MERCY HOSPITAL AUXILIARY INC: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- MERCY HOSPITAL AUXILIARY INC (EIN 39-0912682)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-08-22
- IRS object ID
- 201702349349300905
- Schema version
- 2016v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-08-22T11:52:10-05:00 | ReturnTs |
| Tax Period End | 2016-12-31 | 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 Virchow Krause 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 | 2016-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390912682 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Mercy Health System Association of | BusinessNameLine1Txt |
| Business Name Line2 | Volunteers | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MERC | BusinessNameControlTxt |
| Phone | 6087566000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1000 Mineral Point Ave | AddressLine1Txt |
| City | Janesville | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53545 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SHERRY DUX | PersonNm |
| Person Title | President | PersonTitleTxt |
| Phone | 6087566000 | PhoneNum |
| Signature | 2017-08-11 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Troy E Marine CPA | PreparerPersonNm |
| PTIN | P00187863 | PTIN |
| Phone | 6087525835 | PhoneNum |
| Preparation | 2017-08-11 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 12.148.210.27 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2017-08-11 | IPDt |
| IP Tm | 11:21:06 | IPTm |
| IP Timezone | CD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 1C40C474E7DEB989202A97D331D649435C652DD4 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | SHERRY DUX | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1000 Mineral Point Ave | AddressLine1Txt |
| City | Janesville | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53545 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $740,904 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | n/a | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1963 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | THE MISSION OF THE MERCY HEALTH SYSTEM ASSOCIATION OF VOLUNTEERS IS TO:PERFORM THE HIGHEST QUALITY OF VOLUNTEER SERVICES FOR IMPROVED HEALTHCARE, ACT AS AMBASSADORS OF GOODWILL FOR MERCY HOSPITAL IN THE SOUTHERN WISCONSIN AREA, AND PROVIDE FINANCIAL ASSISTANCE THROUGH FUND RAISING PROJECTS IN THE QUEST FOR HEALTHCARE AT THE LOWEST POSSIBLE COST WITHOUT SACRIFICING QUALITY, SERVICE, AND CONVENIENCE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 24 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 24 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 745 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $20,293 | PYContributionsGrantsAmt |
| CY Contributions Grants | $22,389 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $699,260 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $699,887 | CYProgramServiceRevenueAmt |
| PY Investment Income | $347 | PYInvestmentIncomeAmt |
| CY Investment Income | $390 | CYInvestmentIncomeAmt |
| PY Other Revenue | $3,276 | PYOtherRevenueAmt |
| CY Other Revenue | $15,880 | CYOtherRevenueAmt |
| PY Total Revenue | $723,176 | PYTotalRevenueAmt |
| CY Total Revenue | $738,546 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $147,608 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $159,800 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $0 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $486,931 | PYOtherExpensesAmt |
| CY Other Expenses | $520,369 | CYOtherExpensesAmt |
| PY Total Expenses | $634,539 | PYTotalExpensesAmt |
| CY Total Expenses | $680,169 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $88,637 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $58,377 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $503,836 | TotalAssetsBOYAmt |
| Total Assets EOY | $578,374 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $0 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $0 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $503,836 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $578,374 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE MISSION OF THE MERCY HEALTH SYSTEM ASSOCIATION OF VOLUNTEERS IS TO:PERFORM THE HIGHEST QUALITY OF VOLUNTEER SERVICES FOR IMPROVED HEALTHCARE, ACT AS AMBASSADORS OF GOODWILL FOR MERCY HOSPITAL IN THE SOUTHERN WISCONSIN AREA, AND PROVIDE FINANCIAL ASSISTANCE THROUGH FUND RAISING PROJECTS IN THE QUEST FOR HEALTHCARE AT THE LOWEST POSSIBLE COST WITHOUT SACRIFICING QUALITY, SERVICE, AND CONVENIENCE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $127,642 | ExpenseAmt |
| Revenue | $133,553 | RevenueAmt |
| Desc | MEALS ON WHEELS:REPRESENTS THE COST OF MEALS PREPARED BY MERCY HOSPITAL AND DELIVERED BY VOLUNTEERS TO SHUT-INS OR HOME PATIENTS. A TOTAL OF 34,363 MEALS WERE SERVED DURING THE YEAR. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $129,990 | ExpenseAmt |
| Revenue | $209,888 | RevenueAmt |
| Desc | LIFELINE:REPRESENTS THE COST OF COMMUNICATIONS EQUIPMENT PROVIDED TO INDIVIDUALS IN THEIR HOMES FOR MONITORING AND NOTIFICATION OF EMERGENCY SITUATIONS. STAFFED BY VOLUNTEERS. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $126,236 | ExpenseAmt |
| Revenue | $191,506 | RevenueAmt |
| Desc | GIFT SHOP:STAFFED BY VOLUNTEERS. PROVIDES MERCHANDISE TO PATIENTS AND THEIR FAMILIES AND FRIENDS. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $296,301 | ExpenseAmt |
| Grant | $159,800 | GrantAmt |
| Revenue | $164,940 | RevenueAmt |
| Desc | Castaways Thrift Store:Staffed by volunteers. Sales of used clothing and household items to generate contributions to Mercy Hospital.CONTRIBUTION TO MERCY HOSPITAL:CONTINUAL CONTRIBUTION TO MERCY HOSPITAL FROM FUNDS GENERATED BY ASSOCIATION OF VOLUNTEERS. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $296,301 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Grant | $159,800 | TotalOtherProgSrvcGrantAmt |
| Total Other Prog Srvc Revenue | $164,940 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $680,169 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | 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 |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| 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 | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | 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 | 0 | 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 With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| 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 | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| 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 | 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 |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 24 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 24 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | 0 | 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 |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MERCY HEALTH SYSTEM ASSOC OF VOLUNTEERS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6087566000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1000 Mineral Point Ave | AddressLine1Txt |
| City | JANESVILLE | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53545 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (24 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|
| SheRRY DUX | ||||||
| President | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| dARLENE BECKER | ||||||
| Secretary | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| William Anacker | ||||||
| Treasurer | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| Judy Jaggard | ||||||
| Past President | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Arlene Knudson | ||||||
| Pres. Elect | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Corinne Carey | ||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Steve Gaffney | ||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Bob Knudson | ||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Pam Govert | ||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Steve Hynds | ||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Kathleen Cooper | ||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Nancy Verhoeven | ||||||
| director | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Elaine Lawrence | ||||||
| director | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Diana Pearse | ||||||
| director | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Jean Stoll | ||||||
| director | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Becky Esselman | ||||||
| DIRector | 1.00 | Yes (X) | $0 | $0 | $0 | |
| JoAnn Reed | ||||||
| DIrector | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Linda Vavra | ||||||
| DIrector | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Lisa Brown | ||||||
| DIrector | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Sharon Henning | ||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Lisa Olander | ||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Carol Scheehle | ||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Sandi Ploszaj | ||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Carol Gilhooley | ||||||
| Director | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $0 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | 0 | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Membership Dues | $2,120 | MembershipDuesAmt |
| All Other Contributions | $20,269 | AllOtherContributionsAmt |
| Total Contributions | $22,389 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| LIFELINE | 900099 | $209,698 | $209,698 |
| Gift Shop | 900099 | $191,506 | $191,506 |
| MEALS ON WHEELS | 624210 | $133,553 | $133,553 |
| General Auxiliary | 900099 | $98,046 | $98,046 |
| CASTAWAYS | 900099 | $53,522 | $53,522 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $13,562 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $13,562 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $699,887 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $390 | TotalRevenueColumnAmt |
| Exclusion | $390 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $18,238 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $2,358 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $15,880 | TotalRevenueColumnAmt |
| Exclusion | $15,880 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $738,546 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $699,887 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $16,270 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $150,300 | TotalAmt |
| Program Services | $150,300 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,500 | TotalAmt |
| Program Services | $9,500 | ProgramServicesAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $469 | TotalAmt |
| Program Services | $469 | ProgramServicesAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,819 | TotalAmt |
| Program Services | $3,819 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,155 | TotalAmt |
| Program Services | $18,155 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,604 | TotalAmt |
| Program Services | $9,604 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,771 | TotalAmt |
| Program Services | $6,771 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| MEALS FOR MEALS ON WHEE | $125,545 | $125,545 |
| GIFT SHOP MERCHANDISE | $121,241 | $121,241 |
| LIFELINE EQUIPMENT | $120,201 | $120,201 |
| Miscellaneous Expense | $101,812 | $101,812 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,752 | TotalAmt |
| Program Services | $12,752 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $680,169 | TotalAmt |
| Program Services | $680,169 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $150,294 | BOYAmt |
| EOY | $194,242 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $348,119 | BOYAmt |
| EOY | $378,709 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $5,423 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $0 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,423 | BOYAmt |
| EOY | $5,423 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $503,836 | BOYAmt |
| EOY | $578,374 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $503,836 | BOYAmt |
| EOY | $578,374 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $503,836 | BOYAmt |
| EOY | $578,374 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $503,836 | BOYAmt |
| EOY | $578,374 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $58,377 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $16,161 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Cash | Yes (X) | MethodOfAccountingCashInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | 0 | FSAuditedInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type3 Func Int | Yes (X) | SupportingOrgType3FuncIntInd |
| Supported Organizations | 1 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp
Supported Organization Name SupportedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MERCY HEALTH SYSTEM CORPORATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390816848 | EIN |
| Organization Type | 3 | OrganizationTypeCd |
| Governing Document Listed | Yes (1) | GoverningDocumentListedInd |
| Support | $125,000 | SupportAmt |
| Other Support | $0 | OtherSupportAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 1 | SupportedOrganizationsTotalCnt |
| Support Sum | $125,000 | 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 | Yes (1) | 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 Type3 Sprt Org All Form990SchAType3SprtOrgAllGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timely Provided Documents | Yes (1) | TimelyProvidedDocumentsInd |
| Officers Close Relationship | Yes (1) | OfficersCloseRelationshipInd |
| Supported Org Voice Investment | 0 | SupportedOrgVoiceInvestmentInd |
Form990 Sch A Type3 Func Int Form990SchAType3FuncIntGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Test | Yes (X) | ActivitiesTestInd |
| Activities Further Exempt Prps | Yes (1) | ActivitiesFurtherExemptPrpsInd |
| Activities Engaged Org Invlmnt | Yes (1) | ActivitiesEngagedOrgInvlmntInd |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Section A Line 6 | Mercy Association of Volunteers donates to Mercy Health System and Mercy Foundation. Mercy Foundation is a subordinate member of Mercy Health System. Funds from the Mercy Association of Volunteers are donated to charity functions of the Mercy Foundation. |
| SECTION E LINE 2A | Mercy Health System Association of Volunteers supports Mercy Health System purpose by providing volunteer services to patients and their families, to support and improve Healthcare services, act as ambassadors of goodwill for Mercy Health System and their patients, provide financial assistance to Mercy Health System in quest to provide lowest possible health care costs. |
| Section E Line 2B | MERCY ASSOCIATION OF VOLUNTEER SERVICES PROVIDES RECEPTION, ESCORTING, AND OPERATES THE GIFT SHOP WITHIN MERCY HOSPITAL. IF THE ASSOCIATION DID NOT PERFORM THE SERVICES FOR THE ORGANIZATION, MERCY HEALTH SYSTEM WOULD HAVE TO FIND REPLACEMENT SERVICES. THE SERVICES MERCY ASSOCIATION OF VOLUNTEERS PROVIDE ARE REQUIRED FOR THE DAILY OPERATION OF THE HOSPITAL AND DIRECTLY IMPACTS PATIENTS AND THEIR SAFETY. |
Schedule D IRS990ScheduleD
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,423 | OtherCostOrOtherBasisAmt |
| Book Value | $5,423 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $5,423 | TotalBookValueLandBuildingsAmt |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | Cookie Sale | Event1Nm |
| Gross Receipts Event1 | $4,671 | GrossReceiptsEvent1Amt |
| Gross Revenue Event1 | $4,671 | GrossRevenueEvent1Amt |
| Other Direct Expenses Event1 | $2,358 | OtherDirectExpensesEvent1Amt |
| Event2 | Nutman Sale | Event2Nm |
| Gross Receipts Event2 | $3,753 | GrossReceiptsEvent2Amt |
| Gross Revenue Event2 | $3,753 | GrossRevenueEvent2Amt |
| Other Events Total | 4 | OtherEventsTotalCnt |
| Gross Receipts Other Events | $7,456 | GrossReceiptsOtherEventsAmt |
| Gross Revenue Other Events | $7,456 | GrossRevenueOtherEventsAmt |
| Gross Receipts Total | $15,880 | GrossReceiptsTotalAmt |
| Gross Revenue Total Events | $15,880 | GrossRevenueTotalEventsAmt |
| Oth Direct Expnss Total Events | $2,358 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $2,358 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $13,522 | NetIncomeSummaryAmt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|
| Mercy Foundation Inc | ||||||
| 1000 Mineral Point | janesville | WI | 53547 | 237275336 | $25,300 | Support Mercy Health System Corp, the House of Mercy, & Mercy Assisted Care |
| Mercy Health System Corporation | ||||||
| 1000 Mineral Point | Janesville | WI | 53547 | 390816848 | $125,000 | Support general functions |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 2 | Total501c3OrgCnt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | Scholarships | GrantTypeTxt |
| Recipient | 12 | RecipientCnt |
| Cash Grant | $9,500 | CashGrantAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | The organization has an application procedure in place for determining qualifications for those applying for financial scholarships in the medical field. Applications are obtained and reviewed by the board of directors to determine if the applicant fits the standards set forth by the board of directors. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 2 | Arlene Knudson and Bob Knudson have a family relationship. |
| Form 990, Part VI, Section A, line 8b | The organization does not keep records of minutes for any additional committees that can act on behalf of the governing body except for the Board of Directors meetings. |
| Form 990, Part VI, Section B, line 11b | A copy of the Form 990 is reviewed by the Board President prior to filing. A copy of the Form 990 is available for each board member to review but is not required. |
| Form 990, Part VI, Section B, line 12c | As stated in the organization's bylaws, any member on the Board of Directors is required to disclose any possible conflict of interest. If a conflict of interest arises between a member and the organization, that member must abstain from voting on a related matter. |
| Form 990, Part VI, Section C, line 19 | The organization makes all documents available to the public upon request. |
| Form 990, Part XI, line 9: | Prior Period Fund Adjustment 16,161. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 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 System Corporation | |||||||||||
| 1000 Mineral Point Ave | Janesville | WI | 53545 | 390816848 | Hospital | WI | 501(c)(3) | Line 3 | N/A | 0 | |
| Mercy Foundation Inc | |||||||||||
| 1000 Mineral Point Ave | Janesville | WI | 53545 | 237275336 | Support Mercy Hospital and Related Organizations | WI | 501(c)(3) | Line 12a, I | 0 | Mercy Health System Corporation | |
| 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 | 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 | 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 | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| Mercy Health System Corporation | ||
| B | $125,000 | Fair Market Value - Cash |
| Mercy Foundation Inc | ||
| B | $25,300 | Fair Market Value - Cash |