Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (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 |
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Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | 51,870,178 | 59,150,155 | 65,163,269 | 75,507,088 | 156,672,029 | 408,362,719 |
| 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 | 51,870,178 | 59,150,155 | 65,163,269 | 75,507,088 | 156,672,029 | 408,362,719 |
| 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. | 408,362,719 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 51,870,178 | 59,150,155 | 65,163,269 | 75,507,088 | 156,672,029 | 408,362,719 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 2,579,982 | 3,226,815 | 4,836,510 | 6,237,931 | 8,096,527 | 24,977,765 |
| 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.).. | 25,728,909 | 8,213,932 | 33,942,841 | |||
| 11 | Total support. Add lines 7 through 10 | 467,283,325 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (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) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (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) |
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| 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): |
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| 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 | ||||
| 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 2019 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-2019 |
(iii) Distributable Amount for 2019 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2019 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2019: | ||||
| a From 2014....... | ||||
| b From 2015....... | ||||
| c From 2016....... | ||||
| d From 2017....... | ||||
| e From 2018....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2019 distributable amount | ||||
|
i
Carryover from 2014 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2019 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2019 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
7 Excess distributions carryover to 2020. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2015..... | ||||
| b Excess from 2016..... | ||||
| c Excess from 2017..... | ||||
| d Excess from 2018..... | ||||
| e Excess from 2019..... | ||||
| 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.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | MERCY CARE HAS BOARD MEMBERS WHO WORK FOR DIGNITY HEALTH AND ASCENSION CARE MANAGEMENT. LINDA HUNT, DOUG WATSON, TAMMY WILCOX AND KEITH FREY HAVE A BUSINESS RELATIONSHIP THROUGH EMPLOYMENT WITH DIGNITY HEALTH. ROBERT SMITH, JANET WALKER, AND TIM MOORHEAD HAVE A BUSINESS RELATIONSHIP WITH ASCENSION CARE MANAGEMENT. |
| FORM 990, PART VI, SECTION A, LINE 3 | MERCY CARE HAS A MANAGEMENT AGREEMENT WITH AETNA MEDICAID ADMINISTRATORS TO COVER EMPLOYEE SALARY AND BENEFIT COSTS AND GENERAL AND ADMINISTRATIVE EXPENSES INCURRED TO OPERATE THE ORGANIZATION. MERCY CARE HAS NO DIRECT EMPLOYEES. |
| FORM 990, PART VI, SECTION A, LINE 6 | MERCY CARE IS A NONPROFIT CORPORATION WHOSE SPONSOR (MEMBER) ORGANIZATIONS ARE DIGNITY HEALTH AND ASCENSION CARE MANAGEMENT. |
| FORM 990, PART VI, SECTION A, LINE 7A | BOTH DIGNITY HEALTH AND ASCENSION CARE MANAGEMENT SHALL EACH HAVE THE POWER TO NOMINATE AN EVEN NUMBER OF PERSONS UP TO FOUR (4) TO THE BOARD OF DIRECTORS OF THIS CORPORATION. |
| FORM 990, PART VI, SECTION A, LINE 7B | ANY ACTION REQUIRED OR PERMITTED TO BE TAKEN PURSUANT TO THESE ARTICLES BY THE CORPORATE MEMBERS SHALL BE VALID ONLY IF SUCH ACTION HAS RECEIVED THE APPROPRIATE INTERNAL APPROVAL OF EACH VOTING MEMBER ORGANIZATION. IT IS ACKNOWLEDGED THAT THE AUTHORITY OF THE VOTING MEMBER TO GRANT APPROVAL OF THE ACTIONS SET FORTH ABOVE IS, IN CERTAIN INSTANCES, SUBJECT TO RESTRICTIONS WHICH MAY REQUIRE THE MEMBERS TO OBTAIN THE APPROVAL OF CONSENT OF OTHERS WITHIN THE SPONSORING ORGANIZATIONS. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS REVIEWED BY THE MERCY CARE EXECUTIVE MANAGEMENT, EXTERNAL ACCOUNTANTS AND THE MERCY CARE AUDIT AND COMPLIANCE COMMITTEE. A REDACTED VERSION OF THE RETURN IS SUBMITTED TO THE MERCY CARE BOARD OF DIRECTORS FOR REVIEW. |
| FORM 990, PART VI, SECTION B, LINE 12C | MERCY CARE HAS A CONFLICT OF INTEREST POLICY. ALL MERCY CARE CORPORATE MEMBERS, BOARD OF DIRECTORS AND COMMITTEES, AND THE CORPORATE OFFICERS OF MERCY CARE SHALL PREPARE AND SUBMIT TO THE FILING OFFICER ON AN ANNUAL BASIS, NO LATER THAN JULY 31 OF EACH CALENDAR YEAR, AN ANNUAL CONFLICTS OF INTEREST DISCLOSURE STATEMENT. THE CONFLICT OF INTEREST MUST BE FULLY DISCLOSED TO THE BOARD OR COMMITTEE PRIOR TO CONSIDERATION OF AN AFFECTED BUSINESS TRANSACTION. THE INTERESTED PERSON WILL BE COUNTED IN DETERMINING THE PRESENCE OF A QUORUM, BUT WILL NOT BE ELIGIBLE TO VOTE ON THE CONTRACT OR TRANSACTION. THE INTERESTED PERSON MAY PARTICIPATE IN DISCUSSIONS REGARDING THE AFFECTED BUSINESS TRANSACTION, BUT WILL BE EXCUSED FROM THE MEETING PRIOR TO COMPLETION OF THE DISCUSSION, AND DOES NOT RETURN UNTIL DISCUSSION AND VOTING ON THE MATTER HAVE BEEN CONCLUDED. |
| FORM 990, PART VI, SECTION B, LINE 15 | MERCY CARE CONTRACTS WITH AETNA MEDICAID ADMINISTRATORS TO PROVIDE ALL MANAGEMENT SERVICES FOR MERCY CARE. THIS ENTITY DOES NOT HAVE ANY DIRECT EMPLOYEES. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND AUDITED FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART XI, LINE 9: | DISTRIBUTION TO ASCENSION CARE MANAGEMENT -29,850,000. DISTRIBUTION TO DIGNITY HEALTH -29,850,000. DECREASE IN NOTE RECEIVABLE FROM EQUALITY FOUNDATION 214,288. |
| PART VI, LINE 2 | MERCY CARE HAS BOARD MEMBERS WHO WORK FOR THE RELATED ORGANIZATION, DIGNITY HEALTH AND ASCENSION CARE MANAGEMENT. LINDA HUNT, DOUG WATSON, TAMMY WILCOX, KEITH FREY AND MARK SLYTER HAVE A BUSINESS RELATIONSHIP THROUGH EMPLOYMENT WITH DIGNITY HEALTH. ROBERT SMITH, JANET WALKER, TIM MOORHEAD, AND DR. THOMAS GRAF HAVE A BUSINESS RELATIONSHIP WITH ASCENSION CARE MANAGEMENT. |
| PART VI, LINE 3 | MERCY CARE HAS A MANAGEMENT AGREEMENT WITH AETNA MEDICAID ADMINISTRATORS TO COVER EMPLOYEE SALARY AND BENEFIT COSTS AND GENERAL AND ADMINISTRATIVE EXPENSES INCURRED TO OPERATE THE ORGANIZATION. MERCY CARE HAS NO DIRECT EMPLOYEES. |
| PART VI, LINE 6 | MERCY CARE IS A NONPROFIT CORPORATION WHOSE SPONSOR (MEMBER) ORGANIZATIONS ARE DIGNITY HEALTH AND ASCENSION CARE MANAGEMENT. |
| PART VI, LINE 7A | BOTH DIGNITY HEALTH AND ASCENSION CARE MANAGEMENT SHALL EACH HAVE THE POWER TO NOMINATE AN EVEN NUMBER OF PERSONS UP TO FOUR (4) TO THE BOARD OF DIRECTORS OF THIS CORPORATION. |
| PART VI, LINE 7B | ANY ACTION REQUIRED OR PERMITTED TO BE TAKEN PURSUANT TO THESE ARTICLES BY THE CORPORATE MEMBERS SHALL BE VALID ONLY IF SUCH ACTION HAS RECEIVED THE APPROPRIATE INTERNAL APPROVAL OF EACH VOTING MEMBER ORGANIZATION. IT IS ACKNOWLEDGED THAT THE AUTHORITY OF THE VOTING MEMBER TO GRANT APPROVAL OF THE ACTIONS SET FORTH ABOVE IS, IN CERTAIN INSTANCES, SUBJECT TO RESTRICTIONS WHICH MAY REQUIRE THE MEMBERS TO OBTAIN THE APPROVAL OF CONSENT OF OTHERS WITHIN THE SPONSORING ORGANIZATIONS. |
| PART VI, LINE 11A | THE FORM 990 IS REVIEWED BY THE MERCY CARE EXECUTIVE MANAGEMENT, EXTERNAL ACCOUNTANTS AND THE MERCY CARE AUDIT AND COMPLIANCE COMMITTEE. A REDACTED VERSION OF THE RETURN IS SUBMITTED TO THE MERCY CARE BOARD OF DIRECTORS FOR REVIEW. |
| PART VI, LINE 12A, 12B, 12C | MERCY CARE HAS A CONFLICT OF INTEREST POLICY. ALL MERCY CARE CORPORATE MEMBERS, BOARD OF DIRECTORS AND COMMITTEES, AND THE CORPORATE OFFICERS OF MERCY CARE SHALL PREPARE AND SUBMIT TO THE FILING OFFICER ON AN ANNUAL BASIS, NO LATER THAN JULY 31 OF EACH CALENDAR YEAR, AN ANNUAL CONFLICTS OF INTEREST DISCLOSURE STATEMENT. |
| PART VI, LINE 12C | A) THE CONFLICT OF INTEREST MUST BE FULLY DISCLOSED TO THE BOARD OR COMMITTEE PRIOR TO CONSIDERATION OF AN AFFECTED BUSINESS TRANSACTION. THE INTERESTED PERSON WILL BE COUNTED IN DETERMINING THE PRESENCE OF A QUORUM, BUT WILL NOT BE ELIGIBLE TO VOTE ON THE CONTRACT OR TRANSACTION. THE INTERESTED PERSON MAY PARTICIPATE IN DISCUSSIONS REGARDING THE AFFECTED BUSINESS TRANSACTION, BUT WILL BE EXCUSED FROM THE MEETING PRIOR TO COMPLETION OF THE DISCUSSION, AND DOES NOT RETURN UNTIL DISCUSSION AND VOTING ON THE MATTER HAVE BEEN CONCLUDED. |
| PART VI, LINE 15A, 15B | MERCY CARE CONTRACTS WITH AETNA MEDICAID ADMINISTRATORS TO PROVIDE ALL MANAGEMENT SERVICES FOR MERCY CARE. THIS ENTITY DOES NOT HAVE ANY DIRECT EMPLOYEES. |
| PART VI, LINE 19 | THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AUDITED FINANCIAL STATEMENTS AND FORM 990 IS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| PART XI, LINE 9 | DURING THE FISCAL YEAR ENDED JUNE 30, 2020, MERCY CARE PAID A NET ASSET DISTRIBUTION OF $29,850,000 TO ASCENSION CARE MANAGEMENT, $29,850,000 TO DIGNITY HEALTH OFFSET BY A DECREASE IN NOTE RECEIVABLE OF $214,286 FROM EQUALITY HEALTH. |
| Software ID: | |
| Software Version: |