2015-11-16T14:00:33-06:00 2014-12-31 990 2014-01-01 201072726 Mercy Health Foundation MERC 5136392800 615 Elsinore Place Cincinnati OH 45202 Michael Bezney Chairperson 2015-11-12 2014 2016-04-25 22:37:26Z Michael Bezney 615 Elsinore Place Cincinnati OH 45202 30253255 false X WWW.mercy.com X 2004 OH TO SUPPORT THE OPERATIONS OF MERCY HEALTH BY ENCOURAGING CHARITABLE GIVING AND EFFECTIVELY MANAGING GIFT RESOURCES. 8 5 42 331 0 0 13649735 19335904 0 0 1716009 9960778 60404 354987 15426148 29651669 6194278 29755572 0 0 0 3734127 0 0 0 1572944 2322850 7767222 35812549 7658926 -6160880 36024061 241247944 3496186 -745992 32527875 241993936 To carry out the charitable and educational purposes of Mercy Health by providing grants in support of programs that carry out its charitable mission. false false 34911443 29755572 0 MERCY HEALTH FOUNDATION AWARDED $49,755,572 IN GRANTS DURING 2014 TO PROGRAMS THAT ADDRESS THE HEALTHCARE NEEDS OF PERSONS WHO ARE POOR AND UNDERSERVED. 34911443 true true false true false false false false true true true false false true true false true false false false false false false true false false true true true false false false false false false false false true false false false false true false false false true 0 0 42 true false false false false false true true false false false false X 8 5 false false true false true true true true true false false true true true true true true false false false X TRAVIS CRUM 5136392800 615 ELSINORE PLACE CINCINNATI OH 45202 MICHAEL BEZNEY CHAIR, MERCY HEALTH SVP & GENERAL COUNSEL 1.00 54.00 X X 0 1204433 43782 MICHAEL D CONNELLY JD TRUSTEE, PRESIDENT & CEO - MERCY HEALTH 1.00 50.00 X X 0 2087458 38377 SR MARJORIE BOSSE RSM VICE CHAIRPERSON 1.00 3.00 X X 0 0 0 BRIAN CORBIN TRUSTEE 1.00 3.00 X 0 0 0 SR MARIE HARTMANN TRUSTEE 1.00 0 X 0 0 0 SR DORIS A GOTTEMOELLER RSM TRUSTEE 1.00 2.00 X 0 0 0 JAMES P GARRETT TRUSTEE 1.00 1.00 X 0 0 0 TRAVIS CRUM TRUSTEE, VP CORPORATE CONTROLLER - MERCY HEALTH 1.00 50.00 X 0 245248 56886 PETER OWENDOFF Foundation President 40.00 0 X 0 32018 691 ROGER LAGRECA Foundation President 40.00 0 X 0 207402 16252 JAMES SCHULTIS Youngstown Market Foundation President 40.00 0 X 196068 0 33958 TARA MILLER Lourdes Foundation President 40.00 0 X 148792 0 32927 KATHRYN WILLIAMS Lima Market Foundation Development Director 40.00 0 X 192691 0 245354 Timothy Koder Toledo Market Foundation President 40.00 0 X 213603 0 41403 SCOTT PEMBER Lorain Market Foundation Director 40.00 0 X 153577 0 31431 DEIRDRE BELUAN FORMER OFFICER 0.00 40.00 X 0 117150 0 DEBORAH BLOOMFIELD FORMER OFFICER 0.00 50.00 X 0 702053 143556 904731 4595762 684617 5 true true false 0 819725 3564000 1342483 13609696 314293 19335904 0 0 0 0 0 2740608 2740608 0 0 7220170 7220170 0 7220170 7220170 956573 819725 601586 354987 354987 0 0 0 0 0 29651669 0 0 10315765 29457949 29457949 297623 297623 2673884 2272801 401083 54717 46509 8208 753049 640092 112957 252477 206105 46372 1775 1775 7964 7964 47834 47834 1787978 1519781 268197 0 88281 88281 254337 216186 38151 70716 60109 10607 2933 2493 440 944 802 142 Bank service charges 34732 29522 5210 Bad debt 25356 25356 0 0 0 0 35812549 34911443 901106 0 9500 290000 10873133 0 0 84300 682361 117468 0 564893 35724561 223403242 0 0 6322376 36024061 241247944 3496186 -1024039 0 0 278047 3496186 -745992 X 32525078 109503666 2797 73751646 58738624 32527875 241993936 36024061 241247944 X -6160880 -2440568 218067509 X false true X true false X 2086481 2819509 13559917 13649735 19335904 51451546 2086481 2819509 13559917 13649735 19335904 51451546 35917027 15534519 201210 234024 222952 305709 2740608 3704503 107583 135831 113283 104996 956573 1418266 56574315 0.2746 0.0 X Schedule A, Part II, Line 17a 10% Facts and Circumstances Test explanation Mercy Health Foundation was historically classified as a Section 509(a)(3) Type I organization. On January 1, 2014 the nature and amount of support the Foundation receives materially changed when ten other foundations, originally separate entities within the Mercy Health system and all of which traditionally receive public support, merged into Mercy Health Foundation. In 2014 Mercy Health Foundation applied for and was granted a change in status to a Section 509(a)(1) organization. To demonstrate how the merged Mercy Health Foundation would now qualify as a Section 509(a)(1) organization, the application included a pro forma 2012 Schedule A Part II support schedule which aggregated the contributions of all of the foundations for the period 2008 - 2012 and reflected the direct public support these foundations would have provided, had the contributions they received been included on a Mercy Health Foundation support schedule. The pro forma 2012 Schedule A calculated a public support percentage of 65.37%. The support schedule included in the Mercy Health Foundation 2014 Schedule A includes 2010 - 2014 amounts for Mercy Health Foundation only. The ten formerly separate legal entities continue to function, operationally unchanged, within Mercy Health Foundation. Each continues its program to solicit funds from the community in which it resides and from governmental units. The public support received is used to provide, on a continuing basis, grants and other assistance to Section 501(c)(3) hospitals and other regional and community organizations whose mission is to address the healthcare and other needs of the general public, and especially of the poor and underserved. Schedule A, Part II, Line 10 Other Income DESCRIPTION - SPECIAL EVENT REVENUE, COLUMN A - 107583.0, COLUMN B - 135831.0, COLUMN C - 113283.0, COLUMN D - 104996.0, COLUMN E - 956573.0, COLUMN F - 1418266.0; RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 6293 false false false 6293 false Schedule C, Part II-B, Line 1 Description of activities reported on Line 1A through 1I The primary purpose for lobbying activities is to enhance Mercy Health's public position on legislative and regulatory issues that impact patient care throughout its healthcare system. Mercy Health focuses on public policy issues that extend its healing ministry to those who are poor and underserved in the communities it serves. To carry out these efforts, Mercy Health partners with expert consultants and professional trade associations to build awareness and execute specific strategies that will yield a favorable outcome for patient care in the Mercy Health facilities where they are treated. Grants paid to other organizations of $6,293 constitute issue-based lobbying support. 68146907 92374 93379 68332660 63918694 2918149 2993064 1683000 0 0 68146907 79022497 1541931 1691129 0 18251929 84934 63918694 76127070 1513548 2689201 3678195 -2474793 103920 79022497 59996181 14753275 2920231 682862 452236 407519 76127070 0.0477 0.8999 0.0524 true false 525000 20000 545000 65000 56875 8125 42526 30758 11768 29835 29835 0 564893 Mercy Health Investment Management Program 223403242 F 223403242 Other long-term liabilities 278047 278047 X Schedule D, Part V, Line 4 Intended uses of endowment funds THE ENDOWMENT FUNDS ARE RESTRICTED FOR VARIOUS USES RELATED TO THE EXEMPT PURPOSES OF THE AFFILIATED ENTITIES SUPPORTED BY THE FOUNDATION. Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote THE COMPANY (MERCY HEALTH AND AFFILIATED ENTITIES) COMPLETED AN ANALYSIS OF ITS TAX POSITIONS IN ACCORDANCE WITH APPLICABLE ACCOUNTING GUIDANCE AT DECEMBER 31, 2014 AND 2013, AND DETERMINED THAT NO AMOUNTS WERE REQUIRED TO BE RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS AT DECEMBER 31, 2014 OR 2013. Gala 307291 290575 16716 2850 21724 56395 16051 Golf Tournament 202241 13515 188726 1305 17577 24942 8803 19 1266766 515635 751131 17830 58407 112423 112073 32150 119056 1776298 819725 956573 17830 59712 132850 158739 88545 143910 601586 354987 true MERCY HEALTH YOUNGSTOWN LLC 1044 BELMONT AVENUE YOUNGSTOWN OH 44501 340505560 501(C)(3) 2565708 MISSION SUPPORT JEWISH HOSPITAL 4777 E GALBRAITH RD CINCINNATI OH 45236 271408630 501(C)(3) 2244801 MISSION SUPPORT MERCY HEALTH PARTNERS - LOURDES INC 1530 LONE OAK ROAD PADUCAH KY 42003 610600313 501(C)(3) 1963318 MISSION SUPPORT Mercy Health - Regional Medical Center LLC 3700 KOLBE ROAD LORAIN OH 44053 340714704 501(C)(3) 1413262 MISSION SUPPORT MERCY HEALTH - TIFFIN HOSPITAL LLC 45 ST LAWRENCE DRIVE TIFFIN OH 44883 344431174 501(C)(3) 1335439 MISSION SUPPORT MERCY HEALTH - ST VINCENT MEDICAL CENTER LLC 2213 CHERRY STREET TOLEDO OH 43608 344428250 501(C)(3) 995585 MISSION SUPPORT MERCY HEALTH 615 ELSINORE PLACE CINCINNATI OH 45202 311161086 501(C)(3) 916667 BEHAVIORAL HEALTH MERCY HEALTH - FAIRFIELD HOSPITAL LLC 3000 MACK ROAD FAIRFIELD OH 45014 310538532 501(C)(3) 731863 MISSION SUPPORT MERCY HEALTH - ANDERSON HOSPITAL LLC 7500 STATE ROAD CINCINNATI OH 45255 310537085 501(C)(3) 635893 MISSION SUPPORT MERCY HEALTH - WEST HOSPITAL LLC 3300 MERCY HEALTH BLVD CINCINNATI OH 45211 311091597 501(C)(3) 629181 MISSION SUPPORT CATHOLIC MEDICAL MISSION BOARD 10 WEST 17TH ST NEW YORK NY 10011 135602319 501(C)(3) 538000 MISSION SUPPORT MERCY FRANCISCAN AT ST RAPHAEL INC 610 HIGH STREET HAMILTON OH 45011 202934871 501(C)(3) 531509 MISSION SUPPORT MERCY HEALTH 615 ELSINORE PLACE CINCINNATI OH 45202 311161086 501(C)(3) 458333 LEADERSHIP FOUNDATION INITIATIVE MERCY HEALTH NORTH LLC 2200 JEFFERSON AVENUE TOLEDO OH 43604 341344482 501(C)(3) 427000 MISSION SUPPORT MERCY HEALTH 615 ELSINORE PLACE CINCINNATI OH 45202 311161086 501(C)(3) 401500 SHARED SERVICES PROGRAM SUPPORT MERCY HEALTH PHYSICIANS LLC 615 ELSINORE PLACE CINCINNATI OH 45202 463521617 501(C)(3) 394000 MISSION SUPPORT MERCY FRANCISCAN SOCIAL MINISTRIES INC 1800 LOGAN STREET CINCINNATI OH 45210 311222942 501(C)(3) 387533 MISSION SUPPORT BURLINGAME REGIONAL COMMUNITY OF THE SISTERS OF MERCY 2300 ADELINE DRIVE BURLINGAME CA 94010 946071848 501(C)(3) 333000 CORPORATE INITIATIVE UNITED WAY OF GREATER CINCINNATI 2400 RADING ROAD CINCINNATI OH 45202 310537502 501(C)(3) 265000 2014 CAMPAIGN & LOANED EXECUTIVE PROGRAM MERCY HEALTH PHYSICIANS CINCINNATI LLC 4600 MCAULEY PLACE CINCINNATI OH 45242 311007881 501(C)(3) 259627 MISSION SUPPORT COMMUNITY MERCY HEALTH PARTNERS ONE SOUTH LIMESTONE ST SPRINGFIELD OH 45502 310785684 501(C)(3) 256376 HOSPITAL MISSION SUPPORT CINCINNATI SPORTSMEDICINE 10663 MONTGOMERY ROAD CINCINNATI OH 45242 311158604 501(C)(3) 200000 MISSION SUPPORT MERCY HEALTH NORTH LLC 2200 JEFFERSON AVENUE TOLEDO OH 43604 341344482 501(C)(3) 188403 SENIOR OUTREACH PROGRAM CATHOLIC RELIEF SERVICES 228 W LEXINGTON ST BALTIMORE MD 21201 135563422 501(C)(3) 170000 ST FRANCIS DE SALES HOSPITAL & HOSPITAL NETWORK BETHANY HOUSE SERVICES 1841 FAIRMONT AVENUE CINCINNATI OH 45214 311101401 501(C)(3) 160297 MISSION SUPPORT Mercy Health - Regional Medical Center LLC 3700 KOLBE ROAD LORAIN OH 44053 340714704 501(C)(3) 157795 RESOURCE MOTHERS & PARISH NURSING PROGRAM MERCY HEALTH - ST VINCENT MEDICAL CENTER LLC 2213 CHERRY STREET TOLEDO OH 43608 344428250 501(C)(3) 150000 REVITALIZE CHERRY STREET PROGRAM MERCY HEALTH - ALLEN HOSPITAL LLC 200 W LORAIN STREET OBERLIN OH 44074 340864230 501(C)(3) 150000 HOSPITAL MISSION SUPPORT MERCY HEALTH - CLERMONT HOSPITAL LLC 3000 HOSPITAL DRIVE BATAVIA OH 45103 310830955 501(C)(3) 134000 HOSPITAL MISSION SUPPORT URBAN LEAGUE OF GREATER CINCINNATI 3458 READING ROAD CINCINNATI OH 45229 310565428 501(C)(3) 130000 CONFERENCE TITLE SPONSORSHIP HOST CITY NIGHT & HERITAGE PROGRAM ROCKING HORSE CHILDRENS HEALTH CENTER 651 S LIMESTONE STREET SPRINGFIELD OH 45505 311593544 501(C)(3) 123761 MISSION SUPPORT CENTER FOR CREATIVE LEADERSHIP ONE LEADERSHIP PLACE GREENSBORO NC 27438 237079591 501(C)(3) 113499 MISSION SUPPORT LISC 245 N SUPERIOR 2ND FLOOR TOLEDO OH 43604 133030229 501(C)(3) 100000 BUILDING SUSTAINABLE COMMUNITIES PROGRAM STRATEGIES TO END HOMELESSNESS INC 2368 VICTORY PKWY CINCINNATI OH 45206 208286347 501(C)(3) 100000 HOMELESS TO HOMES INITIATIVE XAVIER UNIVERSITY INTERFAITH MEDICAL MISSION 3800 VICTORY PKWY CINCINNATI OH 45207 310537516 501(C)(3) 97500 INTERFAITH GUATEMALA MISSION & NURSING SCHOLARSHIPS MERCY SACRED HEART INC 2120 PAYNE STREET LOUISVILLE KY 40206 611318326 501(C)(3) 73931 MISSION SUPPORT MERCY FRANCISCAN SENIOR HEALTH AND HOUSING SERVICES INC 7010 ROWAN HILLS DRIVE CINCINNATI OH 45227 311308729 501(C)(3) 70430 MISSION SUPPORT CINCINNATI USA REGIONAL CHAMBER OF COMMERCE 3 EAST FOURTH STREET CINCINNATI OH 45202 310239310 501(C)(6) 50000 REDI CINCINNATI SUPPORT MERCY COLLEGE OF OHIO FOUNDATION INC 2221 MADISON AVENUE TOLEDO OH 43604 141963204 501(C)(3) 40000 MISSION SUPPORT MERCY HEALTH - ST CHARLES HOSPITAL LLC 2600 NAVARRE AVENUE TOLEDO OH 43616 344445373 501(C)(3) 32031 HOSPITAL MISSION SUPPORT HEARTBEAT PREGNANCY SUPPORT CENTER 4041 W SYLVANIA AVENUE TOLEDO OH 43623 311002913 501(C)(3) 30000 COMMUNITY FUND AWARD MERCY HEALTH - WILLARD HOSPITAL LLC 1100 NEAL ZICK ROAD WILLARD OH 44890 341577110 501(C)(3) 27461 HOSPITAL MISSION SUPPORT DEPAUL CRISTO REY HIGH SCHOOL 1133 CLIFTON HILLS AVENUE CINCINNATI OH 45220 272417727 501(C)(3) 27000 CORPORATE WORK STUDY TEAM SUPPORT OHIO EQUINE AND AGRICULTURAL ASSOCIATION 4122 LAYBOURNE ROAD SPRINGFIELD OH 45505 383655657 501(C)(3) 26025 MISSION SUPPORT ACCESS HEALTH MAHONING VALLEY 418 MAIN AVENUE SW WARREN OH 44481 274576650 501(C)(3) 25000 MISSION SUPPORT INITIATIVE ON CATHOLIC SOCIAL THOUGHT 213 RYAN HALL GEORGETOWN UNIVERSITY WASHINGTON DC 20057 530196603 501(C)(3) 25000 CATHOLIC SOCIAL THOUGHT AND PUBLIC LIFE INITIATIVE NATIONAL UNDERGROUND RAILROAD FREEDOM CENTER 50 E FREEDOM WAY CINCINNATI OH 45202 311436217 501(C)(3) 25000 MISSION SUPPORT OWENSBORO HEALTH FOUNDATION 2211 MAYFAIR AVENUE OWENSBORO KY 42301 611251763 501(C)(3) 25000 MERCY REACH OWENSBORO PROGRAM SUPPORT MERCY HEALTH CINCINNATI LLC 4600 MCAULEY PLACE CINCINNATI OH 45242 311063783 501(C)(3) 24400 MISSION SUPPORT ABILITY CENTER OF GREATER TOLEDO 5605 MONROE STREET SYLVANIA OH 43560 344428597 501(C)(3) 20000 COMMUNITY FUND AWARD COMMUNITY MERCY HEALTH PARTNERS ONE SOUTH LIMESTONE ST SPRINGFIELD OH 45502 310785684 501(C)(3) 20000 MED ASSIST PROGRAM HEALTH POLICY INSTITUTE OF OHIO 37 W BROAD STREET COLUMBUS OH 43215 300186863 501(C)(3) 20000 MISSION SUPPORT MARCUM & WALLACE MEMORIAL HOSPITAL INC 60 MERCY COURT IRVINE KY 40336 610927491 501(C)(3) 20000 HOSPITAL MISSION SUPPORT MERCY FRANCISCAN AT ST JOHN 1233 MAIN STREET CINCINNATI OH 45202 311222942 501(C)(3) 20000 MISSION SUPPORT MOBILITY FOUNDATION 11110 RESERVOIR ROAD ADA OH 45810 510545760 501(C)(3) 20000 MISSION SUPPORT ST RITA'S MEDICAL CENTER LLC 730 W MARKET STREET LIMA OH 45801 341105619 501(C)(3) 20000 HOSPITAL MISSION SUPPORT ST VINCENT DE PAUL COMMUNITY PHARMACY OF CINCINNATI 1125 BANK STREET CINCINNATI OH 45214 300272954 501(C)(3) 20000 CHARITABLE PHARMACY PROGRAM SUPPORT FUND FOR OUR ECONOMIC FUTURE 1360 E 9TH STREET CLEVELAND OH 44114 270606927 501(C)(3) 16667 MISSION SUPPORT OHIO CHAMBER OF COMMERCE P O BOX 15159 COLUMBUS OH 43215 314357206 501(C)(6) 15600 2015 MEMBERSHIP ALL AFRICA CONFERENCE SISTER TO SISTER 2715 BAINBRIDGE AVE BRONX NY 10458 371424584 501(C)(3) 15000 SISTER TO SISTER REFUGE HOUSE FARM LABOR RESEARCH PROJECT 1221 BROADWAY STREET TOLEDO OH 43609 341329126 501(C)(3) 15000 CLINIC FOR MIGRANT WORKERS SUPPORT THE DAUGHTER PROJECT P O BOX 255 PERRYSBURG OH 43552 264557801 501(C)(3) 15000 RECOVERY FOR VICTIMS OF HUMAN TRAFFICKING MERCY NEIGHBORHOOD MINISTRIES 1602 MADISON ROAD 2ND FLOOR CINCINNATI OH 45206 311376693 501(C)(3) 15000 MISSION SUPPORT NAHSE ANNUAL EDUCATIONAL CONFERENCE 1050 CONNECTICUT AVE NW WASHINGTON DC 20036 621312239 501(C)(3) 15000 CONFERENCE SPONSORSHIP PREVENT BLINDNESS OHIO 1500 WEST THIRD AVE CINCINNATI OH 45212 316063433 501(C)(3) 15000 MISSION SUPPORT CENTER FOR CLOSING THE HEALTH GAP IN GREATER CINCINNATI 3120 BURNET AVE CINCINNATI OH 45229 200902286 501(C)(3) 12500 HEALTH EXPO SPONSORSHIP CATHOLIC CHARITIES 1933 SPIELBUSCH AVENUE TOLEDO OH 43604 344428254 501(C)(3) 12000 FAMILY SUPPORT AND GUIDANCE PROGRAM SUPPORT ABERCRUMBIE GROUP 10301 GIVERNY BLVD CINCINNATI OH 45241 300520187 501(C)(3) 10000 HEALTHCARE SUPPLIER DIVERSITY SYMPOSIUM SUPPORT THE CINCINNATI ART MUSEUM 953 EDEN PARK DRIVE CINCINNATI OH 45202 310536653 501(C)(3) 10000 MISSION SUPPORT CINCINNATI GREEN BERET GOLF CLASSIC 18756 STONE OAK PKWY SAN ANTONIO TX 78258 271206961 501(C)(3) 10000 EVENT SUPPORT FOUNDATION OF AMERICAN COLLEGE OF HEALTHCARE EXECUTIVES ONE NORTH FRANKLIN CHICAGO IL 60606 360724325 501(C)(3) 10000 INNOVATION HEALTHCARE LEADERSHIP FUND SUPPORT LEADERSHIP CONFERENCE OF WOMEN RELIGIOUS 8808 CAMERON STREET SILVER SPRING MD 20910 436033728 501(C)(3) 10000 LCWR 2014 ASSEMBLY SUPPORT EMANUEL COMMUNITY CENTER 1308 RACE STREET CINCINNATI OH 45202 310537060 501(C)(3) 7500 MISSION SUPPORT ZOOLOGICAL SOCIETY OF CINCINNATI 3400 VINE STREET CINCINNATI OH 45220 310537171 501(C)(3) 7500 ZOO LA LA ANIMAL ENCOUNTER SPONSORSHIP NATIONAL ASSOCIATION OF CATHOLIC CHAPLAINS 4915 S HOWELL AVE MILWAUKEE WI 53207 391368967 501(C)(3) 7000 EVENT SPONSORSHIP HEALTHY MOMS AND BABIES INC 2270 BANNING ROAD CINCINNATI OH 45239 311155292 501(C)(3) 6500 MISSION SUPPORT THE ASSUMPTION VILLAGE 9800 MARKET STREET NORTH LIMA OH 44452 341013695 501(C)(3) 5753 MISSION SUPPORT USO METROPOLITAN WASHINGTON 228 MCNAIR RD BLDG 405 FORT MYER VA 22211 530204665 501(C)(3) 5600 2014 TABLE SPONSOR 76 2 SPRINGFIELD MARKET MED ASSIST PROGRAM 1939 118806 LOURDES HOSPITAL PATIENT MISSION FUND 512 22562 LOURDES HOSPITAL ASSOCIATE MISSION FUND 46 27201 LORAIN MARKET CARING FOR OUR OWN FUND 20 9697 NORTHERN MARKET CHARITABLE PHARMACY 109 8280 NORTHERN MARKET TRANSPORTATION SERVICES 1644 29782 NORTHERN MARKET HEALTH CAMPS 973 48174 NORTHERN MARKET FOOD SERVICES 881 4385 Mercy Health We Care Grants 0 17954 Cincinnati market individual grant assistance 2 10782 Schedule I, Part I, Line 2 Description Of Procedure For Monitoring Use Of Grant Funds Any organization receiving funds over $5,000 must complete an accompanied "Verification of Use of a Grant or Other Assistance from the Mercy Health Foundation" form. Organizations signing the form "Attest that the grant/assistance provided by the Foundation is being used for the purpose intended as stated in the request to the Foundation and that additional documentation to support usage of the grant/assistance as stated will be provided to the Foundation upon request." The Verification from must be submitted within 30 days of receiving the grant or assistance. Second notices are sent if the form is not returned within the allocated time frame. No additional grant or assistance will be provided until the form is signed and returned to the Foundation. To the extent additional information is required, requests will be made to the grantee. When the Foundation supports a Mercy Health initiative, the manager of the initiative is expected to attend a Foundation board meeting annually in-person during the course of the Foundation's support for the initiative. This attendance is to report the current year's status of the initiative, and plans for the following year if the Foundation is being asked to continue support or has already made a multi-year commitment. Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. Any organization receiving funds over $5,000 must complete an accompanied "Verification of Use of a Grant or Other Assistance from the Mercy Health Foundation" form. Organizations signing the form "Attest that the grant/assistance provided by the Foundation is being used for the purpose intended as stated in the request to the Foundation and that additional documentation to support usage of the grant/assistance as stated will be provided to the Foundation upon request." The Verification from must be submitted within 30 days of receiving the grant or assistance. Second notices are sent if the form is not returned within the allocated time frame. No additional grant or assistance will be provided until the form is signed and returned to the Foundation. To the extent additional information is required, requests will be made to the grantee. When the Foundation supports a Mercy Health initiative, the manager of the initiative is expected to attend a Foundation board meeting annually in-person during the course of the Foundation's support for the initiative. This attendance is to report the current year's status of the initiative, and plans for the following year if the Foundation is being asked to continue support or has already made a multi-year commitment. false true false false false false false true false MICHAEL BEZNEY CHAIR, MERCY HEALTH SVP & GENERAL COUNSEL 0 554415 0 150549 0 499469 0 15600 0 28182 0 1248215 0 264659 MICHAEL D CONNELLY JD TRUSTEE, PRESIDENT & CEO - MERCY HEALTH 0 1163994 0 556488 0 366976 0 18200 0 20177 0 2125835 0 0 TRAVIS CRUM TRUSTEE, VP CORPORATE CONTROLLER - MERCY HEALTH 0 203647 0 39911 0 1690 0 32048 0 24838 0 302134 0 0 DEIRDRE BELUAN FORMER OFFICER 0 117150 0 0 0 0 0 0 0 0 0 117150 0 0 DEBORAH BLOOMFIELD FORMER OFFICER 0 541196 0 157500 0 3357 0 122873 0 20683 0 845609 0 0 ROGER LAGRECA Foundation President 0 159142 0 0 0 48260 0 8173 0 8079 0 223654 0 0 JAMES SCHULTIS Youngstown Market Foundation President 177587 0 16887 0 1594 0 26240 0 7718 0 230026 0 0 0 TARA MILLER Lourdes Foundation President 129063 0 18711 0 1018 0 15883 0 17044 0 181719 0 0 0 KATHRYN WILLIAMS Lima Market Foundation Development Director 169093 0 18315 0 5283 0 229555 0 15799 0 438045 0 0 0 Timothy Koder Toledo Market Foundation President 205917 0 5778 0 1908 0 25658 0 15745 0 255006 0 0 0 SCOTT PEMBER Lorain Market Foundation Director 147852 0 4242 0 1483 0 10456 0 20975 0 185008 0 0 0 Schedule J, Part I, Line 4b Terms and conditions of the Cincinnati Market SERP The Cincinnati Market SERP is a deferred compensation plan which provides employment continuation incentives to all executive council members. It provides annual credits of a specified percentage of compensation. A benefit is calculated for any individual whose compensation is limited in the qualified cash balance plan due to income which exceeds the IRS maximum. The benefit is based upon Form W-2 compensation and is equal to the amount excluded from the qualified plan. Participants must complete a two tiered vesting provision. participants must be vested under the base qualified plan and must count 24 months after termination during which they do not compete with Mercy Health Cincinnati LLC. Amounts includible as taxable compensation for listed individuals due to executive benefit plan participation in the reporting year were as follows: Deborah Bloomfield $0. Schedule J, Part I, Line 4b Terms and conditions of Mercy Health 457(f) executive retention plan The Mercy Health executive retention plan is a deferred compensation plan which provides employment continuation incentives to persons selected by the Board of Trustees or its delegate. It provides annual credits of a specified percentage of compensation and annual interest credits. Participants vest and cease to receive credits after 5 years of plan participation provided they remain employed. Vesting and cessation of credits occur earlier for death or total disability while employed, involuntary termination of employment within 24 months after a change in control of the organization, or, for certain participants, upon being offered a specified promotion. Payment of the vested account balance in a lump sum occurs upon vesting. Amounts includable as taxable compensation for listed individuals due to retention plan participation in the reporting year were as follows: Michael Bezney $367,889. Schedule J, Part I, Line 4b Terms and conditions of the Youngstown Market SERP The Youngstown Market SERP Plan is a deferred compensation plan which provides supplemental retirement benefits to persons selected by the Mercy Health Youngstown LLC Board of trustees or its delegate. The Plan provides annual credits of a specified percentage of compensation and annual interest credits. Participants vest 100% in their accounts after three years of service, except for participants who had attained at least ten years of service at plan inception, who had immediate vesting. Vesting occurs earlier upon death or total disability. Payments are made during employment for required tax withholding. The vested account balance is paid as a lump sum after termination of employment. Amounts includible as taxable compensation for listed individuals due to SERP participation in the reporting year are as follows: James Schultis $0. Schedule J, Part I, Line 4b Terms and conditions of the Mercy Health System SERP The Mercy Health System SERP is a non-qualified deferred compensation plan which provides supplemental retirement benefits to persons selected by the Board of Trustees or its delegate. The plan provides for annual credits of a specified percentage of an eligible participants base salary paid in a plan year and interest credits. Plan participants vest in plan credits after completing a three year class vesting schedule or earlier for death or total disability or reaching age 60 while employed, or due to involuntary separation of employment other than for cause. Payments during employment are made for required tax withholding and reduce the participants account balance. Distribution of the vested account balance in a lump sum occurs after termination of employment. Amounts includible as taxable compensation for listed individuals due to SERP participation in the reporting year were as follows: Deborah Bloomfield $0; Travis Crum $0; Timothy Koder $0; Roger LaGreca $0; Tara Miller $0; Scott Pember $0; James Schultis $0. Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation Mercy Health Foundation relies upon Mercy Health to establish compensation of the organization's CEO/Executive Director. Mercy Health utilized a compensation committee, an independent compensation consultant, a compensation survey or study, and approval by board or compensation committee to establish the top management official's compensation. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan THE MERCY HEALTH SERP PLAN IS A DEFERRED COMPENSATION PLAN WHICH PROVIDES SUPPLEMENTAL RETIREMENT BENEFITS TO PERSONS SELECTED BY THE BOARD OF TRUSTEES OR ITS DELEGATES. IT PROVIDES ANNUAL CREDITS OF A SPECIFICED PERCENTAGE OF COMPENSATION AND ANNUAL INTEREST CREDITS. PARTICIPANTS VEST 50%, 75%, AND 100% IN THEIR ACCOUNTS AFTER 5, 6, AND 7 YEARS OF SERVICE, RESPECTFULLY. VESTING OCCURS EARLIER FOR DEATH OR TOTAL DISABILITY OR REACHING AGE 60 WHILE EMPLOYED, OR INVOLUNTARY TERMINATION OF EMPLOYMENT WITHIN 24 MONTHS AFTER A CHNAGE IN CONTROL OF THE ORGANIZATION OR DUE TO POSITION ELIMIATION. PAYMENTS DURING EMPLOYMENT ARE MADE FOR REQUIRED TAX WITHHOLDINGS. PAYMENT OF THE VESTED ACCOUNT BALANCE IN A LUMP SUM OCCURS AFTER TERMINATION OF EMPLOYMENT. AMOUNTS INCLUDIBLE AS TAXABLE COMPENSATION FOR LISTED INDIVIDUALS DUE TO SERP PARTICIPATION IN THE REPORTING YEAR WERE AS FOLLOWS: MICHAEL BEZNEY $109,878; MICHAEL CONNELLY $335,383. Schedule J, Part I, Line 7 Non-fixed payments The organization provides annual incentive compensation for listed individuals. The organization's Board of Trustees establishes objective thresholds for quality, community benefit, and financial performance which must be achieved for incentives to be awarded. The Board also establishes threshold, target and maximum levels for incentive awards. Within these established parameters, the Board determines the CEO's incentive award and incentive awards for other listed individuals are determined by the listed individual's supervisor and disclosed to the Board. The Board may authorize modified incentive awards when appropriate in its judgment. X 1 314293 Other 1 false true false Schedule M, Part I, Line 17 Description of charitable gift annuity The Foundation received 25 acres of undeveloped land, including a house and a barn. The appraised value of this property is $525,000. This contribution is subject to a charitable gift annuity liability of $210,707. Therefore $314,293 was recognized as contribution revenue at the time of the gift. Schedule M, Part I Explanations of reporting method for number on contributions Real estate - Other: Reporting the number of contributions. Schedule M, Part I, Line 17 Number of contributions or items contributed Reporting the number of contributions. Form 990, Part VI, Line 15a Determining the compensation of the top management official The compensation of the top management official is determined by Mercy Health, a related tax-exempt organization. Form 990, Part VI, Line 4 Significant changes to organizational documents The Amended Code of Regulations creates two classes of trustees: System and Market. The member elects system trustees whose powers and actions relate to the Corporation as a whole, including the budget, expenditures and finances of the Corporation, the management and investment of Corporate funds and choice of investment advisors and similar service providers, the election of Corporate officers, the designation of the Corporate CEO, and the establishment of Corporate committees and appointment of committee members. System trustees elect market trustees who exercise authority over the actions of the Corporation relevant to and affecting the Markets, including control in the market they serve over fund-raising, development of a culture of philanthropy, and the use of Foundation funds in the Market. Market trustees exercise these powers only as to the market in which they were appointed. Market trustees exercise no powers reserved to the System trustees. Only system trustees attend regular Corporate board meetings, although market trustees may be invited to attend, and each system trustee has one vote. Market trustees attend regular meetings in their particular market as they determine, and each has one vote in the market they serve. Form 990, Part VI, Line 6 Classes of members or stockholders MERCY HEALTH IS THE MEMBER OF MERCY HEALTH FOUNDATION. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body Mercy Health elects all trustees who have full voting rights. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders Certain matters require approval of Mercy Health, the Foundation's Corporate Member. The regulations of the organization describe the level of approval required for various decisions. Form 990, Part VI, Line 11b Review of form 990 by governing body THE FORM 990 IS PREPARED BY THE Mercy Health TAX DEPARTMENT AND REVIEWED BY MANAGEMENT. ONCE THE FORM 990 IS REVIEWED AND APPROVED BY ALL APPLICABLE PARTIES A COPY OF THE FINAL VERSION IS PROVIDED TO ALL MEMBERS OF THE GOVERNING BODY PRIOR TO FILING. Form 990, Part VI, Line 12c Conflict of interest policy All board members are covered by the Mercy Health conflict of interest policy, which requires disclosure on an annual basis. All potential conflicts of interest are reviewed by the Mercy health Corporate Compliance Officer. At the beginning of each board meeting all board members are requested to disclose any conflicts of interest. Board members determined to have a conflict of interest are prohibited from participating in deliberations and decision-making for the transaction in which the conflict exists. Form 990, Part VI, Line 19 Required documents available to the public The governing documents and financial statements are available upon request. The conflict of interest policy is posted on the Mercy Health website. 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