SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public Inspection
Name of the organization
MERCY HOSPITAL COLUMBUS
 
Employer identification number

27-0842031
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? ......................
1b
Yes
 
2
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.
3
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.
a
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:
3a
Yes
 
%
b
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: . . . . . . . .
3b
Yes
 
%
c
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.
4
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"? . . . . . . . . . . . . .

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
Yes
 
c
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? . . . . . . . . . . . . .
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
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) . . .
    66,934   66,934 1.410 %
b Medicaid (from Worksheet 3, column a) . . . . .     499,338 775,649 -276,311  
c Costs of other means-tested government programs (from Worksheet 3, column b) . .            
d Total Financial Assistance and Means-Tested Government Programs . . . . .     566,272 775,649 -209,377 1.410 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).            
f Health professions education (from Worksheet 5) . . .            
g Subsidized health services (from Worksheet 6) . . . .            
h Research (from Worksheet 7) .            
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .            
j Total. Other Benefits . .            
k Total. Add lines 7d and 7j .     566,272 775,649 -209,377 1.410 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(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            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and
training for community members
           
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total            
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
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
159,727
3
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. ......
3
 
4
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
5
Enter total revenue received from Medicare (including DSH and IME).....
5
2,771,255
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
2,821,109
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-49,854
8
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:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
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 .........................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity
(c) Organization's
profit % or stock
ownership %
(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership %
(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?1
Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 MERCY HOSPITAL COLUMBUS
220 Pennsylvania Avenue
COLUMBUS,KS66725
www.mercy.net
H-011-002
X       X   X      
Schedule H (Form 990) 2015
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Schedule H (Form 990) 2015
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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 COLUMBUS
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):
1
Yes No
Community Health Needs Assessment
1 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?........................ 1   No
2 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............... 2   No
3 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...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 15
5 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 ................. 5 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.................................. 6a Yes  
b 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. ............................ 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 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. ..............
8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 15
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): WWW.MERCY.NET/ABOUT/COMMUNITY-BENEFITS
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b   No
11 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   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2015
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Schedule H (Form 990) 2015
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Part VFacility Information (continued)

Financial Assistance Policy (FAP)
MERCY HOSPITAL COLUMBUS
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 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):
a
b
c
d
e
16 Included measures to publicize the policy within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
SEE PART V, SECTION C
b
SEE PART V, SECTION C
c
d
e
f
g
h
i
Billing and Collections
17 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon non-payment?.................................. 17 Yes  
18 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:
a
b
c
d
e
Schedule H (Form 990) 2015
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Schedule H (Form 990) 2015
Page 6
Part VFacility Information (continued)

MERCY HOSPITAL COLUMBUS
Name of hospital facility or letter of facility reporting group  
Yes No
19 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?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
20 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):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 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?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
22 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.
a
b
c
d
23 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? ............................... 23   No
If "Yes," explain in Section C.
24 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? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2015
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Schedule H (Form 990) 2015
Page 7
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference Explanation
FORM 990, SCHEDULE H, PART V, SECTION B, LINE 5 IN EARLY 2015, 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 FIRST-TIME COLLABORATION IS THE LARGEST IN THE REGION SPANNING FOUR STATES - MISSOURI, OKLAHOMA, ARKANSAS AND KANSAS - 51 COUNTIES AND FOUR 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 JOPLINS COMMUNITY HEALTH NEEDS ASSESSMENT: (THE JOPLIN COMMUNITY CONSISTS OF JOPLIN, MO., COLUMBUS, MO., AND COLUMBUS, KS.) - MERCY COWORKERS WHO SERVED ON TEAMS, ORGANIZED ROUNDTABLES AND DEVELOPED PROGRAMS TO RESPOND TO IDENTIFIED NEEDS. - MERCY HOSPITAL COLUMBUS BOARD OF TRUSTEES, AND ITS COMMUNITY BENEFIT SUBCOMMITTEE, WHO REVIEWED AND APPROVED THE PROPOSED INITIATIVES. - THE OZARKS HEALTH COMMISSION, WHICH CONSISTS OF: BURRELL BEHAVIORAL HEALTH, CITIZENS MEMORIAL HEALTHCARE, COXHEALTH, FREEMAN HEALTH SYSTEM, JASPER COUNTY HEALTH DEPT., COLUMBUS HEALTH DEPT., MERCY, POLK COUNTY HEALTH CENTER, SPRINGFIELD-GREENE COUNTY HEALTH DEPT., AND THE TANEY COUNTY HEALTH DEPT. FORM 990, SCHEDULE H, PART V, SECTION B, LINE 6A THE CHNA WAS CONDUCTED IN CONJUNCTION WITH THE FOLLOWING HOSPITAL FACILITIES: Burrell Behavioral Health, Citizens Memorial Healthcare, CoxHealth, and Freeman Health System. FORM 990, SCHEDULE H, PART V, SECTION B, LINE 6B THE CHNA WAS CONDUCTED IN CONJUNCTION WITH THE FOLLOWING NON-HOSPITAL FACILITIES: BURRELL BEHAVIORAL HEALTH, JASPER COUNTY HEALTH DEPARTMENT, JOPLIN HEALTH DEPARTMENT, POLK COUNTY HEALTH CENTER, SPRINGFIELD-GREEN COUNTY HEALTH DEPARTMENT AND TANEY COUNTY HEALTH DEPARTMENT.
FORM 990, SCHEDULE H, PART V, SECTION B, LINE 11 MERCY COLUMBUS IDENTIFIED THE HEALTH NEEDS ESTABLISHED THROUGH THE COMMUNITY HEALTH NEEDS ASSESSMENT, AND DETERMINED THAT IT WAS BEST TO ENGAGE IN PROGRAMS AND PARTNERSHIPS THAT ALREADY EXIST. THOSE PROGRAMS INVOLVE MEETING THE NEEDS OF OUR COMMUNITY WITH DIABETES THAT LACK ACCESS TO HEALTH CARE THROUGH SCHOOL BASED HEALTH CLINICS AND PROVIDING HEALTH CARE NEEDS FOR WOMEN, SPECIFICALLY TEEN PREGNANCY. DURING THIS CYCLE OF THE COMMUNITY HEALTH IMPROVEMENT PLAN, MERCY COLUMBUS WILL NOT BE ADDRESSING THE FOLLOWING IDENTIFIED HEALTH NEEDS: - CARDIOVASCULAR DISEASE: CARDIOVASCULAR DISEASE IS AN IDENTIFIED NEED IN OUR COMMUNITY, BUT THERE ARE MANY FACTORS RELATED TO THIS DISEASE THAT WILL BE ADDRESSED THOUGH COMMUNITY COLLABORATIONS. MERCY COLUMBUS REPRESENTATIVES ARE ACTIVELY ENGAGED IN COMMUNITY COLLABORATIONS THAT PROMOTE HEALTHIER LIFESTYLES TO FIGHT THIS DISEASE. ADDITIONALLY, THIS DISEASE WILL NOT BE RESOLVED AS QUICKLY AS OTHER HEALTH NEEDS THAT ARE CURRENTLY IDENTIFIED IN THIS CHIP. - LUNG DISEASE: LUNG DISEASE IS OUR SECOND HIGHEST IDENTIFIED HEALTH NEED IN OUR COMMUNITY, BUT THERE ARE MANY FACTORS RELATED TO THIS DISEASE THAT WILL BE ADDRESSED THOUGH COMMUNITY COLLABORATIONS. MERCY COLUMBUS REPRESENTATIVES ARE ACTIVELY ENGAGED IN COMMUNITY COLLABORATIONS THAT PROMOTE A TOBACCO FREE LIFESTYLE TO FIGHT THIS DISEASE. ADDITIONALLY, THIS DISEASE WILL NOT BE RESOLVED AS QUICKLY AS OTHER HEALTH NEEDS THAT ARE CURRENTLY IDENTIFIED IN THIS CHIP. - MENTAL HEALTH: MENTAL HEALTH IS OUR THIRD HIGHEST IDENTIFIED HEALTH NEED IN OUR COMMUNITY, DETERMINED BY OUR CHNA, BUT THERE ARE MANY FACTORS RELATED TO THIS HEALTH PROBLEM THAT WILL BE ADDRESSED THOUGH COMMUNITY COLLABORATIONS. MERCY COLUMBUS REPRESENTATIVES ARE ACTIVELY ENGAGED IN COMMUNITY COLLABORATIONS, SUCH AS THE COMMUNITY HEALTH COALITION, THAT WILL BE ADDRESSING THIS HEALTH NEED IN CURRENT PROJECTS AND IMPLEMENTATION STRATEGIES. ADDITIONALLY, THIS HEALTH ISSUE WILL NOT BE RESOLVED AS QUICKLY AS OTHER HEALTH NEEDS THAT ARE CURRENTLY IDENTIFIED IN THIS CHIP. - CANCER: CANCER IS A SIGNIFICANT HEALTH NEED IN OUR COMMUNITY, BUT THERE ARE MANY FACTORS RELATED TO THIS DISEASE THAT WILL BE ADDRESSED THOUGH OUR LOCAL HOSPITAL ONCOLOGY DEPARTMENTS AND COMMUNITY COLLABORATIONS. MERCY COLUMBUS REPRESENTATIVES ARE ACTIVELY ENGAGED IN COMMUNITY COLLABORATIONS THAT PROMOTE HEALTHIER LIFESTYLES THAT EFFECT THE VARIOUS DISEASES OF CANCER. MERCY COLUMBUS MOBILE MAMMOGRAPHY UNIT WILL CONTINUE TO PROVIDE SCREENINGS IN THE COLUMBUS COMMUNITY AND LOOK TO NEW OPPORTUNITIES TO REACH THOSE THAT ARE UNDERSERVED OR UNDERINSURED. ADDITIONALLY, THIS DISEASE WILL NOT BE RESOLVED AS QUICKLY AS OTHER HEALTH NEEDS THAT ARE CURRENTLY IDENTIFIED IN THIS CHIP. PART 990, SCHEDULE H, PART V, SECTION B, LINE 16A, 16B & 16C THE FINANCIAL ASSISTANCE POLICY, APPLICATION AND A PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY ARE AVAILABLE ONLINE AT HTTPS://WWW.MERCY.NET/MERCY-FINANCIAL-ASSISTANCE. FORM 990, SCHEDULE H, PART V, SECTION B, LINE 22 ELIGIBILITY GUIDELINES FOR CHARITY CARE DISCOUNTS THE FEDERAL POVERTY GUIDELINES FOR INCOME ARE THE BASIS FOR DETERMINING ELIGIBILITY FOR CHARITY CARE DISCOUNTS. FOR EXAMPLE, INDIVIDUALS WITH INCOMES BELOW 100% OF THE FEDERAL POVERTY GUIDELINES WILL BE ELIGIBLE FOR FREE CARE. INDIVIDUALS WITH INCOMES GREATER THAN 100% OF THE FEDERAL POVERTY GUIDELINES MAY BE ELIGIBLE FOR CARE AT DISCOUNTED RATES DEPENDING ON THEIR INCOME LEVEL AND/OR THE AMOUNT DUE TO THE HOSPITAL. TO DETERMINE THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE, THE HOSPITAL FACILITY USES AMOUNTS GENERALLY BILLED TO INDIVIDUALS WHO HAVE INSURANCE COVERING SUCH CARE. THE HOSPITAL USES A LOOK BACK METHOD THAT CONSIDERS DISCOUNTS ALLOWED TO MEDICARE AND ALL PRIVATE HEALTH INSURERS.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2015
Page 8
Schedule H (Form 990) 2015
Page 8
Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?  
Name and address Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10
Schedule H (Form 990) 2015
Page 9
Schedule H (Form 990) 2015
Page 9
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Form and Line Reference Explanation
FORM 990, SCHEDULE H, PART I, LINE 6A THE ORGANIZATIONS COMMUNITY BENEFIT REPORT IS PREPARED BY ITS ULTIMATE PARENT ENTITY, MERCY HEALTH (EIN: 43-1423050).
FORM 990, SCHEDULE H, PART I, LINE 7, COLUMN F TOTAL EXPENSES FROM FORM 990, PART IX, LINE 25, COLUMN (A) ARE $4,987,771. INCLUDED IN THIS AMOUNT WAS BAD DEBT EXPENSE (CHARGES) OF $238,634. EXPENSES FOR THE PURPOSE OF CALCULATING LINE 7, COLUMN (F) ARE $4,749,137.
FORM 990, SCHEDULE H, PART I, LINE 7G THE ORGANIZATION DID NOT INCLUDE ANY PHYSICIAN CLINIC COSTS ON LINE 7G.
FORM 990, SCHEDULE H, PART II COMMUNITY BUILDING ACTIVITIES ADDRESS ROOT CAUSES OF HEALTH RELATED PROBLEMS. MULTIDISCIPLINARY COMMUNITY PARTNERSHIPS AND COLLABORATION ADDRESS SYSTEMIC MALFUNCTION AND ROOT CAUSES OF ISSUES LIKE POVERTY, VIOLENCE AND HOMELESSNESS AMONG OTHERS. THEY STRENGTHEN THE COMMUNITYS ABILITY TO PROMOTE HEALTH AND WELL-BEING. IN THE COLUMBUS COMMUNITY, MERCY HAS COMMITTED TO IMPROVING THEIR HOSPITAL TO BETTER SERVE THEIR COMMUNITY. ONE EXAMPLE OF THIS IMPROVEMENT IS TO CREATE BETTER FUNCTIONAL SPACE WITHIN THE HOSPITAL AND IMPROVE THE AESTHETICS OF THE FACILITY. WITH THIS IMPROVEMENT, MERCY COLUMBUS IS ABLE TO PROVIDE BETTER CUSTOMER SATISFACTION AND PROMOTE HEALTH THROUGH BETTER PROGRAMS AND TECHNOLOGY. LIKE OTHER LOCAL KANSAS COMMUNITIES, THE COLUMBUS COMMUNITY HAS NOTABLE POVERTY RATES AND HIGH NUMBERS OF CHILDREN WITH REDUCED OR FREE LUNCHES IN OUR SCHOOLS. PAST COMMUNITY NEED DISCUSSIONS CONFIRMED REPEATEDLY THAT A HEALTHY COMMUNITY SUPPORTS WELL BEING OF RESIDENTS. LIKEWISE, ACCESS TO A FAIR FAMILY WAGE AFFORDS FAMILIES OPPORTUNITIES TO GAIN EDUCATION THAT IN TURN HAS SHOWN TO LEAD TO LEVERAGING HEALTH OPPORTUNITIES. SOLID INFRASTRUCTURE AND A STABLE ECONOMY SET A CONTEXT FOR CITIZENS TO REACH POTENTIAL AND IN TURN CONTRIBUTE TO SOCIETY FOR FUTURE GENERATIONS. COMMUNITY BUILDING ACTIVITY NEEDS TO BE A PRIORITY FOR THIS COMMUNITY.
FORM 990, SCHEDULE H, PART III, SECTION A, LINE 2 TO DETERMINE THE AMOUNT OF BAD DEBT EXPENSE, AT COST, BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENT ACCOUNTS WAS MULTIPLIED BY A RATIO OF COST TO CHARGES. THE RATIO OF COST TO CHARGES USED WAS BASED ON DETAILED COST ACCOUNTING, WHERE AVAILABLE. WHERE COST ACCOUNTING IS NOT AVAILABLE, COST REPORT COST TO CHARGE RATIOS WERE UTILIZED.
FORM 990, SCHEDULE H, PART III, SECTION A, LINE 3 THE FILING ORGANIZATION DETERMINED THAT THE ESTIMATED AMOUNT OF BAD DEBT EXPENSE (AT COST) ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS $0. ALTHOUGH THE CHARITY CARE POLICY REQUIRES THE PARTICIPATION OF THE PATIENT REQUESTING ASSISTANCE, WE HAVE A PROCESS UNDER PRESUMPTIVE 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.
FORM 990, SCHEDULE H, PART III, SECTION A, LINE 4 THE TEXT OF THE FOOTNOTE THAT IS INCLUDED IN MERCY HEALTH AND SUBSIDIARIES AUDITED FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE IS AS FOLLOWS: "PATIENT ACCOUNTS RECEIVABLE THAT ARE DEEMED UNCOLLECTIBLE, INCLUDING THOSE PLACED WITH COLLECTION AGENCIES, ARE INITIALLY CHARGED AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IN ACCORDANCE WITH COLLECTION POLICIES OF THE HEALTH SYSTEM AND, IN CERTAIN CASES, ARE RECLASSIFIED TO CHARITY CARE IF DEEMED TO OTHERWISE MEET THE HEALTH SYSTEMS CHARITY CARE POLICY. THE PROVISION FOR UNCOLLECTIBLE RECEIVABLES IS BASED UPON MANAGEMENTS ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. PERIODICALLY THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES BASED UPON THE PAYOR COMPOSITION AND AGING OF RECEIVABLES WITH CONSIDERATION OF THE HISTORICAL PAYMENT AND WRITE-OFF EXPERIENCE BY PAYOR CATEGORY. THE RESULTS OF THESE REVIEWS ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR UNCOLLECTIBLE RECEIVABLES TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES. AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE, THE HEALTH SYSTEM FOLLOWS ESTABLISHED GUIDELINES FOR PLACING PAST-DUE PATIENT BALANCES WITH COLLECTION AGENCIES."
FORM 990, SCHEDULE H, PART III, SECTION B, LINE 8 IT IS THE POSITION OF MERCY THAT 100% OF ANY SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT. THIS AMOUNT REPRESENTS COST OF PROVIDING SERVICES THAT REMAIN UNCOMPENSATED TO THE PROVIDER. THE UNREIMBURSED COSTS OF MEDICARE IS CALCULATED BY THE GROSS CHARGES NET OF THE COST TO CHARGE RATIO LESS ANY PAYMENTS, DEDUCTIONS OR REIMBURSEMENTS USING THE ANNUAL MEDICARE COST REPORT (CMS FORM 2552-96).
FORM 990, SCHEDULE H, PART III, SECTION C, LINE 9B MERCYS COLLECTION POLICY PROVIDES THAT MERCY WILL PERFORM A REASONABLE COMMUNICATION AND/OR REVIEW OF PATIENT ACCOUNTS AS IT RELATES TO ANY SERVICE PROVIDED AT OUR FACILITIES BEFORE TURNING THE ACCOUNT TO BAD DEBT OR TAKING LEGAL ACTION FOR NONPAYMENT. MERCY ACTIVELY SCRUBS ACCOUNTS FOR PAYOR PLAN COVERAGE, INCLUDING MEDICAID. IN THE EVENT AN ACCOUNT IS TURNED TO COLLECTIONS AND IS IDENTIFIED IN NEED OF FINANCIAL ASSISTANCE DUE TO CIRCUMSTANCE CHANGES, OR IS NOW REQUESTING ASSISTANCE, THE ACCOUNTS ARE RETURNED BY THE AGENCY AND CONSIDERED FOR CHARITY IF THE PATIENT PROVIDES THE REQUESTED INFORMATION. IF THE PATIENT FAILS TO RETURN THE INFORMATION, THE ACCOUNT WILL QUALIFY FOR COLLECTIONS. MERCY UTILIZES THE EXPERIAN TOOL TO ENHANCE THE ABILITY TO DETERMINE THE CHARITY QUALIFICATION PRIOR TO TURNING TO BAD DEBT, A PROCESS KNOWN AS PRESUMPTIVE CHARITY. MERCY WILL GRANT CHARITY IN SITUATIONS WHERE THERE HAS BEEN AN INABILITY TO OBTAIN INFORMATION FROM PATIENTS OR THE INFORMATION PROVIDED IS NOT COMPLETE ENOUGH TO MAKE A CHARITY DETERMINATION WHEN A PATIENT HAS SUBMITTED AN APPLICATION. IN ADDITION, MERCY UTILIZES THE SAME TOOL TO QUALIFY ACCOUNTS PER THE PRACTICE OF PRESUMPTIVE CHARITY PRIOR TO BAD DEBT PLACEMENT FOR BALANCES IN EXCESS OF $6,500. ALL ACCOUNT BALANCES RELATING TO ACCOUNTS IDENTIFIED BY THE HIGHER BALANCES WILL BE CONSIDERED AND FLAGGED FOR CHARITY IF THERE IS AN INABILITY TO PAY AFTER A RETURN FROM THE COLLECTION AGENCY AT APPROXIMATELY 120 DAYS. MERCY WILL PURSUE APPROPRIATE MEANS IN THE COLLECTION OF DELINQUENT ACCOUNTS FROM PATIENTS WITH AN ESTABLISHED ABILITY TO PAY OR AN UNWILLINGNESS TO COOPERATE IN VALIDATING ELIGIBILITY FOR FINANCIAL ASSISTANCE. THESE APPROPRIATE MEANS MAY INCLUDE LEGAL ACTION CONSISTENT WITH MERCY MISSION AND VALUES AFTER A SENDING 3 MONTHLY STATEMENTS WITH THE FINAL INCLUDING NOTIFICATION; IF NO RESOLUTION THEY WILL BE TURNED TO COLLECTIONS. ADDITIONALLY, THEY MAY INCLUDE LIENS UPON REAL PROPERTY AND REASONABLE WAGE GARNISHMENTS. LEGAL ACTIONS WILL GENERALLY NOT INCLUDE BANK GARNISHMENTS, REPOSSESSION OF ASSETS OR FORECLOSURES TO ENSURE SATISFACTION OF A LIEN. MERCY HAS POLICIES AND PROCEDURES ESTABLISHED TO ADDRESS THE INITIATION OF LEGAL ACTION AND ANNUALLY REVIEW COMPLIANCE WITH POLICIES BUT ENSURE 120 DAYS OF BILLING AND COLLECTIONS OCCURS PRIOR TO ANY EXTRAORDINARY COLLECTIONS ARE PURSUED.
FORM 990, SCHEDULE H, PART VI, LINE 2 IN ADDITION TO OUR COLLABORATION WITH THE OZARKS HEALTH COMMISSION FOR OUR RECENT CHNA, MERCY COLUMBUS CONTINUES TO PLAY AN INTEGRAL PART IN THE JOPLIN COMMUNITY HEALTH COLLABORATIVE, TO ASSESS THE HEALTH CARE NEEDS OF THE REGION. MERCY COLUMBUS ALSO EXAMINES THE CURRENT HEALTH NEEDS AND COMPARES THEM TO RECENT HOSPITAL PATIENT VISIT DATA IN THE EMERGENCY DEPARTMENT, AND COUNTY HEALTH RANKINGS. NEXT, A REPRESENTATIVE FROM MERCY COLUMBUS SERVES ON A COMMUNITY BENEFIT SUB-COMMITTEE (ROUNDTABLE DISCUSSIONS) IN AN EFFORT TO GAIN INPUT FROM COMMUNITY MEMBERS. WE THEN ANALYZE THE CURRENT DATA TO PRIORITIZE NEW OR EXISTING NEEDS, REVIEW CURRENT ACTIVITIES IN PLACE, AND THEN END WITH CREATING AN ACTION PLAN IN COLLABORATION WITH THE COMMUNITY.
FORM 990, SCHEDULE H, PART VI, LINE 3 MERCY INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS OR UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY THROUGH SEVERAL MEANS. IF AT ANY TIME A PATIENT EXPRESSES HARDSHIP AND INABILITY TO PAY, THE ACCOUNTS IS PLACED FOR REVIEW. IN ADDITION, PATIENT HAVE SIGNAGE ABOUT THE POLICY AT THE ACCESS POINTS, AND ALL STAFF WORKING WITH THE PATIENT AT POINT OF SERVICE, SCHEDULING, CUSTOMER SERVICE, AND EVEN THROUGH THE MEDICAID ELIGIBILITY SCREENING, HAVE THE MEANS TO SEND THE ACCOUNT FOR REVIEW. THERE IS THE PLAIN LANGUAGE SUMMARY THAT IS BEING PROVIDED TO ALL WHOM EXPRESS HARDSHIP, IN ADDITION TO THE WEB ADDRESS PROVIDING THE APPLICATION, POLICIES, AND EVEN HOW UNINSURED ACCOUNTS ARE HANDLED. LASTLY, THE STATEMENTS MESSAGE TO THE PATIENT THAT MERCY DOES HAVE A FINANCIAL ASSISTANCE PROGRAM AND TO CALL TO SEE IF THEY ARE ELIGIBLE. MERCY STAFFS INTERNAL RESOURCES CERTIFIED TO ASSIST PATIENTS WITH MEDICAID APPLICATIONS AS WELL.
FORM 990, SCHEDULE H, PART VI, LINE 4 MERCY HOSPITAL COLUMBUS PRIMARY SERVICE AREA INCLUDES CHEROKEE COUNTY IN SOUTHEAST KANSAS. THE FOLLOWING INFORMATION IS DERIVED FROM 2016 Sg2 ANALYTICS DATA AND Sg2 INSURANCE COVERAGE ESTIMATES. THE AREA'S POPULATION IS 21,225. 24% OF THE POPULATIONS AVERAGE HOUSEHOLD INCOME IS OVER $75,000. 46% OF THE POPULATION IS 45 AND OLDER. 28% OF HOUSEHOLDS ARE ON MEDICARE, 17% ON MEDICAID, AND 12% UNINSURED.
FORM 990, SCHEDULE H, PART VI, LINE 5 TO CONTINUE PROMOTING COMMUNITY HEALTH, MERCY COLUMBUS COLLABORATES WITH COMMUNITY LEADERS INVOLVED IN IDENTIFYING COMMUNITY HEALTH NEEDS TO RESOLVE LOCAL HEALTH CHALLENGES. OUR EFFORTS IN COMMUNITY BENEFIT FOCUS ON IMPLEMENTING PROGRAMS TO TACKLE UNHEALTHY BEHAVIORS RESULTING IN IMPROVED HEALTH STATUS. SOME PROGRAMS WERE ACCOMPLISHED IN PARTNERSHIP WITH OTHERS, WHILE WE SELECTED SPECIFICALLY BECAUSE MERCY HOSPITAL COLUMBUS HAD AN EXPERTISE TO OFFER, AND THE CLINICAL ABILITY TO MANAGE THE NATURE OF ITS OPERATION. MERCY HOSPITAL COLUMBUS HAS PARTICULAR CONCERN FOR THE VULNERABLE AND UNDERSERVED. OUR MISSION IS TO DELIVER "COMPASSIONATE CARE AND EXCEPTIONAL SERVICE" TO EVERY COMMUNITY MEMBER. IN DEDICATION TO THIS MISSION, MERCY AND THE COLUMBUS BOARD OF TRUSTEES, HAS BEEN ABLE TO CREATE A SHARED ENVIRONMENT IN WHICH THE COMMUNITY CAN FLOURISH. THE TARGET AREAS OF THIS COLLABORATION ARE PHYSICAL HEALTH WITHIN LOCAL SCHOOLS AND HUMAN SERVICES. COMMUNITY LEADERS MEET ON A REGULAR BASIS TO ASSESS, IDENTIFY, AND EVALUATE PROGRAMS THAT MEET THE NEEDS OF THE UNDERSERVED POPULATION. IT IS OUR HOPE THAT THE WORK THAT IS ACCOMPLISHED THROUGH THESE COLLABORATIONS, WILL LEAD TO BETTER HEALTH AND HUMAN SERVICES FOR THE COLUMBUS COMMUNITY.
FORM 990, SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM: THE FILING ORGANIZATION IS PART OF MERCY HEALTH ("MERCY"). MERCY IS A MISSOURI NON-PROFIT CORPORATION WITH ITS HEADQUARTERS ("MINISTRY OFFICE") IN ST. LOUIS, MISSOURI. MERCY PROVIDES HEALTH CARE SERVICES IN FOUR STATES - ARKANSAS, KANSAS, MISSOURI, AND OKLAHOMA - AND HAS OUTREACH MINISTRIES LOCATED IN LOUISIANA, MISSISSIPPI, AND TEXAS. MERCY'S MISSION IS "AS THE SISTERS OF MERCY BEFORE US, WE BRING TO LIFE THE HEALING MINISTRY OF JESUS THROUGH OUR COMPASSIONATE CARE AND EXCEPTIONAL SERVICE." AS OF JUNE 30, 2016, MERCY FACILITIES INCLUDED 33 ACUTE CARE HOSPITALS, 3 MANAGED HOSPITALS, 4 HEART HOSPITALS, 2 CHILDREN'S HOSPITALS, 2 ORTHOPEDIC HOSPITALS AND 3 REHAB HOSPITALS. FOR THE FISCAL YEAR ENDED JUNE 30, 2016, MERCY HAD MORE THAN 9.2 MILLION OUTPATIENT AND PHYSICIAN OFFICE VISITS, APPROXIMATELY 2,100 EMPLOYED PHYSICIANS, AND APPROXIMATELY 40,000 FULL-TIME EQUIVALENT EMPLOYEES, MAKING MERCY THE FIFTH LARGEST CATHOLIC HEALTH SYSTEM IN THE UNITED STATES. MERCY IS SPONSORED BY MERCY HEALTH MINISTRY, WHICH IS GOVERNED BY MEMBERS THAT INCLUDE SISTERS OF MERCY. MANY SERVICES THAT ARE ESSENTIAL TO FULFILLING MERCY'S MISSION ARE CENTRALIZED AT THE MINISTRY OFFICE. SUCH CENTRALIZED SERVICES INCLUDE TREASURY, INFORMATION TECHNOLOGY, CLINICAL QUALITY MANAGEMENT, LEGAL AND COMPLIANCE COUNSEL, COMPENSATION AND BENEFITS, CONSULTING, PERFORMANCE MANAGEMENT, REVENUE MANAGEMENT, INTERNAL AUDIT, ACCOUNTING AND REPORTING, CAPITAL MANAGEMENT, CLINICAL ENGINEERING, AND CLINICAL SAFETY. THE CENTRALIZATION OF SUCH SUPPORT SERVICES ENABLES MERCY TO ENSURE THAT EACH OF ITS COMMUNITIES, WHETHER LARGE OR SMALL, HAS THE SERVICES IT NEEDS.
FORM 990, SCHEDULE H, PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT: N/A.
Schedule H (Form 990) 2015
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