2013-05-15T15:50:39-05:00 2012-06-30 390859910 BAKER TILLY VIRCHOW KRAUSE LLP 500 MIDLAND COURT PO BOX 8130 JANESVILLE WI 535478130 990 2011-07-01 237275336 MERCY FOUNDATION INC MERC 6087566000 PO BOX 5003 - 1000 MINERAL POINT JANESVILLE WI 535475003 JAVON BEA 6087566000 2013-05-09 1 WILLIAM T MURPHY CPA P00074580 6087525835 2013-05-08 2011 2016-02-24 21:20:13Z JAVON BEA PO BOX 5003 - 1000 MINERAL POINT JANESVILLE WI 535475003 731539 0 X N/A X 1972 WI TO SUPPORT MERCY HEALTH SYSTEM CORP, THE HOUSE OF MERCY & MERCY ASSISTED CARE HOSPICE PROGRAM. 3 1 0 80 0 0 212810 264867 164300 120720 76207 35996 -26496 -20230 426821 401353 0 0 0 0 141465 94769 0 0 94769 280507 225702 421972 320471 4849 80882 1484330 1617960 120465 165567 1363865 1452393 X TO SUPPORT MERCY HEALTH SYSTEM CORP, THE HOUSE OF MERCY & MERCY ASSISTED CARE HOSPICE PROGRAM. 0 0 160720 0 HOUSE OF MERCY, A HOMELESS SHELTER, PROVIDED 7,531 SHELTER NIGHTS. A TOTAL OF 281 INDIVIDUALS (160 ADULTS AND 121 CHILDREN) WERE SERVED. 33173 120720 MERCY FOUNDATION PROVIDES SUBSIDY FUNDING FOR THE MERCY HEALTH SYSTEM RESIDENCY PROGRAM. USE OF THESE DONATIONS ARE FOR EDUCATIONAL NECESSITIES OUTSIDE THE NORMAL OPERATING BUDGET OF THE MERCY RESIDENCY PROGRAM. EXPENSES IN FISCAL YEAR 2012 INCLUDED PAYING FOR A MEDICAL MISSION IN CONJUNCTION WITH THE SHOULDER TO SHOULDER, INC. ORGANIZATION. OTHER EXPENSES INCLUDED STIPENDS PAID TO PHYSICIANS FOR THEIR PRECEPTOR TIME AND THEIR TIME SPENT COORDINATING THE ROTATION OF THEIR STUDENTS. 4108 OTHER MISCELLANEOUS PROGRAM EXPENSES 4108 198001 1 1 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 7 0 1 0 0 0 0 0 0 0 0 0 0 0 X 3 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 1 0 0 0 WI X JOHN COOK 6087566642 1000 MINERAL POINT JANESVILLE WI 535475003 LARRY E SQUIRE 1.00 X X 0 2580 0 RICHARD GRUBER 1.00 X 0 210752 30131 MARK GOELZER 1.00 X X 0 429224 699536 JAVON R BEA 1.00 X X 0 4028129 34261 BARB BORTNER 1.00 X 0 197581 32674 0 4868266 796602 0 0 1 0 0 145898 118969 264867 FAMILY PRACTICE RESIDE 900099 120720 120720 120720 38723 38723 209914 212641 -2727 -2727 -2727 97315 145898 117545 -20230 -20230 401353 120720 0 15766 94769 94769 8182 8182 13645 13645 5691 2216 3475 HOUSE OF MERCY EXP (HOM 160720 160720 0 0 STUDENT ACTIVITY EXPENS 32423 32423 0 0 MISCELLANEOUS 2173 1892 281 0 LICENSES, PERMITS & FEE 2118 0 2118 0 750 750 320471 198001 27701 94769 94624 139732 1360517 1390314 29189 87914 1484330 1617960 120465 165567 120465 165567 X 1363865 1452393 1363865 1452393 1484330 1617960 X 80882 7646 X 0 1 1 X 0 X X 0 0 0 MERCY ASSISTED CARE INC 391035110 9 1 0 1 0 MERCY HEALTH SYSTEM CORPORATION 390816848 3 1 0 1 0 2 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 VARIOUS INVESTMENTS 1390314 F 1390314 DUE FROM RELATED PARTY 87914 87914 DUE TO RELATED PARTY 165567 165567 401353 320471 80882 7646 7646 88528 CHARITY BALL 160543 105368 55175 7500 1500 1750 14503 8675 46477 JINGLE MINGLE 73246 40530 32716 6000 2709 0 7375 1185 12448 2 9424 0 9424 0 0 0 0 0 7423 243213 145898 97315 13500 4209 1750 21878 9860 66348 117545 -20230 0 0 0 0 0 0 0 0 0 RICHARD GRUBER 0 132858 0 70359 0 7535 0 12222 0 17909 0 240883 0 0 MARK GOELZER 0 317681 0 111543 0 0 0 676428 0 23108 0 1128760 0 0 JAVON R BEA 0 886939 0 785800 0 2355390 0 15014 0 19247 0 4062390 0 0 BARB BORTNER 0 130267 0 64245 0 3069 0 11786 0 20888 0 230255 0 0 FORM 990, PART VI, SECTION B, LINE 11 NO REVIEW WAS OR WILL BE CONDUCTED FORM 990, PART VI, SECTION B, LINE 12C OFFICERS, DIRECTORS, AND KEY EMPLOYEES ARE REQUIRED TO REPORT ALL CONFLICTS OF INTEREST. THE COMPLIANCE OFFICER IS RESPONSIBLE FOR INVESTIGATING ALL CONFLICTS AND REPORTING TO THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY & FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 7,646. MERCY ALLIANCE INC 1000 MINERAL POINT JANESVILLE WI 535475003 391679859 MANAGEMENT OF HEALTHCARE ORGANIZATIONS WI 501(C)(3) 11A N/A 0 MERCY HEALTH SYSTEM ASSOCIATION OF VOLUNTEERS 1000 MINERAL POINT JANESVILLE WI 535475003 390912682 TO SUPPORT MERCY HEALTH SYSTEM CORPORATION WI 501(C)(3) 11C MERCY HEALTH SYSTEM CORPORATION 0 MERCY HEALTH SYSTEM CORPORATION 1000 MINERAL POINT JANESVILLE WI 535475003 390816848 MEDICAL HEALTHCARE WI 501(C)(3) 3 MERCY ALLIANCE INC 0 MERCY ASSISTED CARE INC 901 MINERAL POINT JANESVILLE WI 535475003 391035110 HOME HEALTH CARE & SERVICES WI 501(C)(3) 9 MERCY ALLIANCE INC 0 MERCY HARVARD HOSPITAL INC 901 GRANT STREET HARVARD IL 60033 311551871 MEDICAL HEALTHCARE IL 501(C)(3) 3 MERCY ALLIANCE INC 0 HARVARD MEMORIAL HOSPITAL FOUNDATION 901 GRANT STREET HARVARD IL 60033 364308662 TO SUPPORT MERCY HARVARD HOSPITAL, INC. IL 501(C)(3) 11A MERCY HARVARD HOSPITAL INC 0 MERCY CRYSTAL LAKE HOSPITAL AND MEDICAL CENTER 1000 MINERAL POINT JANESVILLE WI 535475003 201673011 NONE IL 501(C)(3) 3 MERCY ALLIANCE INC 0 JANESVILLE MEDICAL CENTER INC 1000 MINERAL POINT JANESVILLE WI 535475003 391520130 MANAGEMENT ENTITY OF UNION EMPLOYEES WI MERCY HEALTH SYSTEM CORPORATION C MERCYCARE INSURANCE COMPANY 3430 PALMER DRIVE JANESVILLE WI 53545 391768192 INSURANCE COMPANY WI MERCY HEALTH SYSTEM CORPORATION C MERCYCARE HMO INC - CONSOLIDATED WITH MERCYCARE INSURANCE CO 3430 PALMER DRIVE JANESVILLE WI 53545 201482553 INSURANCE COMPANY WI MERCY HEALTH SYSTEM CORPORATION C 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0