| FORM 990, PART I, LINE 6 |
MERCY HOSPITAL FORT SMITH UTILIZES AN AUXILIARY PROGRAM FOR VOLUNTEERS TO PERFORM VARIOUS FUNCTIONS. SUCH FUNCTIONS INCLUDE FLOWER DELIVERY, INFORMATION DESK, AND PATIENT TRANSPORT. FORM 990, PART III, LINE 4D OTHER PROGRAM SERVICES OTHER SERVICES INCLUDE OUTPATIENT DIAGNOSTICS AND TESTING, SURGERY SERVICES, A WOMEN'S CENTER THAT PROVIDES NEONATOLOGY, OB ANESTHESIA, DIGITAL MAMMOGRAPHY, AND LABOR AND DELIVERY, A CANCER CENTER WITH A COMPREHENSIVE TREATMENT APPROACH INCLUDING RADIATION THERAPY, HOME CARE, HOSPICE, PALLIATIVE CARE, A SLEEP DISORDERS CENTER, AND WOUND CARE WITH HYPERBARIC MEDICINE. MERCY HOSPITAL FORT SMITH PROVIDED 75,899 INPATIENT SERVICE DAYS OF ACUTE OR SUB-ACUTE CARE, PERFORMED 2,535 DELIVERIES, RESPONDED TO 54,175 EMERGENCY ROOM ENCOUNTERS, AND COMPLETED 260,897 OUTPATIENT VISITS. MERCY HOSPITAL FORT SMITH PROVIDES QUALITY CARE REGARDLESS OF RACE, CREED, GENDER, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. RELIEF FROM THE FINANCIAL BURDEN OF HEALTH CARE SERVICES TO THE INDIGENT CONSISTS OF CHARGES OF $30,857,695 FOR CHARITY CARE PROVIDED. |
| FORM 990, PART V, QUESTION 1A |
FORM 1099/1096 FILING VENDORS FOR THE FILING ORGANIZATION ARE PAID BY MERCY HEALTH (EIN 43-1423050). AS SUCH, ALL REQUIRED FORM 1099 AND FORM 1096 REPORTING IS MADE FOR THE ENTIRE MERCY HEALTH SYSTEM (WITH LIMITED EXCEPTIONS) UNDER THE MERCY HEALTH EIN. |
| FORM 990, PART V, QUESTION 2A |
W-3 FILING MOST EMPLOYEES ARE PAID BY A RELATED ORGANIZATION UNDER A COMMON PAYMASTER ARRANGEMENT. AS SUCH, REQUIRED PAYROLL FILING (INCLUDING W-2 AND W-3'S) IS REPORTED UNDER THE RELATED ORGANIZATION, MHM SUPPORT SERVICES, EIN 20-2553101. |
| FORM 990, PART VI, LINE 6A, LINE 7A, 7B |
CLASSES OF MEMBERS OR STOCKHOLDERS THE FILING ORGANIZATION HAS A SOLE CORPORATE MEMBER, MERCY HEALTH FORT SMITH COMMUNITIES. THE FOLLOWING CORPORATE POWERS AND RESPONSIBILITIES ARE RESERVED SOLELY FOR THE SOLE CORPORATE MEMBER: - TO APPROVE THE MISSION AND ESTABLISH THE PHILOSOPHY ACCORDING TO WHICH THE CORPORATION SHALL OPERATE; - TO AMEND THE ARTICLES OF INCORPORATION AND BYLAWS; - TO APPOINT AND REMOVE MEMBERS OF THE BOARD; - TO APPOINT AND REMOVE THE CHIEF EXECUTIVE OFFICER OF THE CORPORATION; - TO APPROVE OR AMEND THE STRATEGIC PLAN, GOALS, AND OBJECTIVES OF THE CORPORATION; - TO APPROVE OR AMEND THE OPERATING, CAPITAL, AND CONSTRUCTION BUDGETS OF THE CORPORATION; - TO LEASE OR SELL ANY OF THE ASSETS OF THE CORPORATION OR ANY CORPORATION CONTROLLED BY THE CORPORATION IN EXCESS OF ONE MILLION DOLLARS ($1,000,000); - TO ENCUMBER ANY OR ALL THE ASSETS OF THE CORPORATION OR ANY CORPORATION CONTROLLED BY THE CORPORATION; - TO AUTHORIZE OR APPROVE THE INCURRENCE OF DEBT BY THE CORPORATION OR ANY CORPORATION CONTROLLED BY THE CORPORATION (OTHER THAN DEBT INCURRED FOR THE ACQUISITION OF GOODS THAT ARE ACQUIRED IN THE ORDINARY COURSE OF BUSINESS) AND TO GRANT ANY SECURITY INTERESTS, PLACE ANY ENCUMBRANCES, ENTER INTO ANY COVENANTS, AND EXECUTE ANY DOCUMENTS AND TAKE ANY ACTIONS NECESSARY OR APPROPRIATE IN CONNECTION WITH THE INCURRENCE OF SUCH DEBT; - TO MERGE, DISSOLVE OR ABANDON THE CORPORATION; AND, - TO APPROVE THE CREATION, OWNERSHIP OR ACQUISITION OF, OR AFFILIATION WITH, ANY OTHER ORGANIZATION BY THE CORPORATION. |
| FORM 990, PART VI, QUESTION 11B |
DSCR THE PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990 THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM, USING INFORMATION PROVIDED BY THE FILING ORGANIZATION. A DRAFT FORM 990 IS REVIEWED BY THE FILING ORGANIZATION'S FINANCE TEAM, INCLUDING THE DIRECTOR OF FINANCE AND THE VICE-PRESIDENT OF FINANCE. THE DRAFT FORM 990 IS ALSO REVIEWED BY MERCY HEALTH'S TAX DEPARTMENT, TO ENSURE ACCURACY AND CONSISTENCY WITH OTHER RELATED ORGANIZATIONS' FORMS 990. AFTER QUESTIONS ARISING FROM THE VARIOUS REVIEWS ARE ADDRESSED AND INCORPORATED INTO THE FORM 990, A REVISED DRAFT IS PROVIDED TO THE FILING ORGANIZATION'S LEADERSHIP TEAM, INCLUDING THE CFO AND CEO, FOR REVIEW. ONCE REVIEWED AND APPROVED BY THE FILING ORGANIZATION'S LEADERSHIP TEAM, THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS FOR REVIEW; IT IS THEN SIGNED AND FILED WITH THE IRS. |
| FORM 990, PART VI, QUESTION 12C |
DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST OFFICERS, DIRECTORS, KEY EMPLOYEES AND OTHER DISQUALIFIED PERSONS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE ANNUALLY AND DID SO IN THE NORMAL COURSE FOR THE YEAR ENDED JUNE 30, 2021. THIS PROCESS IS ADMINISTERED AT THE MERCY HEALTH LEVEL BY MERCY'S CORPORATE COMPLIANCE DEPARTMENT. THE QUESTIONNAIRES ARE REVIEWED WITH LEADERSHIP AT THE LOCAL LEVEL AND POTENTIAL CONFLICTS DISCUSSED AND RESOLVED. THE CONFLICTS AND THEIR RESPECTIVE RESOLUTIONS ARE SHARED AT THE MERCY LEVEL WITH A TEAM INCLUDING MERCY'S CHIEF FINANCIAL OFFICER, CHIEF COMPLIANCE OFFICER AND OTHER MEMBERS OF FINANCE, LEGAL AND HR. SUMMARY RESULTS ARE REVIEWED WITH MERCY'S STEWARDSHIP COMMITTEE OF THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, QUESTIONS 15A & 15B |
OFFICERS & POSITIONS FOR WHICH PROCESS WAS USED & YEAR PROCESS WAS BEGUN FOR THOSE CLASSIFIED AS OFFICERS (AND THUS DISQUALIFIED PERSONS), THE ORGANIZATION RELIES UPON MERCY HEALTH, WHICH USES THE FOLLOWING TO ESTABLISH THE COMPENSATION: EXTERNAL MARKET SALARY SURVEYS, EXTERNAL MARKET SALARY STUDIES, ENGAGEMENT OF AN INDEPENDENT COMPENSATION CONSULTANT, AND REVIEW/APPROVAL OF COMPENSATION BY THE COMPENSATION COMMITTEE OF THE BOARD OF MERCY HEALTH. FOR THOSE CLASSIFIED AS KEY EMPLOYEES, MERCY HEALTH USES THE FOLLOWING TO ESTABLISH THE COMPENSATION: EXTERNAL MARKET SALARY SURVEYS, EXTERNAL MARKET SALARY STUDIES, AND REVIEW/APPROVAL OF EXECUTIVE MANAGEMENT. COMPENSATION REVIEWS ARE COMPLETED ON AN ANNUAL BASIS AND A REVIEW WAS COMPLETED DURING THE REPORTING YEAR. |
| FORM 990, PART VI, QUESTION 19 |
AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMT TO GEN PUBLIC GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST BUT ARE NOT PUBLISHED PUBLICLY. FORM 990, PART VII, SECTION A 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, 2020 THROUGH JUNE 30, 2021. FORM 990, PART VII, SECTION B IT IS POSSIBLE THAT A PORTION OF THE AMOUNTS REPORTED FOR CONSTRUCTION SERVICES MAY INCLUDE EXPENSE REIMBURSEMENT, IN ADDITION TO AMOUNTS PAID FOR SERVICES. HOWEVER, THE AMOUNTS ARE NOT DISTINGUISHABLE. FORM 990, PART VIII 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 FY 2021, it continued to be a difficult time for all healthcare providers. All Mercy facilities adjusted operations for the impacts of the pandemic which meant making changes to patient care areas and cancelling most of our outpatient procedures for periods of time. 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's total system net patient revenues were reduced during the year due to surges in the communities we serve. Mercy did receive funding from the Coronavirus Aid Relief and Economic Security Act ("CARES Act"). Mercy received CARES Act funding across various entities for the year ended June 30, 2021 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. The impact of COVID-19 was significant to our communities and coworkers as unemployment rates soared and Mercy acted quickly to provide continuous care to patients and the community. 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. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS NET TRANSFERS (TO)/FROM AFFILIATES ($93,616,921) EMPLOYEE CRISIS FUND ($25,752) GRANTS AND OTHER CONTRIBUTIONS ($1,846,835) TOTAL ($95,489,508) FORM 990, PART XII, QUESTION 2C AUDIT OF FINANCIAL STATEMENTS THE FILING ORGANIZATION'S FINANCIAL STATEMENTS WERE INCLUDED IN MERCY HEALTH AND SUBSIDIARIES ANNUAL FINANCIAL STATEMENT AUDIT. MERCY HEALTH AND SUBSIDIARIES RECEIVED AN UNQUALIFIED OPINION FROM THE EXTERNAL AUDITORS FOR FISCAL 2021 (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, QUESTION 3A AND 3B SINGLE AUDIT ACT AND 2 CFR 200 AUDIT MERCY HEALTH UNDERGOES A CONSOLIDATED 2 CFR 200 AUDIT EVERY YEAR. THIS AUDIT IS UNDERWAY FOR THE FISCAL YEAR ENDING JUNE 30, 2021 AND WILL BE COMPLETED BY SEPTEMBER 30, 2022. 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, 2021, IT WILL BE INCLUDED ON THE MERCY HEALTH CONSOLIDATED SEFA, AND THEREFORE, ALSO INCLUDED IN THE POPULATION INCLUDED IN THE AUDIT. |
Attach to Form 990 or 990-EZ.