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 Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2017
Open to Public
Inspection
Name of the organization
MERCY HOSPITALCEDAR RAPIDSIA ENDOWMENT
FNDTN INC D/B/A MERCY MEDICAL CTR FDTN
Employer identification number

51-0233180
Return Reference Explanation
FORM 990, PART I, LINE 4 & PART VI, SECTION A, LINE 1B: THE FOLLOWING MERCY MEDICAL CENTER FOUNDATION DIRECTORS ARE NOT INDEPENDENT DUE TO TRANSACTIONS DISCLOSED ON FORM 990, SCHEDULE L OF MERCY MEDICAL CENTER, A RELATED TAX-EXEMPT ORGANIZATION: JANIS KAZIMOUR AND EMMETT J. SHERRMAN.
FORM 990, PART VI, SECTION B, LINE 11B PRIOR TO FILING THE FORM 990 WITH THE IRS, THE FORM IS REVIEWED BY THE MERCYCARE SERVICE CORPORATION, A RELATED ORGANIZATION, EXECUTIVE COMMITTEE. THE MERCY MEDICAL CENTER FOUNDATION BOARD SECRETARY AND FINANCIAL CHAIRMAN SIT ON THIS COMMITTEE. THE COMMITTEE IS PROVIDED WITH GENERAL BACKGROUND INFORMATION REGARDING THE FORM 990, AND THE FORM ITSELF (INCLUDING ATTACHMENTS) IS REVIEWED. UPON REQUEST, THE TAX RETURN WILL BE AVAILABLE FOR REVIEW BY THE MERCY MEDICAL CENTER BOARD OF TRUSTEES AND THE FOUNDATION BOARD OF DIRECTORS. MEMBERS OF THE EXECUTIVE COMMITTEES AND MANAGEMENT ARE AVAILABLE TO ANSWER QUESTIONS FROM THE TRUSTEES ON THE RETURN.
FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REQUIRES ALL DIRECTORS, OFFICERS, AND KEY EMPLOYEES, AS WELL AS EACH EMPLOYEE IN SELECT AREAS TO DISCLOSE ANY INTEREST IN, OBLIGATION OR DUTY TO, OR ACTIVITY FOR ANY CONCERN IN WHICH A DIRECTOR, OFFICER, KEY EMPLOYEE, OR EMPLOYEE OR THEIR FAMILY MEMBER MAY BE INVOLVED THAT: MIGHT CREATE AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST OR MIGHT HAVE THE APPEARANCE OF ADVERSELY AFFECTING THE DIRECTOR'S, OFFICER'S, KEY EMPLOYEE'S, OR EMPLOYEE'S JUDGMENT OR ACTIONS IN PERFORMING HIS/HER DUTIES TOWARDS MERCY. ALL SUCH DIRECTORS, OFFICERS, KEY EMPLOYEES, AND EMPLOYEES SHALL FILE AN INITIAL CONFLICT OF INTEREST REPORT UPON HIRE AND SHALL BE REQUIRED TO FILE AN UPDATED REPORT IMMEDIATELY IF ANY CHANGES OCCUR WHICH RESULT IN A CONFLICT OF INTEREST OR FINANCIAL INTEREST. ALL SUCH DIRECTORS, OFFICERS, KEY EMPLOYEES, AND EMPLOYEES (SUPERVISOR AND ABOVE), PHYSICIANS, AND ANY EMPLOYEE IN A POSITION TO INFLUENCE A PURCHASE DECISION SHALL RE-SUBMIT A CONFLICT OF INTEREST DISCLOSURE STATEMENT, WITH ANY NECESSARY CHANGES, EACH YEAR AND IMMEDIATELY IF ANY ADDITIONAL CONFLICTING OR FINANCIAL INTEREST ARISE. ALL BOARD MEMBERS SHALL SUBMIT IN WRITING A CONFLICT OF INTEREST DISCLOSURE STATEMENT LISTING ALL FINANCIAL AND CONFLICTING INTERESTS. THE STATEMENT SHALL BE RESUBMITTED WITH ANY NECESSARY CHANGES EACH YEAR AND AS ANY ADDITIONAL CONFLICTING OR FINANCIAL INTEREST ARISE.
FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT IS SET BY THE COMPENSATION COMMITTEE OF MERCYCARE SERVICE CORPORATION, A RELATED ORGANIZATION. THE COMMITTEE USES MERCER (US) INC. FOR THE REVIEW OF SALARIES AND COMPARES THEM TO COMPARABLE ENTITIES IN THE REGION. THIS PROCESS WAS LAST COMPLETED AND DOCUMENTED ON MARCH 29, 2018.
FORM 990, PART VI, SECTION C, LINE 19 THE FOUNDATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE FOR REVIEW UPON REQUEST.
FORM 990, PART VII, LINE 1A: MERCYCARE SERVICE CORPORATION, MERCY MEDICAL CENTER AND MERCY CARE MANAGEMENT, INC. AND SUBSIDIARIES ARE RELATED ORGANIZATIONS OF MERCY MEDICAL CENTER FOUNDATION. FOR THOSE INDIVIDUALS WHO PROVIDE SERVICES TO MULTIPLE ORGANIZATIONS, THE HOURS REPORTED ON FORM 990, PART VII, REFLECT TOTAL HOURS RENDERED ON BEHALF OF ALL THE ORGANIZATIONS. IT WOULD BE ADMINISTRATIVELY IMPRACTICABLE FOR MEMBERS OF THE GOVERNING BOARD AND EXECUTIVE TEAM TO BREAKOUT HOURS AMONG EACH ORGANIZATION.
FORM 990, PART XII, LINE 2C: THE OVERSIGHT AND SELECTION PROCESS HAS NOT CHANGED FROM THE PRIOR TAX YEAR.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2017


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