Mercy Long Term Care Initiative

EIN 31-1332491 • 501(c)3 • Cincinnati, OH

Profile

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.

1701 Mercy Health PlaceCincinnati, OH 45237

n/A

Siviq Scores

Precomputed percentiles relative to similar nonprofits. These scores are descriptive rather than judgmental.

No value available

Liabilities-to-assets requires both liabilities and assets on the latest valid filing.

Source year 2017

No value available

Liabilities-to-revenue requires both liabilities and revenue on the latest valid filing.

Source year 2017

No value available

Net margin requires both revenue and expenses on the latest valid filing.

Source year 2017

$5,580,929

Higher top officer pay than 100% of similar nonprofits.

501(c)3 • <$500k nonprofits • Source year 2017

No value available

A valid growth rate could not be computed from the available filing history.

Annualized from 2016 to 2017

No value available

A valid growth rate could not be computed from the available filing history.

Annualized from 2016 to 2017

Balance Sheet

Liabilities / AssetsScore unavailable

Assets

Flat

Flat from 2016

Liabilities

Flat

Flat from 2016

Net Assets

Flat

Flat from 2016

Operations

Liabilities / RevenueScore unavailable Net MarginScore unavailable

Revenue

Flat

Flat from 2016

Expenses

Flat

Flat from 2016

Net Income

Flat

Flat from 2016

Trend Graphs

Balance Sheet Trend

Asset GrowthScore unavailable

Grouped bars show assets, liabilities, and net assets across loaded filings.

Highlighted filing

2017

Assets$0

Liabilities$0

Net Assets$0

Open 2017 Filing

Operations Trend

Revenue GrowthScore unavailable

Revenue, expenses, and net income by year, with the latest filing highlighted.

Highlighted filing

2017

Revenue$0

Expenses$0

Net Income$0

Open 2017 Filing

Filings

Most recent year

2017 • Form 990Detailed filing. Detailed filing data is available for this year.

Open filing

Assets: $0
Liabilities: $0
Net assets: $0
Revenue: $0
Expenses: $0
Net income: $0

	Balance Sheet			Operations
Year	Assets	Liabilities	Net Assets	Revenue	Expenses	Net Income
2017Detailed filing. Detailed filing data is available for this year.	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2016Detailed filing. Detailed filing data is available for this year.	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
2015Detailed filing. Detailed filing data is available for this year.	$0.00	$0.00	$0.00	$0.01	$0.02	$0.02
2014Detailed filing. Detailed filing data is available for this year.	$0.03	$5.38	$5.40	$0.14	$0.04	$0.10
2013Detailed filing. Detailed filing data is available for this year.	$0.10	$5.40	$5.30	$12.1	$7.31	$4.81
2012Facts available. Structured filing facts are available, but richer extracted sections are limited.	$7.02	$6.53	$0.49		$9.76
2011Facts available. Structured filing facts are available, but richer extracted sections are limited.	$6.70	$6.53	$0.17		$10.3
2010Facts available. Structured filing facts are available, but richer extracted sections are limited.	$7.08	$7.09	$0.02		$11.1

Latest Filing Detail

Jump To

Filing Snapshot

Filing Period: Jan 1, 2017 to Dec 31, 2017
Signed: Nov 13, 2018
Return Version: 2017v2.2
Gross Receipts: $0

Mission and Program Overview

Mission

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.

PROVIDENCE RETIREMENT HOME IS A LONG-TERM CARE FACILITY OFFERING MULTI-LEVEL SERVICE. All long-term care operations ceased on October 1, 2013.

Balance Sheet Detail

Line	Beginning	End	Change
Assets
Receivable From Disqualified Prsn	-	$0	-
Receivables From Officers Etc	$0	$0	→ $0
Investments Other Securities	$0	-	-
Investments Program Related	$0	-	-
Land, Buildings, and Equipment, Net	-	$0	-
Loans From Officers Directors	-	$0	-
Other Assets Total	$0	$0	→ $0
Total Assets	$0	$0	→ $0
Liabilities
Other Liabilities	$0	$0	→ $0
Total Liabilities	$0	$0	→ $0
Net Assets / Fund Balance
Total Net Assets Fund Balance	$0	$0	→ $0
Total Liabilities and Net Assets / Fund Balance	$0	$0	→ $0

Compensation and Service Providers

Top Officer Pay100th percentile

Board Members and Trustees

Name	Title
-	Chairman
-	Former Cincinnati Market President & Board Secretary
-	Vice Chair
-	Trustee
-	Trustee (end 2/17)
-	Trustee, Evp & COO, Mercy Health
-	Bd Pres/SECTRY,PRES/CEO CINTI REGION,SVP MERCY HEALTH
-	Cincinnati Region CFO (begin 7/17)
-	Cincinnati Region CFO (end 6/17)
-	FORMER Pres/CEO Cincinnati Region, SVP Mercy Health
-	Former Region CFO
-	Former SVP, Market CFO

Revenue and Support

Revenue Composition

Contributions and Grants: $0
Program Service Revenue: $0
Investment Income: $0
Other Revenue: $0
Change in Net Assets: $0

Expenses and Functional Allocation

Major Expense Lines

Line Item	Amount
Grants and Similar Amounts Paid	$0
Other Expenses	$0
Professional Fundraising Fees	$0
Salaries, Compensation, and Employee Benefits	$0
Total Fundraising Expense	$0

Fundraising, Events, and Gaming

Fundraising activities: No
Gaming activities: No
Professional fundraiser used: No

Fundraising and Gaming Totals

Line Item	Amount
Professional Fundraising Fees	$0

Political and Lobbying Activity

Political campaign activity: No
Lobbying activity: No
Subject to proxy tax: No

Insider Transactions and Loans

Loans and Receivables

Line Item	Beginning	End	Change
Loans from Officers, Directors, Trustees, and Key Employees	-	$0	-
Receivables from Disqualified Persons	-	$0	-
Receivables from Officers, Directors, Trustees, and Key Employees	$0	$0	→ $0

Related Organizations and Partnerships

Related Tax-Exempt Organizations

Organization	Location	Activity	Code	Public Charity	Controlled
Allen Medical Center Medical Office Building	Oberlin, OH	Medical Office Rental	501(c)(3)	10	No
C H Health Services Company	Springfield, OH	Hospital	501(c)(3)	3	No
Community Health Partners Physicians Office Buildings	Lorain, OH	Medical Office Rental	501(c)(3)	10	No
Community Mercy Health Partners	Springfield, OH	Hospital	501(c)(3)	3	No
Community Mercy Health System	Springfield, OH	Market Parent	501(c)(3)	Type III-FI	No
Healthspan Integrated Care	Cincinnati, OH	Hmo	501(c)(3)	-	No
Healthspan Partners	Cincinnati, OH	Market Parent	501(c)(3)	10	No
Hospice of the Valley	Youngstown, OH	Hospice Services	501(c)(3)	10	No
Humility House	Austintown, OH	Nursing Home	501(c)(3)	10	No
Lifestar Ambulance Inc	Toledo, OH	Medical Transportation	501(c)(3)	10	No
Lourdes Hospital Auxiliary Gift Shop	Paducah, KY	Fundraising	501(c)(3)	3	No
Mercy College of Ohio	Toledo, OH	Medical College	501(c)(3)	7	No
Mercy College of Ohio Foundation Inc	Toledo, OH	Foundation	501(c)(3)	10	No
Mercy Franciscan Senior Health and Housing Services Inc	Cincinnati, OH	Retirement Home	501(c)(3)	10	No
Mercy Franciscan Social Ministries Inc	Cincinnati, OH	Low Income Housing	501(c)(3)	7	No
Mercy Health	Cincinnati, OH	Healthcare System Parent	501(c)(3)	3	No
Mercy Health Care Center	Cincinnati, OH	Hospital	501(c)(3)	Type II	No
Mercy Health Foundation	Cincinnati, OH	Fundraising	501(c)(3)	7	No
Mercy Health Retirement Trust	Cincinnati, OH	Retirement Trust	501(c)(3)	7	No
Mercy Long Term Care Initiative	New Albany, OH	Retirement Home	501(c)(3)	10	No
Mercy Property Holdings	Toledo, OH	Title Holding Company	501(c)(2)	2	No
Mercy Sacred Heart Inc	Louisville, KY	Retirement Home	501(c)(3)	10	No
New Vision Medical Laboratories Inc	Lima, OH	Medical Lab Services	501(c)(3)	10	No
Simon Outreach Services	Oregon, OH	Medical Office Rental	501(c)(3)	3	No
St Joseph Health Center Auxiliary	Warren, OH	Fundraising	501(c)(3)	10	No
The Assumption Village	North Lima, OH	Nursing Home	501(c)(3)	10	No
The Wallace S Murray and Frances Rabbitts Murray Memorial Trust	Springfield, OH	Indigent Medical Care	501(c)(3)	Type I	No

Related Partnerships and Joint Ventures

Organization	Location	Activity	Income	Assets	Ownership	Managing Partner
Advanced Health Select LLC	Cincinnati, OH	Clinically-Integrated Network	-	-	-	-
Kidney Services of West Central Ohio	Lima, OH	Dialysis Center	-	-	-	-
Lourdes Ambulatory Surgery Center	Paducah, KY	Surgery Center	-	-	-	-
Marshall County MRI LLC	Benton, KY	MRI facility	-	-	-	-
Mercy Health Innovations LLC	Cincinnati, OH	Business Development	-	-	-	-
NWO Integrated Laboratories Mercy LLC	Toledo, OH	Laboratory services	-	-	-	-
New Vision Medical Lab LLC	Lima, OH	Lab Services	-	-	-	-
Osc-hmhp LLC	Boardman, OH	Orthopedic Surgery Center	-	-	-	-
Premium Surgery Center LLC	Brentwood, TN	Surgery Center	-	-	-	-
Tiffin Ambulatory Surgical Associates	Tiffin, OH	Ambulatory Surgery Center	-	-	-	-
Urologic Oncology of Mahoning Valley LLC	Youngstown, OH	Radiation Therapy	-	-	-	-
West Central Ohio Group Ltd	Lima, OH	Orthopedic Hospital	-	-	-	-
West Central Ohio Regional Healthcare Alliance Ltd	Lima, OH	Healthcare quality	-	-	-	-

Governance and Compliance

Governance Checklist

Compiled or reviewed by an accountant: No
Annual disclosure for covered persons: Yes
Audit committee: Yes
Business relationship with family members: No
Business relationship with organization members: No
Material changes to governing documents: No
Compensation from other sources disclosed: No
CEO compensation reviewed: No
Other officer compensation reviewed: No
Conflict-of-interest policy: Yes
Audited financial statements prepared: Yes
Key decisions subject to board approval: Yes
Management duties delegated: No

Governance Explanations

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 shareholder 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.”

Filing and Contact Details

Filer

Filer Name: Mercy Long Term Care Initiative
EIN: 31-1332491
Phone: 5139525000
Address: 1701 Mercy Health Place, Cincinnati, OH 45237
Doing Business As: Providence Retirement Home

Signing Officer

Name: Eric Smith
Title: CFO Cincinnati Region
Signed: 2018-11-13

Organization Details

Formed: 1991
Legal Domicile: In
Voting Board Members: 16
Independent Board Members: 12
Employees: 0
Volunteers: 12

Supplemental Narrative

Additional Explanations

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 $409,270; Deborah Bloomfield $0.”

Financial Statement Notes

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, 2017 and 2016, and determined that no amounts were required to be recognized in the consolidated financial statements at december 31, 2017 or 2016.”

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IRS990/Form990PartVIISectionAGrp/TitleTxt	1	VICE CHAIR
IRS990/Form990PartVIISectionAGrp/TitleTxt	2	Bd Pres/SECTRY,PRES/CEO CINTI REGION,SVP MERCY HEALTH
IRS990/Form990PartVIISectionAGrp/TitleTxt	3	TRUSTEE (END 2/17)
IRS990/Form990PartVIISectionAGrp/TitleTxt	4	TRUSTEE
IRS990/Form990PartVIISectionAGrp/TitleTxt	5	TRUSTEE
IRS990/Form990PartVIISectionAGrp/TitleTxt	6	TRUSTEE (END 2/17)
IRS990/Form990PartVIISectionAGrp/TitleTxt	7	TRUSTEE
IRS990/Form990PartVIISectionAGrp/TitleTxt	8	TRUSTEE, EVP & COO, MERCY HEALTH
IRS990/Form990PartVIISectionAGrp/TitleTxt	9	TRUSTEE
IRS990/Form990PartVIISectionAGrp/TitleTxt	10	TRUSTEE
IRS990/Form990PartVIISectionAGrp/TitleTxt	11	TRUSTEE
IRS990/Form990PartVIISectionAGrp/TitleTxt	12	TRUSTEE
IRS990/Form990PartVIISectionAGrp/TitleTxt	13	TRUSTEE
IRS990/Form990PartVIISectionAGrp/TitleTxt	14	TRUSTEE
IRS990/Form990PartVIISectionAGrp/TitleTxt	15	TRUSTEE
IRS990/Form990PartVIISectionAGrp/TitleTxt	16	TRUSTEE
IRS990/Form990PartVIISectionAGrp/TitleTxt	17	TRUSTEE
IRS990/Form990PartVIISectionAGrp/TitleTxt	18	CINCINNATI REGION CFO (END 6/17)
IRS990/Form990PartVIISectionAGrp/TitleTxt	19	CINCINNATI REGION CFO (BEGIN 7/17)
IRS990/Form990PartVIISectionAGrp/TitleTxt	20	FORMER REGION CFO
IRS990/Form990PartVIISectionAGrp/TitleTxt	21	FORMER Pres/CEO Cincinnati Region, SVP Mercy Health
IRS990/Form990PartVIISectionAGrp/TitleTxt	22	FORMER SVP, MARKET CFO
IRS990/Form990PartVIISectionAGrp/TitleTxt	23	FORMER CINCINNATI MARKET PRESIDENT & BOARD SECRETARY
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IRS990/FormationYr	0	1991
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IRS990/GamingActivitiesInd	0	false
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IRS990/IncludeFIN48FootnoteInd	0	true
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IRS990/MissionDesc	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.
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IRS990ScheduleA/Form990ScheduleAPartVIGrp/FormAndLineReferenceDesc	0	Schedule A, Part III, Line 12 Other Income
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IRS990ScheduleA/SubstAndDsqlfyPrsnsTotGrp/CurrentTaxYearMinus2YearsAmt	0	0

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