Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Mercy Catholic Medical Center of Southeastern Pennsylvania
Employer identification number
23-1352191
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization?
................
11g(i)
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of support?
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3..
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public Support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2010.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
......................
b
33 1/3% support test—2009.
If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2010.
If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization
..................................................
b
10%-facts-and-circumstances test—2009.
If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported organization
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c
Add lines 7a and 7b..
8
Public Support (Subtract line 7c from line 6.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13
Total support (Add lines 9, 10c, 11 and 12.).
14
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f))
.........
15
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2010.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
..........
b
33 1/3% support tests—2009.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information.
Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2010
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
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 to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Mercy Catholic Medical Center of Southeastern Pennsylvania
Employer identification number
23-1352191
Identifier
Return Reference
Explanation
Organization Mission Statement
Form 990, Part I, Line 1
Mercy Catholic Medical Center is part of Mercy Health System of Southeastern PA ("SEPA"). Our mission is to be a partner in the healing ministry of the Catholic Church in the spirit of the Sisters of Mercy and Hope Ministries. To fulfill that mission, we strive to create an environment that is caring and compassionate within our health system and in our service to the community. We are dedicated to being a transforming, healing presence that supports healthy communities, addresses the diverse health needs of our neighbors at every stage of life, and is accessible to all, including the often forgotten poor and disadvantaged. Through innovative medicine and compassionate care, our hospitals work together to nurture our patients and their families through the healing process with superior services and spiritual support. SEPA is a member of Catholic Health East ("CHE").
Organization Mission Statement
Form 990, Part III, Line 1
Mercy Catholic Medical Center is part of Mercy Health System of Southeastern PA ("SEPA"). Our mission is to be a partner in the healing ministry of the Catholic Church in the spirit of the Sisters of Mercy and Hope Ministries. To fulfill that mission, we strive to create an environment that is caring and compassionate within our health system and in our service to the community. We are dedicated to being a transforming, healing presence that supports healthy communities, addresses the diverse health needs of our neighbors at every stage of life, and is accessible to all, including the often forgotten poor and disadvantaged. Through innovative medicine and compassionate care, our hospitals work together to nurture our patients and their families through the healing process with superior services and spiritual support. SEPA is a member of Catholic Health East ("CHE").
Program Service Statement
Form 990, Part III, Line 4a
Patient Care: Mercy Catholic Medical Center provides quality healthcare regardless of race, creed, sex, national origin, handicap, age or ability to pay. Although reimbursement for services rendered is critical to the operation and stability of Mercy Catholic Medical Center, it is recognized that not all individuals possess the ability to purchase essential medical services, and further that our mission is to serve the community with respect to providing healthcare services and healthcare education. Mercy Catholic Medical Center remains focused on our mission to further the healing ministry of Jesus Christ, especially for the poor and underserved community. Mercy Catholic Medical Center provides free care, subsidizes the care of Medicare and Medicaid patients where the government reimbursement is below costs, and sponsors health programs and activities for the community. These programs include wellness programs, community education programs, special programs for the elderly, handicapped, medically underserved and a variety of broad community support activities. Mercy Catholic Medical Center serviced 21,360 discharges providing 100,055 patient days of which: Patients covered under the Medicare program were 8,375 discharges and 43,264 patient days. Patients covered under the Medicaid program were 36,855 discharges and 35,058 patient days. Mercy Catholic Medical Center provides care to persons covered by governmental programs at below cost. Recognizing its mission to the community, services are provided to both Medicare and Medicaid patients. To the extent that reimbursement from Medicaid is below cost, Mercy Catholic Medical Center recognizes these amounts as charity care in meeting its mission to the community. The unreimbursed value of providing care to these patients was $6,086,074 for the twelve month period ended December 31, 2010. Charity care is also provided through many reduced price services and free programs offered throughout the year based upon the activities and services which Mercy Catholic Medical Center believes will serve a bona fide community health need. These include: (1)Benefits for the Broader Community: (a)Care of the Poor Programs: $141,752, (b)Community Benefit Programs: $462,505, (c)Donations from Revenue: $7,775, (d)Partially Reimbursed Programs: $21,866,816, (e)Volunteer Services Programs: $154,374, Total Benefits for the Broader Community: $22,633,222. These also include (2)Benefits to the Poor: (a)Traditional Charity Care Costs: $443,356, (b)Unpaid Costs: $6,086,074, Total Benefit to the Poor: $6,529,430. The total expense incurred to Mercy Catholic Medical Center for program services for the twelve month period ending December 31, 2010 was $307,383,774 (224,025 Patients).
Form 990, Part VI, Section A, line 6
Mercy Health System of Southeastern Pennsylvania ("SEPA") is the sole corporate member of Mercy Catholic Medical Center of Southeastern Pennsylvania.
Form 990, Part VI, Section A, line 7a
The Board of Directors for SEPA has the authority to appoint members of the governing body.
Form 990, Part VI, Section A, line 7b
The governing body can make recommendations for certain types of actions that require approval by the Board of Directors of SEPA. Some examples include appointing or removing members of the governing board, amending articles of incorporation and amending by-laws.
Form 990, Part VI, Section B, line 11
The organization took steps to educate management, members of the Board and members of appropriate subcommittees of the Board on the compliance requirements mandated by the Form 990. The Form 990 will be reviewed by management and the SEPA Audit & Compliance Committee, which is a subcommittee of the SEPA Board of Trustees. The full Board is appraised of the committee's findings from their review.
Form 990, Part VI, Section B, line 12c
The organization has adopted SEPA's Policy 96-04-09 which sets forth the organization's conflict-of-interest policy and processes. Annually, all those serving the organization and affiliates in a position to affect business decisions, including directors, officers, members of a Board designated committee, and key employees and physicians, receive a copy of the policy and annual disclosure statement to be completed. Disclosures of financial interest or other reportable circumstances as defined in the policy are submitted and reviewed by SEPA's Board or senior management as defined in the policy. The determination of whether a disclosure constitutes a conflict of interest is made by SEPA's Board or an appropriate committee thereof comprised of dis-interested persons and without the participation of the affected individual except to respond to questions about the disclosure. Lastly, the policy addresses potential disciplinary action for violations of the policy. The policy is available to the public upon request.
Form 990, Part VI, Section B, line 15
The organization has adopted SEPA's process for determining compensation which includes the following: SEPA's Board has an independent committee to review and approve all elements of remuneration. SEPA's Board and the independent committee have established a compensation philosophy which details the objectives of market positioning and pay elements. The committee engages with external consultants to provide market data comparing roles to similarly sized health systems utilizing both title and job content comparisons. The committee reviews the market analysis, approves any salary adjustments for the executive population, considers both reasonableness and effectiveness of all remunerative programs and establishes the detailed performance expectations which are incorporated into the incentive plan. All of these discussions and decisions are documented through the provision of meeting minutes.
Form 990, Part VI, Section C, line 19
Organizational Articles of Incorporation, Corporate Bylaws, governance policies believed to be of interest to the public, conflict-of-interest policy, and IRS Form 990 are available to the public upon request.
Form 990, Part VII, Section A:
Individuals compensated by a related organization have responsibilities and perform services for several related organizations including the filing organization. The amount of compensation appearing in Columns (E) and (F) reflect the services performed for this organization and its affiliates.
Changes in Net Assets or Fund Balances:
Form 990, Part XI, line 5:
Net Assets Released from Restriction - Capital Expenditures -203,856. Temporarily Restricted Contributions 334,288. Restructuring Costs -680,517. Loss on the Extinguishment of Debt -1,033,814. Pension Adjustment -6,646,698. Net Asset Transfers 559,323. Other Non Operating Expenditures -98,415. Total to Form 990, Part XI, Line 5: -7,769,689.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.