MERCY FOUNDATION INC: Form 990, tax year 2014

View the entire original 990 at ProPublica ↗

Organization
MERCY FOUNDATION INC (EIN 23-7275336)
Tax period
2014-07-01 to 2015-06-30
Filed
2016-05-10
IRS object ID
201631319349302073
Schema version
2014v6.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2016-05-10T14:41:55-05:00ReturnTs
Tax Period End2015-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN390859910PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1BAKER TILLY VIRCHOW KRAUSE LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1500 MIDLAND COURT PO BOX 8130AddressLine1Txt
CityJANESVILLECityNm
State AbbreviationWIStateAbbreviationCd
ZIP535478130ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2014-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN237275336EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1MERCY FOUNDATION INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlMERCBusinessNameControlTxt
Phone6087566000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 5003 - 1000 MINERAL POINTAddressLine1Txt
CityJANESVILLECityNm
State AbbreviationWIStateAbbreviationCd
ZIP535475003ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonJAVON BEAPersonNm
Person TitlePRESIDENTPersonTitleTxt
Phone6087566000PhoneNum
Signature2016-05-09SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonBRADLEY S MCGUIRE CPAPreparerPersonNm
PTINP00643763PTIN
Phone6087525835PhoneNum
Preparation2016-05-08PreparationDt
Self EmployedYes (X)SelfEmployedInd
FieldValueIRS element (for citing)
Tax2014TaxYr
Build TS2016-08-17 19:52:53ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerJAVON BEAPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 5003 - 1000 MINERAL POINTAddressLine1Txt
CityJANESVILLECityNm
State AbbreviationWIStateAbbreviationCd
ZIP535475003ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$1,405,214GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressN/AWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1972FormationYr
Legal Domicile StateWILegalDomicileStateCd
Activity Or MissionTO SUPPORT MERCY HEALTH SYSTEM CORP, THE HOUSE OF MERCY & MERCY ASSISTED CARE HOSPICE PROGRAM.ActivityOrMissionDesc
Voting Members Governing Body3VotingMembersGoverningBodyCnt
Voting Members Independent1VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers80TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$427,450PYContributionsGrantsAmt
CY Contributions Grants$694,236CYContributionsGrantsAmt
PY Program Service Revenue$106,800PYProgramServiceRevenueAmt
CY Program Service Revenue$66,600CYProgramServiceRevenueAmt
PY Investment Income$225,982PYInvestmentIncomeAmt
CY Investment Income$80,173CYInvestmentIncomeAmt
PY Other Revenue-$12,838PYOtherRevenueAmt
CY Other Revenue-$30,274CYOtherRevenueAmt
PY Total Revenue$747,394PYTotalRevenueAmt
CY Total Revenue$810,735CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$113,160PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$115,669CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$148,001CYTotalFundraisingExpenseAmt
PY Other Expenses$334,362PYOtherExpensesAmt
CY Other Expenses$616,247CYOtherExpensesAmt
PY Total Expenses$447,522PYTotalExpensesAmt
CY Total Expenses$731,916CYTotalExpensesAmt
PY Revenues Less Expenses$299,872PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$78,819CYRevenuesLessExpensesAmt
Total Assets BOY$1,871,870TotalAssetsBOYAmt
Total Assets EOY$1,897,329TotalAssetsEOYAmt
Total Liabilities BOY$0TotalLiabilitiesBOYAmt
Total Liabilities EOY$0TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$1,871,870NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$1,897,329NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionTO SUPPORT MERCY HEALTH SYSTEM CORP, THE HOUSE OF MERCY & MERCY ASSISTED CARE HOSPICE PROGRAM.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$171,239ExpenseAmt
DescHOUSE OF MERCY, A HOMELESS SHELTER, PROVIDED 7,816 SHELTER NIGHTS. A TOTAL OF 253 INDIVIDUALS (151 ADULTS AND 102 CHILDREN) WERE SERVED.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$45,470ExpenseAmt
Revenue$66,600RevenueAmt
DescMERCY FOUNDATION PROVIDES SUBSIDY FUNDING FOR THE MERCY HEALTH SYSTEM RESIDENCY PROGRAM. USE OF THESE DONATIONS ARE FOR EDUCATIONAL NECESSITIES OUTSIDE THE NORMAL OPERATING BUDGET OF THE MERCY RESIDENCY PROGRAM. FUNDS COVERED EXPENSES OF SIX ON A MEDICAL MISSION TO GUATEMALA (IN CONJUNCTION WITH TIMMY GLOBAL HEALTH'S CINCINNATI MD SCHOOL) OCT 9TH - OCT 19TH, 2014.Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

FieldValueIRS element (for citing)
Expense$318,357ExpenseAmt
DescMERCY FOUNDATION DONATED LUCAS (CHEST COMPRESSION) MACHINES PLUS SUPPLIES, DEFIBULATORS AND REFRIDGERATORS TO EMS PROGRAMS.Desc

Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp

FieldValueIRS element (for citing)
Expense$21,617ExpenseAmt
DescOTHER MISCELLANEOUS PROGRAM EXPENSESDesc
FieldValueIRS element (for citing)
Total Other Prog Srvc Expense$21,617TotalOtherProgSrvcExpenseAmt
Total Program Service Expenses$556,683TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building Equipment0ReportLandBuildingEquipmentInd
Report Investments Other SecYes (1)ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other Liabilities0ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising ActivitiesYes (1)FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document5IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee0EmployeeCnt
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo ContributionsYes (1)QuidProQuoContributionsInd
Quid Pro Quo Contri DisclYes (1)QuidProQuoContriDisclInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members3GoverningBodyVotingMembersCnt
Independent Voting Member1IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn Body0Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower Policy0WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldWIStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1JOHN COOKBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone6087566642PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11000 MINERAL POINTAddressLine1Txt
CityJANESVILLECityNm
State AbbreviationWIStateAbbreviationCd
ZIP535475003ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (5 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
LARRY E SQUIRE
TREASURER & DIRECTOR1.002.00Yes (X)Yes (X)$0$2,333$0
RICHARD GRUBER
VICE-PRESIDENT1.0055.00Yes (X)$0$225,377$30,391
MARK GOELZER
SECRETARY & DIRECTOR1.0055.00Yes (X)Yes (X)$0$457,757$31,022
JAVON R BEA
PRESIDENT & DIRECTOR1.0055.00Yes (X)Yes (X)$0$8,005,192$38,785
BARB BORTNER
VICE-PRESIDENT1.0055.00Yes (X)$0$216,651$36,963
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$8,907,310TotReportableCompRltdOrgAmt
Total Other Compensation$137,161TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
Fundraising$166,965FundraisingAmt
Related Organizations$341,500RelatedOrganizationsAmt
Government Grants$3,500GovernmentGrantsAmt
All Other Contributions$182,271AllOtherContributionsAmt
Total Contributions$694,236TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescFAMILY PRACTICE RESIDEDesc
Business900099BusinessCd
Total Revenue Column$66,600TotalRevenueColumnAmt
Related Or Exempt Func Income$66,600RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$66,600TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$41,809TotalRevenueColumnAmt
Exclusion$41,809ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$497,925SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$459,561SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$38,364SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$38,364TotalRevenueColumnAmt
Exclusion$38,364ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$104,644FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event$166,965ContriRptFundraisingEventAmt
Fundraising Direct Expenses$134,918FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column-$30,274TotalRevenueColumnAmt
Exclusion-$30,274ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$810,735TotalRevenueColumnAmt
Related Or Exempt Func Income$66,600RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$49,899ExclusionAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$109,722TotalAmt
Fundraising$109,722FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$301TotalAmt
Fundraising$301FundraisingAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$5,646TotalAmt
Fundraising$5,646FundraisingAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$10,250TotalAmt
Management And General$10,250ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$12,285TotalAmt
Management And General$12,285ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$12,419TotalAmt
Management And General$3,983ManagementAndGeneralAmt
Fundraising$8,436FundraisingAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$2,759TotalAmt
Fundraising$2,759FundraisingAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$689TotalAmt
Management And General$689ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtFundraisingFundraisingAmt
EMS DONATIONS$318,357$318,357
HOUSE OF MERCY EXP (HOM$171,239$171,239
RESIDENCY PROGRAM EXPEN$45,470$45,470
OTHER FUNDRAISING EXPEN$17,082$17,082

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$25,697TotalAmt
Program Services$21,617ProgramServicesAmt
Management And General$25ManagementAndGeneralAmt
Fundraising$4,055FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$731,916TotalAmt
Program Services$556,683ProgramServicesAmt
Management And General$27,232ManagementAndGeneralAmt
Fundraising$148,001FundraisingAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$139,902BOYAmt
EOY$159,148EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$1,697,921BOYAmt
EOY$1,735,718EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$34,047BOYAmt
EOY$2,463EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$1,871,870BOYAmt
EOY$1,897,329EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$1,871,870BOYAmt
EOY$1,897,329EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$1,871,870BOYAmt
EOY$1,897,329EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$1,871,870BOYAmt
EOY$1,897,329EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$78,819ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$53,360NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3Yes (X)SupportingOrganization509a3Ind
Supporting Org Type1Yes (X)SupportingOrgType1Ind
Supported Organizations2SupportedOrganizationsCnt

Supported Org Information SupportedOrgInformationGrp (2 entries)

EINEINOrganization TypeOrganizationTypeCdGoverning Document ListedGoverningDocumentListedIndSupportSupportAmtOther SupportOtherSupportAmt
MERCY ASSISTED CARE INC
3910351109Yes (1)$0$0
MERCY HEALTH SYSTEM CORPORATION
3908168483Yes (1)$0$0
FieldValueIRS element (for citing)
Supported Organizations Total2SupportedOrganizationsTotalCnt
Support Sum$0SupportSumAmt
Other Support Sum$0OtherSupportSumAmt

Form990 Sch A Supporting Org Form990SchASupportingOrgGrp

FieldValueIRS element (for citing)
Listed By Name Governing DocYes (1)ListedByNameGoverningDocInd
Suprt Org No IRS Determination0SuprtOrgNoIRSDeterminationInd
Supported Org Section C4560SupportedOrgSectionC456Ind
Supported Org Not Organized US0SupportedOrgNotOrganizedUSInd
Organization Change Suprt Org0OrganizationChangeSuprtOrgInd
Support Non Supported Org0SupportNonSupportedOrgInd
Payment Substantial Contribtr0PaymentSubstantialContribtrInd
Loan Disqualified Person0LoanDisqualifiedPersonInd
Controlled Disqualified Prsn0ControlledDisqualifiedPrsnInd
Disqualified Prsn Controll Int0DisqualifiedPrsnControllIntInd
Disqualified Prsn Ownr Int0DisqualifiedPrsnOwnrIntInd
Excess Business Holdings Rules0ExcessBusinessHoldingsRulesInd
Contribution Controller0ContributionControllerInd
Contribution Family0ContributionFamilyInd
Contribution35 Controlled0Contribution35ControlledInd

Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp

FieldValueIRS element (for citing)
Power Appoint Majority Dir TrstYes (1)PowerAppointMajorityDirTrstInd
Operate Benefit Non Suprt Org0OperateBenefitNonSuprtOrgInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Total Book Value Land Buildings$0TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp

FieldValueIRS element (for citing)
DescVARIOUS INVESTMENTSDesc
Book Value$1,735,718BookValueAmt
Method ValuationFMethodValuationCd
FieldValueIRS element (for citing)
Total Book Value Securities$1,735,718TotalBookValueSecuritiesAmt

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

FieldValueIRS element (for citing)
Event1CHARITY BALLEvent1Nm
Gross Receipts Event1$181,718GrossReceiptsEvent1Amt
Charitable Contri Event1$114,359CharitableContriEvent1Amt
Gross Revenue Event1$67,359GrossRevenueEvent1Amt
Cash Prizes Event1$2,500CashPrizesEvent1Amt
Non Cash Prizes Event1$4,000NonCashPrizesEvent1Amt
Rent Facility Costs Event1$1,832RentFacilityCostsEvent1Amt
Food And Beverage Event1$16,397FoodAndBeverageEvent1Amt
Entertainment Event1$3,000EntertainmentEvent1Amt
Other Direct Expenses Event1$55,774OtherDirectExpensesEvent1Amt
Event2JINGLE MINGLEEvent2Nm
Gross Receipts Event2$80,782GrossReceiptsEvent2Amt
Charitable Contri Event2$52,606CharitableContriEvent2Amt
Gross Revenue Event2$28,176GrossRevenueEvent2Amt
Cash Prizes Event2$5,500CashPrizesEvent2Amt
Non Cash Prizes Event2$1,500NonCashPrizesEvent2Amt
Rent Facility Costs Event2$600RentFacilityCostsEvent2Amt
Food And Beverage Event2$5,005FoodAndBeverageEvent2Amt
Entertainment Event2$500EntertainmentEvent2Amt
Other Direct Expenses Event2$23,738OtherDirectExpensesEvent2Amt
Other Events Total3OtherEventsTotalCnt
Gross Receipts Other Events$9,109GrossReceiptsOtherEventsAmt
Charitable Contri Other Events$0CharitableContriOtherEventsAmt
Gross Revenue Other Events$9,109GrossRevenueOtherEventsAmt
Oth Direct Expnss Other Events$14,572OthDirectExpnssOtherEventsAmt
Gross Receipts Total$271,609GrossReceiptsTotalAmt
Charitable Contributions Tot$166,965CharitableContributionsTotAmt
Gross Revenue Total Events$104,644GrossRevenueTotalEventsAmt
Cash Prizes Total Events$8,000CashPrizesTotalEventsAmt
Non Cash Prizes Total Events$5,500NonCashPrizesTotalEventsAmt
Rent Fclty Costs Total Events$2,432RentFcltyCostsTotalEventsAmt
Food And Beverage Total Events$21,402FoodAndBeverageTotalEventsAmt
Entertainment Total Events$3,500EntertainmentTotalEventsAmt
Oth Direct Expnss Total Events$94,084OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events$134,918DirectExpenseSummaryEventsAmt
Net Income Summary-$30,274NetIncomeSummaryAmt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (4 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
RICHARD GRUBER
VICE-PRESIDENT$0$130,941$0$82,314$0$12,122$0$14,517$0$15,874$0$255,768$0$0
MARK GOELZER
SECRETARY & DIRECTOR$0$453,043$0$0$0$4,714$0$17,160$0$13,862$0$488,779$0$0
JAVON R BEA
PRESIDENT & DIRECTOR$0$1,076,489$0$3,313,796$0$3,614,907$0$17,160$0$21,625$0$8,043,977$0$0
BARB BORTNER
VICE-PRESIDENT$0$138,043$0$75,288$0$3,320$0$14,119$0$22,844$0$253,614$0$0

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION B, LINE 11MANAGEMENT REVIEWS THE FORM 990 BEFORE FILING AND IT IS AVAILABLE TO THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION B, LINE 12COFFICERS, DIRECTORS, AND KEY EMPLOYEES ARE REQUIRED TO REPORT ALL CONFLICTS OF INTEREST. THE COMPLIANCE OFFICER IS RESPONSIBLE FOR INVESTIGATING ALL CONFLICTS AND REPORTING TO THE BOARD.
FORM 990, PART VI, SECTION C, LINE 19GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY & FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (13 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationIndDirect Controlling NADirectControllingNACd
MERCY ALLIANCE INC
1000 MINERAL POINT AVEJANESVILLEWI53548391679859SUPPORT OF HEALTHCAREWI501(C)(3)11AMERCYROCKFORD HEALTH SYSTEM CORPORATION0
MERCY HEALTH SYSTEM ASSOCIATION OF VOLUNTEERS
1000 MINERAL POINT AVEJANESVILLEWI53548390912682SUPPORT OF HEALTHCAREWI501(C)(3)11CMERCY HEALTH SYSTEM CORPORATION0
MERCY HEALTH SYSTEM CORPORATION
1000 MINERAL POINT AVEJANESVILLEWI53548390816848SUPPORT OF HEALTHCAREWI501(C)(3)3MERCY ALLIANCE INC0
MERCY ASSISTED CARE INC
901 MINERAL POINT AVEJANESVILLEWI53548391035110HEALTHCAREWI501(C)(3)9MERCY ALLIANCE INC0
MERCY HARVARD HOSPITAL INC
901 GRANT STREETHARVARDIL60033311551871HEALTHCAREIL501(C)(3)3MERCY ALLIANCE INC0
HARVARD MEMORIAL HOSPITAL FOUNDATION
901 GRANT STREETHARVARDIL60033364308662SUPPORT OF HEALTHCAREIL501(C)(3)LINE 11A, IMERCY HARVARD HOSPITAL INC0
MERCY CRYSTAL LAKE HOSPITAL AND MEDICAL CENTER
1000 MINERAL POINT AVEJANESVILLEWI535475003201673011NONEIL501(C)(3)LINE 3MERCY ALLIANCE INC0
MERCYROCKFORD HEALTH SYSTEM CORPORATION
2400 N ROCKTON AVEROCKFORDIL61103472158680SUPPORT OF HEALTHCAREIL501(C)(3)LINE 11A, I0N/A
ROCKFORD MEMORIAL HOSPITAL
2400 N ROCKTON AVEROCKFORDIL61103362167847HEALTHCAREIL501(C)(3)LINE 3ROCKFORD HEALTH SYSTEM0
ROCKFORD HEALTH SYSTEM
2400 N ROCKTON AVEROCKFORDIL61103363197915HEALTHCAREIL501(C)(3)LINE 11C, III-FIMERCYROCKFORD HEALTH SYSTEM CORPORATION0
ROCKFORD MEMORIAL DEVELOPMENT FOUNDATION
2400 N ROCKTON AVEROCKFORDIL61103363197918SUPPORT OF HEALTHCAREIL501(C)(3)LINE 11A, IROCKFORD HEALTH SYSTEM0
VISITING NURSES ASSN OF THE ROCKFORD AREA
4223 E STATE STREETROCKFORDIL61108362167945HEALTHCAREIL501(C)(3)LINE 9ROCKFORD HEALTH SYSTEM0
ROCKFORD HEALTH PHYSICIANS
2300 N ROCKTON AVEROCKFORDIL61103363097436HEALTHCAREIL501(C)(3)LINE 3ROCKFORD HEALTH SYSTEM0

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (4 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdDirect Controlling NADirectControllingNACdEntity TypeEntityTypeTxtControlled OrganizationControlledOrganizationIndAddress Line1ForeignAddress/AddressLine1TxtCountryForeignAddress/CountryCdLegal Domicile Foreign CountryLegalDomicileForeignCountryCd
JANESVILLE MEDICAL CENTER INC
1000 MINERAL POINT AVEJANESVILLEWI53548391520130MANAGEMENT OF UNION EMPLOYEESWIN/AC0
MERCYCARE INSURANCE COMPANY
580 N WASHINGTON STJANESVILLEWI53546391768192INSURANCEWIN/AC0
MERCYCARE HMO INC - CONSOLIDATED WITH MERCYCARE INSURANCE CO
580 N WASHINGTON STJANESVILLEWI53546201482553INSURANCEWIN/AC0
ROCKFORD HEALTH INSURANCE LTD
INSURANCEN/AC0WELLESLEY HOUSE SO 2ND FLBDBD
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (1)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (1)SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

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