MERCYHEALTH DEVELOPMENT FOUNDATION INC: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- MERCYHEALTH DEVELOPMENT FOUNDATION INC (EIN 36-3197918)
- Tax period
- 2020-07-01 to 2021-06-30
- Filed
- 2022-05-16
- IRS object ID
- 202201369349314535
- Schema version
- 2020v4.2
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule I
- Schedule J
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-05-16T17:04:31-05:00 | ReturnTs |
| Tax Period End | 2021-06-30 | 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 | 2020-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 363197918 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MERCYHEALTH DEVELOPMENT FOUNDATION INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MERC | BusinessNameControlTxt |
| Phone | 8159715000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2400 ROCKTON AVE | AddressLine1Txt |
| City | ROCKFORD | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61103 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JAVON BEA | PersonNm |
| Person Title | PRESIDENT/CEO | PersonTitleTxt |
| Phone | 8159715000 | PhoneNum |
| Signature | 2022-05-16 | 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 | 2022-05-15 | 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 | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JAVON BEA | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2400 ROCKTON AVE | AddressLine1Txt |
| City | ROCKFORD | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61103 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $6,531,049 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | HTTPS://MERCYHEALTHSYSTEM.ORG/PROGRAM/FOUNDATION/ | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1982 | FormationYr |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Activity Or Mission | MERCYHEALTH DEVELOPMENT FOUNDATION, INC. HAS A MISSION TO PROVIDE ASSISTANCE TO ALL ENTITIES OF THE MERCY HEALTH SYSTEM (MHS) BY RECEIVING, MAINTAINING, AND ADMINISTERING FUNDS RECEIVED FROM THE PUBLIC AND OTHER AVAILABLE RESOURCES TO FURTHER THE EXEMPT PURPOSE OF THESE NON-PROFIT 501(C)(3) ORGANIZATIONS AND TO SUPPORT THE MHS MISSION OF "EXCEPTIONAL HEALTH CARE SERVICES WITH A PASSION FOR MAKING LIVES BETTER". | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 30 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,964,895 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,291,423 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $160,787 | PYInvestmentIncomeAmt |
| CY Investment Income | $633,433 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$66,316 | PYOtherRevenueAmt |
| CY Other Revenue | -$22,586 | CYOtherRevenueAmt |
| PY Total Revenue | $2,059,366 | PYTotalRevenueAmt |
| CY Total Revenue | $1,902,270 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $1,261,621 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $454,715 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $201,060 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $217,318 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $59,054 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $589,043 | PYOtherExpensesAmt |
| CY Other Expenses | $93,664 | CYOtherExpensesAmt |
| PY Total Expenses | $2,051,724 | PYTotalExpensesAmt |
| CY Total Expenses | $765,697 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $7,642 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,136,573 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $37,967,208 | TotalAssetsBOYAmt |
| Total Assets EOY | $46,926,350 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,790,191 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,860,355 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $36,177,017 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $45,065,995 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE MISSION OF MERCY HEALTH SYSTEM (MHS) IS "EXCEPTIONAL HEALTH CARE SERVICES WITH A PASSION FOR MAKING LIVES BETTER". WITH A VISION OF QUALITY - EXCELLENCE IN PATIENT CARE, SERVICE - EXCEPTIONAL PATIENT AND CUSTOMER CARE, PARTNERING - BEST PLACE TO WORK AND - COST-EFFECTIVE CARE AND A COMMITMENT TO THE VALUES OF: HEALING IN THE BROADEST SENSE, PATIENTS COME FIRST, TREAT EACH OTHER LIKE FAMILY AND ALWAYS SEEK EXCELLENCE. THE MERCYHEALTH DEVELOPMENT FOUNDATION, INC. ASSISTS IN THIS MISSION BY USING ITS RESOURCES TO SUPPORT ALL AFFILIATED ENTITIES TO HELP THEM FULFILL THEIR COMMITMENT TO THIS MISSION. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $58,446 | ExpenseAmt |
| Grant | $22,644 | GrantAmt |
| Desc | IN FY2021 ENDOWMENTS AND RESTRICTED FUNDS PROVIDED EDUCATION AND TRAINING FOR EMPLOYEES THROUGHOUT THE HEALTH SYSTEM INCLUDING TRAINING AND CONFERENCES FOR HOSPITALISTS. IN ADDITION, RESTRICTED GIFTS AND ENDOWMENTS HELPED FUND PATIENT EXPENSES FOR INDIGENT INDIVIDUALS, MEALS FOR CANCER PATIENTS UNDERGOING TREATMENT AND EQUIPMENT/ITEMS NEEDED IN THE NICU THROUGHOUT THE SYSTEM. DONATIONS FROM THE AUXILIARY ASSISTED WITH CARE ON THE CARE MOBILE, NURSING SCHOLARSHIPS FOR MINORITY STUDENTS, PET THERAPY, RADIOLOGY SCHOOL ASSISTANCE, NEW TREADMILLS FOR CARDIOLOGY REHAB AND VARIOUS IMPROVEMENT PROJECTS. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $263,427 | ExpenseAmt |
| Grant | $263,427 | GrantAmt |
| Desc | THROUGH CHARITABLE CONTRIBUTIONS, THE FOUNDATION SUPPORTS THE RONALD MCDONALD CARE MOBILE STAFFED AND OPERATED BY MERCYHEALTH EMPLOYEES, WHICH PROVIDES FREE MEDICAL CARE TO UNINSURED AND UNDERINSURED CHILDREN AT MORE THAN 12 DIFFERENT SITES IN NORTHERN ILLINOIS AND SOUTHERN WISCONSIN. THE CARE MOBILE VISITS INCLUDE VACCINATIONS, LEAD OR BLOOD SCREENINGS, MEDICAL DIAGNOSES, AND TREATMENT/CARE TO AVOID AN EMERGENCY ROOM VISIT.AN ANNUAL CHARITY BALL FUNDRAISER BENEFITS THE HOUSE OF MERCY: A HOMELESS SHELTER IN JANESVILLE. IN FY2021 THE HOUSE OF MERCY PROVIDED 7,936 SHELTER NIGHTS. A TOTAL OF 255 INDIVIDUALS (120 ADULTS AND 135 CHILDREN) WERE SERVED. OTHER FUNDRAISERS WHOSE PROCEEDS BENEFITED THE HOUSE OF MERCY INCLUDE: BOOK SALE FUNDRAISERS, JEWELRY SALE FUNDRAISERS AND JEANS DAYS. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $239,357 | ExpenseAmt |
| Grant | $168,644 | GrantAmt |
| Desc | THE PARTNER CRISIS FUND RAISED FUNDS IN FY21 FOR AN EMPLOYEE CRISIS FUND. THE CRISIS FUND PROVIDES ASSISTANCE TO EMPLOYEES WHO HAVE EXPERIENCED A CRISIS SUCH AS A FLOOD OR FIRE IN THEIR HOME OR A SEVERE ILLNESS, INJURY OR DEATH OF A SPOUSE OR CHILD. MERCYHEALTH DEVELOPMENT FOUNDATION, INC. PROVIDED FUNDING ASSISTANCE FOR PATIENT CARE EXAMS AND THERAPIES, CLASSES, AND EQUIPMENT AS WELL AS PROVIDED INDIGENT INDIVIDUALS/FAMILIES WITH RENT ASSISTANCE AND TRANSPORTATION COSTS (BUS TOKENS). DONATIONS WERE ALSO USED TO ASSIST MERCYHEALTH AT HOME, A RELATED ORGANIZATION, IN CARING FOR THE ELDERLY, THE HOMEBOUND, THE RECOVERING AND THOSE FACING END OF LIFE. ADDITIONAL DONATIONS ARE ALSO USED TO FUND THE AUTISM SUPPORT PROGRAM, 2 INDIVIDUALS WERE ASSISTED IN FY21 THROUGH THAT PROGRAM. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $561,230 | 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 | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | 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 | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | 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 | Yes (1) | 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 | 11 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| 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 | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | 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 | IL | StatesWhereCopyOfReturnIsFldCd |
| States Where Copy Of Return Is Fld | WI | 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 (15 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 |
|---|---|---|---|---|---|---|---|
| JAVON R BEA | |||||||
| PRESIDENT & CEO (SEE PAGES 43-46) | 1.00 | 66.00 | Yes (X) | Yes (X) | $0 | $5,057,986 | $7,074,160 |
| MARK L GOELZER MD | |||||||
| DIRECTOR/PHYSICIAN | 1.00 | 45.00 | Yes (X) | $0 | $501,965 | $29,148 | |
| PATRICK O'KEEFE | |||||||
| CHAIRPERSON | 3.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| W WALTER BOOTHE | |||||||
| VICE-CHAIR | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| MARC L BARBEAU | |||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| JASON BREDENKAMP MD | |||||||
| DIRECTOR (TERM 01/2021) | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| CHRIS CLAPPER | |||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| JERE JOHNSON | |||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| LISA RUDY | |||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| TWILA SCHOCK | |||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| ERIC THORNBERG | |||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| KATHY WEBER | |||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| TODD ANDERSON | |||||||
| VICE PRESIDENT/CFO (AS OF 05/2020) | 0.00 | 55.00 | Yes (X) | $0 | $542,858 | $18,158 | |
| SHANNON DUNPHY-ALEXANDER | |||||||
| SR EXECUTIVE DIRECTOR | 1.00 | 56.00 | Yes (X) | $0 | $313,241 | $15,917 | |
| KIMBERLY SCACCIA | |||||||
| VP-REVENUE CYCLE (AS OF 03/2020) | 1.00 | 40.00 | Yes (X) | $0 | $299,091 | $21,962 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $6,715,141 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $7,159,345 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $70,276 | FundraisingAmt |
| Related Organizations | $285,168 | RelatedOrganizationsAmt |
| Government Grants | $5,250 | GovernmentGrantsAmt |
| All Other Contributions | $930,729 | AllOtherContributionsAmt |
| Noncash Contributions | $38,989 | NoncashContributionsAmt |
| Total Contributions | $1,291,423 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $43,297 | TotalRevenueColumnAmt |
| Exclusion | $43,297 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $5,196,329 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $4,606,193 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $590,136 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $590,136 | TotalRevenueColumnAmt |
| Exclusion | $590,136 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $0 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $70,276 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $22,586 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$22,586 | TotalRevenueColumnAmt |
| Exclusion | -$22,586 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,902,270 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $610,847 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $419,864 | TotalAmt |
| Program Services | $419,864 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $34,851 | TotalAmt |
| Program Services | $34,851 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $199,475 | TotalAmt |
| Program Services | $79,790 | ProgramServicesAmt |
| Management And General | $71,811 | ManagementAndGeneralAmt |
| Fundraising | $47,874 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,059 | TotalAmt |
| Program Services | $6,045 | ProgramServicesAmt |
| Management And General | $4,499 | ManagementAndGeneralAmt |
| Fundraising | $3,515 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,784 | TotalAmt |
| Program Services | $1,514 | ProgramServicesAmt |
| Management And General | $1,362 | ManagementAndGeneralAmt |
| Fundraising | $908 | FundraisingAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,823 | TotalAmt |
| Management And General | $8,823 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $33,652 | TotalAmt |
| Management And General | $33,652 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,039 | TotalAmt |
| Program Services | $16,840 | ProgramServicesAmt |
| Management And General | $5,908 | ManagementAndGeneralAmt |
| Fundraising | $4,291 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,869 | TotalAmt |
| Program Services | $1,869 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,678 | TotalAmt |
| Management And General | $8,469 | ManagementAndGeneralAmt |
| Fundraising | $2,209 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $383 | TotalAmt |
| Management And General | $383 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $396 | TotalAmt |
| Program Services | $396 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $593 | TotalAmt |
| Management And General | $356 | ManagementAndGeneralAmt |
| Fundraising | $237 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $101 | TotalAmt |
| Program Services | $61 | ProgramServicesAmt |
| Management And General | $20 | ManagementAndGeneralAmt |
| Fundraising | $20 | FundraisingAmt |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,130 | TotalAmt |
| Management And General | $10,130 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $765,697 | TotalAmt |
| Program Services | $561,230 | ProgramServicesAmt |
| Management And General | $145,413 | ManagementAndGeneralAmt |
| Fundraising | $59,054 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,253,481 | BOYAmt |
| EOY | $1,901,726 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,024,194 | BOYAmt |
| EOY | $1,958,503 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $86,080 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $86,080 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,093,692 | BOYAmt |
| EOY | $28,970,698 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,595,841 | BOYAmt |
| EOY | $14,095,423 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $37,967,208 | BOYAmt |
| EOY | $46,926,350 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $775,792 | BOYAmt |
| EOY | $785,655 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,014,399 | BOYAmt |
| EOY | $1,074,700 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,790,191 | BOYAmt |
| EOY | $1,860,355 | 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 | $18,904,718 | BOYAmt |
| EOY | $24,672,576 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,272,299 | BOYAmt |
| EOY | $20,393,419 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,177,017 | BOYAmt |
| EOY | $45,065,995 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $37,967,208 | BOYAmt |
| EOY | $46,926,350 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $1,136,573 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $7,752,405 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| 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) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type1 | Yes (X) | SupportingOrgType1Ind |
| Supported Organizations | 6 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp (6 entries)
| EINEIN | Organization TypeOrganizationTypeCd | Governing Document ListedGoverningDocumentListedInd | SupportSupportAmt | Other SupportOtherSupportAmt |
|---|---|---|---|---|
| JAVON BEA HOSPITAL | ||||
| 362167847 | 3 | Yes (1) | $330,421 | $0 |
| MH VISITING NURSES ASSOCIATION INC | ||||
| 362167945 | 10 | Yes (1) | $17,035 | $0 |
| ROCKFORD HEALTH PHYSICIANS | ||||
| 363907436 | 3 | Yes (1) | $18,639 | $0 |
| MERCY ASSISTED CARE INC | ||||
| 391035110 | 10 | Yes (1) | $0 | $0 |
| MERCY HEALTH SYSTEM CORPORATION | ||||
| 390816848 | 3 | Yes (1) | $9,697 | $0 |
| MERCY HARVARD HOSPITAL | ||||
| 311551871 | 3 | Yes (1) | $0 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 6 | SupportedOrganizationsTotalCnt |
| Support Sum | $375,792 | SupportSumAmt |
| Other Support Sum | $0 | OtherSupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | Yes (1) | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | 0 | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | 0 | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | 0 | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | 0 | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | 0 | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | 0 | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | 0 | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | 0 | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | 0 | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | 0 | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | 0 | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | 0 | ContributionControllerInd |
| Contribution Family | 0 | ContributionFamilyInd |
| Contribution35 Controlled | 0 | Contribution35ControlledInd |
Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Power Appoint Majority Dir Trst | 0 | PowerAppointMajorityDirTrstInd |
| Operate Benefit Non Suprt Org | 0 | OperateBenefitNonSuprtOrgInd |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART IV, SECTION B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | THE BYLAWS OF MERCYHEALTH DEVELOPMENT FOUNDATION (FOUNDATION) PROVIDE THAT MERCY HEALTH CORPORATION (MHC) IS THE SOLE CORPORATE MEMBER OF THE FOUNDATION. MHC IS ALSO THE SOLE CORPORATE MEMBER OF EACH OF THE SUPPORTED ORGANIZATIONS AND HAS THE POWER TO APPOINT EACH MEMBER OF THE RESPECTIVE BOARDS OF DIRECTORS. PURSUANT TO A WRITTEN DETERMINATION FROM THE INTERNAL REVENUE SERVICE, THE FOUNDATION IS OPERATED, SUPERVISED, OR CONTROLLED BY THE SUPPORTED ORGANIZATIONS, AND THUS THE FOUNDATION IS A TYPE I SUPPORTING ORGANIZATION. | 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
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,185,108 | BeginningYearBalanceAmt |
| Contributions | $200 | ContributionsAmt |
| Investment Earnings Or Losses | $677,188 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $46,915 | OtherExpendituresAmt |
| Administrative Expenses | $339 | AdministrativeExpensesAmt |
| End Year Balance | $3,815,242 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,931,724 | BeginningYearBalanceAmt |
| Contributions | $37,162 | ContributionsAmt |
| Investment Earnings Or Losses | $222,483 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $5,839 | OtherExpendituresAmt |
| Administrative Expenses | $422 | AdministrativeExpensesAmt |
| End Year Balance | $3,185,108 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,837,167 | BeginningYearBalanceAmt |
| Contributions | $3,382 | ContributionsAmt |
| Investment Earnings Or Losses | $287,205 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $192,748 | OtherExpendituresAmt |
| Administrative Expenses | $3,282 | AdministrativeExpensesAmt |
| End Year Balance | $2,931,724 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,687,807 | BeginningYearBalanceAmt |
| Contributions | $2,045 | ContributionsAmt |
| Investment Earnings Or Losses | $278,141 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $124,027 | OtherExpendituresAmt |
| Administrative Expenses | $6,799 | AdministrativeExpensesAmt |
| End Year Balance | $2,837,167 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,469,894 | BeginningYearBalanceAmt |
| Contributions | $11,630 | ContributionsAmt |
| Investment Earnings Or Losses | $288,013 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $75,297 | OtherExpendituresAmt |
| Administrative Expenses | $6,433 | AdministrativeExpensesAmt |
| End Year Balance | $2,687,807 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.14000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.45000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.41000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,779 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,779 | DepreciationAmt |
| Book Value | $0 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $83,301 | OtherCostOrOtherBasisAmt |
| Depreciation | $83,301 | DepreciationAmt |
| Book Value | $0 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | INTEREST IN BENEFICIAL TRUST | Desc |
| Book Value | $14,095,423 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $14,095,423 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO RELATED ORGANIZATIONS | Desc |
| Amt | $1,074,700 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,074,700 | TotalLiabilityAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART V, LINE 4: | FormAndLineReferenceDesc |
| Explanation | FUNDS WERE USED TO PROVIDE A LECTURE SERIES, FOR CONTINUING EDUCATION FOR EMPLOYEES WANTING TO IMPROVE THEIR CREDENTIALS OR TO FOCUS ON A NEW SKILL OR SOME TECHNOLOGY NOT CURRENTLY AVAILABLE IN THE ROCKFORD COMMUNITY. THERE WERE ALSO MISCELLANEOUS PROJECTS DESIGNATED BY THE FOUNDATION BOARD IN ACCORDANCE WITH THE SPECIFIC ENDOWMENT. ALL FUNDS WERE EXPENDED PER THE SPECIFIC DIRECTION OF EACH ENDOWMENT. | ExplanationTxt |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | GOLF EVENT | Event1Nm |
| Gross Receipts Event1 | $41,465 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $41,465 | CharitableContriEvent1Amt |
| Non Cash Prizes Event1 | $560 | NonCashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $8,764 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $5,099 | FoodAndBeverageEvent1Amt |
| Other Direct Expenses Event1 | $2,583 | OtherDirectExpensesEvent1Amt |
| Event2 | GIVE A GIFT | Event2Nm |
| Gross Receipts Event2 | $24,809 | GrossReceiptsEvent2Amt |
| Charitable Contri Event2 | $24,809 | CharitableContriEvent2Amt |
| Other Direct Expenses Event2 | $1,058 | OtherDirectExpensesEvent2Amt |
| Other Events Total | 1 | OtherEventsTotalCnt |
| Gross Receipts Other Events | $4,002 | GrossReceiptsOtherEventsAmt |
| Charitable Contri Other Events | $4,002 | CharitableContriOtherEventsAmt |
| Rent Fclty Costs Other Events | $3,295 | RentFcltyCostsOtherEventsAmt |
| Oth Direct Expnss Other Events | $1,227 | OthDirectExpnssOtherEventsAmt |
| Gross Receipts Total | $70,276 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $70,276 | CharitableContributionsTotAmt |
| Non Cash Prizes Total Events | $560 | NonCashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $12,059 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $5,099 | FoodAndBeverageTotalEventsAmt |
| Oth Direct Expnss Total Events | $4,868 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $22,586 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$22,586 | NetIncomeSummaryAmt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| JAVON BEA HOSPITAL | |||||||
| 2400 N ROCKTON AVE | ROCKFORD | IL | 61103 | 362167847 | 501(C)(3) | $330,421 | RONALD MCDONALD CAREMOBILE, PARTNER CRISIS FD & OTHER RESTRICTED DONATIONS |
| ROCKFORD HEALTH PHYSICIANS | |||||||
| 2300 N ROCKTON AVE | ROCKFORD | IL | 61103 | 363907436 | 501(C)(3) | $18,639 | FREE CLINIC REIMB - INDIGENT ASSISTANCE |
| MERCYHEALTH VISITING NURSES ASSOCIATION INC | |||||||
| 4223 E STATE STREET | ROCKFORD | IL | 61108 | 362167945 | 501(C)(3) | $17,035 | HOSPICE, VNA EXPENSES, OTHER GRANTS |
| MERCY HEALTH SYSTEM CORPORATION | |||||||
| PO BOX 5003 - 1000 MINERAL POINT | JANESVILLE | WI | 53547 | 390816848 | 501(C)(3) | $9,697 | HOSPICE, NURSING SCHOLARSHIPS, PATIENT EXPENSES, PARTNER CRISIS |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 4 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (4 entries)
| Grant TypeGrantTypeTxt | RecipientRecipientCnt | Cash GrantCashGrantAmt |
|---|---|---|
| FINANCIAL ASSISTANCE FOR FAMILIES WITH AN AUTISTIC CHILD. | 2 | $1,770 |
| FINANCIAL ASSISTANCE FOR EMPLOYEES DEALING WITH A CRISIS. | 18 | $15,502 |
| FINANCIAL ASSISTANCE FOR INDIVIDUALS FOR MAMMOGRAPHY/CANCER SCREENINGS. | 33 | $9,316 |
| AUXILIARY SCHOLARSHIPS FOR INDIVIDUALS NEEDING ASSISTANCE TO ATTEND COLLEGE OR CERTIFICATION PROGRAMS. | 8 | $8,263 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | APPLICATIONS ARE SUBMITTED TO THE HOSPITAL VERIFYING A NEED FOR FUNDS OR PRODUCTS (IE AUTOMATIC ELECTRONIC DEFIBRILLATORS-AED). A DETERMINATION IS MADE THROUGH A PREDETERMINED SCORING METHOD AS TO WHAT ORGANIZATIONS WILL BE RECIPIENTS OF THE FUNDS OR PRODUCTS. CASH CONTRIBUTIONS ARE MADE ONLY TO RECOGNIZED CHARITIES FOR WHICH GOOD FAITH REGARDING FUND USE HAS BEEN ESTABLISHED. THE CONTRIBUTION IS ONLY FOR THE AMOUNT OF THE APPEAL AND FOR A SPECIFIED NEED. | ExplanationTxt |
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 (5 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 43-46) | $0 | $1,471,858 | $0 | $0 | $0 | $3,586,128 | $0 | $7,056,412 | $0 | $17,748 | $0 | $12,132,146 | $0 | $0 |
| TODD ANDERSON | ||||||||||||||
| VICE PRESIDENT/CFO (AS OF 05/2020) | $0 | $355,005 | $0 | $182,313 | $0 | $5,540 | $0 | $0 | $0 | $18,158 | $0 | $561,016 | $0 | $0 |
| MARK L GOELZER MD | ||||||||||||||
| DIRECTOR/PHYSICIAN | $0 | $355,312 | $0 | $142,289 | $0 | $4,364 | $0 | $11,400 | $0 | $17,748 | $0 | $531,113 | $0 | $0 |
| SHANNON DUNPHY-ALEXANDER | ||||||||||||||
| SR EXECUTIVE DIRECTOR | $0 | $237,151 | $0 | $75,861 | $0 | $229 | $0 | $11,400 | $0 | $4,517 | $0 | $329,158 | $0 | $0 |
| KIMBERLY SCACCIA | ||||||||||||||
| VP-REVENUE CYCLE (AS OF 03/2020) | $0 | $227,500 | $0 | $67,625 | $0 | $3,966 | $0 | $0 | $0 | $21,962 | $0 | $321,053 | $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 2020. |
| PART I, LINE 4B | INCENTIVE PLAN DISTRIBUTION: JAVON R. BEA - $2,627,335. |
| 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 $3.3 BILLION IN FY2021. THIS HAS ALLOWED THE HEALTH SYSTEM TO GO FROM SERVING 89,000 PATIENTS IN 1989 TO OVER 2.1 MILLION PATIENTS TODAY WORKING TOGETHER WITH OVER 7,300+ 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 M IRS990ScheduleM
Securities Publicly Traded SecuritiesPubliclyTradedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 1 | ContributionCnt |
| Noncash Contributions Rpt F990 | $28,859 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | PURCHASED COST | MethodOfDeterminingRevenuesTxt |
Other Non Cash Contri Table OtherNonCashContriTableGrp (2 entries)
| Non Cash CheckboxNonCashCheckboxInd | DescDesc | ContributionContributionCnt | Noncash Contributions Rpt F990NoncashContributionsRptF990Amt | Method Of Determining RevenuesMethodOfDeterminingRevenuesTxt |
|---|---|---|---|---|
| Yes (X) | PREPARED FOOD DONATIONS | 15 | $9,730 | PURCHASED COST |
| Yes (X) | MISC - SNACKS/DRINKS/BALLONS/GOODIE BAGS | 2 | $400 | PURCHASED COST |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | Yes (1) | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | 0 | ThirdPartiesUsedInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, COLUMN (B): | FormAndLineReferenceDesc |
| Explanation | OTHER ITEMS - SNACKS/FOOD (PREPARED FOODS)/GOODIE BAGS, ETC - ARE LISTED BY NUMBER OF CONTRIBUTORS - AS THE ACTUAL # OF ITEMS WERE TOO NUMEROUS AND SPREAD OUT TO COUNT INDIVIDUALLY. THESE WERE COVID DONATIONS MADE TO VARIOUS HOSPITALS/CLINICS FROM AUGUST 2020 TO MARCH 2021 TO SUPPORT AND ENCOURAGE THE HEALTHCARE WORKERS AT THESE FACILITIES. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | THE BOARD OF DIRECTORS SHALL BE ASSISTED THROUGH THE WORK OF VARIOUS STANDING AND SPECIAL COMMITTEES. EACH COMMITTEE SHALL HAVE A CHARTER, WHICH MUST BE APPROVED BY THE BOARD OF DIRECTORS AND WHICH SHALL SPECIFY THE COMPOSITION OF THE COMMITTEE (INCLUDING QUALIFICATIONS OF COMMITTEE MEMBERS, IF ANY), AND THE AUTHORITY AND RESPONSIBILITIES OF THE COMMITTEE. EXCEPT AS SPECIFICALLY DETERMINED BY THE BOARD OF DIRECTORS, COMMITTEES SHALL ACCOUNT DIRECTLY TO THE BOARD OF DIRECTORS THROUGH REGULAR REPORTING AT SUCH TIME AND IN SUCH FORMAT AS MAY BE DETERMINED BY THE BOARD. TO THE EXTENT PROVIDED BY ITS CHARTER, A STANDING COMMITTEE MAY BE GRANTED THE AUTHORITY TO EXERCISE THE POWER OF THE BOARD BETWEEN BOARD MEETINGS, EXCEPT THAT NO COMMITTEE SHALL TAKE ANY OF THE FOLLOWING ACTIONS: (A) ADOPT A PLAN FOR DISTRIBUTION OF THE ASSETS OR DISSOLUTION OF THE FOUNDATION; (B) FILL VACANCIES ON THE BOARD OR ANY COMMITTEE THEREOF; (C) ELECT, APPOINT OR REMOVE ANY DIRECTOR, OFFICER OR COMMITTEE MEMBER, OR FIX THE COMPENSATION OF ANY COMMITTEE MEMBER; (D) AMEND OR REPEAL THE ARTICLES OF INCORPORATION OR THE BYLAWS; (E) ADOPT A PLAN OF MERGER OR CONSOLIDATION, OR AUTHORIZE THE SALE, LEASE, EXCHANGE OR MORTGAGE OF ALL OR SUBSTANTIALLY ALL OF THE PROPERTY OR ASSETS OF THE FOUNDATION; OR (F) AMEND, ALTER, REPEAL OR TAKE ACTION INCONSISTENT WITH ANY RESOLUTION OR ACTION OF THE BOARD IF, BY ITS TERMS, SUCH RESOLUTION OR ACTION PROVIDES THAT IT SHALL NOT BE AMENDED, ALTERED OR REPEALED BY A COMMITTEE. |
| FORM 990, PART VI, SECTION A, LINE 6 | MERCY HEALTH CORPORATION (MHC) IS THE SOLE CORPORATE MEMBER OF MERCYHEALTH DEVELOPMENT FOUNDATION, INC. (FOUNDATION). THE BOARD OF DIRECTORS OF THE SOLE MEMBER (THE "SOLE MEMBER BOARD") SHALL HAVE EXCLUSIVE AUTHORITY OVER THE FOLLOWING ACTIONS OF THE FOUNDATION AND, THROUGH THE FOUNDATION, ANY CORPORATION, ASSOCIATION, PARTNERSHIP, TRUST, JOINT VENTURE, OR OTHER ENTITY WHOLLY OR PARTIALLY CONTROLLED BY THE FOUNDATION (EACH A "SUBSIDIARY"), AS WELL AS OTHER ENTITIES CONTROLLED BY THE SOLE MEMBER (COLLECTIVELY, THE "SYSTEM"). UNLESS EXPRESSLY STATED TO THE CONTRARY HEREIN, THE SOLE MEMBER MAY EXERCISE SUCH POWER WITH OR WITHOUT A PRIOR ACTION OR RECOMMENDATION OF THE BOARD. (A) MAJORITY VOTE. THE FOLLOWING FOUNDATION ACTIONS MAY BE TAKEN BY A MAJORITY VOTE OF THE SOLE MEMBER BOARD: (I) ELECTION AND REMOVAL OF THE DIRECTORS OR DIRECTORS OF ANY SUBSIDIARY; (II) INITIATION OR APPROVAL OF THE FORMATION OF A NEW SUBSIDIARY, OR AN EQUITY INVESTMENT BY THE FOUNDATION OR A SUBSIDIARY IN ANY UNRELATED PERSON; (III) ADOPTION OF THE ANNUAL CONSOLIDATED OPERATING AND CAPITAL BUDGETS OF THE FOUNDATION AND ITS SUBSIDIARIES, WHICH SHALL BE CONSISTENT WITH THE STRATEGIC PLANS AND STRATEGIC CAPITAL PLANS OF THE SYSTEM; (IV) INITIATION OR APPROVAL OF UNBUDGETED OR OUT-OF-BUDGET CAPITAL EXPENDITURES BY THE FOUNDATION OR ONE OR MORE SUBSIDIARIES THAT EXCEED $500,000 AS EITHER A SINGLE ITEM OR A SERIES OF RELATED ITEMS; (V) INITIATION OR APPROVAL OF BUDGETED CAPITAL EXPENDITURES BY THE FOUNDATION OR ONE OR MORE SUBSIDIARIES EXCEEDING $1,500,000; (VI) APPROVAL OF LOCAL BANKING RELATIONSHIP OF THE FOUNDATION OR ITS SUBSIDIARIES AND THE FOUNDATION'S OR ANY SUBSIDIARY'S ENGAGEMENT OF INDEPENDENT AUDITORS; (VII) INITIATION OR APPROVAL OF LOANS OR OTHER INCURRENCE OF DEBT BY THE FOUNDATION OR ANY SUBSIDIARY EXCEEDING $500,000; (VIII) APPROVAL OF ANY ACTION THAT COULD IMPAIR THE TAX-EXEMPT STATUS OF THE FOUNDATION OR ANY SUBSIDIARY; (IX) INITIATION OR APPROVAL OF THE HIRING OR REMOVAL OF THE CHIEF EXECUTIVE OFFICER, PRESIDENT AND/OR CHIEF OPERATING OFFICER OF FOUNDATION OR ANY SUBSIDIARY; (X) ANY OTHER ACTION RESERVED TO THE FOUNDATION BY THE ARTICLES OF INCORPORATION OR BYLAWS OF A SUBSIDIARY; AND (XI) APPROVAL OF ANY AND ALL SUCH OTHER MATTERS REGARDING THE FOUNDATION AND THE CONDUCT OF ITS BUSINESS ACTIVITIES AND OWNERSHIP OF ITS ASSETS AS MAY RIGHTLY COME BEFORE THE SOLE MEMBER BOARD; (B) SUPERMAJORITY VOTE. THE FOLLOWING FOUNDATION ACTIONS MAY BE TAKEN BY A SUPERMAJORITY VOTE OF THE SOLE MEMBER BOARD (AS DEFINED IN THE SOLE MEMBER'S CORPORATE BYLAWS): (I) APPROVAL OF THE ISSUANCE OF INDEBTEDNESS EXCEEDING $5 MILLION ON BEHALF OF THE FOUNDATION OR ANY SUBSIDIARY; (II) INITIATION OR APPROVAL OF ANY ACQUISITION, MERGER, CONSOLIDATION, DISSOLUTION OR OTHER AFFILIATION OF THE FOUNDATION OR A SUBSIDIARY WITH AN UNRELATED ENTITY; (III) INITIATION OR APPROVAL OF ANY ACQUISITION, MERGER, CONSOLIDATION, DISSOLUTION, OR SALE OF SUBSTANTIALLY ALL OF THE ASSETS OF THE FOUNDATION OR A SUBSIDIARY; (IV) INITIATION OR APPROVAL OF CHANGES TO THE MISSION OF THE FOUNDATION OR ANY OTHER AMENDMENT OR RESTATEMENT OF THE FOUNDATION'S ARTICLES OF INCORPORATION OR THESE BYLAWS; (V) INITIATION OR APPROVAL OF CHANGES TO THE MISSION OF A SUBSIDIARY OR ANY OTHER AMENDMENT OR RESTATEMENT OF A SUBSIDIARY'S ARTICLES OF INCORPORATION OR CORPORATE BYLAWS; (VI) INITIATION OR APPROVAL OF MATERIAL CHANGES TO THE SCOPE OF SERVICES OF FOUNDATION OR ITS SUBSIDIARIES IF SUCH CHANGES WOULD HAVE A MATERIAL NET EFFECT (I.E., AN ACTUAL OR REASONABLY FORESEEABLE VALUE OR ECONOMIC EFFECT OF AT LEAST $1,000,000) ON THE OPERATING MARGIN OF FOUNDATION OR ITS SUBSIDIARIES; AND (VII) REMOVAL OF ANY DIRECTOR OF THE FOUNDATION OR A DIRECTOR OF A SUBSIDIARY BASED UPON A FINDING OF CAUSE, AS THAT TERM IS DEFINED IN SECTION 3.5(A) OF THE BYLAWS. |
| 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 | MHC COMPLIANCE DEPARTMENT (ACTING ON BEHALF OF MHDF AND FOLLOWING GUIDELINES SET FORTH IN THE POLICY) GENERALLY SENDS OUT A COPY OF THE POLICY WITH THE CONFLICT OF INTEREST FORM INCLUDED. EMPLOYEES AND EACH BOARD MEMBER COMPLETE THE FINANCIAL INTEREST DISCLOSURE STATEMENT WHICH IS A PART OF THE POLICY THE MHC COMPLIANCE DEPARTMENT REVIEWS AND RETAINS THESE STATEMENTS. IF A CONFLICT IS IDENTIFIED, ALL AFFECTED PARTIES ARE INFORMED, POTENTIAL CONFLICTS REVIEWED AND APPROPRIATE ACTIONS ARE TAKEN AS A RESULT OF THE REVIEW. EMPLOYEES ARE USUALLY GIVEN THE POLICY AND A STATEMENT TO COMPLETE ANNUALLY AT THE BEGINNING OF THE YEAR OR AS A NEW PARTY IS HIRED OR JOINS THE MHDF BOARD. THIS PROCESS WAS LAST COMPLETED IN 2020, WHEN THE QUESTIONNAIRES WERE SENT TO ADDRESS ANY 2020 CONFLICTS IDENTIFIED. THE MHC CONFLICT OF INTEREST POLICY IS AVAILABLE UPON REQUEST. |
| FORM 990, PART VI, SECTION C, LINE 19 | NO DOCUMENTS AVAILABLE TO THE PUBLIC. |
| FORM 990, PART XII, LINE 2C: | NO CHANGE FROM PRIOR YEAR. |
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 | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| MERCY HEALTH CORPORATION | |||||||||||
| 2400 N ROCKTON AVE | ROCKFORD | IL | 61103 | 472158680 | SUPPORT OF HEALTHCARE | IL | 501(C)(3) | LINE 12B, II | N/A | 0 | |
| ROCKFORD HEALTH PHYSICIANS | |||||||||||
| 2400 N ROCKTON AVE | ROCKFORD | IL | 61103 | 363907436 | HEALTHCARE | IL | 501(C)(3) | LINE 3 | 0 | MERCY HEALTH CORPORATION | |
| JAVON BEA HOSPITAL | |||||||||||
| 2400 N ROCKTON AVE | ROCKFORD | IL | 61103 | 362167847 | HEALTHCARE | IL | 501(C)(3) | LINE 3 | 0 | MERCY HEALTH CORPORATION | |
| MERCYHEALTH VISITING NURSES ASSOCIATION INC | |||||||||||
| 4223 E STATE STREET | ROCKFORD | IL | 61108 | 362167945 | HEALTHCARE | IL | 501(C)(3) | LINE 10 | 0 | MERCY HEALTH CORPORATION | |
| 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 | 0 | MERCY HEALTH SYSTEM CORPORATION | |
| MERCY HEALTH SYSTEM CORPORATION | |||||||||||
| 1000 MINERAL POINT AVE | JANESVILLE | WI | 53548 | 390816848 | HEALTHCARE | WI | 501(C)(3) | LINE 3 | 0 | MERCY HEALTH CORPORATION | |
| MERCY ASSISTED CARE INC | |||||||||||
| 901 MINERAL POINT | JANESVILLE | WI | 53548 | 391035110 | HEALTHCARE | WI | 501(C)(3) | LINE 10 | 0 | MERCY HEALTH CORPORATION | |
| MERCY HARVARD HOSPITAL INC | |||||||||||
| 901 GRANT STREET | HARVARD | IL | 60033 | 311551871 | HEALTHCARE | IL | 501(C)(3) | LINE 3 | 0 | MERCY HEALTH CORPORATION | |
| MERCY CRYSTAL LAKE HOSPITAL AND MEDICAL CENTER | |||||||||||
| 1000 MINERAL POINT AVE | JANESVILLE | WI | 53548 | 201673011 | NONE | WI | 501(C)(3) | LINE 3 | 0 | MERCY HEALTH CORPORATION | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (4 entries)
| Address Line1ForeignAddress/AddressLine1Txt | CityForeignAddress/CityNm | CountryForeignAddress/CountryCd | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Legal Domicile StateLegalDomicileStateCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ROCKFORD HEALTH INSURANCE LTD | |||||||||||||
| WELLESLEY HOUSE SO 2ND FL | PEMBROKE HM | BD | INSURANCE | BD | N/A | C | 0 | ||||||
| JANESVILLE MEDICAL CENTER INC | |||||||||||||
| MANAGEMENT OF UNION EMPLOYEES | N/A | C | 0 | 1000 MINERAL POINT AVE | JANESVILLE | WI | 53548 | 391520130 | WI | ||||
| MERCYCARE INSURANCE COMPANY | |||||||||||||
| INSURANCE | N/A | C | 0 | 580 N WASHINGTON ST | JANESVILLE | WI | 53546 | 391768192 | WI | ||||
| MERCYCARE HMO INC - CONSOLIDATED WITH MERCYCARE INSURANCE CO | |||||||||||||
| INSURANCE | N/A | C | 0 | 580 N WASHINGTON ST | JANESVILLE | WI | 53546 | 201482553 | WI | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | 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 | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | 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 | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |