| FORM 990, PART III, LINE 4A |
THE FOLLOWING STATISTICS ARE OFFERED FOR THE FISCAL YEAR ENDING 9-30-2019: 428 MEDICARE, MEDICAID, AND MEDICARE ADVANTAGE ADMISSIONS AND 430 DISMISSALS; AGED PATIENTS SERVICES - 613 DAYS; PEDIATRICS SERVICES - 3 DAYS; SWING BED DAYS - 588; EKGS PERFORMED - 270; inpatient OCCUPATIONAL THERAPY - 483 HOURS; INPATIENT PHYSICAL THERAPY - 2,839 HOURS; outpatient Therapy - 2,001 Instances of service; ER visits - 936. FORM 990, PART VI, SECTION A, LINE 1A EXECUTIVE COMMITTEE HAS FULL AUTHORITY UNDER THE BYLAWS TO ACT ON MATTERS OF URGENT BUSINESS THAT ARISE BETWEEN BOARD MEETINGS, AS LONG AS SUCH DECISIONS DO NOT CONFLICT WITH THE POLICIES OF THE BOARD. |
| FORM 990, PART VI, SECTION A, LINE 6 |
MEMBERSHIP IN MERCY HOSPITAL, INC. IS LIMITED TO THE CONGREGATIONS OF THE VARIOUS CHURCHES OF THE CHURCH OF GOD IN CHRIST MENNONITE WITHIN THE AREA SERVED BY THE HOSPITAL. |
| FORM 990, PART VI, SECTION A, LINE 7A |
THE VARIOUS CONGREGATIONS, BEING THE MEMBERS OF MERCY HOSPITAL, INC., HAVE THE RIGHT TO ELECT, ADD, OR REMOVE BOARD MEMBERS. |
| FORM 990, PART VI, SECTION A, LINE 7B |
THE VARIOUS CONGREGATIONS, BEING THE MEMBERS OF MERCY HOSPITAL, INC., HAVE THE RIGHT TO APPROVE THE BYLAWS, ARTICLES OF INCORPORATION, AND APPROVE OR REMOVE BOARD MEMBERS. |
| FORM 990, PART VI, SECTION B, LINE 11B |
AN INDEPENDENT ACCOUNTING FIRM PREPARES THE FORM 990. THE FORM 990 WITH ALL REQUIRED SCHEDULES IS THEN REVIEWED BY THE ORGANIZATION'S CFO AND ADMINISTRATOR. ANY QUESTIONS OR CONCERNS ARE ADDRESSED AND ANY NECESSARY CHANGES ARE MADE. THE FINAL FORM 990, WITH ALL REQUIRED SCHEDULES, IS PROVIDED TO ALL VOTING MEMBERS OF THE BOARD PRIOR TO FILING THE 990. |
| FORM 990, PART VI, SECTION B, LINE 12C |
BOARD MEMBERS AND THE ADMINISTRATOR REVIEW THE CONFLICT OF INTEREST POLICY ANNUALLY. EACH INDIVIDUAL IS RESPONSIBLE FOR DISCLOSING ANY POTENTIAL CONFLICTS. AN ADMINISTRATIVE BOARD DETERMINES WHETHER A CONFLICT IS PRESENT. IF A CONFLICT OF INTEREST IS PRESENT THE INTERESTED BOARD MEMBER IS EXCUSED FROM THE BOARDROOM DURING THE VOTE. THE ADMINISTRATIVE BOARD IS COMPOSED OF THREE INDIVIDUALS: AARON HERBEL, ADMINISTRATOR AND ACTING CFO; LORIE FRIESEN DON, AND VERLA FRIESEN, CORPORATE COMPLIANCE OFFCER. |
| FORM 990, PART VI, SECTION B, LINES 15A & 15B |
AT THE TIME OF HIRE AND ANNUALLY THEREAFTER, THE KHA'S PUBLISHED WAGE SCALE AND AN INFORMAL SURVEY OF AREA COMPENSATION COMPARABLES ARE USED TO ESTABLISH REASONABLE COMPENSATION LEVELS. IN ADDITION, AN ANNUAL PERFORMANCE EVALUATION IS PERFORMED BY THE EXECUTIVE COMMITTEE OF THE HOSPITAL BOARD OF DIRECTORS. THE EVALUATIONS COMPLETED BY THE EXECUTIVE COMMITTEE ARE THEN PRESENTED TO THE BOARD OF DIRECTORS FOR APPROVAL. DOCUMENTATION OF THE APPROVED EVALUATIONS FOR COMPENSATION IS INCLUDED IN THE BOARD MINUTES. |
| FORM 990, PART VI, SECTION C, LINE 19 |
THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST TO THE HOSPITAL ADMINISTRATOR. |
| FORM 990 PART IX LINE 11G |
DESCRIPTION:PURCHASED MEDICAL SERVICES TOTAL FEES:499323 |
| FORM 990 PART IX LINE 11G |
DESCRIPTION:PURCHASED PLANT MAINT SERVICES TOTAL FEES:15861 |
| FORM 990 PART IX LINE 11G |
DESCRIPTION:PURCHASED LAUNDRY SERVICES TOTAL FEES:15301 |
Attach to Form 990 or 990-EZ.