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 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2016
Open to Public
Inspection
Name of the organization
BROTHERS OF MERCY NURSING HOME CO INC
 
Employer identification number

23-7155198
Return Reference Explanation
FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN INDEPENDENT OUTSIDE ACCOUNTING FIRM. IT IS REVIEWED BY THE CFO AND A COPY IS PROVIDED TO THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION B, LINE 12C QUESTIONNAIRE IS SENT OUT ANNUALLY AND INFORMATION REGARDING POTENTIAL CONFLICTS OF INTEREST IS MAINTAINED BY ADMINISTRATION. COMPLETED QUESTIONNAIRES ARE KEPT ON FILE IN THE FINANCE OFFICE.
FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS REVIEWS SALARIES FOR TOP MANAGEMENT OFFICIALS AND USES COMPARABILITY DATA FROM NYAHSA (NEW YORK ASSOCATION FOR HOMES AND SERVICES FOR THE AGING) IN ORDER TO DETERMINE SALARIES.
FORM 990, PART VI, SECTION C, LINE 18 THE FORM 1023 AND FORM 990 ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART VI, SECTION C, LINE 19 DISCLOSURE OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS IS BASED ON THE PURPOSE OF THE REQUEST.
FORM 990, PART IX, LINE 11G CONSULTING: PROGRAM SERVICE EXPENSES 296,435. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 296,435. DIETARY SERVICES: PROGRAM SERVICE EXPENSES 662,679. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 662,679. MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 136,507. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 136,507. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 187,056. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 187,056. THERAPY SERVICES: PROGRAM SERVICE EXPENSES 1,549,377. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,549,377. X-RAY SERVICES: PROGRAM SERVICE EXPENSES 84,882. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 84,882.
FORM 990, PART XII, LINE 2C: THERE HAS BEEN NO CHANGE IN THE AUDIT OVERSIGHT PROCESS OR THE AUDITOR SELECTION PROCESS.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2016


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