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. Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
MERCY RIDGE INC
Employer identification number
52-2097927
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 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 monetary support
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 2
Part II
Support Schedule for Organizations Described in Sections 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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
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 2013 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2013.
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—2012.
If the organization did not check a 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—2013.
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—2012.
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 3
Part III
Support Schedule for Organizations Described in Section 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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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......
18,641,943
19,128,540
19,208,716
17,313,231
17,961,498
92,253,928
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.
18,641,943
19,128,540
19,208,716
17,313,231
17,961,498
92,253,928
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
8
Public support (Subtract line 7c from line 6.)
92,253,928
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
9
Amounts from line 6...
18,641,943
19,128,540
19,208,716
17,313,231
17,961,498
92,253,928
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
1,109,962
1,070,363
1,025,553
993,993
927,741
5,127,612
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
1,109,962
1,070,363
1,025,553
993,993
927,741
5,127,612
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.)
..
467,919
432,930
483,665
472,006
373,439
2,229,959
13
Total support. (Add lines 9, 10c, 11, and 12.)..
20,219,824
20,631,833
20,717,934
18,779,230
19,262,678
99,611,499
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 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
92.610 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
92.120 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
5.150 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
5.580 %
19a
33 1/3% support tests—2013.
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—2012.
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information.
Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and 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) 2013
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.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
MERCY RIDGE INC
Employer identification number
52-2097927
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 3
MERCY RIDGE HAS A MANAGEMENT SERVICE AGREEMENT WITH CRSA/LCS MANAGMENT LLC (CRSA), THE SUCCESSOR TO COOPERATIVE RETIREMENT SERVICES OF AMERICA, INC., UNDER WHICH CRSA PROVIDES A VARIETY OF MANAGEMENT SERVICES TO MERCY RIDGE. AMOUNG THE SERVICES PROVIDED UNDER THE MANAGEMENT SERVICES CONTRACT IS THE FULL-TIME SERVICES OF THE EXECUTIVE DIRECTOR OF MERCY RIDGE, WHO IS A FULL-TIME EMPLOYEE OF CRSA. THE BOARD OF DIRECTORS OF MERCY RIDGE REVIEWED AND APPROVED THE AGREEMENT WITH CRSA, INCLUDING THE AMOUNT OF COMPENSATION PAID TO THE EXECUTIVE DIRECTOR FOR HIS SERVICES TO MERCY RIDG. MERCY RIDGE RETAINS THE RIGHT TO TERMINATE THE MANAGEMENT SERVICES AGREEMENT, INCLUDING THE SERVICES OF THE EXECUTIVE DIRECTOR, UPON 60 DAYS PRIOR WRITTEN NOTICE.
FORM 990, PART VI, SECTION A, LINE 6
THE MEMBERS OF MERCY RIDGE, INC. ARE THE ROMAN CATHOLIC ARCHBISHOP OF BALTIMORE, A CORPORATION SOLE, AND MERCY HEALTH SERVICES, INC. BOTH MEMBERS ARE 501(C)(3) ORGANIZATIONS.
FORM 990, PART VI, SECTION A, LINE 7A
EACH OF THE TWO MEMBERS HAS THE RIGHT TO APPOINT AN EQUAL NUMBER OF DIRECTORS TO THE BOARD OF DIRECTORS OF MERCY RIDGE. CURRENTLY, EACH MEMBER APPOINTS FOUR (4) DIRECTORS TO THE BOARD. EACH DIRECTOR APPOINTED BY A MEMBER SERVES AT THE PLEASURE OF THE MEMBER THAT APPOINTED HIM OR HER AND IS SUBJECT TO REMOVAL AT ANY TIME BY THE APPOINTING MEMBER. IN ADDITION, THE BOARD OF DIRECTORS ELECTS TWO RESIDENTS OF MERCY RIDGE TO SERVE AS FULL VOTING MEMBERS OF THE BOARD ("RESIDENT BOARD MEMBERS"), FOLLOWING CONSULTATION WITH THE RESIDENT COUNCIL OF MERCY RIDGE. THE RESIDENT COUNCIL SUBMITS AT LEAST TWO NOMINEES FOR ANY OPENING FOR A RESIDENT BOARD MEMBER. THE RESIDENT BOARD MEMBERS ARE SUBJECT TO APPROVAL BY THE TWO MEMBERS.
FORM 990, PART VI, SECTION A, LINE 7B
THE FOLLOWING DECISIONS ARE SUBJECT TO APPROVAL BY BOTH MEMBERS: A) APPROVAL OF THE TWO MERCY RIDGE RESIDENTS WHO ARE ELECTED TO SERVE ON THE MERCY RIDGE BOARD. B) DISSOLUTION, LIQUIDATION, WINDING UP OR ABANDONMENT OF MERCY RIDGE. C) AMENDMENT OF THE ARTICLES OF INCORPORATION OR BYLAWS OF MERCY RIDGE.
FORM 990, PART VI, SECTION B, LINE 11
THE FORM 990 IS REVIEWED FOR ACCURACY BY THE DIRECTOR OF FINANCIAL SERVICE FOR MERCY RIDGE AND BY THE TREASURER OF MERCY RIDGE. THE TREASURER OF MERCY RIDGE REVIEWS THE FORM 990 WITH THE BOARD AT A MEETING SCHEDULED PRIOR TO FILING AND COPIES OF THE FORM 990 ARE PROVIDED TO ALL MEMBERS OF THE BOARD OF DIRECTORS OF MERCY RIDGE FOR THEIR REVIEW PRIOR TO FILING. ANY ADDITIONAL COMMENTS/QUESTIONS FROM BOARD MEMBERS ARE RESPONDED TO PRIOR TO FILING THE FORM 990.
FORM 990, PART VI, SECTION B, LINE 12C
MERCY RIDGE HAS ADOPTED A CONFLICT OF INTEREST POLICY. UNDER THE POLICY, EACH BOARD MEMBER, THE EXECUTIVE DIRECTOR, AND THE DIRECTOR OF FINANCE IS REQUIRED TO COMPLETE AN ANNUAL DISCLOSURE FORM REGARDING ALL BUSINESS RELATIONSHIPS THAT HE OR SHE, OR ANY FAMILY MEMBER, HAS WITH MERCY RIDGE, ANY OF ITS AFFILIATES OR ANY OTHER ORGANIZATIONS THAT DO BUSINESS WITH MERCY RIDGE AND ALL RELATIONSHIPS BETWEEN AND AMOUNG OFFICERS AND BOARD MEMBERS. THE COMPLETED DISCLOSURE FORMS ARE REVIEWED BY THE EXECUTIVE DIRECTOR. IN ADDITIO TO THE ANNUAL DISCLOSURE, ANY COVERED PERSON UNDER THE CONFLICT OF INTEREST POLICY HAS AN ONGOING DUTY TO DISCLOSE THE EXISTENCE OF ANY ACTUAL OR POTENTIAL CONFLICT TO THE BOARD. FOLLOWING THE DISCLOSURE, THE COVERED PERSON MAY MAKE A PRESENTATION, BUT MUST THEN LEAVE THE MEETING AND THE OTHER MEMBERS OF THE BOARD SHALL DETERMINE WHETHER A CONFLICT EXISTS. UNDER THE POLICY, A CONFLICT OF INTEREST EXISTS WHEN AN INDIVIDUAL'S OWN PERSONAL INTEREST WOULD, OR MAY, INTERFERE WITH HIS OR HER IMPARTIALITY REGARDING THE MATTER. IF A CONFLICT EXISTS, THE PERSON MUST ABSTAIN FROM VOTING AND MAY NOT BE PRESENT DURING DELIBERATIONS ON THE MATTER. THE BOARD, AFTER CONDUCTING SUCH ADDITIONAL DUE DILIGENCE AS IT DETERMINES IS APPROPRIATE, SHALL MAKE A DECISION ON THE MATTER BASED UPON WHETHER THE PARTICULAR PROPOSAL IS FAIR, REASONABLE AND IN THE BEST INTEREST OF THE ORGANIZATION.
FORM 990, PART VI, SECTION B, LINE 15
MERCY RIDGE HAS A MANAGEMENT SERVICE AGREEMENT WITH CRSA/LCS MANAGEMENT LLC (CRSA), THE SUCCESSOR TO COOPERATIVE RETIREMENT SERVICES OF AMERICA, INC., UNDER WHICH CRSA PROVIDES A VARIETY OF MANAGEMENT SERVICES TO MERCY RIDGE. AMOUNG THE SERVICES PROVIDED UNDER THE MANAGEMENT SERVICES CONTRACT IS THE FULL-TIME SERVICES OF THE EXECUTIVE DIRECTOR OF MERCY RIDGE, WHO IS A FULL-TIME EMPLOYEE OF CRSA. THE BOARD OF DIRECTORS OF MERCY RIDGE REVIEWED AND APPROVED THE AGREEMENT WITH CRSA, INCLUDING THE AMOUNT OF COMPENSATION PAID TO THE EXECUTIVE DIRECTOR FOR HIS SERVICES TO MERCY RIDGE. MERCY RIDGE RETAINS THE RIGHT TO TERMINATE THE MANAGEMENT SERVICES AGREEMENT, INCLUDING THE SERVICES OF THE EXECUTIVE DIRECTOR, UPON 60 DAYS PRIOR WRITTEN NOTICE.
FORM 990, PART VI, SECTION C, LINE 19
THE GOVERNING DOCUMENTS OF THE ORGANIZATION, ITS CONFLICTS OF INTEREST POLICY, AND ITS FINANCIAL STATEMENTS ARE AVAILABLE FROM THE ORGANIZATION UPON REQUEST.
FORM 990, PART XI, LINE 9:
UNREALIZED GAIN ON SWAP 33,174. TRANSFER TO MEMBERS -1,118,856. ROUNDING -2.
PART VI, SECTION A, LINES 1A AND 1B - VOTING INDEPENDENT MEMBERS
THE BOARD OF DIRECTORS OF MERCY RIDGE, INC., IS MADE UP OF TEN MEMBERS. FOUR DIRECTORS ARE APPOINTED BY EACH OF THE TWO MEMBERS OF THE CORPORATION, MERCY HEALTH SERVICES, INC.("MHS") AND THE ARCHBISHOP OF BALTIMORE, A CORPORATION SOLE ("THE ARCHDIOCESE"), BOTH OF WHICH ARE 501(C)(3) CORPORATIONS. THE OTHER TWO BOARD MEMBERS ARE RESIDENTS OF MERCY RIDGE WHO ARE ELECTED BY THE BOARD. MHS, AND ITS DIRECT SUBSIDIARY STELLA MARIS ("SM"), PROVIDE CERTAIN MANAGEMENT SERVICES TO MERCY RIDGE AND ALL OF THE FOUR MERCY RIDGE BOARD MEMBERS OF MHS ARE EITHER DIRECTORS OR OFFICERS OF MHS. IN ADDITION, IN ORDER TO ACCOMODATE THE NEEDS OF RETIRED PRIESTS, THE ARCHDIOCESE HAS A CONTRACT WITH MERCY RIDGE TO PROVIDE SIXTEEN INDEPENDENT LIVING APARTMENTS AND FIVE ASSISTED LIVING UNITS FOR RETIRED PRIESTS. FOUR MERCY RIDGE DIRECTORS APPOINTED BY THE ARCHDIOCESE ARE OFFICERS OF THE ARCHDIOCESE.
PART VI, SECTION B, LINE 14 - DOCUMENT RETENTION AND DESTRUCTION POLICY
MERCY RIDGE ADHERES TO THE SAME DOCUMENT RETENTION AND DESTRUCTION POLICY AS MERCY HEALTH SERVICES AND OTHER MERCY ENTITIES.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.