mercy Hospital Washington, EIN 43-1066883.

Form 990, Schedule R, Part V

LAWSON ERP SOFTWARE IS THE PRIMARY ACCOUNTING SOFTWARE USED BY MERCY HEALTH SYSTEM, INC. AND SUBSIDIARIES. THE MAJORITY OF THE INTERCOMPANY/RELATED ORGANIZATION TRANSACTIONS ARE PROCESSED THROUGH LAWSON VIA INTERCOMPANY JOURNAL ENTRIES. WITH THE CURRENT DESIGN OF THE ERP SYSTEM, THERE ARE VARIOUS LIMITATIONS ON THE RELATED ORGANIZATION INFORMATION THAT CAN BE EXTRACTED FROM LAWSON. DUE TO THESE LIMITATIONS, MOST OF THE RELATED ORGANIZATION ACTIVITY FOR THE FILING ORGANIZATION HAS BEEN CLASSIFIED ON SCHEDULE R, PART V, IN LINES P AND Q.

Schedule R (Form 990) 2019

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: AS THE SISTERS OF MERCY BEFORE US, WE BRING TO LIFE THE HEALING MINISTRY OF JESUS THROUGH OUR COMPASSIONATE CARE AND EXCEPTIONAL SERVICE.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	14
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	9
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	0
6	Total number of volunteers (estimate if necessary) .............	6	42
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	581,590	227,656
9	Program service revenue (Part VIII, line 2g) .........	105,782,888	109,664,752
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	124	0
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	466,066	437,193
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	106,830,668	110,329,601
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	79,994	22,339
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)	34,658,891	34,652,881
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)....	43,954,412	52,332,019
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	78,693,297	87,007,239
19	Revenue less expenses. Subtract line 18 from line 12.......	28,137,371	23,322,362
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	39,229,147	35,355,539
21	Total liabilities (Part X, line 26).............	2,068,460	1,910,108
22	Net assets or fund balances. Subtract line 21 from line 20.....	37,160,687	33,445,431

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 82,499,862 including grants of $ 22,339 ) (Revenue $ 109,864,756 )
	MERCY HEALTH SPRINGFIELD COMMUNITIES AND ITS SUBSIDIARIES PROVIDE HIGH-QUALITY, COMPASSIONATE, FAITH-BASED HEALTH CARE IN A VARIETY OF TRADITIONAL MEDICAL SETTINGS. THIS ORGANIZATION PROVIDES SERVICES TO THE COMMUNITIES WE SERVE, WITH PARTICULAR CONCERN FOR THE ECONOMICALLY POOR, IN THE WAY OF INPATIENT HOSPITAL SERVICES, OUTPATIENT SERVICES, EMERGENCY ROOM CARE, HOME HEALTH SERVICES, AND PHYSICIAN CLINIC OFFICE VISITS.

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 expenses82,499,862

(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) Swope Jon........................................................................ President, central communities	1.0 .......................59.0	X			0	1,207,500	171,207
(19) Scarrow MD Alan........................................................................ Pres.,Sprg comm thru (9/17)	1.0 .......................59.0	X			0	994,313	35,084
(20) DAVISON JUSTIN........................................................................ VICE PRESIDENT FINANCE	1.0 .......................59.0	X			0	217,762	15,731
(21) HANNASCH SUSAN........................................................................ VP-REGIONAL GENERAL COUNSEL	1.0 .......................9.0	X			0	369,067	59,728
(22) Marion Tanya........................................................................ Regional VP-Human resources	2.0 .......................58.0		X		0	329,347	59,431
(23) O'Connor Judy........................................................................ VP-Nursing	60.0 .......................0.0		X		178,335	0	30,879
(24) Bond MD Jeffrey B........................................................................ Physician	60.0 .......................0.0			X	393,015	0	45,300
(25) Bray Dennis........................................................................ Chief CRNA	60.0 .......................0.0			X	252,142	0	33,798
(26) Oleniacz Sharron........................................................................ Nurse anesthetist	60.0 .......................0.0			X	239,941	0	7,363
(27) Mauppins Desiree L........................................................................ NURSE ANESTHETIST	60.0 .......................0.0			X	224,960	0	6,212
(28) Wong John S........................................................................ Nurse anesthetist	60.0 .......................0.0			X	215,407	0	7,313

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	1,503,800	6,054,325	810,747

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	218,939
e	Government grants (contributions)		1e	8,717

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

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		227,656

		Business Code
2a	NET PATIENT SERVICE REVENUE	622110	108,858,200	108,858,200
b	OTHER OPERATING REVENUE	900099	806,552	806,552
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		109,664,752

3 Investment income (including dividends, interest, and othersimilar amounts) ......			0
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents			6a
b	Less: rental expenses			6b
c	Rental income or (loss)	0	0	6c
d	Net rental income or (loss).......			0
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory			7a
b	Less: cost or other basis and sales expenses			7b
c	Gain or (loss)			7c
d	Net gain or (loss).........			0
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a	0
b	Less: direct expenses ...		8b	0
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a	0
b	Less: direct expenses ...		9b	0
c	Net income or (loss) from gaming activities..			0
10a	Gross sales of inventory, less returns and allowances ..
			10a	0
b	Less: cost of goods sold ..		10b	0
c	Net income or (loss) from sales of inventory..			0
Business Code			Miscellaneous Revenue
11a	CAFE & VENDING		900099	437,193		437,193
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			437,193
12	Total revenue. See instructions.....			110,329,601	109,664,752	437,193

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	22,339	22,339
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	0	0
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............	0	0
4	Benefits paid to or for members .......	0	0
5	Compensation of current officers, directors, trustees, and key employees ...........	207,642	192,210	15,432
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........	48,747	45,044	3,703
7	Other salaries and wages........	28,423,556	26,208,686	2,214,870
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	935,167	934,852	315
9	Other employee benefits .......	3,487,372	3,138,635	348,737
10	Payroll taxes ...........	1,550,397	1,348,776	201,621
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	0
c	Accounting ...........	0
d	Lobbying ...........	10,697		10,697
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	2,215,234	1,859,648	355,586
12	Advertising and promotion ....	871		871
13	Office expenses .......	1,150,418	1,079,848	70,570
14	Information technology ......	0
15	Royalties ..	0
16	Occupancy ...........	2,579,738	1,861,442	718,296
17	Travel ............	60,962	54,161	6,801
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	0
20	Interest ...........	0
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	2,031,264	1,913,793	117,471
23	Insurance ...	271,479	271,479
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 EXPENSES	13,962,972	13,962,972
b	SHARED SERVICE FEES	13,372,787	13,238,970	133,817
c	BAD DEBT	16,219,925	16,219,925
d	REPAIRS & MAINTENANCE	309,182	66,608	242,574
e	All other expenses	146,490	80,474	66,016
25	Total functional expenses. Add lines 1 through 24e	87,007,239	82,499,862	4,507,377	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 ........			1,886,003	1	1,885,703
2	Savings and temporary cash investments .........			408,106	2	0
3	Pledges and grants receivable, net ......			431,440	3	10,585,677
4	Accounts receivable, net .............			9,543,560	4	0
5	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
				0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
				0	6	0
7	Notes and loans receivable, net ...........			0	7	0
8	Inventories for sale or use ............			1,523,858	8	1,594,839
9	Prepaid expenses and deferred charges ......			22,700	9	24,290
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	51,471,674
b	Less: accumulated depreciation	10b	32,715,922	20,121,661	10c	18,755,752
11	Investments—publicly traded securities .			1,781,166	11	0
12	Investments—other securities. See Part IV, line 11 .....			0	12	0
13	Investments—program-related. See Part IV, line 11 ..			0	13	0
14	Intangible assets ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			3,510,653	15	2,509,278
16	Total assets. Add lines 1 through 15 (must equal line 33)...			39,229,147	16	35,355,539

17	Accounts payable and accrued expenses .....	2,068,460	17	1,910,108
18	Grants payable ...	0	18	0
19	Deferred revenue .........	0	19	0
20	Tax-exempt bond liabilities .........	0	20	0
21	Escrow or custodial account liability. Complete Part IV of Schedule D	0	21	0
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
		0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	0	23	0
24	Unsecured notes and loans payable to unrelated third parties ..	0	24	0
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	0	25	0
26	Total liabilities. Add lines 17 through 25..	2,068,460	26	1,910,108

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........		27
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	37,160,687	32	33,445,431
33	Total liabilities and net assets/fund balances ........	39,229,147	33	35,355,539