2016-11-09T14:02:40-06:00 2015-12-31 990 2015-01-01 311332491 Mercy Long Term Care Initiative MERC 5139525000 1701 Mercy Health Place Cincinnati OH 45237 Todd Lupton SVP & CFO, SOUTHERN DIVISION 2016-10-11 2015 2017-02-10 21:41:12Z X Providence Retirement Home Todd Lupton 1701 Mercy Health Place Cincinnati OH 45237 8188 false X N/A X 1991 IN PROVIDENCE RETIREMENT HOME IS A LONG-TERM CARE FACILITY OFFERING MULTI-LEVEL SERVICE. All long-term care operations ceased on October 1, 2013. 14 11 0 11 0 0 0 99896 4111 802 0 43089 4077 143787 8188 0 0 0 0 0 38826 24884 38826 24884 104961 -16696 26755 0 -5376428 0 5403183 0 PROVIDENCE RETIREMENT HOME EXTENDS THE HEALING MINISTRY OF JESUS BY IMPROVING THE HEALTH OF OUR COMMUNITIES WITH EMPHASIS ON PEOPLE WHO ARE POOR AND UNDER-SERVED. false false 21152 0 4111 The operating assets of the organization were sold on October 1 2013. All Long-Term care facility operations ceased as of that date. 21152 true false false false false false false false false false false false false false false true false true false false false false false false false false false false false true false false false false false false false false false false false false false true false false false true 0 0 0 false false false false false false false false false false X 14 11 false false false false true true true true true false false true true true true true true false false false X Travis Crum 5139525000 1701 Mercy Health PLACE Cincinnati OH 45237 TIMOTHY INGRAM CHAIRMAN 0.5 2.5 X X 0 0 0 JAMES J MCGRAW JR VICE CHAIRMAN 0.5 2.5 X X 0 0 0 JOHN STARCHER JR BD PRES & SECTRY, PRESIDENT/CEO CINCINNATI REGION, EVP OP 0.5 54.5 X X 0 1215329 19774 GERMAINE BENNETT TRUSTEE 0.5 2.5 X 0 0 0 SR MARJORIE BOSSE RSM TRUSTEE 0.5 3.5 X 0 0 0 KIMBERLY MAUER TRUSTEE 0.5 3.5 X 0 0 0 L RICHARD ROEDERSHEIMER MD TRUSTEE 0.5 40.0 X 0 422363 36000 EDWARD J VONDERBRINK TRUSTEE 0.5 2.0 X 0 0 0 ANTHONY J ARETZ PHD TRUSTEE 0.5 3.5 X 0 0 0 DANIEL GEEDING TRUSTEE 0.5 2.5 X 0 0 0 ED HERZIG MD TRUSTEE 0.5 40.0 X 0 312601 32428 REENA DHANDA PATIL MD TRUSTEE 0.5 2.5 X 0 0 0 DONNA ZARING TRUSTEE 0.5 2.5 X 0 0 0 Howard BELL MD TRUSTEE (Resigned in 2015) 1.0 2.0 X 0 0 0 Janet Reid TRUSTEE 0.5 1.0 X 0 0 0 DAVID NOWISKI REGION CFO (TO 6/1) 0.5 56.0 X 0 555988 105758 TODD LUPTON SVP & CFO, SOUTHERN DIVISION (FROM 6/1) 1.0 4.0 X 0 393800 28851 YOUSUF JAMAL AHMAD FORMER OFFICER 0.0 44.0 X 0 995663 29530 PATRICK KOWALSKI FORMER OFFICER 0.0 41.5 X 0 242026 21203 DEBORAH BLOOMFIELD FORMER OFFICER 0.0 50.0 X 0 805758 277576 0 4943528 551120 0 true true false 0 0 NET PATIENT SERVICE REVENUE 4111 4111 0 0 0 0 4111 0 0 0 0 Other revenue 900099 4077 4077 0 0 0 0 4077 8188 4111 0 4077 X 8582 7295 1287 0 15000 12750 2250 120 102 18 Loss from discontinued operations 1182 1005 177 0 0 0 0 24884 21152 3732 0 733 26022 0 0 0 0 0 0 0 26755 0 -5376428 0 0 -5376428 0 X 5403183 5403183 0 26755 0 X -16696 -5386487 X false true X true false X 29083 233240 58243 0 0 320566 10303141 9759089 12026856 99896 4111 32193093 0 0 0 10332224 9992329 12085099 99896 4111 32513659 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 32513659 4 1215 1017 802 0 3038 0 4 1215 1017 802 0 3038 0 201311 82959 31376 43089 4077 362812 10533539 10076503 12117492 143787 8188 32879509 0.9889 0.9883 0.0001 0.0001 X Schedule A, Part III, Line 12 Other Income DESCRIPTION - CAFETERIA, COLUMN A - 2873.0, COLUMN B - 1367.0, COLUMN C - 1951.0, COLUMN D - , COLUMN E - , COLUMN F - 6191.0; DESCRIPTION - PHONE & TV, COLUMN A - 15611.0, COLUMN B - 16042.0, COLUMN C - 12189.0, COLUMN D - , COLUMN E - , COLUMN F - 43842.0; DESCRIPTION - OTHER OPERATING REVENUE, COLUMN A - 178804.0, COLUMN B - 61619.0, COLUMN C - 13889.0, COLUMN D - , COLUMN E - , COLUMN F - 254312.0; DESCRIPTION - BEAUTY SHOP, COLUMN A - 0.0, COLUMN B - 10.0, COLUMN C - , COLUMN D - , COLUMN E - , COLUMN F - 10.0; DESCRIPTION - LAUNDRY, COLUMN A - 3578.0, COLUMN B - 3911.0, COLUMN C - 3347.0, COLUMN D - , COLUMN E - , COLUMN F - 10836.0; DESCRIPTION - VENDING MACHINES, COLUMN A - 0.0, COLUMN B - 0.0, COLUMN C - , COLUMN D - , COLUMN E - , COLUMN F - 0.0; DESCRIPTION - GIFT SHOP, COLUMN A - 445.0, COLUMN B - 10.0, COLUMN C - , COLUMN D - , COLUMN E - , COLUMN F - 455.0; DESCRIPTION - MISCELLANEOUS REVENUE, COLUMN A - 0.0, COLUMN B - 0.0, COLUMN C - 0.0, COLUMN D - 43089.0, COLUMN E - 4077.0, COLUMN F - 47166.0; 0 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote THE COMPANY [MERCY HEALTH PARTNERS AND AFFILIATED ENTITIES] COMPLETED AN ANALYSIS OF ITS TAX POSITIONS IN ACCORDANCE WITH APPLICABLE ACCOUNTING GUIDANCE AT DECEMBER 31, 2015 AND 2014, AND DETERMINED THAT NO AMOUNTS WERE REQUIRED TO BE RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS AT DECEMBER 31, 2015 OR 2014. true true false false false false false false false JOHN STARCHER JR BD PRES & SECTRY, PRESIDENT/CEO CINCINNATI REGION, EVP OP 0 727193 0 356655 0 131481 0 11886 0 7888 0 1235103 0 0 L RICHARD ROEDERSHEIMER MD TRUSTEE 0 297523 0 89252 0 35588 0 16218 0 19782 0 458363 0 0 ED HERZIG MD TRUSTEE 0 261991 0 29604 0 21006 0 16375 0 16053 0 345029 0 0 YOUSUF JAMAL AHMAD FORMER OFFICER 0 360103 0 139969 0 495591 0 10763 0 18767 0 1025193 0 111976 PATRICK KOWALSKI FORMER OFFICER 0 151350 0 56493 0 34183 0 6651 0 14552 0 263229 0 0 DEBORAH BLOOMFIELD FORMER OFFICER 0 588516 0 190400 0 26842 0 251633 0 25943 0 1083334 0 0 DAVID NOWISKI REGION CFO (TO 6/1) 0 365751 0 97915 0 92322 0 75895 0 29863 0 661746 0 0 TODD LUPTON SVP & CFO, SOUTHERN DIVISION (FROM 6/1) 0 207899 0 80000 0 105901 0 11519 0 17332 0 422651 0 0 Schedule J, Part I, Line 4b Terms and conditions of the Mercy Health SERP 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 delegate. It provides annual credits of a specified percentage of compensation and annual interest credits. Participants vest 50%, 75%, and 100% in their accounts after 5, 6, and 7 years of service, respectively. Vesting occurs earlier for death or total disability or reaching age 60 while employed, or involuntary termination of employment within 24 months after a change in control of the organization or due to position elimination. 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 includable as taxable compensation for listed individuals due to SERP participation in the reporting year were as follows: John Starcher, Jr. $111,779. 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: Yousuf Jamal Ahmad $159,920; David Nowiski $0; Deborah Bloomfield $0; Todd Lupton $0. Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation The compensation of Mercy Long Term Care Initiative's President, John Starcher, Jr., is determined by Mercy Health, a related tax-exempt organization. Mercy Health utilizes an independent compensation consultant, a compensation survey, and approval by board or compensation committee when determining Mr. Starcher's compensation. Schedule J, Part I, Line 4a Severance or change-of-control payment Severance benefits consisting of continuation of base salary and insurance benefits were provided to listed individuals for specified periods. The listed individuals executed releases and waivers of claims in exchange for the severance benefits. Salary continuation amounts provided during the reporting year to listed individuals were as follows: Yousuf Jamal Ahmad $286,582. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan The Cincinnati Market SERP is a deferred compensation plan which provides employment continuation incentives to all executive council members. The plan is no longer accepting new participants and the cessation of contributions has occurred. 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: Yousuf Jamal Ahmad $0; Patrick Kowalski $0; Deborah Bloomfield $0. Form 990, Part VI, Line 15 POLICIES NO COMPENSATION WAS PAID TO ANY OFFICER OR KEY EMPLOYEE BY THE FILING ORGANIZATION. Form 990, Part VI, Line 6 Classes of members or stockholders MERCY HEALTH CINCINNATI LLC IS THE SOLE MEMBER OF MERCY LONG TERM CARE INITIATIVE DBA PROVIDENCE RETIREMENT HOME. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body Mercy Health elects all board members who have full voting rights. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders CERTAIN MATTERS REQUIRE APPROVAL OF THE MERCY HEALTH CORPORATE MEMBER, THE MERCY HEALTH GOVERNING BODY, OR THE MERCY HEALTH CEO. 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 MERCY HEALTH'S Tax Department and reviewed by management. Once the Form 990 is reviewed 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 Each year trustees complete a conflict of interest statement that is subsequently approved by the audit & corporate responsibility committee (ACRC) at Mercy Health Cincinnati LLC and then sent to MERCY HEALTH for their ACRC to approve. Any conflicts of interest that occur during the year are required to be brought to the attention of the ACRC at Mercy Health Cincinnati LLC. Form 990, Part VI, Line 19 Required documents available to the public THE SYSTEM-WIDE CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE POSTED ON THE MERCY HEALTH WEBSITE. Form 990, Part IX, Line 11g Other Fees Consulting - Total Expense: 7636, Program Service Expense: 6491, Management and General Expenses: 1145, Fundraising Expenses: ; Other Purchased Services - Total Expense: 946, Program Service Expense: 804, Management and General Expenses: 142, Fundraising Expenses: ; Form 990, Part XI, Line 9 Other changes in net assets or fund balances Equity transfers to affiliates - -5386487; MERCY HEALTH 1701 Mercy Health Place CINCINNATI OH 45237 311161086 HEALTHCARE SYSTEM PARENT OH 501(c)(3 3 NA false MERCY HEALTH FOUNDATION 1701 Mercy Health Place CINCINNATI OH 45237 201072726 FUNDRAISING OH 501(c)(3 7 MERCY HEALTH false MERCY HEALTH RETIREMENT TRUST 1701 Mercy Health Place CINCINNATI OH 45237 316046304 RETIREMENT TRUST OH 501(c)(3 7 MERCY HEALTH false COMMUNITY HEALTH PARTNERS PHYSICIANS OFFICE BUILDINGS 3700 KOLBE ROAD LORAIN OH 44053 341268828 MEDICAL OFFICE RENTAL OH 501(c)(3 9 MERCY HEALTH - REGIONAL MEDICAL CENTER LLC false ALLEN MEDICAL CENTER MEDICAL OFFICE BUILDING 200 WEST LORAIN ST OBERLIN OH 44074 364504991 MEDICAL OFFICE RENTAL OH 501(c)(3 Type II MERCY HEALTH - 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