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 AUXILIARY OF CENTRAL IOWA
Employer identification number
42-6076069
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)
No
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
No
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
No
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
(1)
MERCY FOUNDATION OF DES MOINES IA
237358794
7
Yes
Yes
Yes
306,049
Total
306,049
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:
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 AUXILIARY OF CENTRAL IOWA
Employer identification number
42-6076069
Identifier
Return Reference
Explanation
PROGRAM SERVICE ACCOMPLISHMENTS
FORM 990, PART III, LINE 4A
I. INTRODUCTION: ORGANIZATION'S MISSION, VISION, AND TAX-EXEMPT PURPOSE TO ENDEAVOR TO SERVE MERCY MEDICAL CENTER WHEREVER THERE MAY BE A NEED WE ARE CAPABLE OF FULFILLING. TO BE RESPONSIBLE STEWARDS OF HUMAN AND MATERIAL RESOURCES BY CONTRIBUTING OUR SERVICES TO SUPPORT AND BENEFIT THE CARE AND CONCERNS OF MERCY MEDICAL CENTER. MERCY AUXILIARY BEGAN THEIR MODEST GIVING BACK IN OCTOBER 1948. A FINE GROUP FROM MERCY'S ADVISORY BOARD AND SEVERAL OTHER LOCAL ENTITIES WERE INVITED TO A MEETING WHERE IT WAS AGREED THAT MERCY NEEDED A UNIT TO STIMULATE INTEREST IN MERCY'S SCHOOL OF NURSING. "THIS WAS TO BE ACCOMPLISHED BY PROMOTING THE EDUCATIONAL INTERESTS AND SOCIAL ACTIVITIES FOR THE STUDENT NURSES IN A VARIETY OF WAYS." THEIR FIRST YEAR AFTER FORMING THE "GUILD" THEY HAD $100 LEFTOVER TO DONATE. THE STUDENTS WANTED TOASTERS FOR QUICK BREAKFASTS. TODAY, THE INTERESTS HAVE GONE WAY BEYOND OUR NURSING SCHOOL. MERCY AUXILIARY HAS EXPANDED ITS CONTRIBUTION EFFORTS THROUGHOUT THE ENTIRE HOSPITAL AND THE PROGRAMS THEY SERVE. EACH YEAR THE AUXILIARY ALONG WITH ITS INCOME PRODUCING PROGRAMS, THE ANNUAL AND LIFETIME MEMBERSHIPS, AND DONATIONS PROVIDE SEVERAL HUNDRED THOUSAND CONTRIBUTED DOLLARS EACH YEAR TO MERCY. SOME OF OUR PROGRAMS INCLUDE SEVERAL GIFT SHOP LOCATIONS WITHIN OUR MERCY HOSPITALS AND ITS FACILITIES, A HAIR SALON, AND A STARBUCKS. WE SPONSOR OTHER PROGRAMS THAT FUND OUR OPERATIONS AS WELL, SUCH AS A PROFITABLE BABY PHOTO PROGRAM AND JEWELRY FUNDRAISERS EACH YEAR. WE OFFER MANY OPPORTUNITIES THROUGHOUT THE YEAR AND ALL SPECIALS; FUNDRAISERS, ETC. ARE OFFERED TO THE EMPLOYEES, PATIENTS AND TO THE PUBLIC. ALL PROCEEDS BENEFIT CARE AND PROGRAMS AT MERCY MEDICAL CENTER, A TAX-EXEMPT PRIMARY CARE HOSPITAL. A BOARD OF DIRECTORS GOVERNS THE AUXILIARY WITH INDEPENDENT COMMUNITY REPRESENTATIVES. II. QUALITATIVE DESCRIPTION OF COMMUNITY BENEFIT THE AUXILIARY SUPPORTS THE DES MOINES COMMUNITY BY SUPPORTING THE MISSION OF MERCY MEDICAL CENTER-DES MOINES AND ITS COMMUNITY BENEFIT PROGRAMS.
Classes of members or stockholders
Form 990, Part VI, Section A, Line 6
THE ORGANIZATION'S SOLE CORPORATE MEMBER IS CATHOLIC HEALTH INITIATIVES - IOWA CORPORATION ("CHI-IOWA"), AN IOWA NONPROFIT CORPORATION.
Members or stockholders electing members of governing body
Form 990, Part VI, Section A, Line 7a
PURSUANT TO THE ORGANIZATION'S BYLAWS, ALL MEMBERS OF THE BOARD OF DIRECTORS ARE APPOINTED, REPLACED, AND REMOVED BY CHI-IOWA, THE SOLE CORPORATE MEMBER.
Decisions requiring approval by members or stockholders
Form 990, Part VI, Section A, Line 7b
MERCY AUXILIARY OF CENTRAL IOWA'S CORPORATE MEMBER IS CHI-IOWA. PURSUANT TO ARTICLE IX OF THE ORGANIZATION'S BYLAWS, BOTH CHI-IOWA AND CATHOLIC HEALTH INITIATIVES ("CHI") (CHI-IOWA'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 CHI-IOWA BOARD: *APPROVE MEMBERS OF THE MERCY AUXILIARY BOARD; *APPROVE REMOVAL OF A MEMBER OF THE GOVERNING BODY OF MERCY AUXILIARY; *ADOPTION OF LONG RANGE AND STRATEGIC PLANS FOR MERCY AUXILIARY; *SUBSTANTIAL CHANGE IN THE MISSION OR PHILOSOPHY OF MERCY AUXILIARY; *AMENDMENT OF THE CORPORATE DOCUMENTS OF MERCY AUXILIARY; *REMOVAL OF A MEMBER OF THE GOVERNING BODY OF MERCY AUXILIARY; *APPROVAL OF ISSUANCE OF DEBT BY MERCY AUXILIARY; *APPROVAL OF PARTICIPATION OF MERCY AUXILIARY IN A JOINT VENTURE; *APPROVAL OF A MERGER INVOLVING MERCY AUXILIARY; *APPROVAL OF THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF MERCY AUXILIARY; *TO REQUIRE THE TRANSFER OF ASSETS BY MERCY AUXILIARY TO CHI TO ACCOMPLISH CHI'S GOALS AND OBJECTIVES, AND TO SATISFY CHI DEBTS. TO THE EXTENT PERMITTED BY LAW, CHI SHALL POSSESS THE SAME RIGHTS AND POWERS RESERVED TO CHI-IOWA, PURSUANT TO ARTICLE VII OF THE ORGANIZATION'S ARTICLES OF INCORPORATION. PURSUANT TO ARTICLE VII OF MERCY AUXILIARY'S ARTICLES OF INCORPORATION, CHI-IOWA 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
ONCE THE RETURN IS PREPARED, THE RETURN IS REVIEWED BY THE PRESIDENT AND TREASURER. THE PRESIDENT AND TREASURER PRESENT THE RETURN TO THE MERCY AUXILIARY OF CENTRAL IOWA BOARD AT A BOARD MEETING. SUBSEQUENT TO REVIEW BY THE BOARD AND PRESIDENT, THE TAX DEPARTMENT FILES THE RETURN WITH THE APPROPRIATE FEDERAL AND STATE AGENCIES, MAKING ANY NON-SUBSTANTIVE CHANGES NECESSARY TO EFFECT E-FILING. ANY SUCH CHANGES ARE NOT RE-SUBMITTED TO THE BOARD.
Conflict of interest policy
Form 990, Part VI, Section B, Line 12c
THE ORGANIZATION'S CONFLICT OF INTEREST POLICY REQUIRES THAT EACH BOARD MEMBER COMPLETE AN ANNUAL QUESTIONNAIRE THAT DISCLOSES POTENTIAL AND ACTUAL CONFLICTS OF INTEREST. ADDITIONALLY, BOARD MEMBERS ARE ASKED TO DISCLOSE ANY POTENTIAL CONFLICTS OF INTEREST AT THE BEGINNING OF EACH BOARD OR COMMITTEE MEETING. IF A POTENTIAL CONFLICT EXISTS, THE BOARD OR COMMITTEE DETERMINES WHETHER THE BOARD MEMBER SHOULD BE EXCLUDED FROM VOTING OR PARTICIPATING IN DISCUSSIONS ON THAT PARTICULAR MATTER.
Process used to establish compensation of top management official
Form 990, Part VI, Section B, Line 15a
THE ORGANIZATION'S PRESIDENT IS COMPENSATED BY CHI-IOWA CORP, A RELATED ORGANIZATION, WHO USED A THIRD-PARTY CONSULTANT TO SURVEY COMPENSATION TRENDS ANNUALLY AND RECOMMEND COMPENSATION RANGES FOR THE TOP MANAGEMENT OFFICIAL. THESE RECOMMENDATIONS ARE PRESENTED TO THE BOARD FOR FINAL DETERMINATION AND APPROVAL. THE SALARIES ARE COMPARED TO INDUSTRY STANDARDS AND GUIDELINES FOR APPROPRIATENESS.
Process used to establish compensation of other officers/key employees
Form 990, Part VI, Section B, Line 15b
DURING THE TAX YEAR ENDED JUNE 30, 2011, THE ORGANIZATION DID NOT PAY ANY COMPENSATION TO OFFICERS, DIRECTORS, OR KEY EMPLOYEES. ANY EXECUTIVE COMPENSATION PAID TO OFFICERS, DIRECTORS OR KEY EMPLOYEES BY RELATED ORGANIZATIONS WAS SET BY A COMPENSATION COMMITTEE UTILIZING AN INDEPENDENT CONSULTANT AND COMPARABILITY STUDIES TO DETERMINE COMPENSATION. THE ORGANIZATION'S BOARD OF DIRECTORS OVERSEES THE COMPENSATION SETTING PROCESS TO ENSURE REASONABLENESS AND COMPLIANCE WITH MERCY AUXILIARY OF CENTRAL IOWA'S COMPENSATION PHILOSOPHY.
Public Disclosure
Form 990, Part VI, Section C, Line 19
MERCY AUXILIARY OF CENTRAL IOWA'S FINANCIAL STATEMENTS ARE INCLUDED IN CATHOLIC HEALTH INITIATIVES' CONSOLIDATED AUDITED FINANCIAL STATEMENTS THAT ARE AVAILABLE AT WWW.CATHOLICHEALTHINIT.ORG OR AT WWW.DACBOND.COM. THE ORGANIZATION'S CONFLICT OF INTEREST POLICY IS NOT PUBLICLY AVAILABLE. THE ORGANIZATION'S GOVERNING DOCUMENTS ARE AVAILABLE ON THE IOWA SECRETARY OF STATE'S WEBSITE.
COMPENSATION PAID BY RELATED ORGANIZATIONS
FORM 990, PART VII, SECTION A
COMPENSATION REPORTED ON FORM 990, PART VII WAS PAID TO THE INDIVIDUALS BY RELATED ORGANIZATIONS IN EXCHANGE FOR THE FULFILLMENT OF THEIR DUTIES AS FULL-TIME, 40 HOUR-PER-WEEK EMPLOYEES.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.