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 PROFESSIONAL PRACTICE ASSOCIATES INC
Employer identification number
42-1470935
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.") .
6,300,000
6,000,000
11,000,000
18,004,613
13,814,458
55,119,071
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......
16,550,625
18,095,812
22,544,392
27,562,197
29,483,596
114,236,622
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
0
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
0
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
0
6
Total. Add lines 1 through 5.
22,850,625
24,095,812
33,544,392
45,566,810
43,298,054
169,355,693
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
0
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.
0
c
Add lines 7a and 7b..
0
0
0
0
0
0
8
Public Support (Subtract line 7c from line 6.)
169,355,693
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...
22,850,625
24,095,812
33,544,392
45,566,810
43,298,054
169,355,693
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
0
0
0
0
19,810
19,810
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
0
c
Add lines 10a and 10b.
0
0
0
0
19,810
19,810
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
0
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
0
0
9,100
44,500
136,968
190,568
13
Total support (Add lines 9, 10c, 11 and 12.).
22,850,625
24,095,812
33,553,492
45,611,310
43,454,832
169,566,071
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
99.880 %
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
99.960 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
0.010 %
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
0 %
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
OTHER INCOME, SCHEDULE A, PART III, SECTION B, LINE 12, TUITION/PATIENT EDUCATION INCOME AND AFFILIATE EXPENSE REIMBURSEMENTS: 2006 - $0 2007 - $0 2008 - $9,100 2009 - $44,500 2010 - $136,968,
Schedule A (Form 990 or 990-EZ) 2010
Additional Data
Software ID:
10000128
Software Version:
v2010.1.0
-
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 PROFESSIONAL PRACTICE ASSOCIATES INC
Employer identification number
42-1470935
Identifier
Return Reference
Explanation
PROGRAM SERVICE ACCOMPLISHMENTS
FORM 990, PART III, LINE 4A
I. ORGANIZATION'S MISSION, VISION, AND TAX-EXEMPT PURPOSE MERCY PROFESSIONAL PRACTICE ASSOCIATES IS A MULTI-SPECIALTY PHYSICIAN PRACTICE LOCATED IN DES MOINES, IA. THE MISSION OF THE GROUP IS TO PROVIDE HEALTHCARE SERVICES TO THE COMMUNITY ON A NON-DISCRIMINATORY BASIS. THESE SERVICES INCLUDE MANAGING THE EMERGENCY ROOM THAT IS OPEN TO ALL PERSONS REGARDLESS OF ABILITY TO PAY, FOR MERCY MEDICAL CENTER-DES MOINES, A TAX-EXEMPT HOSPITAL. IN ADDITION, THE GROUP PROVIDES SPECIALTY SERVICES IN PEDIATRIC MEDICINE, ENDOCRINOLOGY, PSYCHIATRY, BREAST HEALTH AND SEDATION TO THE COMMUNITY BASED ON NEED. MERCY PROFESSIONAL PRACTICE ASSOCIATES IS GUIDED BY THE VALUES OF REVERENCE, INTEGRITY, COMPASSION, AND EXCELLENCE AND WE HOLD OURSELVES TO A HIGH STANDARD OF GIVING TO THE POOR AND BROADER COMMUNITY. THE GROUP PARTICIPATES IN GOVERNMENT-SPONSORED HEALTH CARE PROGRAMS LIKE MEDICAID AND MEDICARE. II. COMMUNITY BENEFIT APPROACH MERCY PROFESSIONAL PRACTICE ASSOCIATES HAS A TRADITION OF PROVIDING EXCELLENT HEALTH CARE TO ALL PEOPLE. WE ARE EQUALLY COMMITTED TO IMPROVING THE QUALITY OF LIFE IN THE COMMUNITIES WE SERVE BY PARTNERING WITH INDIVIDUALS, ORGANIZATIONS AND ELECTED OFFICIALS TO ANTICIPATE, IDENTIFY AND MEET THE CHANGING HEALTH NEEDS OF CENTRAL IOWANS. MERCY PROFESSIONAL PRACTICE ASSOCIATES HAS FINANCIAL ASSISTANCE POLICIES AND PROGRAMS FOR LOW-INCOME PERSONS LIKE THE UNINSURED/UNDERINSURED PATIENT DISCOUNT POLICY AND THE SELF-PAY AND THIRD-PARTY DISCOUNTS POLICY.
Classes of members or stockholders
Form 990, Part VI, Section A, Line 6
THE ORGANIZATION'S SOLE CORPORATE MEMBER IS CATHOLIC HEALTH INITIATIVES - IOWA CORP. D/B/A MERCY MEDICAL CENTER - DES MOINES, AN IOWA NONPROFIT CORPORATION.
Members or stockholders electing members of governing body
Form 990, Part VI, Section A, Line 7a
THE ORGANIZATION'S SOLE CORPORATE MEMBER HAS THE POWER TO APPOINT, REPLACE OR REMOVE THE MEMBERS OF THE BOARD OF DIRECTORS.
Decisions requiring approval by members or stockholders
Form 990, Part VI, Section A, Line 7b
THE ORGANIZATION'S CORPORATE MEMBER IS CATHOLIC HEALTH INITIATIVES - IOWA CORP. D/B/A MERCY MEDICAL CENTER - DES MOINES ("MMC"). PURSUANT TO THE ORGANIZATION'S BYLAWS, BOTH MMC AND CATHOLIC HEALTH INITIATIVES ("CHI") (MMC'S SOLE CORPORATE MEMBER) HAVE RESERVED POWERS AS OUTLINED IN THE CHI GOVERNANCE MATRIX. PURSUANT TO THE GOVERNANCE MATRIX THE FOLLOWING RIGHTS ARE HELD BY THE MMC BOARD: - APPROVE MEMBERS OF THE MERCY PROFESSIONAL PRACTICE ASSOCIATES ("MPPA") BOARD - AMENDMENT OF THE CORPORATE DOCUMENTS OF MPPA - APPROVE REMOVAL OF A MEMBER OF THE GOVERNING BODY OF MPPA - ADOPTION OF LONG RANGE AND STRATEGIC PLANS FOR MPPA THE FOLLOWING RIGHTS ARE RESERVED TO THE CHI BOARD DIRECTLY OR THROUGH POWERS DELEGATED TO THE CHI CHIEF EXECUTIVE OFFICER: - SUBSTANTIAL CHANGE IN THE MISSION OR PHILOSOPHY OF MPPA - REMOVAL OF A MEMBER OF THE GOVERNING BODY OF MPPA - APPROVAL OF ISSUANCE OF DEBT BY MPPA - APPROVAL OF PARTICIPATION OF MPPA IN A JOINT VENTURE - APPROVAL OF FORMATION OF A NEW CORPORATION BY MPPA - APPROVAL OF A MERGER INVOLVING MPPA - APPROVAL OF THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF MPPA - TO REQUIRE THE TRANSFER OF ASSETS BY MPPA TO CHI TO ACCOMPLISH CHI'S GOALS AND OBJECTIVES, AND TO SATISFY CHI DEBTS ALSO PURSUANT TO THE ORGANIZATION'S BYLAWS, MMC OR CHI MAY, IN EXERCISE OF THEIR APPROVAL POWERS, GRANT OR WITHHOLD APPROVAL IN WHOLE OR IN PART, OR MAY, IN ITS COMPLETE DISCRETION, AFTER CONSULTATION WITH THE BOARD AND ITS PRESIDENT AND THE CHIEF EXECUTIVE OFFICER OF THE ORGANIZATION, RECOMMEND SUCH OTHER OR DIFFERENT ACTIONS AS IT DEEMS APPROPRIATE.
Review of form 990 by governing body
Form 990, Part VI, Section B, Line 11a
THE ORGANIZATION'S ACCOUNTING PERSONNEL WORK WITH THE CHI TAX DEPARTMENT PERSONNEL TO PREPARE THE FORM 990. WHEN AVAILABLE, THE CFO REVIEWS THE RETURN AND ANY NECESSARY REVISIONS ARE INCLUDED IN THE FINAL VERSION WHICH IS APPROVED FOR FILING WITH THE IRS. SUBSEQUENT TO REVIEW BY THE CFO, THE TAX DEPARTMENT FILES THE RETURN WITH THE APPROPRIATE FEDERAL AND STATE AGENCIES, MAKING ANY NON-SUBSTANTIVE CHANGES NECESSARY TO EFFECT E-FILING. SUBSEQUENT TO E-FILING, THE FINAL E-FILED FORM 990 IS PRESENTED TO THE BOARD AT A REGULARLY SCHEDULED BOARD MEETING.
Conflict of interest policy
Form 990, Part VI, Section B, Line 12c
ALL BOARD MEMBERS ARE REQUIRED TO COMPLETE AN ANNUAL CONFLICT OF INTEREST DISCLOSURE STATEMENT. IN ADDITION, ANY BOARD MEMBER WITH A CONFLICT IS REQUIRED TO DECLARE THE CONFLICT BEFORE THE BEGINNING OF EACH BOARD OR COMMITTEE MEETING. THE ENTIRE BOARD OR COMMITTEE DETERMINES WHETHER THE AFFECTED BOARD MEMBER SHOULD BE EXCLUDED FROM THE MEETING DUE TO THE DISCLOSED CONFLICT.
Process used to establish compensation of top management official
Form 990, Part VI, Section B, Line 15a
THE ORGANIZATION'S PRESIDENT/CEO IS COMPENSATED BY CATHOLIC HEALTH INITIATIVES - IOWA CORP. D/B/A MERCY MEDICAL CENTER - DES MOINES ("MMC"), A RELATED TAX-EXEMPT ORGANIZATION. MMC USES A THIRD-PARTY CONSULTANT TO SURVEY COMPENSATION TRENDS ANNUALLY AND PRESENTS COMPENSATION RANGES FOR THE TOP MANAGEMENT OFFICIAL TO THE BOARD OF DIRECTORS FOR FINAL DETERMINATION AND APPROVAL. COMPENSATION IS ALSO COMPARED TO CURRENT INDUSTRY STANDARDS AND GUIDELINES FOR APPROPRIATENESS. THE REVIEW PROCESS IS DOCUMENTED IN THE BOARD MEETING MINUTES AND WAS LAST UNDERTAKEN IN JUNE 2009 FOR CALENDAR YEAR 2010 COMPENSATION.
Process used to establish compensation of other officers/key employees
Form 990, Part VI, Section B, Line 15b
COMPENSATION PAID BY RELATED ORGANIZATION: VARIOUS OFFICERS AND DIRECTORS ARE COMPENSATED BY CATHOLIC HEALTH INITIATIVES - IOWA CORP. D/B/A MERCY MEDICAL CENTER - DES MOINES ("MMC"), A RELATED TAX-EXEMPT ORGANIZATION. MMC USES A THIRD-PARTY CONSULTANT TO SURVEY COMPENSATION TRENDS ANNUALLY AND PRESENTS COMPENSATION RANGES FOR VARIOUS POSITIONS TO THE BOARD OF DIRECTORS FOR FINAL DETERMINATION AND APPROVAL. COMPENSATION IS ALSO COMPARED TO CURRENT INDUSTRY STANDARDS AND GUIDELINES FOR APPROPRIATENESS. THE REVIEW PROCESS IS DOCUMENTED IN THE BOARD MEETING MINUTES AND WAS LAST UNDERTAKEN IN JUNE 2009 FOR CALENDAR YEAR 2010 COMPENSATION. COMPENSATION PAID BY FILING ORGANIZATION: THE ORGANIZATION REFERENCES INDUSTRY COMPENSATION COMPARABILITY STUDIES AND SURVEYS WHEN SETTING COMPENSATION AMOUNTS, WHICH WERE REVIEWED BY AN INDEPENDENT COMPENSATION CONSULTANT, APPROVED BY A COMPENSATION COMMITTEE, AND PAID IN ACCORDANCE WITH A WRITTEN EMPLOYMENT CONTRACT. THE ORGANIZATION'S BOARD OF DIRECTORS OVERSEES THE COMPENSATION SETTING PROCESS TO ENSURE REASONABLENESS AND COMPLIANCE WITH THE ORGANIZATION'S COMPENSATION PHILOSOPHY. THE REVIEW PROCESS IS DOCUMENTED IN THE BOARD MEETING MINUTES AND WAS LAST UNDERTAKEN IN JUNE 2009 FOR CALENDAR YEAR 2010 COMPENSATION.
Public Disclosure
Form 990, Part VI, Section C, Line 19
THE ORGANIZATION'S GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST FROM THE ADMINISTRATION DEPARTMENT, AND ARE ALSO AVAILABLE FROM THE IOWA SECRETARY OF STATE. THE ORGANIZATION'S CONFLICT OF INTEREST POLICY IS NOT PUBLICLY AVAILABLE. THE ORGANIZATION'S FINANCIAL STATEMENTS ARE INCLUDED IN CATHOLIC HEALTH INITIATIVES' CONSOLIDATED AUDITED FINANCIAL STATEMENTS THAT ARE AVAILABLE AT WWW.CATHOLICHEALTHINIT.ORG OR AT WWW.DACBOND.ORG.
ESTIMATE OF HOURS DEVOTED TO RELATED ORGANIZATIONS
FORM 990, PART VII, SECTION A, LINE 1A
THE INDIVIDUALS LISTED IN PART VII THAT REPORT COMPENSATION PAID BY A RELATED ORGANIZATION DEVOTE APPROXIMATELY 40 HOURS PER WEEK TO THE RELATED ORGANIZATIONS AND RECEIVE COMPENSATION IN EXCHANGE FOR THEIR SERVICES PROVIDED.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.