MERCY ASSISTED CARE INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- MERCY ASSISTED CARE INC (EIN 39-1035110)
- Tax period
- 2021-07-01 to 2022-06-30
- Filed
- 2023-05-15
- IRS object ID
- 202331359349312113
- Schema version
- 2021v4.2
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-05-15T14:24:02-05:00 | ReturnTs |
| Tax Period End | 2022-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390859910 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BAKER TILLY US LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 MIDLAND COURT PO BOX 8130 | AddressLine1Txt |
| City | JANESVILLE | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 535478130 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 391035110 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MERCY ASSISTED CARE INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MERC | BusinessNameControlTxt |
| Phone | 6087542201 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 5003 - 901 MINERAL POINT A | AddressLine1Txt |
| City | JANESVILLE | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 535485003 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JAVON BEA | PersonNm |
| Person Title | PRESIDENT/CEO | PersonTitleTxt |
| Phone | 6087542201 | PhoneNum |
| Signature | 2023-05-12 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | JAVON | PersonFirstNm |
| Person Last | BEA | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | XXX-XX-XXXX | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | TROY MARINE CPA | PreparerPersonNm |
| PTIN | P00187863 | PTIN |
| Phone | 6087525835 | PhoneNum |
| Preparation | 2023-05-12 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MERCYHEALTH AT HOME | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JAVON BEA | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 5003 - 901 MINERAL POINT AVE | AddressLine1Txt |
| City | JANESVILLE | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 535485003 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $16,228,667 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | HTTPS://MERCYASSISTEDCARE.ORG/ | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1985 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | EXCEPTIONAL HEALTHCARE SERVICES RESULTING IN HEALING IN ITS BROADEST SENSE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 6 | VotingMembersIndependentCnt |
| Total Employee | 112 | TotalEmployeeCnt |
| Total Volunteers | 6 | TotalVolunteersCnt |
| Total Gross UBI | $738,883 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $231,965 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $12,288 | PYContributionsGrantsAmt |
| CY Contributions Grants | $81,563 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $9,342,867 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $10,366,693 | CYProgramServiceRevenueAmt |
| PY Investment Income | $554 | PYInvestmentIncomeAmt |
| CY Investment Income | $165 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,756,038 | PYOtherRevenueAmt |
| CY Other Revenue | $2,162,088 | CYOtherRevenueAmt |
| PY Total Revenue | $11,111,747 | PYTotalRevenueAmt |
| CY Total Revenue | $12,610,509 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $7,242,265 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $7,836,380 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $2,876,582 | PYOtherExpensesAmt |
| CY Other Expenses | $2,697,256 | CYOtherExpensesAmt |
| PY Total Expenses | $10,118,847 | PYTotalExpensesAmt |
| CY Total Expenses | $10,533,636 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $992,900 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $2,076,873 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $9,245,473 | TotalAssetsBOYAmt |
| Total Assets EOY | $11,848,284 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,971,628 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $2,497,566 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $7,273,845 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $9,350,718 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE MISSION OF MERCY ASSISTED CARE, INC. (MAC) IS TO PROVIDE EXCEPTIONAL HEALTHCARE SERVICES RESULTING IN HEALING IN ITS BROADEST SENSE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $9,255,963 | ExpenseAmt |
| Revenue | $11,378,289 | RevenueAmt |
| Desc | VISITS: SKILLED NURSING 19,741, HOSPICE HOMECARE 7,417HOSPITAL COMMUNITY BENEFIT REPORT - IRS FORM 990, SUPPLEMENT PART III:THE COMMUNITY BENEFIT CONTRIBUTION OF MAC INCLUDES PROGRAMS AND ACTIVITIES THAT IMPROVE ACCESS TO HEALTH CARE AND IMPROVE HEALTH IN OUR COMMUNITIES. IN ORDER TO PORTRAY THE FULL BREADTH OF OUR CONTRIBUTION, OUR COMMUNITY BENEFIT INFORMATION IS DESCRIBED BELOW:SECTION 1: QUALITATIVE DESCRIPTION OF COMMUNITY BENEFIT - DESCRIBES THE ORGANIZATION'S COMMUNITY BENEFIT MISSION, HOW THE MISSION IS TRANSLATED INTO A PROACTIVE APPROACH DESIGNED TO MEET COMMUNITY HEALTH NEEDS, HOW THE ORGANIZATION MEETS TAX-EXEMPT REQUIREMENTS, AND A DESCRIPTION OF COMMUNITY BENEFIT PROGRAMS AND SERVICES THAT HIGHLIGHT THE ORGANIZATION'S IMPACT ON COMMUNITY HEALTH.SECTION 2: QUANTITATIVE DESCRIPTION OF COMMUNITY BENEFIT - DESCRIBES THE ORGANIZATION'S COMMUNITY BENEFIT CONTRIBUTION IN FINANCIAL TERMS PRESENTING THE AMOUNT OF CHARITY CARE, THE UNPAID SHORTFALL FROM GOVERNMENT HEALTH CARE FOR THE INDIGENT, AND THE NET EXPENSE OF COMMUNITY BENEFIT SERVICES.SECTION 1 - QUALITATIVE DESCRIPTION OF COMMUNITY BENEFIT1. MERCY ASSISTED CARE'S (MAC) COMMITMENT TO PROVIDING COMMUNITY BENEFIT - NOTE: MUCH OF THE COMMUNITY BENEFIT FOR ALL THE ENTITIES OF THE ENTIRE MERCY HEALTH CORPORATION (PARENT COMPANY OF MAC) IS PROVIDED AT THE MERCY HEALTH SYSTEM CORPORATION LEVEL.A. THE MISSION OF MAC IS "TO PROVIDE EXCEPTIONAL HEALTHCARE SERVICES RESULTING IN HEALING IN ITS BROADEST SENSE." MERCY ASSISTED CARE PROVIDES QUALITY MEDICAL CARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF MERCY ASSISTED CARE, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES AND FURTHER THAT OUR MISSION IS TO SERVE THE COMMUNITY OF JANESVILLE AND SOUTHERN WISCONSIN WITH RESPECT TO PROVIDING HEALTHCARE SERVICES AND HEALTHCARE EDUCATION. THEREFORE, IN KEEPING WITH OUR COMMITMENT TO SERVE ALL MEMBERS OF OUR COMMUNITY, MERCY ASSISTED CARE ROUTINELY PROVIDES: 1.) FREE CARE AND/OR SUBSIDIZED CARE, 2.) CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS THAT ARE REIMBURSED BELOW COST, AND 3.) HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY WILL BE CONSIDERED WHERE THE NEED AND/OR INDIVIDUAL'S INABILITY TO PAY COEXISTS. THESE ACTIVITIES INCLUDE PARTICIPATION IN HEALTH FAIRS; FLU AND DIABETES CLINICS; FOOT CLINICS; HOSPICE SUPPORT GROUPS; AND A RADIO HEALTH LINE.SERVICES PROVIDED INCLUDE: SKILLED CARE (NURSING/THERAPISTS/AIDS ), HOSPICE, SUPPORTIVE AND EXTENDED HOME CARE. ADDITIONALLY, SALES AND RENTALS OF DURABLE MEDICAL EQUIPMENT AND SUPPLIES ARE PROVIDED TO THE COMMUNITY. MAC PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST. RECOGNIZING ITS MISSION TO THE COMMUNITY, SERVICES ARE PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS. TO THE EXTENT REIMBURSEMENT IS BELOW COST, MERCY ASSISTED CARE, INC. RECOGNIZES THESE AMOUNTS AS CHARITY CARE IN MEETING ITS MISSION TO THE ENTIRE COMMUNITY. CHARITY CARE, AS DETERMINED BY A PATIENT'S INABILTIY TO PAY DUE TO THEIR FINANCIAL CONDITION, AND UNCOMPENSATED CARE (BAD DEBT) ARE OTHER MEANS BY WHICH MERCY ASSISTED CARE, INC. PROVIDED FOR MEDICAL CARE AND WAS NOT COMPENSATED.B. MAC CONSIDERS ITS TARGET POPULATIONS TO BE RESIDENTS OF ROCK AND WALWORTH COUNTIES IN WISCONSIN, AS WELL AS PARTS OF MCHENRY COUNTY IN ILLINOIS. THE SYSTEM USES MULTIPLE STRATEGIES TO IDENTIFY NEEDS IN THESE COMMUNITIES. THESE STRATEGIES INCLUDE ONE-ON-ONE MEETINGS WITH LOCAL COMMUNITY LEADERS, FORMAL SURVEYS, PARTICIPATION ON COMMUNITY TASK FORCES, SUGGESTIONS FROM PATIENTS, AND DIRECT INPUT FROM ITS EMPLOYEES. MAC HAS WORKED WITH VARIOUS COMMUNITY ORGANIZATIONS TO HELP MEET THESE NEEDS:1) MAC SUBSIDIZES ITS HOSPICE PROGRAM (THROUGH FUNDRAISING/DONATIONS FROM MERCYHEALTH DEVELOPMENT FOUNDATION) SO THAT THIS PROGRAM IS AVAILABLE TO THOSE IN NEED WITHIN THE COMMUNITY.2) IT PROVIDES HEALTH SCREENINGS AND HEALTH EDUCATION SEMINARS AT PUBLIC EVENTS AND AT ITS OWN SITES THROUGHOUT THE TARGET AREA.3) ALONG WITH ITS SISTER-CORPORATION (MERCY HEALTH SYSTEM CORPORATION), MAC PROVIDES TRAINING OPPORTUNITIES FOR NURSES, PHYSICIANS, AND OTHER HEALTH PROFESSIONALS. C. COMMUNITY/CHARITY CARE IS PROVIDED BY MAC TO CUSTOMERS WHO ARE UNABLE TO PAY FOR ALL OR A PORTION OF THEIR CHARGES AND WHO MEET ELIGIBILITY REQUIREMENTS. ELIGIBILITY IS BASED ON THE FOLLOWING: INDIVIDUAL OR FAMILY INCOME, INDIVIDUAL OR FAMILY ASSETS, FAMILY SIZE, AND OTHER SOURCES OF PAYMENT FOR SERVICES. ELIGIBILITY FOR ALL OTHER CATEGORICAL AIDS IS A PREREQUISITE BEFORE QUALIFYING FOR COMMUNITY CARE. PATIENTS THAT QUALIFY WILL RECEIVE A REDUCTION IN THE BALANCE OWED AND EXTENDED PAYMENT TERMS. THE AMOUNT OF THE COMMUNITY CARE BENEFIT IS BASED ON THE PATIENT'S ABILITY TO PAY AND THE SIZE OF THE OUTSTANDING BALANCE. IF PATIENT INCOME AND FAMILY ASSETS ARE LESS THAN 200% OF THE FEDERAL POVERTY GUIDELINES, THEN MERCY WILL COVER 100% OF THEIR OUTSTANDING BALANCE VIA ITS COMMUNITY CARE PROGRAM. IF PATIENT INCOME AND FAMILY ASSETS FALL BETWEEN 201% AND 300% OF THE FEDERAL POVERTY GUIDELINE, THEN A PATIENT'S BALANCE CAN BE REDUCED AS MUCH AS 90%. MERCY HAS PROCEDURES IN PLACE TO INFORM THE PUBLIC ABOUT THE AVAILABILITY OF FINANCIAL AID/CHARITY CARE. INFORMATION IS MADE AVAILABLE AT THE TIME OF REGISTRATION, THROUGH PATIENT FINANCIAL COUNSELORS, AND AT THE CUSTOMER SERVICE PATIENT ACCOUNTS AREAS. TRAINING IS PROVIDED TO PERSONNEL AS TO HOW TO COMMUNICATE THIS PROGRAM'S AVAILABILITY TO PATIENTS AND HOW TO DIRECT PATIENT'S INQUIRIES. TRANSLATION SERVICES ARE AVAILABLE AS NEEDED.2. ORGANIZATIONAL DESCRIPTION FOR TAX EXEMPTION- MAC HAS A GOVERNING BODY IN WHICH INDEPENDENT PERSONS REPRESENTATIVE OF THE COMMUNITY COMPRISE A MAJORITY.- MAC PARTICIPATES IN MEDICAID, MEDICARE, CHAMPUS, TRICARE, AND OTHER GOVERNMENT-SPONSORED HEALTH CARE PROGRAMS.3. DESCRIPTION OF COMMUNITY BENEFIT PROGRAMSMAC OFFERS MANY REDUCED PRICE SERVICES AND FREE PROGRAMS THROUGHOUT THE YEAR BASED UPON ACTIVITIES AND SERVICES WHICH MAC BELIEVES WILL SERVE A BONA FIDE COMMUNITY HEALTH NEED. SOME OF THE PROGRAMS INCLUDE:- PARTICIPATION IN HEALTH FAIRS- PARTICIPATION IN HOSPICE SUPPORT GROUPS 4. LINKS TO ADDITIONAL COMMUNITY BENEFIT INFORMATION MERCY HEALTH SYSTEM'S WEB PAGE: WWW.MERCYHEALTHSYSTEM.ORGSECTION 2 - QUANTIFIABLE COMMUNITY BENEFITFISCAL YEAR ENDED JUNE 30, 2022:1) CHARITY CARE - AT COST $42,8712) MEDICAID SHORTFALL - NET EXPENSE $200,635 TOTAL QUANTIFIABLE COMMUNITY BENEFIT $243,506 | Desc |
| Total Program Service Expenses | $9,255,963 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 15 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 112 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 6 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 0 | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | WI | StatesWhereCopyOfReturnIsFldCd |
| States Where Copy Of Return Is Fld | IL | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TODD ANDERSON VP & CFO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 8159716738 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2400 N ROCKTON AVE | AddressLine1Txt |
| City | ROCKFORD | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61103 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| JAVON R BEA | |||||||||
| PRESIDENT & CEO (SEE PAGES 32-35) | 1.00 | 66.00 | Yes (X) | Yes (X) | $0 | $11,908,792 | $619,061 | ||
| MARK L GOELZER MD | |||||||||
| DIRECTOR/PHYSICIAN | 1.00 | 45.00 | Yes (X) | $0 | $444,609 | $28,511 | |||
| ROWLAND J MCCLELLAN | |||||||||
| CHAIR & DIRECTOR | 1.00 | 6.00 | Yes (X) | Yes (X) | $0 | $14,276 | $0 | ||
| THOMAS R POOL | |||||||||
| VICE CHAIR | 1.00 | 6.00 | Yes (X) | Yes (X) | $0 | $13,500 | $0 | ||
| THOMAS D BUDD | |||||||||
| SECRETARY & TREASURER | 1.00 | 6.00 | Yes (X) | Yes (X) | $0 | $13,691 | $0 | ||
| DAVE L SYVERSON | |||||||||
| DIRECTOR | 1.00 | 6.00 | Yes (X) | $0 | $15,306 | $0 | |||
| KATHERINE A SCHACK | |||||||||
| DIRECTOR | 1.00 | 6.00 | Yes (X) | $0 | $13,500 | $0 | |||
| WESLEY M JOST | |||||||||
| DIRECTOR | 1.00 | 6.00 | Yes (X) | $0 | $13,693 | $0 | |||
| TODD ANDERSON | |||||||||
| VICE PRESIDENT/CFO | 1.00 | 56.00 | Yes (X) | $0 | $767,925 | $45,782 | |||
| KIMBERLY SCACCIA | |||||||||
| VP - REVENUE CYCLE | 1.00 | 40.00 | Yes (X) | $0 | $432,755 | $52,988 | |||
| KAYLIE FUHRMAN | |||||||||
| RN HOME HEALTH HOSPICE 5 | 54.00 | $155,501 | $0 | $32,534 | Yes (X) | ||||
| TRACI HEINTZELMAN | |||||||||
| RN HOME HEALTH HOSPICE 1 | 54.00 | $160,461 | $0 | $13,947 | Yes (X) | ||||
| DAWN KLOCKOW | |||||||||
| DIRECTOR OF HOME HEALTH | 40.00 | $150,106 | $0 | $28,299 | Yes (X) | ||||
| JEFFREY LEVERENZ | |||||||||
| DIRECTOR OF BUSINESS OPERATIONS | 40.00 | $120,227 | $0 | $30,499 | Yes (X) | ||||
| BRANDON COOLEY | |||||||||
| HOME HEALTH THERAPY SUPERVISOR | 40.00 | $135,145 | $0 | $6,054 | Yes (X) | ||||
| SHANNON DUNPHY-ALEXANDER | |||||||||
| SR EXECUTIVE DIRECTOR | 1.00 | 56.00 | $0 | $319,804 | $16,364 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $721,440 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $13,957,851 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $874,039 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 12 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| SOUTHERN WISCONSIN ROOFING | |||||
| 3202 KINGSLEY WAY | MADISON | WI | 53713 | WATERPROOFING/ROOF WORK | $125,000 |
| ROCK HAVEN | |||||
| PO BOX 920 | JANESVILLE | WI | 535470920 | HOSPITALIZATION SERIVCES-HOSPICE | $122,062 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $81,563 | GovernmentGrantsAmt |
| Total Contributions | $81,563 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| PATIENT SERVICE REVENU | 621610 | $9,963,200 | $9,963,200 | |
| RENT FROM AFFILIATED O | 531190 | $403,493 | $403,493 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $10,366,693 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $165 | TotalRevenueColumnAmt |
| Exclusion | $165 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $5,772,130 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $3,618,158 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,153,972 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,415,089 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $738,883 | UnrelatedBusinessRevenueAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MISCELLANEOUS | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $8,116 | TotalRevenueColumnAmt |
| Exclusion | $8,116 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $8,116 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $12,610,509 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $11,378,289 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $738,883 | UnrelatedBusinessRevenueAmt |
| Exclusion | $411,774 | ExclusionAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,366,078 | TotalAmt |
| Program Services | $5,479,106 | ProgramServicesAmt |
| Management And General | $886,972 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $245,014 | TotalAmt |
| Program Services | $212,535 | ProgramServicesAmt |
| Management And General | $32,479 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $766,928 | TotalAmt |
| Program Services | $675,728 | ProgramServicesAmt |
| Management And General | $91,200 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $458,360 | TotalAmt |
| Program Services | $388,552 | ProgramServicesAmt |
| Management And General | $69,808 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,000 | TotalAmt |
| Management And General | $5,000 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $382,306 | TotalAmt |
| Program Services | $313,253 | ProgramServicesAmt |
| Management And General | $69,053 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $928 | TotalAmt |
| Program Services | $928 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $40,825 | TotalAmt |
| Program Services | $41,391 | ProgramServicesAmt |
| Management And General | -$566 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $234,233 | TotalAmt |
| Program Services | $234,233 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $300,020 | TotalAmt |
| Program Services | $298,709 | ProgramServicesAmt |
| Management And General | $1,311 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | -$26,995 | TotalAmt |
| Program Services | -$19,679 | ProgramServicesAmt |
| Management And General | -$7,316 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $705,402 | TotalAmt |
| Program Services | $619,963 | ProgramServicesAmt |
| Management And General | $85,439 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,889 | TotalAmt |
| Program Services | $27,889 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| DRUGS & MEDICAL SUPPLIE | $463,123 | $459,040 | $4,083 |
| EQUIPMENT REPAIRS & MAI | $245,446 | $206,849 | $38,597 |
| BAD DEBT | $218,734 | $218,734 | |
| UNREL. BUS. INC. TAX | $35,129 | $35,129 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $65,216 | TotalAmt |
| Program Services | $63,603 | ProgramServicesAmt |
| Management And General | $1,613 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,533,636 | TotalAmt |
| Program Services | $9,255,963 | ProgramServicesAmt |
| Management And General | $1,277,673 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $900 | BOYAmt |
| EOY | $900 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,111,564 | BOYAmt |
| EOY | $5,402,473 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,519,651 | BOYAmt |
| EOY | $1,771,945 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $775,234 | BOYAmt |
| EOY | $858,590 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,593 | BOYAmt |
| EOY | $12,420 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $13,554,312 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $9,769,136 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,810,781 | BOYAmt |
| EOY | $3,785,176 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,750 | BOYAmt |
| EOY | $16,780 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,245,473 | BOYAmt |
| EOY | $11,848,284 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,628,898 | BOYAmt |
| EOY | $1,411,938 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $342,730 | BOYAmt |
| EOY | $1,085,628 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,971,628 | BOYAmt |
| EOY | $2,497,566 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,273,845 | BOYAmt |
| EOY | $9,350,718 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,273,845 | BOYAmt |
| EOY | $9,350,718 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,245,473 | BOYAmt |
| EOY | $11,848,284 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $2,076,873 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,471 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $89 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus1 Year | $12,288 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $81,563 | CurrentTaxYearAmt |
| Total | $95,411 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $13,058,347 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $13,974,628 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $14,568,210 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $14,770,583 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $14,875,608 | CurrentTaxYearAmt |
| Total | $71,247,376 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $13,059,818 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $13,974,717 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $14,568,210 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $14,782,871 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $14,957,171 | CurrentTaxYearAmt |
| Total | $71,342,787 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $71,342,787 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $576 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,164 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,515 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $554 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $165 | CurrentTaxYearAmt |
| Total | $3,974 | TotalAmt |
Post1975 UBTI Post1975UBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $81,861 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $129,651 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $104,689 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $140,916 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $231,965 | CurrentTaxYearAmt |
| Total | $689,082 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $82,437 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $130,815 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $106,204 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $141,470 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $232,130 | CurrentTaxYearAmt |
| Total | $693,056 | TotalAmt |
Other Income509 OtherIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,480 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $877 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $804 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $4,095 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $8,116 | CurrentTaxYearAmt |
| Total | $15,372 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $13,143,735 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $14,106,409 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $14,675,218 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $14,928,436 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $15,197,417 | CurrentTaxYearAmt |
| Total | $72,051,215 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99020 | PublicSupportCY509Pct |
| Public Support PY509 | 0.99980 | PublicSupportPY509Pct |
| Investment Income CY | 0.00960 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00010 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: | FormAndLineReferenceDesc |
| Explanation | MISCELLANEOUS | ExplanationTxt |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,040,465 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,918,162 | DepreciationAmt |
| Book Value | $2,122,303 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $224,958 | OtherCostOrOtherBasisAmt |
| Depreciation | $182,338 | DepreciationAmt |
| Book Value | $42,620 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,288,889 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,668,636 | DepreciationAmt |
| Book Value | $1,620,253 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $3,785,176 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| THIRD PARTY PAYABLES | $252,159 |
| DUE TO MHS | $797,722 |
| DUE TO MHH | $25,600 |
| DUE TO ROCKFORD HEALTH SYSTEM | $10,147 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,085,628 | TotalLiabilityAmt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JAVON R BEA | ||||||||||||||
| PRESIDENT & CEO (SEE PAGES 32-35) | $0 | $1,570,273 | $0 | $1,475,763 | $0 | $8,862,756 | $0 | $602,150 | $0 | $16,911 | $0 | $12,527,853 | $0 | $5,837,133 |
| TODD ANDERSON | ||||||||||||||
| VICE PRESIDENT/CFO | $0 | $545,321 | $0 | $211,257 | $0 | $11,347 | $0 | $11,600 | $0 | $34,182 | $0 | $813,707 | $0 | $0 |
| KIMBERLY SCACCIA | ||||||||||||||
| VP - REVENUE CYCLE | $0 | $310,535 | $0 | $120,856 | $0 | $1,364 | $0 | $11,600 | $0 | $41,388 | $0 | $485,743 | $0 | $0 |
| MARK L GOELZER MD | ||||||||||||||
| DIRECTOR/PHYSICIAN | $0 | $324,023 | $0 | $116,186 | $0 | $4,400 | $0 | $11,600 | $0 | $16,911 | $0 | $473,120 | $0 | $0 |
| SHANNON DUNPHY-ALEXANDER | ||||||||||||||
| SR EXECUTIVE DIRECTOR | $0 | $244,896 | $0 | $74,682 | $0 | $226 | $0 | $11,600 | $0 | $4,764 | $0 | $336,168 | $0 | $0 |
| KAYLIE FUHRMAN | ||||||||||||||
| RN HOME HEALTH HOSPICE 5 | $148,932 | $0 | $0 | $0 | $6,569 | $0 | $0 | $0 | $32,534 | $0 | $188,035 | $0 | $0 | $0 |
| DAWN KLOCKOW | ||||||||||||||
| DIRECTOR OF HOME HEALTH | $143,811 | $0 | $0 | $0 | $6,295 | $0 | $0 | $0 | $28,299 | $0 | $178,405 | $0 | $0 | $0 |
| TRACI HEINTZELMAN | ||||||||||||||
| RN HOME HEALTH HOSPICE 1 | $153,986 | $0 | $0 | $0 | $6,475 | $0 | $0 | $0 | $13,947 | $0 | $174,408 | $0 | $0 | $0 |
| JEFFREY LEVERENZ | ||||||||||||||
| DIRECTOR OF BUSINESS OPERATIONS | $94,227 | $0 | $0 | $0 | $26,000 | $0 | $0 | $0 | $30,499 | $0 | $150,726 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3 | THE CEO IS PAID FROM A RELATED ORGANIZATION, MERCY HEALTH SYSTEM CORPORATION (MHSC). MHSC USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE CEO: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, FORM 990 OF OTHER ORGANIZATION, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. THE MERCY COMPENSATION COMMITTEE OF MHSC IS COMPRISED OF THE BOARD CHAIRPERSON, VICE CHAIR, AND SECRETARY/TREASURER. THE COMPENSATION COMMITTEE IS ASSISTED BY INDEPENDENT LEGAL COUNSEL AND AN INDEPENDENT COMPENSATION CONSULTANT. THE COMPENSATION COMMITTEE, LEGAL COUNSEL, AND THE COMPENSATION CONSULTANT MEET THROUGHOUT THE YEAR AND REPORT DIRECTLY TO THE BOARD OF DIRECTORS ANNUALLY. THIS PROCESS WAS COMPLETED FOR 2021. |
| PART I, LINE 4B | INCENTIVE PLAN DISTRIBUTION: JAVON R. BEA - $5,837,133. |
| PART II, LINE 1: | JAVON R. BEA - DEFERRED COMPENSATION PAYMENT MR. BEA HAS BEEN EMPLOYED BY MHSC AS PRESIDENT AND CEO OVER THE PAST 30 YEARS. DURING THIS TIME, MR. BEA HAS LED AN INCREDIBLE TRANSFORMATION TAKING A SMALL, SINGLE, STAND-ALONE COMMUNITY HOSPITAL AND CREATING A VERTICALLY INTEGRATED HEALTH SYSTEM WITH 85 FACILITIES IN 50 COMMUNITIES THROUGHOUT SOUTHERN WISCONSIN AND NORTHERN ILLINOIS, INCREASING GROSS REVENUE FROM $33 MILLION TO OVER $3.4 BILLION IN FY2022. THIS HAS ALLOWED THE HEALTH SYSTEM TO GO FROM SERVING 89,000 PATIENTS IN 1989 TO OVER 1.9 MILLION PATIENTS TODAY WORKING TOGETHER WITH OVER 7,000+ PARTNERS IN HEALTH CARE. TODAY, MHSC HAS BECOME THE LARGEST EMPLOYER IN SOUTHERN WISCONSIN AND NORTHERN ILLINOIS. THIS GROWTH CAN BE ATTRIBUTED TO MR. BEA'S VISIONARY LEADERSHIP. LEADERSHIP THAT HAS LED TO MHSC RECEIVING NUMEROUS NATIONAL RECOGNIZED AWARDS INCLUDING BEING NAMED THE FIRST FULLY INTEGRATED HEALTH SYSTEM TO RECEIVE THE MALCOLM BALDRIGE NATIONAL QUALITY AWARD, THE MAGNET RECOGNITION AWARD, BEING RANKED #1 AND #2 ON AARP'S TOP 100 BEST PLACES TO WORK FOR WORKERS OVER 50, AND BEING RANKED IN THE TOP 25 ON THE TOP 100 INTEGRATED HEALTHCARE NETWORKS LIST BY MODERN HEALTHCARE FOR OVER 11 STRAIGHT YEARS. THE TURNAROUND OF MHSC IMPLEMENTED BY MR. BEA IS UNPARALLELED. BY PIONEERING A "PARTNERSHIP MODEL" OF COMPENSATION AND DESIGNING A CUSTOM CULTURE OF EXCELLENCE, MR. BEA IS VITAL TO THE DECADES-LONG AND CONTINUING GROWTH AT MHSC. THIS SUCCESS HAS MADE MR. BEA A HIGHLY SOUGHT AFTER SPEAKER AND CONSULTANT AS HE IS NOW WELL-RENOWNED FOR HIS INNOVATIONS IN THE AREAS OF INTEGRATED HEALTHCARE AND PHYSICIAN PARTNERSHIP MODELS. THE TREMENDOUS SUCCESS OF MHSC UNDER THE LEADERSHIP OF MR. BEA HAS ALLOWED HIM TO RECEIVE PAYOUTS FROM A DEFERRED COMPENSATION PACKAGE WHICH MHSC HAS BEEN PAYING INTO OVER MANY YEARS. THESE PAYMENTS ONLY BECAME PAYABLE IF MHSC ATTAINED CERTAIN DEFINED FINANCIAL AND STRATEGIC GOALS AND THE AMOUNTS ARE AT RISK EVERY SINGLE YEAR. AS INDICATED ABOVE, MANY OF THESE GOALS WERE ACHIEVED WITHIN THE PAST TWO YEARS RESULTING IN A RELEASE OF THESE DEFERRED PAYMENTS WHICH IMPACTED MR. BEA'S COMPENSATION REPORTING. THE SETTING OF THESE GOALS WERE LAID OUT BY THE BOARD OF DIRECTORS IN COOPERATION WITH NATIONALLY RECOGNIZED COMPENSATION ATTORNEYS AND CONSULTANTS TO MAKE SURE ALL FACTORS WERE TAKEN INTO CONSIDERATION. MR. BEA'S COMPENSATION HAS ALSO BEEN SCRUTINIZED BY NUMEROUS OUTSIDE ORGANIZATIONS AND MOST IMPORTANTLY, THE INTERNAL REVENUE SERVICE; AND HAS PASSED INSPECTION IN EACH CASE. TOTAL COMPENSATION IS APPROVED ANNUALLY BY THE BOARD OF DIRECTORS OF MHSC. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1A | THE VOTING MEMBERS OF THE EXECUTIVE COMMITTEE CONSISTS OF EIGHT INDIVIDUALS, EACH OF WHOM SHALL HAVE A VOTE, INCLUDING THE CEO, THE CHAIRMAN, VICE-CHAIRMAN, IMMEDIATE PAST CHAIRMAN, TREASURER, AND TWO ADDITIONAL DIRECTORS OF THE BOARD. AT LEAST ONE MEMBER OF THE EXECUTIVE COMMITTEE SHALL BE A PHYSICIAN. THE EXECUTIVE COMMITTEE SHALL IN ALL INSTANCES BE COMPRISED OF AT LEAST 51% COMMUNITY MEMBERS. IN THE EVENT THAT ONE OR MORE OF THE AFOREMENTIONED VOTING MEMBERS OF THE EXECUTIVE COMMITTEE IS UNABLE TO SERVE IN SUCH CAPACITY, THEN THE CHAIRMAN OF THE CORPORATION SHALL DESIGNATE A REPLACEMENT FROM AMONG THE BOARD MEMBERS. THE EXECUTIVE COMMITTEE SHALL MEET AS NEEDED. WHEN THE BOARD OF DIRECTORS IS NOT IN SESSION, THE EXECUTIVE COMMITTEE SHALL HAVE ALL THE POWERS, DUTIES, RESPONSIBILITIES AND AUTHORITY OF THE BOARD, EXCEPT AS PROHIBITED BY LAW. |
| FORM 990, PART VI, SECTION A, LINE 6 | MERCY HEALTH CORPORATION (MHC) IS THE SOLE CORPORATE MEMBER OF MERCY ASSISTED CARE, INC. (MAC). THE SOLE MEMBER SHALL HAVE POWERS AND VOTING RIGHTS TO DO THE FOLLOWING: (A) APPOINT ALL THE DIRECTORS OF THE CORPORATION (B) NOMINATE TO THE CORPORATION'S BOARD OF DIRECTORS ALL CANDIDATES FOR SELECTION AS THE CORPORATION PRESIDENT (C) APPROVE EXPRESSLY ALL AMENDMENTS TO THE CORPORATION'S ARTICLES OF INCORPORATION AND BYLAWS (D) APPROVE ANNUAL BUDGETS, AND STRATEGIC, LONG-RANGE AND HEALTH MANPOWER DEVELOPMENT PLANS OF THE CORPORATION (E) REQUIRE THE CORPORATION'S BOARD OF DIRECTORS TO TAKE ANY ACTION (INCLUDING AUTHORIZING THE PLEDGE OR TRANSFER OF ASSETS TO MHC OR AS DIRECTED BY MHC, OR THE EXECUTION OF CONTRACTS) WHICH WOULD IMPROVE THE CREDIT WORTHINESS OR OTHERWISE RESULT IN FINANCIAL BENEFIT TO MHC AND ITS TAX-EXEMPT AFFILIATED CORPORATIONS (PROVIDED THAT UNDER NO CIRCUMSTANCES MAY MHC REQUIRE TRANSFER OF ASSETS IN VIOLATION OF LAW OR THE TERMS OF ANY CHARITABLE TRUST OR DONATION) (F) APPROVE ALL CONTRACTS OF INDEBTEDNESS EFFECTIVE FOR LONGER THAN EIGHTEEN MONTHS (G) APPROVE ALL PLANS OF MERGER OR CONSOLIDATION (H) APPROVE THE SALE, LEASE, EXCHANGE, MORTGAGE, PLEDGE OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL, THE PROPERTY AND ASSETS OF THE CORPORATION (I) APPROVE A VOLUNTARY DISSOLUTION OF THE CORPORATION (J) APPROVE MATERIAL AMENDMENTS TO THE CORPORATION'S STANDARD FORM OF PHYSICIAN EMPLOYMENT AGREEMENT, PROVIDED THE CORPORATION SHALL HAVE THE AUTHORITY TO NEGOTIATE THE TERMS AND CONDITIONS OF INDIVIDUAL PHYSICIAN EMPLOYMENT AGREEMENTS SO LONG AS THE NEGOTIATED TERMS AND CONDITIONS ARE CONSISTENT WITH THE REQUIREMENTS OF APPLICABLE LAW AND THE STRATEGIC, LONG-RANGE AND HEALTH MANPOWER DEVELOPMENT PLANS APPROVED BY MHC (K) APPROVE MATERIAL AMENDMENTS TO THE STANDARD COMPENSATION SYSTEM USED BY THE CORPORATION TO ESTABLISH INDIVIDUAL PHYSICIAN COMPENSATION (L) REQUIRE THE CORPORATION'S BOARD OF DIRECTORS TO TAKE ANY ACTION (INCLUDING AMENDING THE ARTICLES OF INCORPORATION OR BYLAWS), OR TO MODIFY OR RESCIND AN ACTION ALREADY TAKEN, IF MHC DETERMINES THAT FAILURE TO TAKE THE ACTION, OR TO MODIFY OR RESCIND AN ACTION ALREADY TAKEN, MAY RESULT IN THE CORPORATIONS FAILURE TO OBTAIN OR MAINTAIN ITS EXEMPTION AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3) OF THE CODE |
| FORM 990, PART VI, SECTION A, LINE 7A | SEE NARRATIVE FOR PART VI, LINE 6 |
| FORM 990, PART VI, SECTION A, LINE 7B | SEE NARRATIVE FOR PART VI, LINE 6 |
| FORM 990, PART VI, SECTION B, LINE 11B | MANAGEMENT REVIEWS THE FORM 990 BEFORE FILING AND IT IS AVAILABLE TO THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION B, LINE 12C | BY WRITTEN POLICY, MHC SENDS OUT, ON AN ANNUAL BASIS, THE CORPORATE CONFLICT AND DUALITY OF INTEREST POLICY TO ALL BOARD MEMBERS, CORPORATE OFFICERS AND OTHER KEY INDIVIDUALS (THOSE HAVING RESPONSIBILITY AND AUTHORITY TO MAKE FINAL DECISIONS REGARDING THE ACQUISITION OF PRODUCTS OR SERVICES). EACH RECIPIENT IS REQUIRED TO COMPLETE A FINANCIAL INTEREST DISCLOSURE STATEMENT, WHICH IS SUBMITTED TO THE MHC COMPLIANCE DEPARTMENT FOR REVIEW. WITH RESPECT TO PHYSICIANS AND MANAGERS WHO ARE KEY INDIVIDUALS, ANY POTENTIAL CONFLICT OF INTEREST IS REVIEWED WITH THE APPROPRIATE EXECUTIVE STAFF MEMBER FOR FOLLOW UP WITH THE DISCLOSING PARTY IN ORDER TO REVIEW THE MATTER IN MORE DETAIL. THIS INCLUDES EMPHASIZING THAT THE DISCLOSING PARTY IS NOT PERMITTED TO PARTICIPATE IN ANY NEGOTIATIONS FOR THE PURCHASE OF ANY PRODUCTS OR SERVICES WHERE THE CONFLICT IS DEEMED MATERIAL, OR AUTHORIZE THE SUBSEQUENT PURCHASE OF RELATED GOODS AND SERVICES. THE DISCLOSING PARTY IS ALSO REQUIRED TO IDENTIFY EACH AND EVERY INSTANCE OF A POTENTIAL CONFLICT AS THEY MAY ARISE IN THE ORDINARY COURSE OF BUSINESS. A SIMILAR PROCESS IS FOLLOWED FOR THE BOARD OF DIRECTORS, EXCEPT THAT ANY POTENTIAL CONFLICT IS REVIEWED BY THE BOARD'S GOVERNANCE COMMITTEE. BOARD MEMBERS MAY COMMENT ON TRANSACTIONS WHERE THERE IS A POTENTIAL CONFLICT, BUT CANNOT VOTE ON THE RELATED MATTER AND MAY BE REQUIRED TO LEAVE ANY MEETING WHERE THE POTENTIAL CONFLICT IS REVIEWED BY THE BOARD OR WHERE THE BOARD TAKES ACTION TO EITHER APPROVE OR NOT APPROVE THE PROPOSED TRANSACTION. A BOARD MEMBER ALSO HAS A CONTINUING DUTY TO REPORT ANY CONFLICTS AS THEY MAY ARISE IN THE ORDINARY COURSE OF BUSINESS. IN THE EVENT THAT A POTENTIAL CONFLICT OF INTEREST IS REPORTED OR DISCOVERED OUTSIDE THE ESTABLISHED PROCESS, APPROPRIATE REVIEW AND ACTION WOULD BE TAKEN. THIS PROCESS WAS LAST COMPLETED IN DEC. 2021, WHEN THE QUESTIONNAIRES WERE SENT TO ADDRESS ANY 2021 CONFLICTS IDENTIFIED. MHC AND MAC HAVE THE SAME BOARD, AND THEREFORE THE MHC QUESTIONNAIRE IS USED TO ALSO ADDRESS POTENTIAL AND ACTUAL CONFLICTS FOR THE FILING ORGANIZATION. THE MHC CONFLICT OF INTEREST POLICY IS AVAILABLE UPON REQUEST. |
| FORM 990, PART VI, SECTION C, LINE 19 | NO DOCUMENTS AVAILABLE TO THE PUBLIC. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (9 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| MERCY HEALTH SYSTEM ASSOCIATION OF VOLUNTEERS | |||||||||||
| 1000 MINERAL POINT AVE | JANESVILLE | WI | 53548 | 390912682 | SUPPORT OF HEALTHCARE | WI | 501(C)(3) | LINE 12C, III-FI | MERCY HEALTH SYSTEM CORPORATION | 0 | |
| MERCY HEALTH SYSTEM CORPORATION | |||||||||||
| 1000 MINERAL POINT AVE | JANESVILLE | WI | 53548 | 390816848 | HEALTHCARE | WI | 501(C)(3) | LINE 3 | MERCY HEALTH CORPORATION | 0 | |
| MERCY HARVARD HOSPITAL INC | |||||||||||
| 901 GRANT STREET | HARVARD | IL | 60033 | 311551871 | HEALTHCARE | IL | 501(C)(3) | LINE 3 | MERCY HEALTH CORPORATION | 0 | |
| MERCY CRYSTAL LAKE HOSPITAL AND MEDICAL CENTER | |||||||||||
| 200 LAKE AVE | WOODSTOCK | IL | 60098 | 201673011 | NONE | IL | 501(C)(3) | LINE 3 | MERCY HEALTH CORPORATION | 0 | |
| MERCY HEALTH CORPORATION | |||||||||||
| 2400 N ROCKTON AVE | ROCKFORD | IL | 61103 | 472158680 | SUPPORT OF HEALTHCARE | IL | 501(C)(3) | LINE 12A, I | 0 | N/A | |
| JAVON BEA HOSPITAL | |||||||||||
| 2400 N ROCKTON AVE | ROCKFORD | IL | 61103 | 362167847 | HEALTHCARE | IL | 501(C)(3) | LINE 3 | MERCY HEALTH CORPORATION | 0 | |
| MERCYHEALTH DEVELOPMENT FOUNDATION | |||||||||||
| 2400 N ROCKTON AVE | ROCKFORD | IL | 61103 | 363197918 | SUPPORT OF HEALTHCARE | IL | 501(C)(3) | LINE 12A, I | MERCY HEALTH CORPORATION | 0 | |
| MERCYHEALTH VISITING NURSES ASSOCIATION | |||||||||||
| 4223 E STATE STREET | ROCKFORD | IL | 61108 | 362167945 | HEALTHCARE | IL | 501(C)(3) | LINE 10 | MERCY HEALTH CORPORATION | 0 | |
| ROCKFORD HEALTH PHYSICIANS | |||||||||||
| 2400 N ROCKTON AVE | ROCKFORD | IL | 61103 | 363907436 | HEALTHCARE | IL | 501(C)(3) | LINE 3 | MERCY HEALTH CORPORATION | 0 | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Address Line1ForeignAddress/AddressLine1Txt | CityForeignAddress/CityNm | CountryForeignAddress/CountryCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JANESVILLE MEDICAL CENTER INC | |||||||||||||
| 1000 MINERAL POINT | JANESVILLE | WI | 53548 | 391520130 | MANAGEMENT OF UNION EMPLOYEES | WI | N/A | C | 0 | ||||
| MERCYCARE INSURANCE COMPANY | |||||||||||||
| 580 N WASHINGTON ST | JANESVILLE | WI | 53546 | 391768192 | INSURANCE | WI | N/A | C | 0 | ||||
| MERCYCARE HMO INC - CONSOLIDATED WITH MERCYCARE INSURANCE CO | |||||||||||||
| 580 N WASHINGTON ST | JANESVILLE | WI | 53546 | 201482553 | INSURANCE | WI | N/A | C | 0 | ||||
| ROCKFORD HEALTH INSURANCE LTD | |||||||||||||
| INSURANCE | N/A | C | 0 | WELLESLY HOUSE SO 2ND FL | PEMBROKE HM | BD | BD | ||||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |