TY 2021 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/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) Brent Hubbard Hospital President & Board Member (THRU 4/22)	1.0 ................. 49.0	X				965,251	100,222
(2) Byron Dudley Board Member	1.0 ................. 1.0	X				0	0
(3) David Schmitz Board Member	1.0 ................. 0	X				0	0
(4) Deborah Moore Board Member	1.0 ................. 0	X				0	0
(5) Jeremy Goforth Board Member	1.0 ................. 0	X				0	0
(6) John Carr Board Member	1.0 ................. 0	X				0	0
(7) Marsha Vincent Board Member	1.0 ................. 0	X				0	0
(8) Nicki Gamet Administrator & Board Member	3.0 ................. 52.0	X				243,064	25,488
(9) Rafael Bonilla MD Physician & Board Member	1.0 ................. 49.0	X				425,280	13,238
(10) Randall Angst Board Member	1.0 ................. 0	X				0	0
(11) Robert B Wyrsch MD President, Mercy Clinic Springfield Communities & Board Member	1.0 ................. 49.0	X				1,254,037	52,555
(12) Steven Hite Board Member	1.0 ................. 0	X				0	0
(13) Craig McCoy President - Springfield Communities	1.0 ................. 49.0		X			1,107,455	117,117
(14) David Argueta President Mercy Hospital Springfield	1.0 ................. 49.0		X			645,312	73,226
(15) Judy Penniman VP-Nursing	60.0 ................. 0.0			X		191,761	22,483
(16) Tanya Marion Regional VP - Human Resources	1.0 ................. 50.0			X		485,849	63,701
(17) Desiree L Calbert Chief CRNA	40.0 ................. 0.0				X	407,195	17,662

(A) Name and business address	(B) Description of services	(C) Compensation
360 DEGREE MEDICINE 800 HWY 248 STE 2E BRANSON,MO65616	PHYSICIAN SERVICES	5,008,606
AMN HEALTHCARE 8840 CYPRESS WATERS BLVD STE300 COPPELL,TX75019	PHYSICIAN SERVICES	1,102,543
HEALTHTRUST WORKFORCE SOL 100 SAWGRASS CORP PKWY 6TH FL SUNRISE,FL33323	CONTRACT LABOR	1,069,453
LOCUMSMART PO BOX 736389 DALLAS,TX73638	PHYSICIAN SERVICES	726,778
SNYDER CONSTRUCTION GROUP 4820 N TOWNE CENTRE DRIVE OZARK,MO65721	CONSTRUCTION SERVICES	690,683
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 12

- TIN:

SCHEDULE A
(Form 990)

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

2021

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).)

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 33 1/3% 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 33 1/3% 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 on 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) 2021

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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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 5 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 2021 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2020 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2021. 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—2020. 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—2021. 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—2020. 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) 2021

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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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 on 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 5 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 2021 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2020 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2021 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2020 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2021. 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—2020. 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) 2021

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, 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 lines 3b and 3c 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 box 12a or 12b in Part I, answer lines 4b and 4c 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 lines 5b and 5c 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) .

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

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 on 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 on 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) 2021

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 on lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described on 11a above?

11b

A 35% controlled entity of a person described on line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, 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 line 2 above, 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 lines 2a and 2b 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 on line 2a, above 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 lines 3a and 3b 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?If "Yes" or "No", 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) 2021

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 0.015 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 0.035	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) 2021

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	1
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3
4 Amounts paid to acquire exempt-use assets	4
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5
6 Other distributions (describe in Part VI). See instructions	6
7Total annual distributions. Add lines 1 through 6.	7
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8
9 Distributable amount for 2021 from Section C, line 6	9
10 Line 8 amount divided by Line 9 amount	10

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2021	(iii) Distributable Amount for 2021
1 Distributable amount for 2021 from Section C, line 6
2 Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2021:
a From 2016.......
b From 2017.......
c From 2018.......
d From 2019.......
e From 2020.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2021 distributable amount
i Carryover from 2016 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2021 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2021 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2021, 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 2021. 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 2022. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2017.....
b Excess from 2018.....
c Excess from 2019.....
d Excess from 2020.....
e Excess from 2021.....

Schedule A (Form 990) (2021)

Schedule A (Form 990) 2021

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) 2021

Additional Data

Software ID:	21014044
Software Version:	2021v4.2

- TIN:

Schedule B
(Form 990)

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

2021

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) (2021)

Schedule B (Form 990) (2021) 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
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990) (2021)

Schedule B (Form 990) (2021)

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) (2021)

Schedule B (Form 990) (2021)

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) (2021)

Additional Data

Software ID:	21014044
Software Version:	2021v4.2

- TIN:

SCHEDULE C
(Form 990)

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

2021

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.

Cat. No. 50084S

Schedule C (Form 990) 2021

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) 2018	(b) 2019	(c) 2020	(d) 2021	(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) 2021

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

10,349

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

10,349

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
Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY	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, 2022, DUES WERE $33,159 AND $10,911 RESPECTIVELY. APPROXIMATELY 22.5% OF MISSOURI HOSPITAL ASSOCIATION DUES AND 26.47% OF AMERICAN HOSPITAL ASSOCIATION DUES WERE ATTRIBUTABLE TO LOBBYING ACTIVITIES PERFORMED BY THESE ASSOCIATIONS.

Return Reference

Explanation

Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY

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, 2022, DUES WERE $33,159 AND $10,911 RESPECTIVELY. APPROXIMATELY 22.5% OF MISSOURI HOSPITAL ASSOCIATION DUES AND 26.47% OF AMERICAN HOSPITAL ASSOCIATION DUES WERE ATTRIBUTABLE TO LOBBYING ACTIVITIES PERFORMED BY THESE ASSOCIATIONS.

Schedule C (Form 990) 2021

Additional Data

Software ID:	21014044
Software Version:	2021v4.2

- 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

2021

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) 2021

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 .....	1,386,324		1,386,324
b	Buildings ....	1,810,373	266,728	1,543,645
c	Leasehold improvements	558,004	314,511	243,493
d	Equipment ....	25,585,148	20,467,456	5,117,692
e	Other .....
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				8,291,154

Schedule D (Form 990) 2021

Page 3

Part VII

Investments - Other Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

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

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

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

Part IX

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

(a) Description				(b) Book value

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

Part X

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

1.(a) Description of liability	(b) Book value
(1) Federal income taxes

(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) 2021

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

Schedule D, Part X, Line 2 ASC 740 FOOTNOTE

PRIMARILY ALL OF THE HEALTH SYSTEM 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. THE HEALTH SYSTEM 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, 2022 OR 2021.

Schedule D (Form 990) 2021

Additional Data

Software ID:	21014044
Software Version:	2021v4.2

- 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

2021

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

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		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(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) . . .			2,372,901		2,372,901	3.07 %
b	Medicaid (from Worksheet 3, column a) . . . . .			15,006,683	6,896,444	8,110,239	10.50 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .					0	0 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	0	0	17,379,584	6,896,444	10,483,140	13.58 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	1	271	3,739		3,739	0 %
f	Health professions education (from Worksheet 5) . . .					0	0 %
g	Subsidized health services (from Worksheet 6) . . . .					0	0 %
h	Research (from Worksheet 7) .					0	0 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	3	40	7,045		7,045	0.01 %
j	Total. Other Benefits . .	4	311	10,784	0	10,784	0.01 %
k	Total. Add lines 7d and 7j .	4	311	17,390,368	6,896,444	10,493,924	13.59 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2021

Schedule H (Form 990) 2021

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.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing					0	0 %
2	Economic development					0	0 %
3	Community support					0	0 %
4	Environmental improvements					0	0 %
5	Leadership development and training for community members					0	0 %
6	Coalition building					0	0 %
7	Community health improvement advocacy					0	0 %
8	Workforce development	1	50	88		88	0 %
9	Other	1	622	14,099		14,099	0.02 %
10	Total	2	672	14,187	0	14,187	0.02 %

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. ......

2,762,799

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).....

17,732,366

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

17,636,799

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

95,567

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) 2021

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) 2021

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 21

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): https://www.mercy.net/content/dam/mercy/en/pdf/chna/lebanon-chna-2022.pdf

Other website (list url): http://ozarkshealthcommission.org/communities/springfield-community/

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 22

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

Yes

If "Yes" (list url): https://www.mercy.net/content/dam/mercy/en/pdf/chip/mercy-lebanon-chip-2023.pdf

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) 2021

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 200.0%
and FPG family income limit for eligibility for discounted care of 300.0%

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):

https://www.mercy.net/patients-visitors/billing/financial-assistance/

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

https://www.mercy.net/patients-visitors/billing/financial-assistance/

A plain language summary of the FAP was widely available on a website (list url):
https://www.mercy.net/patients-visitors/billing/financial-assistance/

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) 2021

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) 2021

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) 2021

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
Schedule H, Part V, Section B, Line 3E	THE HOSPITAL FACILITY DID INCLUDE A PRIORITIZED LIST OF THE COMMUNITY'S SIGNIFICANT HEALTH NEEDS IN ITS MOST RECENT CHNA REPORT.
Schedule H, Part V, Section B, Line 5 Facility , 1	Facility , 1 - MERCY HOSPITAL LEBANON. THE OZARKS HEALTH COMMISSION (OHC) BUILT ON THE METHODOLOGY DEVELOPED FOR THE PREVIOUS CHNA AND, IN 2021, A VARIETY OF ORGANIZATIONS ACROSS THE OZARKS CAME TOGETHER TO BETTER UNDERSTAND THE HEALTH STATUS, BEHAVIORS AND NEEDS OF THE POPULATIONS THEY SERVE. UNDER THE UMBRELLA OF THE LOCAL OZARKS HEALTH COMMISSION, THIS COLLABORATION IS THE LARGEST IN THE REGION SPANNING THREE STATES - MISSOURI, OKLAHOMA, AND KANSAS - 30 COUNTIES AND THREE HOSPITAL SYSTEMS. THE WORKING GROUP SAW THE VALUE OF USING A SYSTEMATIC, DATA-DRIVEN ASSESSMENT TO INFORM DECISIONS AND GUIDE EFFORTS TO IMPROVE COMMUNITY HEALTH AND WELLNESS ON A REGIONAL LEVEL. THIS LARGER, CONCERTED APPROACH WILL LEVERAGE COMMON STRENGTHS AND STRATEGIES TO MOVE IN THE SAME DIRECTION ON SIGNIFICANT HEALTH CONCERNS. THE FOLLOWING GROUPS TOOK PART IN SOME PHASE OF THE WORK THAT GENERATED LEBANON COMMUNITY HEALTH NEEDS ASSESSMENT: (THE LEBANON COMMUNITY CONSISTS OF: LEBANON, MO; WAYNESVILLE, MO; HOUSTON, MO; CABOOL, MO; MANSFIELD, MO; HARTVILLE, MO; BUFFALO, MO; AND CAMDENTON, MO.) -MERCY COWORKERS WHO SERVED ON TEAMS, ORGANIZED ROUNDTABLES AND DEVELOPED PROGRAMS TO RESPOND TO IDENTIFIED NEEDS. -THE OZARKS HEALTH COMMISSION, WHICH CONSISTS OF BURRELL BEHAVIORAL HEALTH, CHRISTIAN COUNTY HEALTH DEPT., CITY OF JOPLIN HEALTH DEPT., COX HEALTH, FREEMAN HEALTH SYSTEM, JASPER COUNTY HEALTH DEPT., LAWRENCE COUNTY HEALTH DEPT., MERCY, SPRINGFIELD-GREENE COUNTY HEALTH DEPT., TANEY COUNTY HEALTH DEPT., AND THE VERNON COUNTY HEALTH DEPT. IN 2021, COMMISSION STAKEHOLDERS BEGAN THE RHA PROCESS WITH ANALYSIS OF PUBLICLY AVAILABLE HEALTH DATA (SECONDARY DATA) AND PARTICIPATING HEALTH SYSTEMS' EMERGENCY ROOM UTILIZATION DATA (PRIMARY DATA) TO IDENTIFY HEALTH ISSUES OF GREATEST CONCERN ACROSS THE REGION. THE RESULT WAS A RANKED LIST OF EIGHT OZARKS HEALTH COMMISSION REGION HEALTH ISSUES. A FULL DESCRIPTION OF THE HEALTH ISSUES AND INDICATORS USED CAN BE FOUND IN THE OHC REGIONAL HEALTH ASSESSMENT. TO REPRESENT DIVERSE VIEWS FROM ACROSS THE REGION AND POPULATION, QUALITATIVE DATA WAS GARNERED. ACROSS THE OHC REGION THESE VIEWPOINTS WERE SOLICITED VIA 11 INDIVIDUAL INTERVIEWS, 2 FOCUS GROUPS AND 2,638 SURVEYS. METHODOLOGIES USED FOR THE INITIAL SCORING/RANKING OF THE HEALTH ISSUES AND THE FULL REPORT OF THE QUALITATIVE WORK CAN BE FOUND IN OHC REGIONAL REPORT. THIS PRIORITIZATION INFORMATION CAN BE USED BY ORGANIZATIONS TO DEVELOP COMMUNITY HEALTH IMPROVEMENT PLANS, GUIDE DECISION MAKING, AND FOSTER COLLABORATION ACROSS INITIATIVES. DURING SEPT. AND OCT. 2021, 3 INDIVIDUAL INTERVIEWS AND 10 VIRTUAL FOCUS GROUPS WERE CONDUCTED IN THE LEBANON COMMUNITY. THOSE INTERVIEWED REPRESENTED HEALTH AND SOCIAL SERVICE ORGANIZATIONS, EDUCATION AND COMMUNITY COLLABORATIVES. THE STEERING COMMITTEE HAD ESTABLISHED IN PREVIOUS ASSESSMENTS THAT VULNERABLE, DISENFRANCHISED, AND AT-RISK POPULATIONS ARE A KEY FACTOR WHEN IDENTIFYING AND ADDRESSING COMMUNITY HEALTH NEEDS. POPULATIONS OF INTEREST MAY ALSO BE REFERRED TO AS VULNERABLE POPULATIONS, SUCH AS: PEOPLE IN POVERTY, MINORITIES, THE ELDERLY, VARYING DEMOGRAPHIC GROUPS AND SOCIOECONOMIC STATUS, THOSE EXPERIENCING HIGHER RATES OF CHRONIC DISEASE/ILLNESS AND THOSE EXPERIENCING WORSE HEALTH OUTCOMES. A SUB-COMMITTEE WAS FORMED TO REVIEW AND UPDATE THE PREVIOUS PROCESS FOR IDENTIFYING POPULATIONS OF INTEREST. THE SUB-COMMITTEE AGREED TO CONTINUE TO USE THE PREVIOUSLY USED SOCIAL VULNERABILITY INDEX (SVI), WHICH WAS CREATED TO HELP EMERGENCY PLANNERS IDENTIFY AND MAP GROUPS THAT MAY BE MOST AT RISK IN THE EVENT OF A DISASTER. THE SVI USES U.S. CENSUS AND AMERICAN COMMUNITY SURVEY DATA TO IDENTIFY AT RISK GROUPS BY RANKING ALL CENSUS TRACTS ON 15 SOCIAL FACTORS. THE FACTORS ARE GROUPED INTO FOUR MAIN THEMES, HOUSING & TRANSPORTATION, MINORITY STATUS AND LANGUAGE, HOUSEHOLD COMPOSITION & DISABILITY AND SOCIOECONOMIC STATUS. EACH OF THESE SOCIOECONOMIC INDICATORS ARE PREDICTIVE OF BEHAVIORS THAT LEAD TO POOR HEALTH OUTCOMES RELATED TO COVID-19, HEART DISEASE, LUNG DISEASE, MENTAL HEALTH, ORAL HEALTH, DIABETES, AND CANCER. INCOME AND EMPLOYMENT STATUS ARE MORE DIRECTLY TIED TO A PERSON'S MENTAL HEALTH. THEREFORE, ADDRESSING POPULATIONS THAT LIVE NEAR OR BELOW POVERTY, HAVE LOW EDUCATION LEVELS, AND/OR ARE UNEMPLOYED, WILL IMPACT THEIR HEALTH RELATED TO ALL ASSESSED HEALTH ISSUES (AHI). OF THE 2,628 SURVEY RESPONDENTS FROM THE REGION, 3.56% INDICATED THEY LIVED IN THE LEBANON COMMUNITY. RESPONDENTS WERE ASKED TO RANK COMMUNITY NEEDS, AND THE TOP 10 THAT EMERGED WERE: 1. DRUG AND OTHER SUBSTANCE ABUSE TREATMENT AND REHABILITATION SERVICES, INCLUDING DETOX 2. EMERGENCY MENTAL HEALTH SERVICES 3. INTEGRATED CARE 4. AFFORDABLE, QUALITY CHILDCARE 5. PREVENTION, EDUCATION, AND EARLY INTERVENTION SERVICES FOR SUBSTANCE USE 6. CARE COORDINATION BETWEEN HOSPITALS, CLINICS, AND OTHER HEALTH CARE SETTINGS 7. ADULT MENTAL HEALTH COUNSELING SERVICES 8. ADOLESCENT AND CHILDREN MENTAL HEALTH COUNSELING SERVICES 9. AFFORDABLE HOUSING 10. SOCIAL SERVICES FOR INDIVIDUALS EXPERIENCING HOMELESSNESS THOSE INTERVIEWED REPRESENTED HEALTH AND SOCIAL SERVICE ORGANIZATIONS, EDUCATION AND COMMUNITY COLLABORATIVES. STAKEHOLDERS PARTICIPATING IN INDIVIDUAL INTERVIEWS AND FOCUS GROUPS AGREED WITH SURVEY RESPONDENTS ABOUT ACCESS TO MENTAL HEALTH SERVICES AND HEALTHCARE. THIS INFORMATION WAS CONSIDERED DURING THE PROCESS OF ESTABLISHING HEALTH PRIORITIES FOR THE LEBANON COMMUNITY.
Schedule H, Part V, Section B, Line 6a Facility , 1	Facility , 1 - MERCY HOSPITAL LEBANON. THE CHNA WAS CONDUCTED IN CONJUNCTION WITH THE FOLLOWING HOSPITAL FACILITIES: COXHEALTH SYSTEM, BURRELL BEHAVIORAL HEALTH, AND JORDAN VALLEY COMMUNITY HEALTH CENTER.
Schedule H, Part V, Section B, Line 6b Facility , 1	Facility , 1 - MERCY HOSPITAL LEBANON. THE CHNA WAS CONDUCTED IN CONJUNCTION WITH THE FOLLOWING NON-HOSPITAL FACILITIES: CHRISTIAN COUNTY HEALTH DEPARTMENT, SPRINGFIELD-GREENE COUNTY HEALTH DEPARTMENT AND WEBSTER COUNTY HEALTH DEPARTMENT.
Schedule H, Part V, Section B, Line 11 Facility , 1	Facility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
Schedule H, Part V, Section B, Line 20 Facility , 1	Facility , 1 - MERCY HOSPITAL LEBANON. OTHER AREAS FROM A NOTICE PERSPECTIVE: FAP IS POSTED IN ALL REGISTRATION AREAS, FULL POLICY AND PLAIN LANGUAGE DOCUMENT POSTED ON WEBSITE, PLAIN LANGUAGE DOCUMENT IS AVAILABLE WHEN REQUESTED, THERE IS A NOTICE ON STATEMENT, AND ALL PATIENTS GET THREE STATEMENTS BEFORE THEY CAN GO TO A COLLECTION AGENCY.

Schedule H (Form 990) 2021

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?0
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2021

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
Schedule H, Part VI, Line 1 FOR 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. 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 PROVIDES A CLASSROOM IN ITS FACILITY FOR THE GREATER OZARKS CENTERS FOR ADVANCED PROFESSIONAL STUDIES (GOCAPS) PROGRAM WHICH INCLUDES A CAPSTONE SHOWCASE FOR 40 PEOPLE AT THE END OF THE PROGRAM. THIS IS A YEAR-LONG EXPERIENCE THAT ALLOWS HIGH SCHOOL JUNIORS AND SENIORS TO TEST DRIVE THEIR FUTURE CAREER OPTIONS AND DEVELOP PROFESSIONAL SKILLS BY ENGAGING IN FIRST-HAND EXPERIENCES WITH BUSINESS PARTNERS IN THE MEDICINE AND HEALTHCARE FIELD. ADDITIONALLY, MERCY HOSPITAL LEBANON WORKS WITH LEBANON HIGH SCHOOL AS PART OF A JOB FAIR SERVING 500 STUDENTS IN THE LEBANON PUBLIC SCHOOLS.
Schedule H, Part I, Line 6a Community benefit report prepared by related organization	THE ORGANIZATION'S COMMUNITY BENEFIT REPORT IS PREPARED BY ITS ULTIMATE PARENT ENTITY, MERCY HEALTH (EIN: 43-1423050).
Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance	TOTAL EXPENSES FROM FORM 990, PART IX, LINE 25, COLUMN (A) ARE $87,336,803. INCLUDED IN THIS AMOUNT WAS BAD DEBT EXPENSE (CHARGES) OF $10,123,359. EXPENSES FOR THE PURPOSE OF CALCULATING LINE 7, COLUMN (F) ARE $77,213,444.
Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount	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.
Schedule H, Part III, Line 3 Bad Debt Expense Methodology	THE FILING ORGANIZATION DETERMINED THAT THE ESTIMATED AMOUNT OF BAD DEBT EXPENSE (AT COST) ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS $0. ALTHOUGH THE CHARITY CARE POLICY REQUIRES THE PARTICIPATION OF THE PATIENT REQUESTING ASSISTANCE, WE HAVE A PROCESS UNDER PRESUMPTIVE CHARITY TO ADDRESS ACCOUNTS FOR PATIENTS WHO DO NOT PROVIDE THE INFORMATION. WE BELIEVE THAT OUR CHARITY POLICY IS COMPREHENSIVE ENOUGH TO CAPTURE ALMOST ALL PATIENTS WHO QUALIFY FOR CHARITY CARE.
Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote	IN MAY 2014, THE FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) AND INTERNATIONAL ACCOUNTING STANDARDS BOARD ISSUED ACCOUNTING STANDARDS UPDATE (ASU) 2014-09, REVENUE FROM CONTRACTS WITH CUSTOMERS (TOPIC 606). THE HEALTH SYSTEM ADOPTED ASU 2014-09 ON JULY 1, 2018 USING A FULL RETROSPECTIVE BASIS. UPON ADOPTION, THE MAJORITY OF WHAT WAS PREVIOUSLY CLASSIFIED AS PROVISION FOR UNCOLLECTIBLE ACCOUNTS AND PRESENTED AS A REDUCTION TO PATIENT SERVICE REVENUE ON THE CONSOLIDATED STATEMENT OF OPERATIONS AND CHANGES IN NET ASSETS IS TREATED A PRICE CONCESSION THAT REDUCES THE TRANSACTION PRICE, WHICH IS REPORTED AS PATIENT SERVICE REVENUE. AS SUCH, BAD DEBT EXPENSE IS NOT REFERENCED IN MERCY HEALTH AND SUBSIDIARIES AUDITED FINANCIAL STATEMENTS. BAD DEBT EXPENSE IS TRACKED FOR FORM 990 REPORTING 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 SYSTEM'S CHARITY CARE POLICY. THE PROVISION FOR UNCOLLECTIBLE RECEIVABLES IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. PERIODICALLY THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES BASED UPON THE PAYOR COMPOSITION AND AGING OF RECEIVABLES 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.
Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs	THOUGH THE HOSPITAL DID NOT REPORT A MEDICARE SHORTFALL DURING THE YEAR, IT IS THE POSITION OF MERCY 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).
Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance	MERCY'S COLLECTION POLICY PROVIDES THAT MERCY WILL PERFORM A REASONABLE COMMUNICATION AND/OR REVIEW OF PATIENT ACCOUNTS AS IT RELATES TO ANY SERVICE PROVIDED AT OUR FACILITIES BEFORE TURNING THE ACCOUNT TO BAD DEBT OR TAKING LEGAL ACTION FOR NONPAYMENT. MERCY ACTIVELY SCRUBS ACCOUNTS FOR PAYOR PLAN COVERAGE, 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 FOR ALL COMMUNITIES EXCEPT JOPLIN, MAUDE NORTON, CARTHAGE AND SOUTHEAST KANSAS. THIS PRESUMPTIVE SCREENING PROCESS DETAILS EVALUATIONS THAT TAKE PLACE PRIOR TO PATIENT BILLING AND ADDITIONALLY PRIOR TO BAD DEBT PLACEMENT. THE PRESUMPTIVE SCREENING WAS PER ENCOUNTER AND DID NOT PROMOTE ANY LOOK-BACK ADJUSTMENTS. 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. 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 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 OCCUR PRIOR TO ANY EXTRAORDINARY COLLECTIONS ARE PURSUED.
Schedule H, Part V, Section B, Line 16a FAP website	- MERCY HOSPITAL LEBANON: Line 16a URL: https://www.mercy.net/patients-visitors/billing/financial-assistance/;
Schedule H, Part V, Section B, Line 16b FAP Application website	- MERCY HOSPITAL LEBANON: Line 16b URL: https://www.mercy.net/patients-visitors/billing/financial-assistance/;
Schedule H, Part V, Section B, Line 16c FAP plain language summary website	- MERCY HOSPITAL LEBANON: Line 16c URL: https://www.mercy.net/patients-visitors/billing/financial-assistance/;
Schedule H, Part VI, Line 2 Needs assessment	MERCY HOSPITAL LEBANON BELIEVES THAT ITS COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS IS COMPREHENSIVE ENOUGH TO CAPTURE SUBSTANTIALLY ALL OF THE COMMUNITY'S 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 COMMUNITY'S 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.
Schedule H, Part VI, Line 3 Patient education of eligibility for assistance	MERCY INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS OR UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY THROUGH SEVERAL MEANS. IF AT ANY TIME A PATIENT EXPRESSES HARDSHIP AND INABILITY TO PAY, THE ACCOUNT IS PLACED FOR REVIEW. IN ADDITION, PATIENTS 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 STAFF'S INTERNAL RESOURCES CERTIFIED TO ASSIST PATIENTS WITH MEDICAID APPLICATIONS AS WELL.
Schedule H, Part VI, Line 4 Community information	THE PRIMARY SERVICE AREA FOR MERCY HOSPITAL LEBANON INCLUDES LACLEDE AND PULASKI COUNTIES IN MISSOURI. THE FOLLOWING INFORMATION IS DERIVED FROM THE ADVISORY BOARD DEMOGRAPHICS AND 2021-2022 MO/HIDI INFORMATION. THE AREA'S POPULATION IS 127,953. THE MEDIAN HOUSEHOLD INCOME IS $52,000. 41% OF THE POPULATION IS 45 AND OLDER. 90% OF THE POPULATION IS A HIGH SCHOOL GRADUATE OR GREATER AND THE MEDIAN AGE IS 39.
Schedule H, Part VI, Line 5 Promotion of community health	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 HOSPITAL 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.
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 ARKANSAS, 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, 2022, MERCY FACILITIES INCLUDED 30 ACUTE CARE HOSPITALS, 5 HEART HOSPITALS, 5 REHAB HOSPITALS, 2 CHILDREN'S HOSPITALS, 2 ORTHOPEDIC HOSPTIALS, AND 1 VIRTUAL CARE COMMAND CENTER. FOR THE FISCAL YEAR ENDED JUNE 30, 2022, MERCY HAD MORE THAN 10.4 MILLION CLINIC AND OUTPATIENT VISITS, APPROXIMATELY 2,300 EMPLOYED PHYSICIANS, AND APPROXIMATELY 42,000 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.
Schedule H, Part VI, Line 7 State filing of community benefit report	MO

Schedule H (Form 990) 2021

Additional Data

Software ID:	21014044
Software Version:	2021v4.2

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Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

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

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

Attach to Form 990.
lBullet

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

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization
Mercy Hospital Lebanon

Employer identification number
43-1767432

Part I

General Information on Grants and Assistance

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

Yes No

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

Part II

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

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

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of noncash assistance	(h) Purpose of grant or assistance
(1) Lebanon Area Foundation PO BOX 1042 LEBANON,MO65536	43-1340282	501c3	6,525				FUNDRAISING SPONSORSHIP, HIGH SCHOOL ALUMNI ASSOC FUND DONATION
(2) Mercy Health Foundation Lebanon 100 Hospital Drive Lebanon,MO65536	43-1767432	501c3	48,844				Operational Support
(3) Heritage Baptist Temple 690 Lynn Street Lebanon,MO65536	99-9999999	501c3		10,651	FMV	Medical Supplies	Support Organization's Mission

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

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

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

Cat. No. 50055P

Schedule I (Form 990) 2021

Page 2

Part III

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

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

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

Part IV

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

Return Reference	Explanation
Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds.	THE ASSISTANCE PROVIDED IS INTENDED TO BE USED FOR THE GENERAL OPERATING PURPOSES OF THE DONEE. THE USE OF GRANT FUNDS IS NOT MONITORED AFTER GRANTS ARE GIVEN. HOWEVER, ONE GRANTEE IS PART OF MERCY HEALTH AND THEREFORE A RELATED ORGANIZATION TO MERCY HOSPITAL LEBANON. LEADERSHIP OF THE HOSPITAL AND THE GRANTEE COMMUNICATE ON HOW FUNDS ARE USED, ALTHOUGH THERE IS NO FORMAL MONITORING PROCESS.

Schedule I (Form 990) 2021

Additional Data

Software ID:	21014044
Software Version:	2021v4.2

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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

2021

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

Yes

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) 2021

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, 1099-MISC compensation, and/or 1099-NEC			(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)
1Rafael Bonilla MD Physician & Board Member	(i) (ii)	0 ------------- 405,375	0 ------------- 0	0 ------------- 19,905	0 ------------- 2,656	0 ------------- 10,582	0 ------------- 438,518	0 ------------- 0
2Nicki Gamet Administrator & Board Member	(i) (ii)	0 ------------- 183,796	0 ------------- 48,417	0 ------------- 10,851	0 ------------- 7,812	0 ------------- 17,676	0 ------------- 268,552	0 ------------- 0
3Brent Hubbard Hospital President & Board Member (THRU 4/22)	(i) (ii)	0 ------------- 493,909	0 ------------- 420,327	0 ------------- 51,015	0 ------------- 81,755	0 ------------- 18,467	0 ------------- 1,065,473	0 ------------- 12,409
4Robert B Wyrsch MD President, Mercy Clinic Springfield Communities & Board Member	(i) (ii)	0 ------------- 1,034,549	0 ------------- 172,021	0 ------------- 47,467	0 ------------- 38,792	0 ------------- 13,763	0 ------------- 1,306,592	0 ------------- 0
5Scott Reynolds Former Officer	(i) (ii)	0 ------------- 0	0 ------------- 0	0 ------------- 410,554	0 ------------- 18,940	0 ------------- 0	0 ------------- 429,494	0 ------------- 0
6Alan Scarrow MD Former Officer	(i) (ii)	0 ------------- 1,005,397	0 ------------- 45,095	0 ------------- 45,389	0 ------------- 9,217	0 ------------- 14,936	0 ------------- 1,120,034	0 ------------- 0
7Jon Swope Former Officer	(i) (ii)	0 ------------- 0	0 ------------- 0	0 ------------- 770,349	0 ------------- 30,013	0 ------------- 0	0 ------------- 800,362	0 ------------- 0
8Craig McCoy President - Springfield Communities	(i) (ii)	0 ------------- 612,455	0 ------------- 448,258	0 ------------- 46,742	0 ------------- 102,280	0 ------------- 14,837	0 ------------- 1,224,572	0 ------------- 0
9David Argueta President Mercy Hospital Springfield	(i) (ii)	0 ------------- 438,512	0 ------------- 189,203	0 ------------- 17,597	0 ------------- 55,648	0 ------------- 17,578	0 ------------- 718,538	0 ------------- 0
10Tanya Marion Regional VP - Human Resources	(i) (ii)	0 ------------- 282,629	0 ------------- 146,119	0 ------------- 57,101	0 ------------- 48,928	0 ------------- 14,773	0 ------------- 549,550	0 ------------- 20,957
11Judy Penniman VP-Nursing	(i) (ii)	0 ------------- 154,468	0 ------------- 27,233	0 ------------- 10,060	0 ------------- 7,881	0 ------------- 14,602	0 ------------- 214,244	0 ------------- 0
12Desiree L Calbert Chief CRNA	(i) (ii)	0 ------------- 313,251	0 ------------- 74,624	0 ------------- 19,320	0 ------------- 6,947	0 ------------- 10,715	0 ------------- 424,857	0 ------------- 0
13Kimberly Redman Nurse Anesthetist	(i) (ii)	0 ------------- 182,297	0 ------------- 1,000	0 ------------- 1,042	0 ------------- 1,732	0 ------------- 588	0 ------------- 186,659	0 ------------- 0
14Kelly Riechers Nurse Anesthetist	(i) (ii)	0 ------------- 230,614	0 ------------- 27,138	0 ------------- 19,685	0 ------------- 4,603	0 ------------- 6,743	0 ------------- 288,783	0 ------------- 0
15Ryan Weaver Director - Pharmacy Services	(i) (ii)	0 ------------- 147,665	0 ------------- 13,096	0 ------------- 8,259	0 ------------- 960	0 ------------- 17,560	0 ------------- 187,540	0 ------------- 0
16Paige Williams Patient Service Representative	(i) (ii)	0 ------------- 179,981	0 ------------- 8,213	0 ------------- 37,662	0 ------------- 5,184	0 ------------- 4,694	0 ------------- 235,734	0 ------------- 0

Schedule J (Form 990) 2021

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
Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation	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.
Schedule J, Part I, Line 4a Severance or change-of-control payment	THE FOLLOWING INDIVIDUALS RECEIVED A SEVERANCE PAYMENT AS NOTED: SCOTT REYNOLDS - $410,554 JON SWOPE - $770,349
Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan	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 AND THE PLAN TERMINATED EFFECTIVE AS OF 11/1/2020. THE INDIVIDUAL REPORTABLE ON THIS RETURN WHO PARTICIPATES IN THE SUPPLEMENTAL RETIREMENT PLANS INCLUDE: TANYA MARION AND BRENT HUBBARD. THE AMOUNT OF ALL ACCRUED BENEFITS IS INCLUDED IN COMPENSATION AMOUNTS PROVIDED IN SCHEDULE J, PART II, COLUMN (C). THE FOLLOWING INDIVIDUALS RECEIVED PAYOUTS FROM THE PLAN DURING THE YEAR: -TANYA MARION - $20,957 -BRENT HUBBARD - $12,409
Schedule J, Part II	THE AMOUNTS REPORTED FOR TANYA MARION IN COLUMN (F) ARE EITHER INCLUDED IN B(I) BASE COMPENSATION, B(II) AS BONUS AND INCENTIVE COMPENSATION, OR B(III) AS OTHER REPORTABLE COMPENSATION. THESE AMOUNTS ARE A PAYOUT OF THE SUPPLEMENTAL RETIREMENT PLAN AND EXECUTIVE RETENTION PLAN AND WERE INCLUDED IN COLUMN (C) OF PREVIOUSLY FILED FORMS 990.

Schedule J (Form 990) 2021

Additional Data

Software ID:	21014044
Software Version:	2021v4.2

- TIN:

Schedule L
(Form 990)

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

2021

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) 2021

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) LESLIE O'CONNOR	FAMILY MEMBER OF KEY EMPLOYEE	66,364	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) 2021

Additional Data

Software ID:	21014044
Software Version:	2021v4.2

- TIN:

SCHEDULE O
(Form 990)

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

2021

Open to Public
Inspection

Name of the organization

Mercy Hospital Lebanon

Employer identification number

43-1767432

Return Reference	Explanation
Form 990, Part III, Line 4d Description of other program services	(Expenses $ 26,647,970 including grants of $ 78,311)(Revenue $ 33,922,209) IN ADDITION TO THE PROGRAM SERVICES DESCRIBED ABOVE, MERCY HOSPITAL LEBANON ALSO SERVES PATIENTS IN ADDITIONAL SERVICE LINES, INCLUDING BUT NOT LIMITED TO THE FOLLOWING AREAS: CARDIOVASCULAR; GASTROENTEROLOGY; LAB; NEUROSCIENCE; PULMONARY.
Form 990, Part V, Line 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, Line 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-3'S) IS REPORTED UNDER THE RELATED ORGANIZATION, MHM SUPPORT SERVICES, EIN 20-2553101.
Form 990, Part VI, Line 15a PROCESS TO ESTABLISH COMPENSATION OF TOP MANAGEMENT OFFICIAL	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. COMPENSATION REVIEWS ARE COMPLETED ON AN ANNUAL BASIS, AND A REVIEW WAS COMPLETED DURING THE REPORTING YEAR.
Form 990, Part VI, Line 15b PROCESS TO ESTABLISH COMPENSATION OF OTHER OFFICERS OR KEY EMPLOYEES	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, Line 6 Classes of members or stockholders	THE FILING ORGANIZATION HAS A SOLE CORPORATE MEMBER, MERCY HEALTH SPRINGFIELD COMMUNITIES.
Form 990, Part VI, Line 7a Members or stockholders electing members of governing body	THE SOLE CORPORATE MEMBER HAS THE AUTHORITY TO: -APPOINT OR REMOVE MEMBERS OF THE BOARD, SUBJECT TO THE RESTRICTIONS SET FORTH IN ARTICLE V HEREIN; AND, -APPOINT OR REMOVE THE PRESIDENT OF THE CORPORATION, SUBJECT TO THE RESTRICTIONS SET FORTH IN ARTICLE VII HEREIN.
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders	THE FOLLOWING CORPORATE POWERS AND RESPONSIBILITIES SHALL BE RESERVED TO THE CORPORATE MEMBER AND SHALL REQUIRE CONSULTATION, AS APPLICABLE, OF THE BOARD OF DIRECTORS: -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 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, Line 11b Review of form 990 by governing body	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 ACCOUNTING AND THE VICE-PRESIDENT OF FINANCE. THE DRAFT FORM 990 IS ALSO REVIEWED BY MERCY HEALTH'S TAX DEPARTMENT, TO ENSURE ACCURACY AND CONSISTENCY WITH OTHER RELATED ORGANIZATIONS' FORMS 990. AFTER QUESTIONS ARISING FROM THE VARIOUS REVIEWS ARE ADDRESSED AND INCORPORATED INTO THE FORM 990, A REVISED DRAFT IS PROVIDED TO THE FILING ORGANIZATION'S LEADERSHIP TEAM, INCLUDING THE CFO AND CEO, FOR REVIEW. ONCE REVIEWED AND APPROVED BY THE FILING ORGANIZATION'S LEADERSHIP TEAM, THE FORM 990 IS THEN SIGNED AND FILED WITH THE IRS.
Form 990, Part VI, Line 12c Conflict of interest policy	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, 2022. 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, Line 19 Required documents available to the public	GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST BUT ARE NOT PUBLISHED PUBLICLY.
Form 990, Part VII, Section A	FORMER EMPLOYEE COMPENSATION IS REPORTED FOR THE CALENDAR YEAR ENDING WITHIN THE ORGANIZATION'S FISCAL YEAR WHILE AVERAGE HOURS ARE BASED ON THE FISCAL YEAR PERIOD FROM JULY 1, 2021 THROUGH JUNE 30, 2022.
Form 990, Part VII, Section B, Line 1	IT IS POSSIBLE THAT A PORTION OF THE AMOUNTS REPORTED FOR SNYDER CONSTRUCTION GROUP WERE RELATED TO MATERIALS IN ADDITION TO AMOUNTS PAID FOR SERVICES. HOWEVER, THE AMOUNTS ARE NOT DISTINGUISHABLE.
Form 990, Part XI, Line 9 Other changes in net assets or fund balances	NET TRANSFERS (TO)/FROM AFFILIATES - -17974202; EMPLOYEE CRISIS FUND - -36303;
Form 990, Part XII, Line 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 2022 (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.
Form 990, Part XII, Line 3a and 3b	SINGLE AUDIT ACT AND 2 CFR 200 AUDIT MERCY HEALTH UNDERGOES A CONSOLIDATED 2 CFR 200 AUDIT EVERY YEAR AND THIS AUDIT WAS COMPLETED FOR THE FISCAL YEAR ENDING JUNE 30, 2022 BY MARCH 31, 2023. EACH ENTITY THAT RECEIVES FEDERAL FUNDS DURING THE YEAR IS INCLUDED ON THE SCHEDULE OF EXPENDITURES OF FEDERAL AWARDS (SEFA) AND IS ALSO INCLUDED IN THE POPULATION INCLUDED IN THE AUDIT. IF THE FILING ENTITY RECEIVED FEDERAL FUNDS DURING THE YEAR ENDED JUNE 30, 2022, IT WILL BE INCLUDED ON THE MERCY HEALTH CONSOLIDATED SEFA, AND THEREFORE, ALSO INCLUDED IN THE POPULATION INCLUDED IN THE AUDIT.
IMPACT OF COVID-19 PANDEMIC	EARLY IN 2020, THE MERCY HEALTH SYSTEM WAS CALLED TO SERVE AS THE COVID-19 PANDEMIC SWEPT ACROSS THE WORLD. DURING FY22, THE IMPACT OF COVID-19 AND INFLATION HAS BEEN AND STILL IS SIGNIFICANT TO OUR COMMUNITIES WITH CHANGES IN PATIENT CARE REVENUES DUE TO SURGES, INCREASING THE COSTS OF SALARIES AND AGENCY LABOR, AND SUPPLY CHAIN IMPACTS. ALL MERCY FACILITIES ADJUSTED OPERATIONS FOR THE IMPACTS OF THE PANDEMIC. IN ADDITION, MERCY FOUNDATIONS AND OUTREACH MINISTRIES EXPERIENCED LIMITATIONS IN FUNDRAISING FOR PROGRAM AND CAPITAL SUPPORT EFFORTS THAT ASSIST THE UNDERSERVED IN OUR COMMUNITIES. MERCY DID RECEIVE FUNDING FROM THE CORONAVIRUS AID RELIEF AND ECONOMIC SECURITY ACT ("CARES ACT"). MERCY RECEIVED CARES ACT FUNDING FOR THE PAST THREE YEARS ACROSS VARIOUS ENTITIES AND RECOGNIZED A PORTION OF THIS FUNDING IN OTHER OPERATING REVENUE. THESE FUNDS HELPED TO OFFSET REVENUE LOSSES AND ADDITIONAL EXPENSES INCURRED DUE TO THE PANDEMIC; HOWEVER, THESE FUNDS FELL SHORT OF THE SYSTEM LOSSES EXPERIENCED SINCE THE START OF THE PANDEMIC. MERCY CONTINUES TO MONITOR THE IMPACTS OF THE PANDEMIC BOTH TO THE HEALTH SYSTEM AND THE COMMUNITIES SERVED AS WE CONTINUE TO PROVIDE ASSISTANCE AND MAINTAIN ACCESS TO CARE WITHIN OUR COMMUNITIES.

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

Cat. No. 51056K

Schedule O (Form 990) 2021

Additional Data

Software ID:	21014044
Software Version:	2021v4.2

- 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

2021

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 1000 Mier St Laredo,TX78040 74-2912461	Women's domestic violence shelter	TX	501(c)(3)	7	Mercy Ministries of Laredo	Yes
(2)McAuley Portfolio Management Company 14528 S Outer Forty Suite 100 Chesterfield,MO63017 26-1708048	Portfolio Management.	MO	501(c)(3)	Type II	Mercy Health	Yes
(3)Mercy ACO Clinical Services Inc 14528 S Outer Forty Suite 100 Chesterfield,MO63017 46-4504901	Virtual Care Center	MO	501(c)(3)	3	Mercy Health	Yes
(4)Mercy Clinic East Communities 645 Maryville Centre Drive Suite 100 St Louis,MO63141 43-1771217	Physician Group	MO	501(c)(3)	10	Mercy Health East Communities	Yes
(5)Mercy Clinic Fort Smith Communities 7301 Rogers Avenue Fort Smith,AR72903 26-1318597	Physician Clinic	AR	501(c)(3)	3	Mercy Health Fort Smith Communities	Yes
(6)Mercy Clinic Oklahoma Communities Inc 4300 W Memorial Road Oklahoma City,OK73120 27-0473057	Physician Group	OK	501(c)(3)	3	Mercy Health Oklahoma Communities Inc	Yes
(7)Mercy Clinic Springfield Communities 1965 Fremont Street Suite 2950 Springfield,MO65804 43-1560263	Physician Group	MO	501(c)(3)	3	Mercy Health Springfield Communities	Yes
(8)Mercy Family Center 110 Veterans Blvd Metairie,LA70005 72-1069468	Family counseling service	LA	501(c)(3)	7	Mercy Health	Yes
(9)Mercy Health 14528 S Outer Forty Suite 100 Chesterfield,MO63017 43-1423050	Corporate Office	MO	501(c)(3)	1	NA		No
(10)Mercy Health East Communities 14528 S Outer Forty Suite 100 Chesterfield,MO63017 43-1718408	Health System	MO	501(c)(3)	Type I	Mercy Health	Yes
(11)Mercy Health Fort Smith Communities 7301 Rogers Avenue Fort Smith,AR72917 26-1318515	Holding Company	AR	501(c)(3)	Type II	Mercy Health	Yes
(12)Mercy Health Foundation 14528 S Outer Forty Suite 100 Chesterfield,MO63017 20-0901499	Foundation	MO	501(c)(3)	Type II	Mercy Health	Yes
(13)Mercy Health Foundation Ada 430 N Monte Vista Street Ada,OK74820 46-3596274	Foundation	OK	501(c)(3)	Type I	Mercy Hospital Ada Inc	Yes
(14)Mercy Health Foundation Ardmore 1011 14th Avenue NW Ardmore,OK73401 71-0962525	Foundation	OK	501(c)(3)	Type I	Mercy Hospital Ardmore Inc	Yes
(15)Mercy Health Foundation Berryville 214 Carter Street Berryville,AR72616 71-0759301	Foundation	AR	501(c)(3)	Type I	Mercy Hospital Berryville	Yes
(16)Mercy Health Foundation Fort Scott 401 Woodland Hills Blvd Fort Scott,KS66701 48-1077073	Foundation	KS	501(c)(3)	7	Mercy Kansas Communities Inc	Yes
(17)Mercy Health Foundation Fort Smith 7301 Rogers Avenue Fort Smith,AR72917 23-7330425	Foundation	AR	501(c)(3)	7	Mercy Health Fort Smith Communities	Yes
(18)Mercy Health Foundation Jefferson 1400 US Highway 61 South Festus,MO63028 46-2797051	Foundation	MO	501(c)(3)	Type II	Mercy Hospital Jefferson	Yes
(19)Mercy Health Foundation Joplin 100 Mercy Way Joplin,MO64804 27-0906136	Foundation	MO	501(c)(3)	7	Mercy Health Southwest MissouriKansas Communities	Yes
(20)Mercy Health Foundation Lebanon 100 Hospital Drive Lebanon,MO65536 82-2514567	Foundation	MO	501(c)(3)	Type II	Mercy Hospital Lebanon	Yes
(21)Mercy Health Foundation Lincoln 1000 East Cherry Street Troy,MO63379 81-1477159	Foundation	MO	501(c)(3)	Type II	Mercy Hospitals East Communities	Yes
(22)Mercy Health Foundation Northwest Arkansas 2710 Rife Medical Lane Rogers,AR72758 71-0601687	Foundation	AR	501(c)(3)	7	Mercy Hospital Rogers	Yes
(23)Mercy Health Foundation of Oklahoma 4300 W Memorial Road Oklahoma City,OK73120 45-4732301	Foundation	OK	501(c)(3)	Type I	Mercy Health Oklahoma Communities Inc	Yes
(24)Mercy Health Foundation Oklahoma City 4300 W Memorial Road Oklahoma City,OK73120 46-3184231	Foundation	OK	501(c)(3)	Type I	Mercy Hospital Oklahoma City Inc	Yes
(25)Mercy Health Foundation Springfield 1235 E Cherokee Street Springfield,MO65804 32-0195818	Foundation	MO	501(c)(3)	Type II	Mercy Health Springfield Communities	Yes
(26)Mercy Health Foundation St Francis 100 W Highway 60 Mountain View,MO65548 43-1873914	Foundation	MO	501(c)(3)	Type I	Mercy St Francis Hospital	Yes
(27)Mercy Health Foundation St Louis 14528 S Outer Forty Suite 100 Chesterfield,MO63017 56-2410020	Foundation	MO	501(c)(3)	Type II	Mercy Health East Communities	Yes
(28)Mercy Health Foundation Washington 901 E Fifth Street Washington,MO63090 56-2410022	Foundation	MO	501(c)(3)	Type II	Mercy Health East Communities	Yes
(29)Mercy Health Northwest Arkansas Communities 2710 Rife Medical Lane Rogers,AR72758 62-1684203	Physician Group	AR	501(c)(3)	10	Mercy Health	Yes
(30)Mercy Health Oklahoma Communities Inc 4300 W Memorial Road Oklahoma City,OK73120 73-1453048	Health System	OK	501(c)(3)	Type I	Mercy Health	Yes
(31)Mercy Health Plans of Missouri Inc 3265 S National Avenue Springfield,MO65807 32-0481419	HMO	MO	501(c)(4)		Mercy Health	Yes
(32)Mercy Health Plans Inc 3265 S National Avenue Springfield,MO65807 32-0486150	PPO	MO	501(c)(4)		Mercy Health Plans of Missouri Inc	Yes
(33)Mercy Health Southwest MissouriKansas Communities 100 Mercy Way Joplin,MO64804 30-0584463	Health System	MO	501(c)(3)	Type II	Mercy Health	Yes
(34)Mercy Health Springfield Communities 1235 E Cherokee Street Springfield,MO65804 43-1856028	Health System	MO	501(c)(3)	Type II	Mercy Health	Yes
(35)Mercy Hospital Ada Inc 430 N Monte Vista Street Ada,OK74820 46-2288155	Hospital	OK	501(c)(3)	3	Mercy Health Oklahoma Communities Inc	Yes
(36)Mercy Hospital Ardmore Inc 1011 14th Avenue NW Ardmore,OK73401 73-1500629	Hospital	OK	501(c)(3)	3	Mercy Health Oklahoma Communities Inc	Yes
(37)Mercy Hospital Aurora 500 Porter Avenue Aurora,MO65605 43-1936696	Hospital	MO	501(c)(3)	3	Mercy Health Springfield Communities	Yes
(38)Mercy Hospital Berryville 214 Carter Street Berryville,AR72616 71-0759299	Hospital	AR	501(c)(3)	3	Mercy Health Northwest Arkansas Communities	Yes
(39)Mercy Hospital Booneville 880 West Main Street Booneville,AR72927 46-3851119	Hospital	AR	501(c)(3)	3	Mercy Hospital Fort Smith	Yes
(40)Mercy Hospital Carthage 3125 Dr Russell Smith Way Carthage,MO64836 45-3808607	Hospital	MO	501(c)(3)	3	Mercy Health Southwest MissouriKansas Communities	Yes
(41)Mercy Hospital Cassville 94 Main Street Cassville,MO65625 43-1936699	Hospital	MO	501(c)(3)	3	Mercy Health Springfield Communities	Yes
(42)Mercy Hospital Columbus 220 Pennsylvania Avenue Columbus,KS66725 27-0842031	Hospital	KS	501(c)(3)	3	Mercy Health Southwest MissouriKansas Communities	Yes
(43)Mercy Hospital El Reno Inc 2115 Parkview Drive El Reno,OK73036 27-2716065	Hospital	OK	501(c)(3)	3	Mercy Hospital Oklahoma City Inc	Yes
(44)Mercy Hospital Fort Smith 7301 Rogers Avenue Fort Smith,AR72903 71-0240352	Hospital	AR	501(c)(3)	3	Mercy Health Fort Smith Communities	Yes
(45)Mercy Hospital Healdton Inc 3462 Hospital Rd Healdton,OK73438 26-3173902	Hospital	OK	501(c)(3)	3	Mercy Hospital Ardmore Inc	Yes
(46)Mercy Hospital Jefferson 1400 Highway 61 South Festus,MO63028 43-0687077	Hospital	MO	501(c)(3)	3	Mercy Health East Communities	Yes
(47)Mercy Hospital Joplin 100 Mercy Way Joplin,MO64804 27-0814858	Hospital	MO	501(c)(3)	3	Mercy Health Southwest MissouriKansas Communities	Yes
(48)Mercy Hospital Kingfisher Inc 1000 Kingfisher Regional Hospital Circle Kingfisher,OK73750 46-3433074	Hospital	OK	501(c)(3)	3	Mercy Hospital Oklahoma City Inc	Yes
(49)Mercy Hospital Lincoln 1000 East Cherry Street Troy,MO63379 47-2219204	Hospital	MO	501(c)(3)	3	Mercy Hospitals East Communities	Yes
(50)Mercy Hospital Logan County Inc 200 South Academy Guthrie,OK73044 45-2998842	Hospital	OK	501(c)(3)	3	Mercy Hospital Oklahoma City Inc	Yes
(51)Mercy Hospital Oklahoma City Inc 4300 W Memorial Road Oklahoma City,OK73120 73-0579285	Hospital	OK	501(c)(3)	3	Mercy Health Oklahoma Communities Inc	Yes
(52)Mercy Hospital Ozark 801 W River Street Ozark,AR72949 71-0689680	Hospital	AR	501(c)(3)	3	Mercy Hospital Fort Smith	Yes
(53)Mercy Hospital Paris 500 E Academy Paris,AR72855 71-0655753	Hospital	AR	501(c)(3)	3	Mercy Hospital Fort Smith	Yes
(54)Mercy Hospital Rogers 2710 Rife Medical Lane Rogers,AR72758 71-0294390	Hospital	AR	501(c)(3)	3	Mercy Health Northwest Arkansas Communities	Yes
(55)Mercy Hospital Springfield 1235 E Cherokee Street Springfield,MO65804 44-0552485	Hospital	MO	501(c)(3)	3	Mercy Health Springfield Communities	Yes
(56)Mercy Hospital Tishomingo Inc 1000 South Byrd Tishomingo,OK73460 27-4433830	Hospital	OK	501(c)(3)	3	Mercy Hospital Ada Inc	Yes
(57)Mercy Hospital Waldron 1341 W 6th Street Waldron,AR72958 71-0557895	Hospital	AR	501(c)(3)	3	Mercy Hospital Fort Smith	Yes
(58)Mercy Hospital Watonga Inc 500 Clarence Nash Blvd Watonga,OK73772 45-5199762	Hospital	OK	501(c)(3)	3	Mercy Hospital Oklahoma City Inc	Yes
(59)Mercy Hospitals East Communities 615 S New Ballas Road St Louis,MO63141 43-0653493	Hospital	MO	501(c)(3)	3	Mercy Health East Communities	Yes
(60)Mercy Kansas Communities Inc 401 Woodland Hills Blvd Ft Scott,KS66701 48-0956045	Hospital	KS	501(c)(3)	3	Mercy Health Southwest MissouriKansas Communities	Yes
(61)Mercy Ministries of Laredo 2500 Zacatecas St Laredo,TX78046 20-0198462	Outreach	TX	501(c)(3)	7	Mercy Health	Yes
(62)Mercy Research 524 North Booneville Avenue Springfield,MO65802 87-0796305	Research	MO	501(c)(3)	4	Mercy Health	Yes
(63)Mercy St Francis Hospital 100 W Highway 60 Mountain View,MO65548 44-0607149	Hospital	MO	501(c)(3)	3	Mercy Health Springfield Communities	Yes
(64)MHM Support Services 14528 S Outer Forty Suite 100 Chesterfield,MO63017 20-2553101	Centralized Health System Functions	MO	501(c)(3)	Type I	Mercy Health	Yes
(65)Mission Clinical Services 300 Werner Street Hot Springs,AR71913 13-4239691	Child advocacy center	AR	501(c)(3)	3	Mercy Health	Yes
(66)Mercy Health Foundation South (fka St Anthony's Charitable Foundation) 10010 Kennerly Road St Louis,MO63128 26-1516789	Fundraising	MO	501(c)(3)	Type I	Mercy Hospital South (fka St Anthony's Medical Center)	Yes
(67)Mercy Hospital South (fka St Anthony's Medical Center) 10010 Kennerly Road St Louis,MO63128 43-0980256	Hospital	MO	501(c)(3)	3	Mercy Health East Communities	Yes
(68)St Anthony's Physician Organization 10010 Kennerly Road St Louis,MO63128 43-1784536	Health care	MO	501(c)(3)	3	Mercy Hospital South (fka St Anthony's Medical Center)	Yes
(69)Mercy Specialty Hospital Southeast Kansas 1619 W 7th Street Galena,KS66739 84-3730625	Hospital	KS	501(c)(3)	3	Mercy Health Southwest MOKS Communities	Yes

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

Cat. No. 50135Y

Schedule R (Form 990) 2021

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?		(k) Percentage ownership
(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	(k) Percentage ownership
(1) Fort Smith Emergency Medical Services 1701 S Greenwood Fort Smith,AR72901 71-0416615	Emergency Medical Services	AR	NA
(2) Plaza Surgery Services Company LLC 12700 Southfork Road St Louis,MO63128 20-4709312	Inactive	MO	NA
(3) St Edward Mercy Medical Center Multi-Purpose Office Building Horizontal Pro perty 7301 Rogers Avenue Fort Smith,AR72903 71-0554050	Office Building	AR	NA
(4) Platinum CPS Holdings LLC 14528 S Outer Forty Suite 100 Chesterfield,MO63017 84-2493007	Holding Company	MO	NA
(5) Maryville Cancer Center LLC 2227 Vadalabene Drive Maryville,IL62062 81-3385885	Outpatient Center	IL	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	(h) Percentage ownership	(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	(h) Percentage ownership	Yes	No
(1) Frontenac Properties Inc 14528 S Outer Forty Suite 100 Chesterfield,MO63017 52-1914421	Holding company	DE	NA	C Corporation
(2) Mercy Commercial Services Inc 14528 S Outer Forty Suite 100 Chesterfield,MO63017 46-4953543	Corporate Parent of VCC taxable commercial services	MO	NA	C Corporation
(3) Mercy Health Center Condominium Inc 4300 W Memorial Rd Oklahoma City,OK73120 68-0640970	Real estate	OK	NA	C Corporation
(4) Mercy Managed Care Corporation 14528 S Outer Forty Suite 100 Chesterfield,MO63017 73-1441665	Holding company	OK	NA	C Corporation
(5) St Anthony's Physician Organization of Illinois 10010 Kennerly Road St Louis,MO63128 32-0457168	Health Care	MO	NA	C Corporation
(6) McAuley Insurance Company Ltd Aon House 30 Woodbourne Avenue Pembroke,bermudaHM08 BD 000000000	Inactive	BD	NA	C Corporation

Schedule R (Form 990) 2021

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

Yes

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

Yes

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

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

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

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

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

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

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

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	Q	729,894	FMV
(2) Mercy Health East Communities	Q	57,648	FMV
(3) Mercy Health Springfield Communities	Q	10,226,106	FMV
(4) Mercy Hospital Springfield	Q	78,919	FMV
(5) MHM Support Services	P	1,423,399	FMV

Schedule R (Form 990) 2021

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?		(k) Percentage ownership
(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	(k) Percentage ownership

Schedule R (Form 990) 2021

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. See instructions.

Return Reference

Explanation

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.

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) 2021

Additional Data

Software ID:	21014044
Software Version:	2021v4.2

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	11
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	8
5	Total number of individuals employed in calendar year 2021 (Part V, line 2a) ......	5	0
6	Total number of volunteers (estimate if necessary) .............	6	31
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	31,246
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	615,512	30,189
9	Program service revenue (Part VIII, line 2g) .........	98,081,966	99,992,798
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	750	10,511
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	271,339	254,716
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	98,969,567	100,288,214
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	44,716	78,311
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)	33,891,233	41,907,151
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	44,440,480	45,351,341
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	78,376,429	87,336,803
19	Revenue less expenses. Subtract line 18 from line 12.......	20,593,138	12,951,411
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	19,958,012	22,561,130
21	Total liabilities (Part X, line 26).............	235,335	7,897,547
22	Net assets or fund balances. Subtract line 21 from line 20.....	19,722,677	14,663,583

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 27,928,829 including grants of $ 0 ) (Revenue $ 35,877,529 )
	MERCY HOSPITAL LEBANON PROVIDES QUALITY MEDICAL HEALTH CARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY BY OFFERING ESSENTIAL HEALTH SERVICES TO ITS COMMUNITY. IN ACTIVE PURSUIT OF THIS MISSION, MERCY HOSPITAL LEBANON PROVIDES A WIDE VARIETY OF SERVICES IN THEIR 58 BED FACILITY AND IN FY22, HAD 82,130 TOTAL CASES. AT MERCY HOSPITAL LEBANON, CANCER CARE IS ABOUT MORE THAN PROVIDING CLINICAL TREATMENTS. MERCY HOSPITAL LEBANON ALSO OFFERS SUPPORT SERVICES TO HELP YOU MAINTAIN YOUR PHYSICAL, MENTAL AND EMOTIONAL HEALTH. MERCY'S CANCER SPECIALISTS CARE FOR ALMOST EVERY TYPE OF CANCER AND PARTICIPATE IN CLINICAL RESEARCH TO BRING YOU THE MOST ADVANCED CANCER TREATMENT AVAILABLE. IN FY22, MERCY HOSPITAL LEBANON HAD 4,262 CASES AND 71 PATIENT DAYS FOR THIS SERVICE LINE.

4b	(Code: ) (Expenses $ 12,051,850 including grants of $ 0 ) (Revenue $ 15,481,873 )
	MERCY HOSPITAL LEBANON HAS A TEAM OF EXPERT DOCTORS, NURSES AND TECHNICIANS THAT BLEND COMPASSIONATE CARE WITH THE LATEST, MOST ADVANCED DIAGNOSTIC AND TREATMENT RESOURCES IN PROVIDING EMERGENCY CARE. MERCY HOSPITAL LEBANON'S EMERGENCY DEPARTMENT IS READY 24 HOURS A DAY, 7 DAYS A WEEK, 365 DAYS A YEAR WITH FAST, EXPERIENCED AND PROFESSIONAL CARE. IN FY22, MERCY HOSPITAL LEBANON HAD 22,014 CASES FOR THIS SERVICE LINE.

4c	(Code: ) (Expenses $ 11,451,909 including grants of $ 0 ) (Revenue $ 14,711,187 )
	MERCY HOSPITAL LEBANON'S RADIOLOGISTS USE THE LATEST TECHNOLOGIES TO PRODUCE PRECISE IMAGES AND EXACTING TEST RESULTS. MERCY OFFERS A FULL RANGE OF DIAGNOSTIC IMAGING SERVICES FOR ADULTS AND CHILDREN. MERCY RADIOLOGISTS GIVE MORE INSIGHT INTO YOUR CONDITION, SO YOU RECEIVE AN ACCURATE DIAGNOSIS AND THE MOST EFFECTIVE TREATMENT. IN FY22, MERCY HOSPITAL LEBANON HAD 19,326 CASES FOR THIS SERVICE LINE.

	(Code: ) (Expenses $ 26,647,970 including grants of $ 78,311 ) (Revenue $ 33,922,209 )
	IN ADDITION TO THE PROGRAM SERVICES DESCRIBED ABOVE, MERCY HOSPITAL LEBANON ALSO SERVES PATIENTS IN ADDITIONAL SERVICE LINES, INCLUDING BUT NOT LIMITED TO THE FOLLOWING AREAS: CARDIOVASCULAR; GASTROENTEROLOGY; LAB; NEUROSCIENCE; PULMONARY.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 26,647,970 including grants of $ 78,311 ) (Revenue $ 33,922,209 )
4e	Total program service expenses78,080,558

(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/1099-NEC)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(18) Kelly Riechers Nurse Anesthetist	40.0 .......................0.0	X		0	277,437	11,346
(19) Kimberly Redman Nurse Anesthetist	40.0 .......................0.0	X		0	184,339	2,320
(20) Paige Williams Patient Service Representative	40.0 .......................0.0	X		0	225,856	9,878
(21) Ryan Weaver Director - Pharmacy Services	40.0 .......................0.0	X		0	169,020	18,520
(22) Alan Scarrow MD Former Officer	0.0 .......................0.0		X	0	1,095,881	24,153
(23) Jon Swope Former Officer	0.0 .......................0.0		X	0	770,349	30,013
(24) Scott Reynolds Former Officer	0.0 .......................0.0		X	0	410,554	18,940

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	0	8,858,640	600,862

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	18,829
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f	11,360

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

h Total. Add lines 1a-1f.......		30,189

		Business Code
2a	NET PATIENT SERVICE REVENUE	622110	96,833,299	96,802,053	31,246
b	OTHER OPERATING REVENUE	900099	3,158,599	3,158,599
c	RENTAL INCOME FROM RELATED ORGANIZATIONS	532000	900	900
d
e
f	All other program service revenue.		0	0	0	0
g	Total. Add lines 2a–2f .....		99,992,798

3 Investment income (including dividends, interest, and othersimilar amounts) ......
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		500	6a
b	Less: rental expenses			6b
c	Rental income or (loss)	0	500	6c
d	Net rental income or (loss).......			500			500
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	10,511		7a
b	Less: cost or other basis and sales expenses			7b
c	Gain or (loss)	10,511	0	7c
d	Net gain or (loss).........			10,511			10,511
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	CAFE & VENDING		900099	254,216			254,216
b
c
d	All other revenue ....			0	0	0	0
e	Total. Add lines 11a–11d ......			254,216
12	Total revenue. See instructions.....			100,288,214	99,961,552	31,246	265,227

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	78,311	78,311
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......	0	0
5	Compensation of current officers, directors, trustees, and key employees ...........
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........	72,499	67,873	4,626
7	Other salaries and wages........	36,447,095	34,663,624	1,783,471
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	954,127	858,714	95,413
9	Other employee benefits .......	2,824,746	2,542,271	282,475
10	Payroll taxes ...........	1,608,684	1,447,816	160,868
11	Fees for services (non-employees):
a	Management ......
b	Legal .........
c	Accounting ...........
d	Lobbying ...........	10,349		10,349
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	1,301,868	1,061,282	240,586	0
12	Advertising and promotion ....	1,581		1,581
13	Office expenses .......	1,080,011	1,058,298	21,713
14	Information technology ......	45,708	45,708
15	Royalties ..
16	Occupancy ...........	2,509,957	2,508,873	1,084
17	Travel ............	78,173	77,113	1,060
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....
20	Interest ...........
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	1,549,527	1,527,020	22,507
23	Insurance ...	303,388	241,260	62,128
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	16,739,421	16,739,421
b	SHARED SERVICE FEES	10,979,032	4,501,403	6,477,629
c	BAD DEBT	10,123,359	10,123,359
d	REPAIRS & MAINTENANCE	399,942	386,795	13,147
e	All other expenses	229,025	151,417	77,608	0
25	Total functional expenses. Add lines 1 through 24e	87,336,803	78,080,558	9,256,245	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 ........			1,894,447	1	2,076,105
2	Savings and temporary cash investments .........			0	2	0
3	Pledges and grants receivable, net ......			9,928	3	0
4	Accounts receivable, net .............			8,569,215	4	10,000,999
5	Loans and other receivables from 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 ............			1,918,527	8	2,141,671
9	Prepaid expenses and deferred charges ......			33,302	9	39,911
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	29,339,849
b	Less: accumulated depreciation	10b	21,048,695	7,532,593	10c	8,291,154
11	Investments—publicly traded securities .			0	11	0
12	Investments—other securities. See Part IV, line 11 .....			0	12
13	Investments—program-related. See Part IV, line 11 ..			0	13
14	Intangible assets ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			0	15	11,290
16	Total assets. Add lines 1 through 15 (must equal line 33)...			19,958,012	16	22,561,130

17	Accounts payable and accrued expenses .....	235,266	17	7,897,547
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	69	25	0
26	Total liabilities. Add lines 17 through 25..	235,335	26	7,897,547

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	19,686,374	27	14,663,583
28	Net assets with donor restrictions ...........	36,303	28	0
	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 .....	0	29	0
30	Paid-in or capital surplus, or land, building or equipment fund ...	0	30	0
31	Retained earnings, endowment, accumulated income, or other funds	0	31	0
32	Total net assets or fund balances ...........	19,722,677	32	14,663,583
33	Total liabilities and net assets/fund balances ........	19,958,012	33	22,561,130