Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (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 listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| Total | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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 VI.).. | ||||||
| 11 | Total support Add lines 7 through 10. | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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 VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e | Discount claimed for blockage or other factors (explain in detail in Part VI): | |||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| 7 | Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions) | |||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2014 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2014 |
(iii) Distributable Amount for 2014 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2014 from Section C, line 6 |
||||
|
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions) |
||||
| 3 Excess distributions carryover, if any, to 2014: | ||||
| a From 2009.......X | ||||
| b From 2010.......X | ||||
| c From 2011.......X | ||||
| d From 2012.......X | ||||
| e From 2013....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2014 distributable amount | ||||
|
i
Carryover from 2009 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2014 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2014 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
||||
|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
||||
|
7 Excess distributions carryover to 2015. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a From 2010.......X | ||||
| b From 2011.......X | ||||
| c From 2012.......X | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| FORM 990 - ORGANIZATION'S MISSION | HEALTHCARE DELIVERY SYSTEM DESIGNATED TO PROMOTE WELLNESS AND CURE ILLNESS. AS A MINISTRY OF THE ROMAN CATHOLIC CHURCH, WE ARE COMMITTED TO BEING A TRANSFORMING, HEALING PRESCENCE WITHIN OUR COMMUNITY. ADOPTING THE SPIRIT OF THE SISTERS OF ST. JOSEPH IN "WORKING TO ACHIEVE UNITY OF NEIGHBOR WITH NEIGHBOR AND NEIGHBOR WITH GOD," WE ATTEST TO THE VALUE OF HUMAN LIFE IN ALL ITS CYCLES. THIS IS DONE THROUGH RESPECT FOR THE UNBORN AND RECOGNITION OF THE TRANSCENDENT MEANING OF SUFFERING AND DEATH BY COMBINING PROFESSIONAL EXCELLENCE WITH A COMPASSIONATE CONCERN FOR THE WHOLE PERSON. WE SEEK TO UNDERSTAND AND RESPOND TO THE NEEDS OF OUR COMMUNITY THROUGH COLLABORATING WITH OTHERS THAT SHARE A COMMON MISSION AND VISION. WITH ATTENTION TO FISCAL RESPONSIBILITY, QUALITY SERVICES ARE MADE AVAILABLE AND ACCESSIBLE TO THOSE WHO NEED THEM. |
| FORM 990, PAGE 2, PART III, LINE 4A | GIVE OF THEIR TIME AND TALENT AS SPECIALISTS PROVIDING CARE TO SJBC PATIENTS IN THEIR PRIVATE OFFICES. THROUGH THE GENEROSITY OF OUR PHYSICIAN VOLUNTEERS 448 PRIVATE SPECIALTY PHYSICIAN VISITS WERE DELIVERED TO PATIENTS SERVED THROUGH THE CLINIC. SJBC WORKS CLOSELY WITH OTHER COMMUNITY HEALTHCARE AGENCIES TO NAVIGATE PATIENTS TOWARDS THE APPROPRIATE SETTING WHEN THE NEED OF THE PATIENT IS OUTSIDE THE SCOPE OF THE CLINIC'S SERVICES. HEALTH EDUCATION, NUTRITION AND PHYSICAL ACTIVITY CLASSES ARE OFFERED SEVERAL TIMES A YEAR. OUTSIDE THE CLINIC SETTING, SJBC COORDINATED A COMMUNITY HEALTH FAIR AND VOLUNTEER PHYSICIANS SERVED AS SPEAKERS IN AN ADULT NIGHT CLASS IN AN EFFORT TO PROVIDE HEALTH EDUCATION TO THE UNDERSERVED. |
| FORM 990, PAGE 6, PART VI, LINE 4 | EFFECTIVE JUNE 27, 2014, MERCY MISSION SERVICES, INC. AMENDED ITS ARTICLES OF INCORPORATION AND BYLAWS TO CHANGE ITS MEMBER FROM MERCY HOSPITAL, INC. TO THE GENERAL SUPERIOR AND COUNCIL OF THE RELIGIOUS CONGREGATION OF SISTERS OF ST. JOSEPH OF ST. AUGUSTINE, FLORIDA. |
| FORM 990, PAGE 6, PART VI, LINE 6 | UNTIL 27, 2014, THE SOLE MEMBER OF MERCY MISSION SERVICES WAS MERCY HOSPITAL, INC. EFFECTIVE JUNE 27, 2014, THE MEMBERS OF MERCY MISSION SERVICES, INC. ARE THE GENERAL SUPERIOR AND COUNCIL OF THE RELIGIOUS CONGREGATION OF SISTERS OF ST. JOSEPH OF ST. AUGUSTINE, FLORIDA. SEE LINE 7 FOR ADDITIONAL INFORMATION. |
| FORM 990, PAGE 6, PART VI, LINE 7A | THE GENERAL SUPERIOR AND COUNCIL OF THE RELIGIOUS CONGREGATION OF SISTERS OF ST. JOSEPH OF ST. AUGUSTINE, FLORIDA ARE THE MEMBERS OF OF MERCY MISSION SERVICES, INC. THE MEMBERS HAVE THE RIGHT TO APPOINT ALL PERSONS TO THE BOARD OF DIRECTORS OF MERCY MISSION SERVICES, INC. |
| FORM 990, PAGE 6, PART VI, LINE 7B | AS THE MEMBERS, GENERAL SUPERIOR AND COUNCIL OF THE RELIGIOUS CONGREGATION OF SISTERS OF ST. JOSEPH OF ST. AUGUSTINE, FLORIDA MUST APPROVE CERTAIN DECISIONS OF THE GOVERNING BODY, INCLUDING THE STRATEGIC PLAN, ANNUAL CAPITAL PLAN, AND ANNUAL OPERATING BUDGET. THE MEMBERS MUST ALSO APPROVE SIGNIFICANT CHANGES SUCH AS A MERGER, DISSOLUTION, SALEO F ASSETS IN EXCESS OF CERTAIN LIMITS, A MATERIAL CHANGE IN MISSION, AND MODIFICATIONS TO GOVERNING DOCUMENTS. |
| FORM 990, PAGE 6, PART VI, LINE 11B | PRIOR TO FILING, THE FORM 990 FOR MERCY MISSION SERVICES, INC. IS REVIEWED BY SENIOR MANAGEMENT. IN ADDITION, CERTAIN KEY SECTIONS OF THE FORM ARE REVIEWED BY THE BOARD OF DIRECTORS. THE BOARD RECEIVES A COPY OF THE RETURN IN ITS FINAL FORM BEFORE IT IS FILED WITH THE INTERNAL REVENUE SERVICE. |
| FORM 990, PAGE 6, PART VI, LINE 12C | MERCY MISSION SERVICES, INC. HAS ADOPTED CATHOLIC HEALTH EAST'S POLICY 103, WHICH SETS FORTH THE ORGANIZATION'S CONFLICT OF INTEREST POLICY AND PROCESSES. ANNUALLY, ALL THOSE SERVING MERCY MISSION SERVICES, INC. IN A FIDUCIARY CAPACITY, INCLUDING DIRECTORS, OFFICERS, AND KEY EMPLOYEES RECEIVE A COPY OF THE POLICY AND ANNUAL DISCLOSURE STATEMENT TO BE COMPLETED. DISCLOSURES OF FINANCIAL INTEREST OR OTHER REPORTABLE CIRCUMSTANCES AS DEFINED IN THE POLICY ARE SUBMITTED AND REVEIWED BY THE ORGANIZATION'S CEO AND BOARD CHAIR. SUMMARY INFORMATION IS REPORTED TO THE ENTIRE BOARD AND IS AVAILABLE TO THE BOARD THROUGHOUT THE YEAR AS BUSINESS COMES BEFORE THE BOARD OR MANAGEMENT FOR ACTION. THE POLICY CONTAINS A CONTINUING AFFIRMATIVE OBLIGATION ON ALL AFFECTED INDIVIDUALS TO DISCLOSE COMPENSATION OR OTHER CIRCUMSTANCES THROUGHOUT THE YEAR WHICH MAY RISE TO THE LEVEL OF AN ACTUAL OR APPARENT CONFLICT. THE DETERMINATION OF WHETHER A DISCLOSED FINANCIAL OR OTHER INTEREST CONSTITUTES A CONFLICT OF INTEREST IS MADE BY THE BOARD OR AN APPROPRIATE COMMITTEE THEREOF COMPRISED OF DISINTERESTED PERSONS AND WITHOUT THE PARTICIPATION OF THE AFFECTED INDIVIDUAL EXCEPT TO RESPOND TO QUESTIONS ABOUT THE DISCLOSURE. THE POLICY FURTHER ADDRESSES THE PROCEDURE FOR THE BOARD'S FURTHER CONSIDERATION OF THE PROPOSED TRANSACTION/MATTER WITHOUT THE PARTICIPATION OF THE AFFECTED PERSON AND THE DOCUMENTATION OF THE PROCEEDINGS. LASTLY, THE POLICY ADDRESSES POTENTIAL DISCIPLINARY ACTION FOR VIOLATIONS OF THE POLICY. THE POLICY IS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PAGE 6, PART VI, LINE 15A | THE BOARD OF DIRECTORS REVIEWS AND APPROVES ALL ELEMENTS OF REMUNERATION FOR THE EXECUTIVE DIRECTOR. THE BOARD OBTAINS MARKET DATA COMPARING THE ORGANIZATION'S EXECUTIVE DIRECTOR ROLE TO SIMILARLY SIZED ORGANIZATIONS UTILIZING BOTH TITLE AND JOB CONTENT COMPARISONS. THE BOARD REVIEWS THE MARKET ANALYSIS AND APPROVES ANY SALARY ADJUSTMENTS FOR THE EXECUTIVE DIRECTOR. ALL OF THESE DISCUSSIONS AND DECISIONS ARE DOCUMENTED THROUGH THE PROVISION OF MEETING MINUTES. |
| FORM 990, PAGE 6, PART VI, LINE 19 | UNTIL JUNE 27, 2014, MERCY MISSION SERVICES, INC. WAS A SUBSIDIARY ORGANIZATION IN THE TRINITY HEALTH SYSTEM. TRINITY HEALTH MAKES CERTAIN OF ITS KEY DOCUMENTS AVAILABLE TO THE PUBLIC ON ITS WEBSITE, WWW.TRINITY- HEALTH.ORG, IN THE "ABOUT US" SECTION. IN THIS SECTION, THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE PUBLICLY AVAILABLE. MERCY MISSION SERVICES, INC.'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | CONSULTING 13,824 0 0 PURCHASED PATIENT SERVICES 61,436 0 0 SERVICE CONTRACTS 13,123 0 0 |
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