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 FOUNDATION OF DES MOINES IA
Employer identification number
23-7358794
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.") ....
5,549,203
4,284,850
3,645,085
3,854,426
6,606,960
23,940,524
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
0
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
0
4
Total. Add lines 1 through 3
5,549,203
4,284,850
3,645,085
3,854,426
6,606,960
23,940,524
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)..
3,104,399
6
Public support. Subtract line 5 from line 4.
20,836,125
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..
5,549,203
4,284,850
3,645,085
3,854,426
6,606,960
23,940,524
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
780,046
764,294
726,694
763,309
758,303
3,792,646
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
1,023
1,023
10
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
146,616
114,926
120,835
101,396
133,189
616,962
11
Total support (Add lines 7 through 10).
28,351,155
12
Gross receipts from related activities, etc. (see instructions)
..................
12
0
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
73.490 %
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
71.810 %
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......
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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
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 FOUNDATION OF DES MOINES IA
Employer identification number
23-7358794
Return Reference
Explanation
FORM 990, PART III, LINE 1, ORGANIZATION'S MISSION
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 4A, ORGANIZATION'S MISSION
INTRODUCTION ORGANIZATION'S MISSION, VISION, AND TAX-EXEMPT PURPOSE MERCY FOUNDATION IS AN EXTENSION OF THE HEALING MINISTRY OF CHRIST INSPIRED BY THE SISTERS OF MERCY. THROUGH THIS HERITAGE, WE CONNECT DONORS TO CRITICAL NEEDS. OUR PURPOSE IS TO SECURE VITAL FUNDING THAT ENSURES EQUAL ACCESS, CLINICAL EXCELLENCE AND HIGH QUALITY CARE FOR ALL. MERCY FOUNDATION IS THE PREFERRED CHANNEL OF GIVING TO MERCY COLLEGE OF HEALTH SCIENCES, HOUSE OF MERCY, MERCY MEDICAL CENTER-DES MOINES, WEST LAKES AND CENTERVILLE, AND BISHOP DRUMM RETIREMENT CENTER. ALL THE SUPPORTED ORGANIZATIONS ARE LISTED IN THE OFFICIAL CATHOLIC DIRECTORY AS TAX-EXEMPT. BY SUPPORTING MERCY FOUNDATION YOU ARE PROVIDING VITAL SUPPORT NECESSARY TO MEET THE NEEDS OF IOWANS FROM BIRTH TO END OF LIFE. MERCY AND ITS AFFILIATES SERVE THOSE IN ALL STAGES OF LIFE, INCLUDING PREMATURE INFANTS, DRUG-ADDICTED MOTHERS, COLLEGE STUDENTS WORKING TOWARDS A CAREER IN HEALTH CARE, THE ELDERLY, AND FAMILIES FACING A LOVED ONES' LAST DAYS. THE FOUNDATION IS GOVERNED BY AN INDEPENDENT BOARD IN WHICH THE MAJORITY OF THE MEMBERS ARE INDEPENDENT PERSONS, REPRESENTATIVE OF THE COMMUNITY. QUALITATIVE DESCRIPTION OF COMMUNITY BENEFIT VARIOUS ENTITIES WERE PROVIDED FUNDING IN THE AMOUNT OF OVER $7.3 MILLION IN FISCAL YEAR 2014. THE MONIES WERE USED BY THE ENTITIES FOR CHARITABLE, COMMUNITY BENEFIT AND HEALTHCARE ACTIVITIES SUCH AS: HOUSE OF MERCY: ONGOING OPERATION SUPPORT FOR THIS RESIDENTIAL CARE FACILITY FOR ADULT AND TEENAGE WOMEN, WHETHER SINGLE, PARENTING OR PREGNANT, TO HELP THEM DEVELOP PERSONAL RESPONSIBILITY AND BECOME INDEPENDENT MEMBERS OF THE COMMUNITY. COMPREHENSIVE SERVICES INCLUDE: TRANSITIONAL HOUSING, MEALS, TRANSPORTATION, COUNSELING AND SUPPORT, LICENSED CHILD CARE, PARENTING AND NUTRITION CLASSES, JOB SKILLS TRAINING AND EDUCATION/EMPLOYMENT ASSISTANCE. MERCY MEDICAL CENTER-DES MOINES: MONEY USED FOR NUMEROUS ACTIVITIES INCLUDING: PROVIDING CHARITY AND OR SUBSIDIZED HEALTH CARE FOR NEEDY MEMBERS OF THE COMMUNITY, EQUIPMENT PURCHASES TO IMPROVE ACCESS AND QUALITY OF HEALTHCARE WITHIN THE COMMUNITY. MERCY MEDICAL CENTER-CENTERVILLE: MONEY USED FOR ONGOING OPERATIONAL AND CAPITAL PURCHASES FOR HEALTHCARE AND OR CHARITABLE RELATED ACTIVITIES. MERCY CLINICS, INC.: MONEY USED FOR OPERATIONAL HEALTHCARE/CHARITABLE PURCHASES SUCH AS: PROVIDING CHARITY AND OR SUBSIDIZED HEALTH CARE FOR NEEDY MEMBERS OF THE COMMUNITY, RESEARCH AND MEDICAL EDUCATION, AND DISEASE PREVENTION. BISHOP DRUMM CARE CENTER: MONEY USED FOR ONGOING OPERATIONAL AND CAPITAL PURCHASES RELATED TO THEIR RESIDENTIAL ASSISTED LIVING PROGRAM AND FOR THEIR STATE LICENSED NURSING FACILITY INCLUDING THE SPECIAL UNIT DEVOTED TO ALZHEIMER'S DISEASE. MERCY COLLEGE OF HEALTH SCIENCES: MONEY USED TO PROVIDE CHARITY OR SUBSIDIZED HEALTH CARE EDUCATION TO NEEDY MEMBERS OF THE COMMUNITY.
Form 990, Part VI, Sec A, Line 6, Classes of members or stockholders
THE SOLE MEMBER OF THE ORGANIZATION 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 SOLE MEMBER HAS THE POWER TO APPOINT AND/OR REMOVE THE MEMBERS OF THE BOARD OF DIRECTORS OF THIS CORPORATION OR ANY AFFILIATE OF THIS CORPORATION.
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 (CHI-IOWA CORP). PURSUANT TO SECTION X OF THE ORGANIZATION'S BYLAWS, BOTH CHI-IOWA CORP AND CATHOLIC HEALTH INITIATIVES ("CHI") (CHI-IOWA CORP'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 CORP BOARD: *APPROVE MEMBERS OF THE MERCY FOUNDATION BOARD *AMENDMENT OF THE CORPORATE DOCUMENTS OF MERCY FOUNDATION *APPROVE REMOVAL OF A MEMBER OF THE GOVERNING BODY OF MERCY FOUNDATION *ADOPTION OF LONG RANGE AND STRATEGIC PLANS FOR MERCY FOUNDATION 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 MERCY FOUNDATION *REMOVAL OF A MEMBER OF THE GOVERNING BODY OF MERCY FOUNDATION *APPROVAL OF ISSUANCE OF DEBT BY MERCY FOUNDATION *APPROVAL OF PARTICIPATION OF MERCY FOUNDATION IN A JOINT VENTURE *APPROVAL OF FORMATION OF A NEW CORPORATION BY MERCY FOUNDATION *APPROVAL OF A MERGER INVOLVING MERCY FOUNDATION *APPROVAL OF THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF MERCY FOUNDATION *TO REQUIRE THE TRANSFER OF ASSETS BY MERCY FOUNDATION TO CHI TO ACCOMPLISH CHI'S GOALS AND OBJECTIVES, AND TO SATISFY CHI DEBTS. PURSUANT TO SECTION X OF THE ORGANIZATION'S BYLAWS, CHI-IOWA CORP 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 CHI'S TAX DEPARTMENT PERSONNEL 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 CHIEF FINANCIAL OFFICER, 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 15, PROCESS USED TO ESTABLISH COMPENSATION
DURING THE TAX YEAR ENDED 6/30/14, NO OFFICERS, DIRECTORS OR TRUSTEES RECEIVED COMPENSATION FROM THE ORGANIZATION. ANY EXECUTIVE COMPENSATION PAID TO OFFICERS, DIRECTORS OR TRUSTEES BY RELATED ORGANIZATIONS WAS SET BY THE RELATED ORGANIZATION'S COMPENSATION COMMITTEE UTILIZING BOTH AN INDEPENDENT CONSULTANT AND COMPARABILITY STUDIES TO DETERMINE COMPENSATION. THEREFORE, THESE QUESTIONS ARE MORE APPROPRIATELY ANSWERED AS "N/A" BUT HAVE 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 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 CONFLICT OF INTEREST POLICY IS NOT PUBLICLY AVAILABLE. THE ORGANIZATION'S GOVERNING DOCUMENTS ARE AVAILABLE ON THE IOWA SECRETARY OF STATE'S WEBSITE.
Form 990 , Part XI, Line 9, Other changes in net assets or fund balances
DISTRIBUTION TO MEDICAL CENTER ANESTHESIOLOGISTS - -6842; UNCOLLECTIBLE PLEDGES - -17354;
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.