4A (Expenses $ 9232109 including grants of $ 0) (Revenue $ 11731407)
MERCY HOSPITAL BERRYVILLE 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 BERRYVILLE PROVIDES A WIDE VARIETY OF SERVICES IN THEIR 25 BED FACILITY AND IN FY22, HAD 22,038 TOTAL CASES. MERCY HOSPITAL BERRYVILLE 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 BERRYVILLE'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 BERRYVILLE HAD 9,735 CASES FOR THIS SERVICE LINE.

4B (Expenses $ 2416029 including grants of $ 0) (Revenue $ 3070092)
MERCY HOSPITAL BERRYVILLE'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 BERRYVILLE HAD 9,585 CASES FOR THIS SERVICE LINE.

4C (Expenses $ 2187072 including grants of $ 0) (Revenue $ 2779151)
MERCY HOSPITAL BERRYVILLE'S PULMONOLOGISTS ARE EXPERIENCED IN DIAGNOSING AND TREATING BREATHING DISORDERS, FROM ASTHMA TO LUNG CANCER TO SLEEP DISORDERS. MERCY'S TEAM OF PULMONOLOGISTS WILL WORK WITH YOU TO MEASURE YOUR LUNG FUNCTION, MAKE AN ACCURATE DIAGNOSIS AND DETERMINE THE RESPIRATORY TREATMENT THAT'S RIGHT FOR YOU. ADDITIONAL RESPIRATORY CONDITIONS MERCY TREATS INCLUDE COPD, PNEUMONIA, AND OBSTRUCTIVE SLEEP APNEA. IN FY22, MERCY HOSPITAL BERRYVILLE HAD 214 CASES AND 833 PATIENT DAYS FOR THIS SERVICE LINE.

4D (Expenses $ 3827762 including grants of $ 69608) (Revenue $ 4832043)
IN ADDITION TO THE PROGRAM SERVICES DESCRIBED ABOVE, MERCY HOSPITAL BERRYVILLE ALSO SERVES PATIENTS IN ADDITIONAL SERVICE LINES, INCLUDING BUT NOT LIMITED TO THE FOLLOWING AREAS: GASTROENTEROLOGY; ORTHOPEDICS; REHABILITATION; UROLOGY & NEPHROLOGY; WOMEN & INFANTS.

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 3 Facility , 1
Facility , 1 - MERCY HOSPITAL BERRYVILLE. THE CHNA HAS ALL THE SECTIONS REFERENCED ABOVE AND INCLUDES AN EXECUTIVE SUMMARY, POTENTIALLY AVAILABLE RESOURCES, EVALUATION OF IMPACT, REFERENCES, AND APPENDICES.

Schedule H, Part V, Section B, Line 5 Facility , 1
Facility , 1 - MERCY HOSPITAL BERRYVILLE. IN CONDUCTING ITS COMMUNITY HEALTH NEEDS ASSESSMENT, MERCY BERRYVILLE COLLECTED AND ANALYZED A SIGNIFICANT QUANTITY OF PRIMARY AND SECONDARY DATA. PRIMARY DATA WAS COLLECTED, AND COMMUNITY INPUT WAS SOLICITED, BY MEANS OF THE 2021 NORTHWEST ARKANSAS COMMUNITY HEALTH SURVEY, WHICH WAS LED BY MERCY. SECONDARY DATA WAS COLLECTED AND ANALYZED FROM PUBLICLY AVAILABLE DATA RESOURCES AND FROM INTERNAL MERCY DATA. THE THOUGHTS AND OPINIONS OF PEOPLE WITHIN MERCY'S SERVICE AREA OF CARROLL COUNTY WERE CENTRAL TO THE HEALTH NEEDS ASSESSMENT PROCESS. INPUT FROM PEOPLE REPRESENTING BROAD INTERESTS OF THE COMMUNITY WAS SOLICITED THROUGH A ROBUST SURVEY PROCESS GUIDED BY A MERCY-LED COMMUNITY COALITION AND BY SEEKING INPUT FROM COMMUNITY PARTNERS. NORTHWEST ARKANSAS IS HOME TO HISPANIC AND MARSHALLESE MINORITY POPULATIONS THAT INCLUDE MEMBERS WHO ARE LOW INCOME, MEDICALLY UNDERSERVED, AND EXPERIENCE SIGNIFICANT HEALTH DISPARITIES. INPUT FROM THESE GROUPS WAS SOUGHT BY INTENTIONALLY SEEKING OUT THEIR PARTICIPATION IN THE SURVEY AND BY SOLICITING INPUT FROM ORGANIZATIONS REPRESENTING THESE GROUPS. THE FOLLOWING GROUPS TOOK PART IN SOME PHASE OF THE WORK THAT GENERATED BERRYVILLE COMMUNITY HEALTH NEEDS ASSESSMENT: (THE BERRYVILLE COMMUNITY CONSISTS OF: CARROLL COUNTY, AR.) -MERCY COWORKERS WHO SERVED ON TEAMS AND DEVELOPED PROGRAMS TO RESPOND TO IDENTIFIED NEEDS. -ARKANSAS CHILDREN'S NORTHWEST, ARKANSAS DEPARTMENT OF HEALTH, BENTON, MADISON, AND WASHINGTON COUNTY HEALTH UNITS, COMMUNITY CLINIC NORTHWEST ARKANSAS, HARK AT THE EXCELLERATE FOUNDATION, MARSHALLESE CONSULATE AND COVID-19 TASK FORCE, NWA COUNCIL HEALTH CARE TRANSFORMATION DIVISION, OZARK GUIDANCE CENTER, UNIVERSITY OF ARKANSAS, UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES, VA MEDICAL CENTER, WASHINGTON REGIONAL MEDICAL CENTER, AND WHOLE HEALTH INSTITUTE. MERCY CONVENED A COMMUNITY COALITION OF 17 NORTHWEST ARKANSAS HEALTH CARE AND SOCIAL SERVICE ORGANIZATIONS TO CONDUCT A COMPREHENSIVE COMMUNITY HEALTH SURVEY IN 2021. THE SURVEY WAS DEVELOPED TO BUILD ON THE 2018 NWA COMMUNITY HEALTH SURVEY AND TO INCORPORATE INPUT AND SPECIFIC NEEDS OF THE COALITION PARTNERS. THE FINAL SURVEY WAS MADE UP OF 30 QUESTIONS FOCUSED ON HEALTH ISSUES AND NEEDS MOST IMPORTANT TO THE RESPONDENTS, WELLNESS, MENTAL HEALTH, BARRIERS TO CARE, COVID-19 VACCINATION, CHILDHOOD IMMUNIZATIONS, AND THE NWA COVID-19 RESPONSE. THE SURVEY WAS TRANSLATED INTO SPANISH AND MARSHALLESE BY CERTIFIED MEDICAL INTERPRETERS. THE NORTHWEST ARKANSAS COUNCIL HOSTED THE SURVEY ON THEIR WEBSITE FROM JULY TO SEPTEMBER 2021 IN THE THREE LANGUAGES. THE NWA COUNCIL PROMOTED THE SURVEY ON SOCIAL MEDIA, AND EACH PARTNER ORGANIZATION DISTRIBUTED THE SURVEY ELECTRONICALLY TO THEIR CO-WORKERS, PATIENTS, CLIENTS, AND COMMUNITY MEMBERS BY EMAIL AND THROUGH SOCIAL MEDIA. FLYERS AND BUSINESS CARDS WITH QR CODES FOR THE SURVEY IN EACH LANGUAGE WERE PRODUCED AND DISTRIBUTED BY COALITION PARTNERS IN THE COMMUNITY AND AT COMMUNITY EVENTS. SURVEYS WERE ALSO MADE AVAILABLE IN PAPER FORMAT FOR PARTICIPANTS WHO PREFERRED TO COMPLETE IT MANUALLY OR DID NOT HAVE COMPUTER ACCESS. INTENTIONAL EFFORTS WERE MADE TO INCLUDE AND OVERSAMPLE HISPANIC AND MARSHALLESE COMMUNITY MEMBERS BY ATTENDING COMMUNITY EVENTS, REACHING PARTICIPANTS AT WORKPLACES, USING CULTURALLY SPECIFIC SOCIAL MEDIA OUTLETS, AND UTILIZING HISPANIC AND MARSHALLESE COMMUNITY HEALTH WORKERS. 2,231 RESPONSES WERE INCLUDED IN THE FINAL ANALYTIC SAMPLE. 53% OF RESPONDENTS WERE FROM BENTON COUNTY, 39% FROM WASHINGTON COUNTY, 5% FROM CARROLL COUNTY, AND 3% FROM MADISON COUNTY. 1,647 (74%) OF RESPONDENTS WERE WHITE, 194 (9%) WERE HISPANIC, 123 (6%) WERE MARSHALLESE OR OTHER PACIFIC ISLANDER. AMERICAN INDIAN/ALASKA NATIVE, BLACK/AFRICAN AMERICAN, ASIAN, AND OTHER RACES MADE UP THE REMAINDER OF RESPONDENTS. OF THE 2,231 SURVEY RESPONDENTS FROM THE REGION, 5% INDICATED THEY LIVED IN THE BERRYVILLE COMMUNITY. RESPONDENTS WERE ASKED TO RANK COMMUNITY NEEDS, AND THE TOP 5 THAT EMERGED WERE: 1. ACCESS TO AFFORDABLE HEALTH CARE 2. MENTAL OR BEHAVIORAL HEALTH 3. DIABETES 4. HEART DISEASE 5. OBESITY AND OVERWEIGHT

Schedule H, Part V, Section B, Line 6a Facility , 1
Facility , 1 - MERCY HOSPITAL BERRYVILLE. THE CHNA WAS NOT CONDUCTED WITH ANOTHER HOSPITAL FACILITY. MERCY HOSPITAL BERRYVILLE PARTICIPATED IN THE NORTHWEST ARKANSAS COMMUNITY HEALTH SURVEY PORTION OF THE CHNA.

Schedule H, Part V, Section B, Line 6b Facility , 1
Facility , 1 - MERCY HOSPITAL BERRYVILLE. THE CHNA ITSELF WAS NOT CONDUCTED WITH ANOTHER ORGANIZATION. THE OTHER ORGANIZATIONS WHO PARTICIPATED IN THE NORTHWEST ARKANSAS COMMUNITY HEALTH SURVEY WERE: ARKANSAS COALITION OF MARSHALLESE, ARKANSAS DEPARTMENT OF HEALTH, BENTON, MADISON, AND WASHINGTON COUNTY HEALTH UNITS, COMMUNITY CLINIC NORTHWEST ARKANSAS, HARK AT THE EXCELLERATE FOUNDATION, MARSHALLESE CONSULATE AND COVID-19 TASK FORCE, NWA COUNCIL HEALTH CARE TRANSFORMATION DIVISION, OZARK GUIDANCE CENTER, UNIVERSITY OF ARKANSAS, UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES NORTHWEST, AND WHOLE HEALTH INSTITUTE.

Schedule H, Part V, Section B, Line 11 Facility , 1
Facility , 1 - MERCY HOSPITAL BERRYVILLE. IN CONJUNCTION WITH THE CHNA, MERCY HOSPITAL BERRYVILLE'S BOARD ADOPTED AN IMPLEMENTATION STRATEGY IN FY22 RELATED TO THE 2021 CHNA. MERCY HOSPITAL BERRYVILLE WILL ADDRESS THE COMMUNITY HEALTH NEEDS IDENTIFIED BEGINNING IN FY23. MERCY HOSPITAL BERRYVILLE IS ADDRESSING THE SIGNIFICANT NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA BY FOCUSING PROGRAMMING, SERVICES AND EDUCATION OR AWARENESS AROUND: (1) ACCESS TO CARE, AND (2) BEHAVIORAL HEALTH. THE FIRST IDENTIFIED NEED OR PRIORITY IS ACCESS TO CARE: (1) INCREASE ACCESS TO HEALTH CARE AND COMMUNITY RESOURCES FOR UNINSURED AND AT RISK PERSONS, AND (2) INCREASE THE NUMBER OF PRACTICING PRIMARY CARE PHYSICIANS IN THE REGION. THE SECOND IDENTIFIED NEED OR PRIORITY IS BEHAVIORAL HEALTH: (1) INCREASE ACCESS TO OUTPATIENT BEHAVIORAL HEALTH SERVICES FOR PRIMARY CARE PATIENTS. FOR ALL THESE IDENTIFIED NEEDS AND PRIORITIES, MERCY BERRYVILLE CONTINUES TO WORK CLOSELY WITH ITS LOCAL PUBLIC SCHOOL SYSTEM, NONPROFIT ORGANIZATIONS, THE CHAMBER OF COMMERCE, AND PUBLIC OFFICIALS TO ENSURE WE ARE COLLABORATIVELY ADDRESSING THE NEEDS OF OUR COMMUNITY IN A MEASURABLE WAY. MERCY BERRYVILLE REMAINS ACTIVELY ENGAGED IN ITS REPRESENTATION ON THE HEALTH COMMISSION TO STAY ATTACHED TO KEY LEADERS IN OUR COMMUNITY AIMING TO ACHIEVE SIMILAR WORK AND OUTCOMES, PARTICULARLY FOR PATIENTS AND OUR VULNERABLE POPULATIONS. OTHER HEALTH ISSUES IDENTIFIED IN THE CHNA PROCESS (DIABETES, HEART DISEASE, AND OBESITY) WERE NOT CHOSEN AS PRIORITY FOCUS AREAS FOR DEVELOPMENT OF THE CURRENT COMMUNITY HEALTH IMPROVEMENT PLAN DUE TO MERCY'S CURRENT LACK OF RESOURCES AVAILABLE TO ADDRESS THESE NEEDS AND THE INTENTION TO FOCUS ON THE TWO PRIORITIZED HEALTH NEEDS.

Schedule H, Part V, Section B, Line 20 Facility , 1
Facility , 1 - MERCY HOSPITAL BERRYVILLE. 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, Part VI, Line 7 STATE FILING OF COMMUNITY BENEFIT REPORT
N/A

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 $21,083,299. INCLUDED IN THIS AMOUNT WAS BAD DEBT EXPENSE (CHARGES) OF $2,156,823. EXPENSES FOR THE PURPOSE OF CALCULATING LINE 7, COLUMN (F) ARE $18,926,476.

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 ACCOUNT, 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
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 BERRYVILLE: 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 BERRYVILLE: 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 BERRYVILLE: Line 16c URL: https://www.mercy.net/patients-visitors/billing/financial-assistance/;

Schedule H, Part VI, Line 4 Community information
THE PRIMARY SERVICE AREA FOR MERCY HOSPITAL BERRYVILLE INCLUDES CARROLL COUNTY, ARKANSAS AND BARRY COUNTY, MISSOURI. THE FOLLOWING INFORMATION IS DERIVED FROM THE ADVISORY BOARD DEMOGRAPHICS. THE AREA'S POPULATION IS 28,667. THE MEDIAN HOUSEHOLD INCOME IS $49,000. 49.4% OF THE POPULATION IS 45 AND OLDER. 87% OF THE POPULATION IS A HIGH SCHOOL GRAD OR GREATER AND THE MEDIAN AGE IS 45.

Schedule H, Part VI, Line 2 Needs assessment
MERCY HOSPITAL BERRYVILLE 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. THE NEEDS ASSESSMENT PROCESS INCLUDES MEASUREMENT OF A WIDE VARIETY OF DEMOGRAPHIC AND PUBLIC HEALTH INDICATORS, INCLUDING THOSE MEASURING SOCIAL DETERMINANTS OF HEALTH AND THOSE FOCUSED PARTICULARLY ON UNDERSERVED AND VULNERABLE POPULATIONS. HOSPITAL UTILIZATION DATA IS ALSO COLLECTED. THE PROCESS INCLUDED A COMMUNITY-WIDE ELECTRONIC HEALTH NEEDS SURVEY, AND A HEALTH SURVEY FOCUSED SPECIFICALLY ON UNINSURED PATIENTS. MERCY REFINES ITS IMPLEMENTATION STRATEGIES TO MEET THE NEEDS OF THE COMMUNITY AND MONITORS PROGRESS THROUGH BY PERIODIC REVIEW BY THE HOSPITAL'S COMMUNITY BOARD.

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 STAFFS INTERNAL RESOURCES CERTIFIED TO ASSIST PATIENTS WITH MEDICAID APPLICATIONS AS WELL.

Schedule H, Part VI, Line 5 Promotion of community health
MERCY HOSPITAL BERRYVILLE 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 CONDITIONS, EDUCATIONAL PROGRAMS, HEALTH RESOURCE COORDINATION, COMMUNITY BLOOD DRIVES AND HEALTH FAIRS. MERCY HOSPITAL BERRYVILLE 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 BERRYVILLE 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."