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 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 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.") .
18,004,613
13,814,458
18,527,509
22,432,245
1,580,404
74,359,229
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......
27,562,197
29,483,596
31,627,687
33,638,243
28,191,227
150,502,950
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
44,500
21,000
32,400
144,284
66,410
308,594
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.
45,611,310
43,319,054
50,187,596
56,214,772
29,838,041
225,170,773
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
0
0
0
0
0
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
0
0
0
0
0
c
Add lines 7a and 7b..
0
0
0
0
0
0
8
Public support (Subtract line 7c from line 6.)
225,170,773
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...
45,611,310
43,319,054
50,187,596
56,214,772
29,838,041
225,170,773
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
0
19,810
35,200
79,774
66,176
200,960
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
0
c
Add lines 10a and 10b.
0
19,810
35,200
79,774
66,176
200,960
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
115,968
53,352
71,250
0
240,570
13
Total support. (Add lines 9, 10c, 11, and 12.)..
45,611,310
43,454,832
50,276,148
56,365,796
29,904,217
225,612,303
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
99.800 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
99.840 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
0.080 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
0.060 %
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:
13000248
Software Version:
2013v3.1
-
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 PROFESSIONAL PRACTICE ASSOCIATES INC
Employer identification number
42-1470935
Return Reference
Explanation
FORM 990, PART III, LINE 1, PROGRAM SERVICE ACCOMPLISHMENTS
THE MISSION OF THE CORPORATION IS TO NURTURE THE HEALING MINISTRY OF THE CHURCH, SUPPORTED BY EDUCATION AND RESEARCH. FIDELITY TO THE GOSPEL URGES THE CORPORATION TO EMPHASIZE HUMAN DIGNITY AND SOCIAL JUSTICE AS IT CREATES HEALTHIER COMMUNITIES. THE CORPORATION, SPONSORED BY A LAY-RELIGIOUS PARTNERSHIP, CALLS OTHER CATHOLIC SPONSORS AND SYSTEMS TO UNITE TO ENSURE THE FUTURE OF CATHOLIC HEALTH CARE. TO FULFILL THIS MISSION, THE CORPORATION, AS A VALUES-BASED ORGANIZATION, WILL ASSURE THE INTEGRITY OF THE MINISTRY IN BOTH CURRENT AND DEVELOPING ORGANIZATIONS AND ACTIVITIES; RESEARCH AND DEVELOP NEW MINISTRIES THAT INTEGRATE HEALTH, EDUCATION, PASTORAL, AND SOCIAL SERVICES; PROMOTE LEADERSHIP DEVELOPMENT AND FORMATION FOR MINISTRY THROUGHOUT THE ENTIRE ORGANIZATION; ADVOCATE FOR SYSTEMIC CHANGES WITH SPECIFIC CONCERN FOR PERSONS WHO ARE POOR, ALIENATED, AND UNDERSERVED; AND STEWARD RESOURCES BY GENERAL OVERSIGHT OF THE ENTIRE ORGANIZATION.
Form 990, Part III, Line 3, Significant changes in program services
ON FEBRUARY 1, 2014 THE ORGANIZATION TRANSFERRED ITS OPERATIONS TO MERCY CLINICS, INC.
FORM 990, PART III, LINE 4A, PROGRAM SERVICE ACCOMPLISHMENTS
I. ORGANIZATION'S MISSION, VISION, AND TAX-EXEMPT PURPOSE MERCY PROFESSIONAL PRACTICE ASSOCIATES, INC. IS A MULTI-SPECIALTY PHYSICIAN PRACTICE LOCATED IN DES MOINES, IA. THE MISSION OF THE GROUP IS TO PROVIDE HEALTH CARE 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, INC. 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, SUCH AS MEDICAID AND MEDICARE. II. COMMUNITY BENEFIT APPROACH MERCY PROFESSIONAL PRACTICE ASSOCIATES, INC. 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, INC. 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.
Form 990, Part VI, Sec A, Line 6, Classes of members or stockholders
THE ORGANIZATION'S SOLE CORPORATE MEMBER IS CATHOLIC HEALTH INITIATIVES - IOWA CORP. D/B/A MERCY MEDICAL CENTER - DES MOINES, AN IOWA NONPROFIT CORPORATION.
Form 990, Part VI, Sec A, Line 7a, Members or stockholders electing members of governing body
THE ORGANIZATION'S SOLE CORPORATE MEMBER HAS THE POWER TO APPOINT AND/OR REMOVE THE MEMBERS OF THE BOARD OF DIRECTORS.
Form 990, Part VI, Sec A, Line 7b, Decisions requiring approval by members or stockholders
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, INC. (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.
Form 990, Part VI, Sec B, Line 11b, Review of form 990 by governing body
THE ORGANIZATION'S ACCOUNTING PERSONNEL WORK WITH TAX DEPARTMENT PERSONNEL OF CATHOLIC HEALTH INITIATIVES (CHI) TO PREPARE THE FORM 990. 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.
Form 990, Part VI, Sec B, Line 12c, Conflict of interest policy
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.
FORM 990, PART VI, LINE 15A, PROCESS USED TO ESTABLISH COMPENSATION OF TOP MANAGEMENT OFFICIAL
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. EXECUTIVE COMPENSATION PAID BY RELATED ORGANIZATIONS WAS SET BY THE RELATED ORGANIZATION'S COMPENSATION COMMITTEE UTILIZING BOTH AN INDEPENDENT CONSULTANT AND COMPARABILITY STUDIES TO DETERMINE COMPENSATION. THEREFORE, THIS QUESTION IS MORE APPROPRIATELY ANSWERED AS "N/A" BUT HAS BEEN ANSWERED "NO" IN ACCORDANCE WITH THE FORM 990 INSTRUCTIONS.
FORM 990, PART VI, LINE 15B, PROCESS USED TO ESTABLISH COMPENSATION OF OTHER OFFICERS/KEY EMPLOYEES
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. EXECUTIVE COMPENSATION PAID BY RELATED ORGANIZATIONS WAS SET BY THE RELATED ORGANIZATION'S COMPENSATION COMMITTEE UTILIZING BOTH AN INDEPENDENT CONSULTANT AND COMPARABILITY STUDIES TO DETERMINE COMPENSATION. THEREFORE, THIS QUESTION IS MORE APPROPRIATELY ANSWERED AS N/A BUT HAS BEEN ANSWERED NO IN ACCORDANCE WITH THE FORM 990 INSTRUCTIONS.
Form 990, Part VI, Sec C, Line 19, Required documents available to the public
THE ORGANIZATION'S GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST FROM THE ADMINISTRATION DEPARTMENT, AND THE ARTICLES OF INCORPORATION 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.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.