MERCY HOSPITAL AUXILIARY INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- MERCY HOSPITAL AUXILIARY INC (EIN 39-0912682)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-15
- IRS object ID
- 201343199349301749
- Schema version
- 2012v2.1
- 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) |
|---|---|---|
| Timestamp | 2013-11-15T09:16:17-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390859910 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BAKER TILLY VIRCHOW KRAUSE LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 MIDLAND COURT PO BOX 8130 | AddressLine1 |
| City | JANESVILLE | City |
| State | WI | State |
| ZIP Code | 535478130 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390912682 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MERCY HEALTH SYSTEM ASSOCIATION OF VOLUNTEERS | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | MERC | NameControl |
| Phone | 6087566000 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1000 MINERAL POINT AVE | AddressLine1 |
| City | JANESVILLE | City |
| State | WI | State |
| ZIP Code | 53545 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JUDY JAGGARD | Name |
| Title | PRESIDENT | Title |
| Phone | 6087566000 | Phone |
| Date Signed | 2013-11-13 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | WILLIAM T MURPHY CPA | Name |
| PTIN | P00074580 | PTIN |
| Phone | 6087525835 | Phone |
| Date Prepared | 2013-11-13 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | JUDY JAGGARD | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1000 MINERAL POINT AVE | AddressLine1 |
| City | JANESVILLE | City |
| State | WI | State |
| ZIP Code | 53545 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 609131 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | N/A | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1963 | YearFormation |
| State Legal Domicile | WI | StateLegalDomicile |
| Activity Or Mission Description | 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. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 21 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 21 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 1037 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 9185 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 11125 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 535949 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 593470 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 130 | InvestmentIncomePriorYear |
| Investment Income Current Year | 192 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 3686 | OtherRevenuePriorYear |
| Other Revenue Current Year | 2571 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 548950 | TotalRevenuePriorYear |
| Total Revenue Current Year | 607358 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 11500 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 9000 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 0 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 0 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 492127 | OtherExpensePriorYear |
| Other Expenses Current Year | 526841 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 503627 | TotalExpensesPriorYear |
| Total Expenses Current Year | 535841 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 45323 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 71517 | RevenuesLessExpensesCY |
| Total Assets BOY | 305686 | TotalAssetsBOY |
| Total Assets EOY | 377203 | TotalAssetsEOY |
| Total Liabilities BOY | 0 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 0 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 305686 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 377203 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | 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. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 120788 | Expense |
| Revenue | 115671 | Revenue |
| Description | MEALS ON WHEELS:REPRESENTS THE COST OF MEALS PREPARED BY MERCY HOSPITAL AND DELIVERED BY VOLUNTEERS TO SHUT-INS OR HOME PATIENTS. APPROXIMATELY 120 MEALS DELIVERED EACH DAY. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 103385 | Expense |
| Revenue | 237053 | Revenue |
| Description | LIFELINE:REPRESENTS THE COST OF COMMUNICATIONS EQUIPMENT PROVIDED TO INDIVIDUALS IN THEIR HOMES FOR MONITORING AND NOTIFICATION OF EMERGENCY SITUATIONS. STAFFED BY VOLUNTEERS. 935 INDIVIDUALS RECEIVE LIFELINE SERVICES. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 104272 | Expense |
| Revenue | 148940 | Revenue |
| Description | GIFT SHOP:STAFFED BY VOLUNTEERS. PROVIDES MERCHANDISE TO PATIENTS AND THEIR FAMILIES AND FRIENDS. | Description |
Activity Other ActivityOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 207396 | Expense |
| Grants | 9000 | Grants |
| Revenue | 91806 | Revenue |
| Description | 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. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Other Program Service Exp | 207396 | TotalOfOtherProgramServiceExp |
| Total Of Other Program Service Grnt | 9000 | TotalOfOtherProgramServiceGrnt |
| Total Of Other Program Service Rev | 91806 | TotalOfOtherProgramServiceRev |
| Total Program Service Expense | 535841 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 1 | GrantsToIndividuals |
| Schedule J Required | 0 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 21 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 21 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 0 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 0 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MERCY HEALTH SYSTEM ASSOC OF VOLUN | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 6087566000 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1000 MINERAL POINT RD | AddressLine1 |
| City | JANESVILLE | City |
| State | WI | State |
| ZIP Code | 53545 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | X | NoListedPersonsCompensated |
Form990 Part VII Section A Form990PartVIISectionA (21 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|---|
| JUDY JAGGARD | ||||||
| PRESIDENT | 1.00 | X | X | 0 | 0 | 0 |
| ARLENE KNUDSON | ||||||
| SECRETARY | 1.00 | X | X | 0 | 0 | 0 |
| BRAD BASTIAN | ||||||
| TREASURER | 1.00 | X | X | 0 | 0 | 0 |
| STEVE HYNDS | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| ELAINE LAWRENCE | ||||||
| PAST PRESIDENT | 1.00 | X | 0 | 0 | 0 | |
| DARLENE BECKER | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| DIANA PEARSE | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| JOANN BROWN | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| KATHLEEN COOPER | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| CORAL NYQUIST | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| NANCY VERHOEVEN | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| VERGEAN JURS | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| NAOMI HACKBARTH | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| SUE DEAN BUCKHOLZ | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| SONIA HULL | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| MARY ANN HARRIS | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| JOANN REED | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| PAM GOVERT | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| JEAN STOLL | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| STEVE GAFFNEY | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| SHERRY DUX | ||||||
| PRESIDENT ELECT | 1.00 | X | X | 0 | 0 | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 0 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 0 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| Membership Dues | 2430 | MembershipDues |
| All Other Contributions | 8695 | AllOtherContributions |
| Total Contributions | 11125 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| LIFELINE | 900099 | 237053 | 237053 |
| GIFT SHOP | 900099 | 148940 | 148940 |
| MEALS ON WHEELS | 624210 | 115671 | 115671 |
| CASTAWAYS | 900099 | 79841 | 79841 |
| MEMBERSHIP FUNDS | 900099 | 6920 | 6920 |
Total Oth Program Service Revenue TotalOthProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 5045 | TotalRevenueColumn |
| Related Or Exempt Function Income | 5045 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 593470 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 192 | TotalRevenueColumn |
| Exclusion | $192 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 4344 | GrossIncomeFundraisingEvents |
| Fundraising Direct Expenses | 1773 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2571 | TotalRevenueColumn |
| Exclusion | $2,571 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 607358 | TotalRevenueColumn |
| Related Or Exempt Function Income | 593470 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $2,763 | ExclusionAmount |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9000 | Total |
| Program Services | 9000 | ProgramServices |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1224 | Total |
| Program Services | 1224 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 19275 | Total |
| Program Services | 19275 | ProgramServices |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10248 | Total |
| Program Services | 10248 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9830 | Total |
| Program Services | 9830 | ProgramServices |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8794 | Total |
| Program Services | 8794 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| CONTRIBUTION TO MERCY H | 161000 | 161000 |
| MEALS FOR MEALS ON WHEE | 115093 | 115093 |
| GIFT SHOP MERCHANDISE | 99758 | 99758 |
| LIFELINE EQUIPMENT | 80565 | 80565 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 21054 | Total |
| Program Services | 21054 | ProgramServices |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 535841 | Total |
| Program Services | 535841 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 107327 | BOY |
| EOY | 74834 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 192936 | BOY |
| EOY | 296946 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 5423 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 0 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5423 | BOY |
| EOY | 5423 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 305686 | BOY |
| EOY | 377203 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 305686 | BOY |
| EOY | 377203 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 305686 | BOY |
| EOY | 377203 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 305686 | BOY |
| EOY | 377203 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 71517 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Method Of Accounting Cash | X | MethodOfAccountingCash |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 0 | FSAudited |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | X | SupportingOrganization509a3 |
| Supporting Org509a3 Type3 Func Int | X | SupportingOrg509a3Type3FuncInt |
| Certification Checkbox | X | CertificationCheckbox |
| Contrib By Controlling Individual | 0 | ContribByControllingIndividual |
| Contribution By Related Party | 0 | ContributionByRelatedParty |
| Contrib By35 Controlled Entity | 0 | ContribBy35ControlledEntity |
Supported Org Information SupportedOrgInformation
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MERCY HEALTH SYSTEM CORPORATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390816848 | EIN |
| Type Of Organization | 3 | TypeOfOrganization |
| Listed In Governing Doc | 1 | ListedInGoverningDoc |
| Supported Organization Notified | 1 | SupportedOrganizationNotified |
| Organized In US | 1 | OrganizedInUS |
| Amount | $139,500 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 1 | TotalNumberOfSupportedOrgs |
| Sum Of Amounts | 139500 | SumOfAmounts |
Schedule D IRS990ScheduleD
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 5423 | OtherCostOrOtherBasis |
| Book Value | 5423 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 5423 | TotalOfBookValueLandBuildings |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Form990 Schedule I Part III Form990ScheduleIPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Grant | SCHOLARSHIPS | TypeOfGrant |
| Number Of Recipients | 9 | NumberOfRecipients |
| Amount Of Cash Grant | 9000 | AmountOfCashGrant |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | Identifier |
| Return Reference | PART I, LINE 2: | ReturnReference |
| Explanation | SCHEDULE I, PART I, LINE 2: 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. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (4 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| 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 11 | 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. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| MERCY HEALTH SYSTEM CORPORATION | |||||||||||
| 1000 MINERAL POINT | JANESVILLE | WI | 53547 | 390816848 | HOSPITAL | WI | 501(C)(3) | LINE 3 | N/A | 0 | |
| MERCY FOUNDATION INC | |||||||||||
| 1000 MINERAL POINT | JANESVILLE | WI | 53547 | 237275336 | SUPPORT MERCY HOSPITAL AND RELATED ORGANIZATIONS | WI | 501(C)(3) | LINE 11A, I | 0 | MERCY HEALTH SYSTEM CORPORATION | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| MERCY HEALTH SYSTEM CORPORATION | ||
| B | 139500 | FAIR MARKET VALUE - CASH |
| MERCY FOUNDATION INC | ||
| B | 21500 | FAIR MARKET VALUE - CASH |