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.
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OMB No. 1545-0047
2021
Open to Public
Inspection
Name of the organization
MERCY HOSPITAL PARIS
 
Employer identification number

71-0655753
Return Reference Explanation
FORM 990, PART V, QUESTION 1A FORM 1099/1096 FILING VENDORS FOR THE FILING ORGANIZATION ARE PAID BY MERCY HEALTH (EIN 43-1423050). AS SUCH, ALL REQUIRED FORM 1099 AND FORM 1096 REPORTING IS MADE FOR THE ENTIRE MERCY HEALTH SYSTEM (WITH LIMITED EXCEPTIONS) UNDER THE MERCY HEALTH EIN.
FORM 990, PART V, QUESTION 2A W-3 FILING MOST EMPLOYEES ARE PAID BY A RELATED ORGANIZATION UNDER A COMMON PAYMASTER ARRANGEMENT. AS SUCH, REQUIRED PAYROLL FILING (INCLUDING W-2 AND W-3'S) IS REPORTED UNDER THE RELATED ORGANIZATION, MHM SUPPORT SERVICES, EIN 20-2553101.
FORM 990, PART VI, SECTION A, LINE 6 THE FILING ORGANIZATION HAS A SOLE CORPORATE MEMBER, MERCY HOSPITAL FORT SMITH.
FORM 990, PART VI, SECTION A, LINE 7A MERCY HOSPITAL FORT SMITH (THE SOLE CORPORATE MEMBER) HAS THE AUTHORITY TO: - APPOINT THE BOARD OF TRUSTEES OF THE CORPORATION.
FORM 990, PART VI, SECTION A, LINE 7B MERCY HOSPITAL FORT SMITH (THE SOLE CORPORATE MEMBER) HAS RESERVED SOLELY THE FOLLOWING CORPORATE POWERS AND RESPONSIBILITIES: - ESTABLISH THE PHILOSOPHY ACCORDING TO WHICH THE CORPORATION OPERATES; - AMEND THE ARTICLES OF INCORPORATION AND BYLAWS OF THE CORPORATION; - APPROVE THE OPERATING, CAPITAL, AND CONSTRUCTION BUDGETS FOR THE CORPORATION; - APPROVE THE STRATEGIC PLAN, GOALS, AND OBJECTIVES OF THE CORPORATION. ONLY MERCY HEALTH SHALL HAVE THE RIGHT AND DUTY TO: - LEASE, SELL, OR ENCUMBER CORPORATE REAL ESTATE IN EXCESS OF ONE MILLION DOLLARS ($1,000,000), AND, IN ADDITION, TO AUTHORIZE AND APPROVE THE INCURRENCE OF DEBT BY THE CORPORATION, AND, IN CONNECTION THEREWITH, GRANT ALL SECURITY INTERESTS, PLACE ALL ENCUMBRANCES, ENTER INTO ANY COVENANTS, AND EXECUTE ALL DOCUMENTS AND TAKE ALL ACTIONS NECESSARY IN CONNECTION WITH THE INCURRENCE OF SUCH DEBT; AND, - MERGE, DISSOLVE, OR ABANDON THE CORPORATION.
FORM 990, PART VI, SECTION B, LINE 11B DSCR THE PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990 THE FORM 990 IS PREPARED BY MERCY HEALTH'S TAX DEPARTMENT, 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 THEN SIGNED AND FILED WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 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, 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, SECTION C, LINE 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 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 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 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 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.
FORM 990, PART XI, LINE 9: NET TRANSFERS (TO)/FROM AFFILIATES -1,325,504. EMPLOYEE CRISIS FUND -7,673.
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 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, QUESTION 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.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990) 2021


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