Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
MediumBullet Do not enter Social Security numbers on this form as it may be made public. By law, the IRS
generally cannot redact the information on the form.
MediumBullet Information about Form 990 and its instructions is at www.IRS.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
A For the 2013 calendar year, or tax year beginning 07-01-2013 , 2013, and ending 06-30-2014
BCheck if applicable:
CName of organization
MERCY HEALTH FOUNDATION ST LOUIS
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
615 SOUTH NEW BALLAS ROAD
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
ST LOUIS, MO63141
D Employer identification number

56-2410020
E Telephone number

G Gross receipts $ 7,838,416
F Name and address of principal officer:
TANYA LIEBER
615 SOUTH NEW BALLAS ROAD
ST LOUIS,MO63141
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.MERCY.NET/STLOUISMO/GIVING
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 2003
M State of legal domicile: MO
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: MERCY HEALTH FOUNDATION ST. LOUIS'S (THE "FOUNDATION") PRIMARY ACTIVITY IS TO ENGAGE IN FUNDRAISING ACTIVITIES TO SUPPORT CHARITY CARE PROVIDED TO THE PATIENTS OF MERCY HOSPITALS EAST COMMUNITIES ST. LOUIS (THE "MEDICAL CENTER"), THE ORGANIZATION BEING SUPPORTED BY THE FOUNDATION, AND TO PROVIDE FUNDING FOR CAPITAL EXPENSES INCURRED AND PROGRAMS CARRIED ON BY THE MEDICAL CENTER ON BEHALF OF PATIENTS. THE FOUNDATION SPENDS APPROXIMATELY 95% OF ITS TIME AND RESOURCES DIRECTED AT THESE ACTIVITIES. IN ADDITION, THE FOUNDATION SPENDS APPROXIMATELY 5% OF ITS TIME AND RESOURCES PERFORMING COMMUNITY RELATIONS ON BEHALF OF THE FOUNDATION AND THE MEDICAL CENTER.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 28
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 25
5 Total number of individuals employed in calendar year 2013 (Part V, line 2a) ...... 5 0
6 Total number of volunteers (estimate if necessary) ............. 6 25
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b 0
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 3,523,721 5,250,820
9 Program service revenue (Part VIII, line 2g) ......... 0 0
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 1,299,716 2,084,910
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 769,361 0
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 5,592,798 7,335,730
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 3,118,380 6,150,647
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 0 0
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet718,280    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 1,241,279 1,204,508
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 4,359,659 7,355,155
19 Revenue less expenses. Subtract line 18 from line 12....... 1,233,139 -19,425
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 18,671,907 18,516,834
21 Total liabilities (Part X, line 26)............. 591,337 455,689
22 Net assets or fund balances. Subtract line 21 from line 20..... 18,080,570 18,061,145
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2013)
Form 990 (2013)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III ..............
1
Briefly describe the organization’s mission: THE COMMITMENT TO PROVIDE CARE TO ALL WHO NEED IT, REGARDLESS OF THEIR ABILITY TO PAY, MEANS THAT MERCY HEALTH FOUNDATION ST. LOUIS MUST BE THE CONSISTENT GENERATOR OF COMMUNITY SUPPORT UPON WHICH MERCY HOSPITALS EAST COMMUNITIES ST. LOUIS RELIES.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ......................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ............................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 6,150,647 including grants of $ 6,150,647 ) (Revenue $ 0 )
DONATIONS TO MERCY HOSPITALS EAST COMMUNITIES ST. LOUIS TO SUPPORT THE PROVISION OF CHARITY CARE TO PATIENTS OF THE MERCY HOSPITALS EAST COMMUNITIES ST. LOUIS, CAPITAL NEEDS AND PROGRAMS IDENTIFIED TO BENEFIT PATIENTS CARED FOR AT THE MERCY HOSPITALS EAST COMMUNITIES ST. LOUIS.
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet6,150,647
Form 990 (2013)
Form 990 (2013)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment........................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part I..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part II........
4
 
No
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C,
Part III............................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part IClick to see attachment........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes," complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If "Yes," complete Schedule D, Part VClick to see attachment......
10
Yes
 
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If "Yes," complete Schedule D, Part VI.Click to see attachment...................
11a
 
No
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIClick to see attachment.......
11b
Yes
 
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment............
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment.........................
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If "Yes," complete Schedule D, Parts XI and XII Click to see attachment.................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E....
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?.....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I (see instructions).... Click to see attachment
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............ Click to see attachment
18
Yes
 
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III................... Click to see attachment
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....
20a
 
No
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return?
20b
 
 
Form 990 (2013)
Form 990 (2013)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II... Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants or other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........ Click to see attachment
22
 
No
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
 
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I........
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I...................
25b
 
No
26
Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If so, complete Schedule L, Part II....................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part III.........
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV ..........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If "Yes,"
complete Schedule L, Part IV.....................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV...
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M.............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1........................ Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2... Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2013)
Form 990 (2013)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V ..............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
0
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
 
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
0
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
 
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?..........................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions?...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
Yes
 
b
If "Yes," did the organization notify the donor of the value of the goods or services provided?.....
7b
Yes
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?............................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?............................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?............
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?..........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?.......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year. ....................
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
Form 990 (2013)
Form 990 (2013)
Page 6
Part VI
Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI ..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year .....................
1a
28
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
25
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
 
No
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done.......................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
 
No
b
Other officers or key employees of the organization ................
15b
 
No
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization:
MediumBulletDENISE SCOFFIC645 MARYVILLE CENTRE DRIVE STE 100ST LOUISMO63141 (314) 364-2959
Form 990 (2013)
Form 990 (2013)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII ..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) BARBANELL MD SETH........................................................................
VP-CLIN PERF ACCELERATION & BOARD MEMBER
 2.00
.......................58.00 		X           0 396,403 42,980
(2) BOLSTER WILLIAM........................................................................
BOARD MEMBER
 1.00
.......................1.00 		X           0 0 0
(3) BUSCH STEVEN........................................................................
BOARD MEMBER
 1.00
........................50 		X           0 0 0
(4) COHEN PETER........................................................................
BOARD MEMBER
 1.00
.......................0.00 		X           0 0 0
(5) CONDIE BERT........................................................................
BOARD MEMBER
 .50
.......................0.00 		X           0 0 0
(6) FINGER JIM........................................................................
BOARD MEMBER
 .50
.......................0.00 		X           0 0 0
(7) FRESTA JOE........................................................................
BOARD MEMBER
 .50
.......................0.00 		X           0 0 0
(8) GAREA JOE........................................................................
BOARD MEMBER
 1.00
.......................0.00 		X           0 0 0
(9) GORGEN RON........................................................................
BOARD MEMBER
 .50
.......................0.00 		X           0 0 0
(10) HARROLD JASON........................................................................
BOARD MEMBER
 1.00
.......................0.00 		X           0 0 0
(11) HENRY WENDY........................................................................
BOARD MEMBER
 1.00
.......................0.00 		X           0 0 0
(12) HERBER JOHN........................................................................
BOARD MEMBER
 .50
.......................0.00 		X           0 0 0
(13) JONES DARRYL........................................................................
BOARD MEMBER
 .50
.......................0.00 		X           0 0 0
(14) LEGG LINDA........................................................................
BOARD MEMBER
 .50
.......................0.00 		X           0 0 0
(15) LOWENBAUM MICHAEL........................................................................
BOARD MEMBER
 .20
.......................0.00 		X           0 0 0
(16) MEINERS DAVID........................................................................
PHYSICIAN & BOARD MEMBER
 1.00
.......................52.00 		X           0 809,968 29,961
(17) MEYER WHITY........................................................................
BOARD MEMBER
 1.00
.......................0.00 		X           0 0 0
Form 990 (2013)
Form 990 (2013)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) MOZELIAK JOHN........................................................................
BOARD MEMBER
 1.00
.......................0.00 		X           0 0 0
(19) RITTER PEGGY........................................................................
BOARD MEMBER
 1.00
.......................0.00 		X           0 0 0
(20) RUSNACK MARSHA........................................................................
BOARD MEMBER
 1.00
.......................0.00 		X           0 0 0
(21) STERN MITCH........................................................................
BOARD MEMBER
 1.00
.......................0.00 		X           0 0 0
(22) STUBBLEFIELD GREG........................................................................
BOARD MEMBER
 1.00
.......................0.00 		X           0 0 0
(23) TEGELER TIM........................................................................
BOARD MEMBER
 1.00
.......................0.00 		X           0 0 0
(24) TRELZ TESSA........................................................................
BOARD MEMBER
 1.00
.......................0.00 		X           0 0 0
(25) TWARDOWSKI GREG........................................................................
BOARD MEMBER
 .50
.......................0.00 		X           0 0 0
(26) VON GONTARD MIMI........................................................................
PATIENT RELATIONS SPECIALIST & BOARD MEMBER
 1.00
.......................40.00 		X           0 58,136 10,923
(27) WIESEHAN FRED........................................................................
BOARD MEMBER
 1.00
.......................0.00 		X           0 0 0
(28) WILSON BARBARA........................................................................
BOARD MEMBER
 1.00
.......................0.00 		X           0 0 0
(29) JOHNSTON JEFFREY A........................................................................
PRESIDENT, MERCY HOSPITAL ST. LOUIS
 1.00
.......................61.00 		    X       0 588,337 223,557
(30) MATEJKA CHERYL L........................................................................
CHIEF FINANCIAL OFFICER
 2.00
.......................55.00 		    X       0 413,101 78,538
(31) LIEBER TANYA........................................................................
VP-PHILANTHROPY
 50.00
.......................0.00 		    X       0 170,458 11,519
(32) ARNOLD PATRICIA R........................................................................
FOUNDATION PRESIDENT
 20.00
.......................40.00 		      X     0 313,527 54,929
(33) SORENSEN DONN........................................................................
PRESIDENT, EAST COMMUNITIES
 3.00
.......................61.00 		      X     0 811,498 245,528
(34) COMBS RANDALL J........................................................................
FORMER OFFICER
 0.00
.......................60.00 		          X 0 952,001 218,404
(35) MCCURRY MICHAEL........................................................................
FORMER OFFICER
 0.00
.......................60.00 		          X 0 1,088,774 202,595
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 0 5,602,203 1,118,934
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet0
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
CONTEMPORARY EVENTS LLC190 CARONDOLET PLAZA STE 1111ST LOUISMO63105 EVENT ORGANIZER 170,115
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet1
Form 990 (2013)
Form 990 (2013)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII .............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512-514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c 1,102,299
d Related organizations...1d 440,272
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		3,708,249
g Noncash contributions included in lines
1a-1f:$ 		 
h Total. Add lines 1a-1f.......MediumBullet 5,250,820
Program Service RevenueAmt Business Code
2a
b
c
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet  
OtherAmt RevenueAmt 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 2,084,910     2,084,910
4 Income from investment of tax-exempt bond proceeds..MediumBullet        
5 Royalties...........MediumBullet        
(i) Real (ii) Personal
6a Gross rents    
b Less: rental expenses    
c Rental income or (loss)    
d Net rental income or (loss).......MediumBullet        
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory    
b Less: cost or other basis and sales expenses    
c Gain or (loss)    
d Net gain or (loss)..........MediumBullet        
8a Gross income from fundraising events (not including
$ 1,102,299
of contributions reported on line 1c). See Part IV, line 18 ..
a 502,686
b Less: direct expenses ...b 502,686
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet        
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet        
Miscellaneous Revenue Business Code
11a            
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet  
12 Total revenue. See Instructions......MediumBullet 7,335,730 0 0 2,084,910
Form 990 (2013)
Form 990 (2013)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX ...............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 6,150,647 6,150,647
2 Grants and other assistance to individuals in the United States. See Part IV, line 22    
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16    
4 Benefits paid to or for members    
5 Compensation of current officers, directors, trustees, and key employees ....        
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....        
7 Other salaries and wages        
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....        
9 Other employee benefits .......        
10 Payroll taxes ...........        
11 Fees for services (non-employees):        
a Management ......        
b Legal .........        
c Accounting ...........        
d Lobbying ...........        
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ......        
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 4,301   4,301  
12 Advertising and promotion ....        
13 Office expenses ....... 52,511   52,511  
14 Information technology ......        
15 Royalties ..        
16 Occupancy ...........        
17 Travel ............        
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ......        
19 Conferences, conventions, and meetings ....        
20 Interest ...........        
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization .....        
23 Insurance ..............        
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a SHARED SERVICE FEES 894,053   268,216 625,837
b ADMINISTRATIVE EXPENSE 113,337   113,337  
c OTHER FUNDRAISING 92,443     92,443
d
e All other expenses 47,863   47,863  
25 Total functional expenses. Add lines 1 through 24e 7,355,155 6,150,647 486,228 718,280
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2013)
Form 990 (2013)
Page 11
Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash–non-interest-bearing ............. 613,472 1 357,165
2 Savings and temporary cash investments .........   2  
3 Pledges and grants receivable, net ........... 2,856,592 3 3,471,722
4 Accounts receivable, net .............   4 231,794
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
  5  
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
  6  
7 Notes and loans receivable, net .............   7  
8 Inventories for sale or use ..............   8  
9 Prepaid expenses and deferred charges .......... 64,494 9 22,720
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a  
b Less: accumulated depreciation ..... 10b     10c  
11 Investments—publicly traded securities ..........   11  
12 Investments—other securities. See Part IV, line 11 ..... 15,137,349 12 14,433,433
13 Investments—program-related. See Part IV, line 11 .....   13  
14 Intangible assets ...............   14  
15 Other assets. See Part IV, line 11 ...........   15  
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 18,671,907 16 18,516,834
Liabilities 17 Accounts payable and accrued expenses ......... 4,169 17  
18 Grants payable .................   18  
19 Deferred revenue ................ 192,295 19 238,292
20 Tax-exempt bond liabilities .............   20  
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22  
23 Secured mortgages and notes payable to unrelated third parties ..   23  
24 Unsecured notes and loans payable to unrelated third parties ....   24  
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.................... 394,873 25 217,397
26 Total liabilities. Add lines 17 through 25......... 591,337 26 455,689
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 266,585 27 391,236
28 Temporarily restricted net assets ........... 12,375,862 28 12,229,074
29 Permanently restricted net assets ........... 5,438,123 29 5,440,835
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds ........   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ........... 18,080,570 33 18,061,145
34 Total liabilities and net assets/fund balances ........ 18,671,907 34 18,516,834
Form 990 (2013)
Form 990 (2013)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI ..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
7,335,730
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
7,355,155
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
-19,425
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
18,080,570
5
Net unrealized gains (losses) on investments ...............
5
 
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
0
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
18,061,145
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII .............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
Yes
 
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
Yes
 
Form 990 (2013)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


Software ID:  
Software Version:  
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
right arrow Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
Name of the organization
MERCY HEALTH FOUNDATION ST LOUIS
 
Employer identification number

56-2410020
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization? ................
11g(i)
 
No
(ii) A family member of a person described in (i) above? ......................
11g(ii)
 
No
(iii) A 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
No
h
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) (iv) Is the organization in col. (i) listed in your governing document? (v) Did you notify the organization in col. (i) of your support? (vi) Is the organization in col. (i) organized in the U.S.? (vii) Amount of monetary support
Yes No Yes No Yes No
(A) MERCY HOSPITALS EAST COMMUNITIES ST LOUIS
  		430653493 3 Yes   Yes   Yes   6,125,647
Total 6,125,647

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..  
6 Public support. Subtract line 5 from line 4.  
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..            
11 Total support (Add lines 7 through 10).  
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization, check this box and stop here.................................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public support (Subtract line 7c from line 6.)  
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) ..            
13 Total support. (Add lines 9, 10c, 11, and 12.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2013

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Name of the organization
MERCY HEALTH FOUNDATION ST LOUIS
 
Employer identification number

56-2410020
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......................... Arrow Bullet $  
Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Page 2
Name of organization
MERCY HEALTH FOUNDATION ST LOUIS
  		Employer identification number

56-2410020
Part I
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

   
RESTRICTED
RESTRICTED
RESTRICTED, RESTRICTEDRESTRICTED

$RESTRICTED


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Page 3
Name of organization
MERCY HEALTH FOUNDATION ST LOUIS
  		Employer identification number

56-2410020
Part II
Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Page 4
Name of organization
MERCY HEALTH FOUNDATION ST LOUIS
  		Employer identification number

56-2410020
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Additional Data


Software ID:  
Software Version:  
SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions. SchDMd Bullet Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
MERCY HEALTH FOUNDATION ST LOUIS
 
Employer identification number

56-2410020
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) .....    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2013

Schedule D (Form 990) 2013
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIII and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance .... 5,438,123 5,422,949 5,424,723 5,398,319 5,383,506
b Contributions ........   -1,000 730 850 401
c Net investment earnings, gains, and losses 21,227 16,174 1,496 25,554 14,412
d Grants or scholarships .....          
e Other expenditures for facilities
and programs ........ 		18,515        
f Administrative expenses ....     4,000    
g End of year balance ...... 5,440,835 5,438,123 5,422,949 5,424,723 5,398,319
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet0 %
b
Permanent endowment SchDMd Bullet100.000 %
c
Temporarily restricted endowment SchDMd Bullet0 %
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
No
(ii) related organizations ........................
3a(ii)
Yes
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
Yes
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11a. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................      
b Buildings ................        
c Leasehold improvements ............        
d Equipment ................        
e Other .................        
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 0
Schedule D (Form 990) 2013

Schedule D (Form 990) 2013
Page 3
Part VII
Investments—Other Securities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11b. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
(3)Other
(A) OTHER LONG TERM INVESTMENTS 		14,433,433 F








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet 14,433,433
Part VIII
Investments—Program Related. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11c. See Form 990, Part X, line 13.
(a) Description of investment (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes  
DUE TO RELATED EXEMPT ENTITIES 217,397








Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 217,397
2. Liability for uncertain tax positions In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII ..................................................
Schedule D (Form 990) 2013

Schedule D (Form 990) 2013
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIII.) ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1 Total expenses and losses per audited financial statements ........... 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIII.) ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIII
Supplemental Information
Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Return Reference Explanation
PART V, LINE 4: TO PROVIDE FINANCIAL SUPPORT OF THE SPECIFIC PROGRAM SERVICE DESIGNATED BY THE DONOR.
PART X, LINE 2 THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF MERCY HEALTH AND AFFILIATES DO NOT INCLUDE A FOOTNOTE TO REPORT THE ORGANIZATION'S LIABILITY FOR UNCERTAIN TAX PROVISIONS UNDER ASC 740, AS THEY ARE DEEMED IMMATERIAL FOR DISCLOSURE.
Schedule D (Form 990) 2013

Additional Data


Software ID:  
Software Version:  




SCHEDULE G (Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Supplemental Information Regarding
Fundraising or Gaming Activities
Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrowAttach to Form 990 or Form 990-EZ. right arrowSee separate instructions.
right arrowInformation about Schedule G (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
MERCY HEALTH FOUNDATION ST LOUIS
 
Employer identification number

56-2410020
Part I
Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17.
Form 990-EZ filers are not required to complete this part.
1
Indicate whether the organization raised funds through any of the following activities. Check all that apply.
a e
b f
c g
d
2a
Did the organization have a written or oral agreement with any individual (including officers, directors, trustees
or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?
b
If "Yes," list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.
(i) Name and address of individual
or entity (fundraiser) 		(ii) Activity (iii) Did fundraiser have custody or control of contributions? (iv) Gross receipts
from activity 		(v) Amount paid to
(or retained by)
fundraiser listed in
col. (i) 		(vi) Amount paid to
(or retained by)
organization
Yes No
             
             
             
             
             
             
             
             
             
             
Total .................right arrow      
3
List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing.
For Paperwork Reduction Act Notice, see the Instructions for Form 990or 990-EZ.
Cat. No. 50083H
Schedule G (Form 990 or 990-EZ) 2013
Schedule G (Form 990 or 990-EZ) 2013
Page 2
Part II
Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.
(a) Event #1

BENEFIT 4 KIDS-GOLF EVENT
(event type) 		(b) Event #2

MARDI GRAS-DINNER/AUCTION
(event type) 		(c) Other events

 
(total number) 		(d) Total events
(add col. (a) through col. (c))
VerticalRevenue 1 Gross receipts . . . 872,602 732,383   1,604,985
2 Less: Contributions . . 668,283 434,016   1,102,299
3 Gross income (line 1
minus line 2) . . . 		204,319 298,367   502,686
VerticalDirectExpenses 4 Cash prizes . . .        
5 Noncash prizes . .        
6 Rent/facility costs . .        
7 Food and beverages .        
8 Entertainment . . .        
9 Other direct expenses . 204,319 298,367   502,686
10 Direct expense summary. Add lines 4 through 9 in column (d) ........... right arrow 502,686
11 Net income summary. Subtract line 10 from line 3, column (d)........... right arrow 0
Part III
Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.
VerticalRevenue (a) Bingo (b) Pull tabs/Instant
bingo/progressive bingo 		(c) Other gaming (d) Total gaming (add col.(a) through col.(c))
1 Gross revenue . . . .        
VerticalDirectExpenses 2 Cash prizes . . . .        
3 Non-cash prizes . . .        
4 Rent/facility costs . . .        
5 Other direct expenses . .        
6 Volunteer labor . . .
%
%
%
7 Direct expense summary. Add lines 2 through 5 in column (d) ........... right arrow  
8 Net gaming income summary. Subtract line 7 from line 1, column (d) ......... right arrow  
9
Enter the state(s) in which the organization operates gaming activities:
a
Is the organization licensed to operate gaming activities in each of these states? ............
b
If "No," explain:
 
10a
Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? .....
b
If "Yes," explain:
 
Schedule G (Form 990 or 990-EZ) 2013
Schedule G (Form 990 or 990-EZ) 2013
Page 3
11
Does the organization operate gaming activities with nonmembers? .................
12
Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity
formed to administer charitable gaming? ..........................
13
Indicate the percentage of gaming activity operated in:
a
The organization's facility ......................
13a
%
b
An outside facility ........................
13b
%
14
Enter the name and address of the person who prepares the organization's gaming/special events books and records:
Name right arrow
DENISE SCOFFIC
Address right arrow
645 MARYVILLE CENTRE DR SUITE 100
ST LOUIS,MO63141
15a
Does the organization have a contract with a third party from whom the organization receives gaming
revenue? ......................................
b
If "Yes," enter the amount of gaming revenue received by the organization right arrow $   and the
amount of gaming revenue retained by the third party right arrow $   .
c
If "Yes," enter name and address of the third party:
Name right arrow
Address right arrow
 
 
16
Gaming manager information:
Name right arrow
Gaming manager compensation right arrow $  
Description of services provided right arrow
 
17
Mandatory distributions:
a
Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license? ............................
b
Enter the amount of distributions required under state law distributed to other exempt organizations or spent
in the organization's own exempt activities during the tax year right arrow$  
Part IV
Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v), and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also complete this part to provide any additional information (see instructions).
Return Reference Explanation
Schedule G (Form 990 or 990-EZ) 2013
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
lBullet Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
Name of the organization
MERCY HEALTH FOUNDATION ST LOUIS
 
Employer identification number
56-2410020
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) MERCY HOSPITALS EAST COMMUNITIES ST LOUIS
615 S NEW BALLAS ROAD
ST LOUIS,MO63141 		43-0653493 501(C)(3) 6,125,647   CASH   SUPPORT CHARITY CARE, PROGRAMS, & CAPITAL NEEDS TO BENEFIT PATIENTS OF THE HOSPITAL
(2) MERCY HEALTH FOUNDATION WASHINGTON
901 E FIFTH STREET
WASHINGTON,MO63090 		56-2410022 501(C)(3) 25,000   CASH   GENERAL SUPPORT




















2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
2
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
0
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2013

Schedule I (Form 990) 2013
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance












Part IV
Supplemental Information. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Return Reference Explanation
PART I, LINE 2: GRANTS WERE MADE TO RELATED ENTITIES WHICH REPORT ON THE USE OF THE FUNDS.
Schedule I (Form 990) 2013


Additional Data


Software ID:  
Software Version:  


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
SchJMediumBullet Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
MERCY HEALTH FOUNDATION ST LOUIS
 
Employer identification number

56-2410020
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..
2
 
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ................
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2013

Schedule J (Form 990) 2013
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1)BARBANELL MD SETHVP-CLIN PERF ACCELERATION & BOARD ME (i)
(ii)		 0
286,464 		0
56,122 		0
53,817 		0
30,065 		0
12,915 		0
439,383 		0
0
(2)MEINERS DAVIDPHYSICIAN & BOARD MEMBER (i)
(ii)		 0
754,736 		0
0 		0
55,232 		0
15,515 		0
14,446 		0
839,929 		0
0
(3)JOHNSTON JEFFREY APRESIDENT, MERCY HOSPITAL ST. LOUIS (i)
(ii)		 0
431,258 		0
136,049 		0
21,030 		0
205,133 		0
18,424 		0
811,894 		0
0
(4)MATEJKA CHERYL LCHIEF FINANCIAL OFFICER (i)
(ii)		 0
300,405 		0
74,056 		0
38,640 		0
61,337 		0
17,201 		0
491,639 		0
0
(5)LIEBER TANYAVP-PHILANTHROPY (i)
(ii)		 0
143,141 		0
14,313 		0
13,004 		0
2,285 		0
9,234 		0
181,977 		0
0
(6)ARNOLD PATRICIA RFOUNDATION PRESIDENT (i)
(ii)		 0
228,702 		0
56,969 		0
27,856 		0
46,000 		0
8,929 		0
368,456 		0
0
(7)SORENSEN DONNPRESIDENT, EAST COMMUNITIES (i)
(ii)		 0
560,884 		0
175,609 		0
75,005 		0
232,962 		0
12,566 		0
1,057,026 		0
0
(8)COMBS RANDALL JFORMER OFFICER (i)
(ii)		 0
692,164 		0
227,203 		0
32,634 		0
208,979 		0
9,425 		0
1,170,405 		0
0
(9)MCCURRY MICHAELFORMER OFFICER (i)
(ii)		 0
795,361 		0
260,997 		0
32,416 		0
187,506 		0
15,089 		0
1,291,369 		0
0
Schedule J (Form 990) 2013

Schedule J (Form 990) 2013
Page 3
Part III
Supplemental Information
Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Return Reference Explanation
PART I, LINE 1A CHARTER TRAVEL IS PROVIDED TO CERTAIN EMPLOYEES AS AND WHEN APPROPRIATE, AND AS DEEMED NECESSARY FOR BUSINESS TRAVEL. AFTER CHARTER TRAVEL APPROVAL HAS BEEN GRANTED IN ACCORDANCE WITH THE FINANCIAL JUSTIFICATION PROCESS, THE APPROVED CHARTER TRAVEL FOR BUSINESS IS A REIMBURSABLE EXPENSE WHICH IS NOT TAXABLE TO THE EMPLOYEES. TRAVEL FOR COMPANIONS IS PROVIDED IN RARE INSTANCES AND IN ACCORDANCE WITH THE CO-WORKER TRAVEL AND OTHER EXPENSE POLICY AND PROCEDURES. WHERE COMPANION TRAVEL HAS RESULTED IN A TAXABLE EVENT, THE EMPLOYEES ARE TAXED FOR SUCH TRAVEL. SPOUSAL TRAVEL WAS PROVIDED FOR THE FOLLOWING EMPLOYEE OF A RELATED ORGANIZATION: MICHAEL MCCURRY. LIMITED INSTANCES OF TAX GROSS-UPS MAY HAVE OCCURRED WITH RESPECT TO EXECUTIVES. HOUSING BENEFITS ARE PROVIDED THROUGH A RELOCATION PROGRAM IN ACCORDANCE WITH COMPANY POLICY. SUCH BENEFITS ARE SUBJECT TO TAX TO THE EMPLOYEE. PAYMENT BY THE COMPANY OF COSTS FOR TEMPORARY HOUSING BY EMPLOYEES FOR THE CONVENIENCE OF THE COMPANY IS MADE IN ACCORDANCE WITH THE CO-WORKER TRAVEL AND OTHER EXPENSE POLICY AND PROCEDURES. AS A REIMBURSABLE EXPENSE, THIS TYPE OF LODGING IS NOT TAXABLE TO THE EMPLOYEE.
PART I, LINE 4B PART I, LINE 4B: MERCY HEALTH, THE ULTIMATE PARENT COMPANY, OFFERS SUPPLEMENTAL RETIREMENT PLANS TO CERTAIN EXECUTIVES WHICH PROVIDE BENEFITS UPON VESTING DATE BASED ON COMPENSATION, AGE AT THE TIME OF BENEFIT COMMENCEMENT, LENGTH OF SERVICE WITH THE COMPANY AND/OR ITS AFFILIATES, AND LENGTH OF TENURE IN THE PLAN. THE FOLLOWING INDIVIDUALS PARTICIPATED IN THE FOLLOWING PLANS. THERE WERE NO PAYMENTS FOR THE FISCAL YEAR ENDED 6/30/2014. SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) COMBS,RANDY; MCCURRY,MICHAEL; JOHNSTON,JEFF; SORENSEN,DONN SUPPLEMENTAL MANAGEMENT RETIREMENT PLAN (SMRP) MATEJKA, CHERYL L; ARNOLD, PATRICIA; JOHNSTON,JEFF; SORENSEN,DONN; BARBANELL,SETH THE AMOUNT OF ALL ACCRUED BENEFITS IS INCLUDED IN COMPENSATION AMOUNTS PROVIDED IN SCHEDULE J, PART II, COLUMN (C).
PART I, LINE 7 THE RELATED ORGANIZATION WHICH EMPLOYS THOSE INDIVIDUALS LISTED ON PART VII PROVIDES A NON-FIXED BONUS PLAN FOR WHICH CERTAIN TIERS OF ITS EMPLOYEES ARE ELIGIBLE. FOR FISCAL YEAR 2014 (JULY 1, 2013 - JULY 30, 2014) PAYMENT OF ALL OR PART OF THE BONUS WAS CONTINGENT UPON ATTAINMENT OF CERTAIN FINANCIAL TARGETS AND NON-FINANCIAL GOALS DEEMED NECESSARY BY MERCY. PAYMENTS ARE MADE ANNUALLY IN OCTOBER FOLLOWING (I) THE CONCLUSION OF THE FISCAL YEAR AND (II) DETERMINATION OF GOAL ACHIEVEMENT. BONUS OPPORTUNITIES ARE TIERED PERCENTAGES AND ARE DEPENDENT UPON THE LEADERSHIP LEVEL AND ATTAINMENT PERCENTAGE. MERCY'S ATTAINMENT OF FINANCIAL TARGETS AND NON-FINANCIAL GOALS IS REVIEWED BY THE COMPENSATION COMMITTEE OF MERCY HEALTH AND IS TAKEN INTO ACCOUNT WHEN ANALYZING EXECUTIVE COMPENSATION FOR REASONABLENESS.
PART I, LINE 3 MERCY HEALTH (PARENT COMPANY) IS RESPONSIBLE FOR ESTABLISHING THE COMPENSATION OF THE ORGANIZATION'S CEO/EXECUTIVE DIRECTOR. THE FOLLOWING METHODS WERE USED BY MERCY HEALTH TO ESTABLISH COMPENSATION: -INDEPENDENT COMPENSATION CONSULTANT -COMPENSATION SURVEY OR STUDY -APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE MERCY HEALTH EAST COMMUNITIES USES A WRITTEN EMPLOYMENT CONTRACT AND EMPLOYS THE ORGANIZATION'S PRESIDENT.
Schedule J (Form 990) 2013

Additional Data


Software ID:  
Software Version:  
SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
Name of the organization
MERCY HEALTH FOUNDATION ST LOUIS
 
Employer identification number

56-2410020
Return Reference Explanation
FORM 990, PART V, QUESTION 1A INDEPENDENT CONTRACTORS INDEPENDENT CONTRACTORS FOR THE FILING ORGANIZATION ARE PAID BY MERCY HEALTH (EIN 43-1423050). AS SUCH, ALL REQUIRED FORM 1099 AND FORM 1096 REPORTING IS MADE FOR THE ENTIRE MERCY HEALTH SYSTEM (WITH LIMITED EXCEPTIONS) UNDER THE MERCY HEALTH EIN.
FORM 990, PART VI, SECTION A, LINE 6 THE MEMBER OF MERCY HEALTH FOUNDATION ST. LOUIS IS MERCY HEALTH EAST COMMUNITIES, A SUPPORTING ORGANIZATION UNDER SECTION 509(A)(3). THE MEMBER OF MERCY HEALTH EAST COMMUNITIES IS MERCY HEALTH.
FORM 990, PART VI, SECTION A, LINE 7A MERCY HEALTH EAST COMMUNITIES HAS RESERVE POWERS TO APPOINT AND REMOVE ALL DIRECTORS AND OFFICERS FOR MERCY HEALTH FOUNDATION ST. LOUIS.
FORM 990, PART VI, SECTION A, LINE 7B MERCY HEALTH EAST COMMUNITIES RESERVES THE FOLLOWING POWERS AND RESPONSIBILIES: -TO APPROVE AND ESTABLISH THE MISSION AND PHILOSOPHY ACCORDING TO WHICH THE CORPORATION AND ALL ORGANIZATIONS CONTROLLED BY THE CORPORATION SHALL OPERATE; -TO ADOPT OR AMEND THE ARTICLES OF INCORPORATION AND THESE BYLAWS IN ACCORDANCE WITH ARTICLES IX AND X OF THESE BYLAWS AND TO AMEND THE ORGANIZATIONAL DOCUMENTS OF ANY ORGANIZATION CONTROLLED BY THE CORPORATION; -TO APPOINT OR REMOVE, WITH OR WITHOUT CAUSE, THE EXECUTIVE DIRECTOR OF THE CORPORATION OR ANY ORGANIZATION CONTROLLED BY THE CORPORATION; -TO APPROVE OR AMEND THE OVERALL STRATEGIC, LONG RANGE, BUSINESS PLANS, GOALS AND OBJECTIVES OF THE CORPORATION OR ANY ORGANIZATION CONTROLLED BY THE CORPORATION; -TO APPROVE OR AMEND THE CONSOLIDATED OPERATING AND CAPITAL BUDGETS FOR THE CORPORATION OR ANY ORGANIZATION CONTROLLED BY THE CORPORATION AND CHANGES IN BUDGETS IN EXCESS OF AN AMOUNT ESTABLISHED FROM TIME TO TIME BY THE CORPORATE MEMBER; -TO AUTHORIZE AND APPROVE THE LEASE OR SALE OF ANY OF THE ASSETS OF THE CORPORATION OR ANY ORGANIZATION CONTROLLED BY THE CORPORATION IN EXCESS OF AN AMOUNT ESTABLISHED FROM TIME TO TIME BY THE CORPORATE MEMBER; -TO ENCUMBER ANY OR ALL OF THE ASSETS OF THE CORPORATION OR ANY ORGANIZATION CONTROLLED BY THE CORPORATION; -TO AUTHORIZE AND APPROVE THE INCURRENCE OF DEBT BY THE CORPORATION OR ANY ORGANIZATION CONTROLLED BY THE CORPORATION (OTHER THAN DEBT INCURRED FOR THE ACQUISITION OF GOODS IN THE ORDINARY COURSE OF BUSINESS) AND TO GRANT ANY SECURITY INTERESTS, PLACE ANY ENCUMBRANCES, ENTER INTO ANY COVENANTS, AND EXECUTY ANY DOCUMENTS AND TAKE ANY ACTIONS NECESSARY OR APPROPRIATE IN CONNECTION WITH THE INCURRENCE OF SUCH DEBT; -TO MERGE, DISSOLVE, OR ABANDON THE CORPORATION OR ANY ORGANIZATION CONTROLLED BY THE CORPORATION, SUBJECT TO APPROVAL BY THE BOARD AS REQUIRED PURSUANT TO THE MISSOURI NONPROFIT CORPORATION ACT; -TO MANAGE AND DIRECT THE INVESTMENT OF GIFTS AND GRANTS THAT ARE MADE TO THE CORPORATION; -TO RESOLVE ANY IMPASSE OR DEADLOCK THAT OCCURS WITH ANY ACTION TAKEN OR PROPOSED TO BE TAKEN OR CONSIDERED BY THE BOARD OR THE EXECUTIVE COMMITTEE; -TO DETERMINE HOW TO EXPEND THE UNRESTRICTED FUNDS IN THE EVENT THAT THE CORPORATE MEMBER MAKES A RECOMMENDATION FOR THE EXPENDITURE OF UNRESTRUCTED FUNDS AND SUCH RECOMMENDATION IS NOT APPROVED BY THE BOARD; AND, -TO APPROVE OF THE CORPORATION'S RECEIPT AND ACCEPTANCE OF GIFTS AND GRANTS OF RESTRICTED FUNDS.
FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM, USING INFORMATION PROVIDED BY THE FILING ORGANIZATION. A DRAFT FORM 990 IS REVIEWED BY THE FILING ORGANIZATION'S LEADERSHIP. THE DRAFT FORM 990 IS ALSO REVIEWED BY THE MERCY HEALTH TAX DEPARTMENT, TO ENSURE ACCURACY AND CONSISTENCY WITH OTHER RELATED ORGANIZATIONS' FORM 990S. AFTER QUESTIONS ARISING FROM THE VARIOUS REVIEWS ARE ADDRESSED AND INCORPORATED INTO THE FORM 990, A DRAFT IS PROVIDED TO THE FILING ORGANIZATION'S LEADERSHIP TEAM FOR REVIEW. ONCE REVIEWED AND APPROVED BY THE FILING ORGANIZATION'S LEADERSHIP TEAM, IT IS THEN FILED WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12C OFFICERS, DIRECTORS, KEY EMPLOYEES AND OTHER DISQUALIFIED PERSONS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE ANNUALLY AND DID SO IN THE NORMAL COURSE FOR THE YEAR ENDED JUNE 30, 2014. THIS PROCESS IS ADMINISTERED AT THE MERCY HEALTH LEVEL BY MERCY'S BUSINESS RISK (INTERNAL AUDIT) DEPARTMENT. THE QUESTIONNAIRES ARE REVIEWED WITH LEADERSHIP AT THE LOCAL LEVEL AND POTENTIAL CONFLICTS DISCUSSED AND RESOLVED. THE CONFLICTS AND THEIR RESPECTIVE RESOLUTIONS ARE SHARED AT THE MERCY LEVEL WITH A TEAM INCLUDING MERCY'S CHIEF FINANCIAL OFFICER, CHIEF COMPLIANCE OFFICER AND OTHER MEMBERS OF FINANCE, LEGAL AND HR. SUMMARY RESULTS ARE REVIEWED WITH MERCY'S STEWARDSHIP COMMITTEE (FORMERLY FINANCE, AUDIT AND COMPLIANCE COMMITTEE) OF THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION B, LINE 15 FOR THOSE CLASSIFIED AS OFFICERS (AND THUS DISQUALIFIED PERSONS), MERCY HEALTH (ULTIMATE PARENT COMPANY) USES THE FOLLOWING TO ESTABLISH THE COMPENSATION: EXTERNAL MARKET SALARY SURVEYS, EXTERNAL MARKET SALARY STUDIES, ENGAGEMENT OF AN INDEPENDENT COMPENSATION CONSULTANT, AND ANNUAL REVIEW/APPROVAL OF COMPENSATION BY THE COMPENSATION COMMITTEE OF THE MERCY HEALTH BOARD. FOR THOSE CLASSIFIED AS KEY EMPLOYEES, THE FOLLOWING ARE USED TO ESTABLISH THE COMPENSATION: EXTERNAL MARKET SALARY SURVEYS, EXTERNAL MARKET SALARY STUDIES, AND REVIEW/APPROVAL OF EXECUTIVE MANAGEMENT. COMPENSATION REVIEWS ARE COMPLETED ON AN ANNUAL BASIS, AND A REVIEW WAS COMPLETED DURING THE REPORTING YEAR.
FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE MADE AVAILABLE FROM TIME TO TIME BUT ARE NOT PUBLISHED PUBLICLY; WE ARE NOT REQUIRED TO MAKE THESE DOCUMENTS AVAILABLE TO THE PUBLIC. FINANCIAL RESULTS ARE AVAILABLE VIA REQUEST OF COPY OF FORM 990.
PART XII, LINE 2 AUDITED FINANCIAL STATEMENTS THE FILING ORGANIZATION'S FINANCIAL STATEMENTS WERE INCLUDED IN THE MERCY HEALTH AND SUBSIDIARIES ANNUAL FINANCIAL STATEMENT AUDIT. THE MERCY HEALTH AND SUBSIDIARIES RECEIVED AN UNQUALIFIED OPINION FROM THE EXTERNAL AUDITORS FOR FISCAL 2014 (THE TAX YEAR CURRENTLY BEING REPORTED). HOWEVER, NO SEPARATE AUDIT OPINION IS ISSUED ON THE FINANCIAL STATEMENTS OF THE FILING ORGANIZATION. THE ULTIMATE RESPONSIBILITY FOR OVERSIGHT OF THE FINANCIAL STATEMENT AUDIT AND SELECTION OF THE EXTERNAL AUDITOR LIES WITH THE STEWARDSHIP COMMITTEE (FORMERLY FINANCE, AUDIT, AND COMPLIANCE COMMITTEE) OF THE MERCY HEALTH BOARD OF DIRECTORS. AUDIT RESULTS ARE COMMUNICATED TO THIS COMMITTEE.
PART XII, LINE 3 SINGLE AUDIT ACT AND OMB CIRCULAR A-133 THE CONSOLIDATED GROUP OF MERCY HEALTH IS REQUIRED TO UNDERGO AN AUDIT AS SET FORTH IN THE SINGLE AUDIT ACT AND OMB CIRCULAR A-133. THE SINGLE AUDIT WAS CONDUCTED ON A CONSOLIDATED BASIS.
FORM 990, SCHEDULE R, PART V SYSTEM LIMITATIONS LAWSON ERP SOFTWARE IS THE PRIMARY ACCOUNTING SOFTWARE USED BY MERCY HEALTH AND SUBSIDIARIES. THE MAJORITY OF THE INTERCOMPANY/RELATED ORGANIZATION TRANSACTIONS ARE PROCESSED THROUGH LAWSON VIA INTERCOMPANY JOURNAL ENTRIES. WITH THE CURRENT DESIGN OF THE ERP SYSTEM, THERE ARE VARIOUS LIMITATIONS ON THE RELATED ORGANIZATION INFORMATION THAT CAN BE EXTRACTED FROM LAWSON. DUE TO THESE LIMITATIONS, MOST OF THE RELATED ORGANIZATION ACTIVITY FOR THE FILING ORGANIZATION HAS BEEN CLASSIFIED ON SCHEDULE R,PART V, IN LINES P & Q.
FORM 990, PART V, QUESTION 2A SALARIES AND WAGES EMPLOYEES ARE PAID BY A RELATED ORGANIZATION. AS SUCH, ALL REQUIRED PAYROLL FILING (INCLUDING W-2 AND W-3'S) WAS REPORTED UNDER THE RELATED ORGANIZATION'S EIN.
FORM 990, SCHEDULE R, PART II MERCY HOSPITALS EAST COMMUNITIES MERCY HOSPITALS EAST COMMUNITIES CONSISTS OF MERCY HOSPITALS EAST COMMUNITIES ST. LOUIS, EIN 43-0653493, AND MERCY HOSPITALS EAST COMMUNITIES WASHINGTON, EIN 43-1066883.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2013

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.
MediumBullet Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
MERCY HEALTH FOUNDATION ST LOUIS
 
Employer identification number

56-2410020
Part I
Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income


 		(e)
End-of-year assets


 		(f)
Direct controlling
entity










Part II
Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section


 		(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled entity?
Yes No
(1) CASA DE MISERICORDIA

1602 MCCLELLAND STREET

LAREDO,TX78044
74-2912461 		WOMEN'S DOMESTIC VIOLENCE SHELTER TX 501C3 7 MERCY MINISTRIES OF LAREDO
 
Yes
 
(2) JEFFERSON LAND COMPANY INC

14528 S OUTER FORTY ST 100

CHESTERFIELD,MO63017
43-1330360 		TITLE HOLDING COMPANY MO 501C2   MERCY HOSPITAL JEFFERSON
 
Yes
 
(3) LAREDO MEDICAL GROUP

14528 S OUTER FORTY ST 100

CHESTERFIELD,MO63017
74-2764726 		DISSOLVED 5/5/2014 TX 501C3 9 MERCY HEALTH SYSTEM TX
 
Yes
 
(4) MCAULEY PORTFOLIO MGMT CO

14528 S OUTER FORTY ST 100

CHESTERFIELD,MO63017
26-1708048 		PORTFOLIO MANAGEMENT MO 501C3 11-II MERCY HEALTH
 
Yes
 
(5) MERCY ACO CLINICAL SERVICES INC

14528 S OUTER FORTY ST 100

CHESTERFIELD,MO63017
46-4504901 		VIRTUAL CARE CENTER MO 501C3 3 MERCY HEALTH
 
Yes
 
(6) MERCY CLINIC EAST COMMUNITIES

645 MARYVILLE CTR DR STE 100

ST LOUIS,MO63141
43-1771217 		PHYSICIAN GROUP MO 501C3 9 MERCY HEALTH EAST COMMUNITIES
 
Yes
 
(7) MERCY CLINIC FORT SMITH COMM

7301 ROGERS AVENUE

FORT SMITH,AR72917
26-1318597 		PHYSICIAN CLINIC AR 501C3 9 MERCY HEALTH FORT SMITH COMM
 
Yes
 
(8) MERCY CLINIC HOT SPRINGS COMM

1 MERCY LANE

HOT SPRINGS,AR71913
26-1125131 		SOLD TO CHI 3/31/2014 AR 501C3 9 MERCY HEALTH HOT SPRINGS COMM
 
Yes
 
(9) MERCY CLINIC OKLAHOMA COMM

4300 W MEMORIAL ROAD

OKLAHOMA CITY,OK73120
27-0473057 		PHYSICIAN GROUP OK 501C3 9 MERCY HEALTH OK COMMUNITIES
 
Yes
 
(10) MERCY CLINIC SPRINGFIELD COMM

1965 FREMONT STREET SUITE 2950

SPRINGFIELD,MO65804
43-1560263 		PHYSICIAN GROUP MO 501C3 3 MERCY HEALTH SPRINGFIELD COMM
 
Yes
 
(11) MERCY FAMILY CENTER

14528 S OUTER FORTY ST 100

CHESTERFIELD,MO63017
72-1069468 		FAMILY COUNSELING SERVICES MO 501C3 7 MERCY HEALTH
 
Yes
 
(12) MERCY FDTN HEALTH INNOV

14528 S OUTER FORTY ST 100

CHESTERFIELD,MO63017
20-0901499 		FOUNDATION MO 501C3 11-II MERCY HEALTH
 
Yes
 
(13) MERCY HEALTH

14528 S OUTER FORTY ST 100

CHESTERFIELD,MO63017
43-1423050 		CORPORATE OFFICE MO 501C3 1 N/A
 
No
(14) MERCY HEALTH CENTER FOUNDATION INC

4300 W MEMORIAL ROAD

OKLAHOMA CITY,OK73120
73-1593024 		DISSOLVED 5/20/2014 OK 501C3 11-I MERCY HOSPITAL OKLAHOMA CITY
 
Yes
 
(15) MERCY HEALTH EAST COMMUNITIES

645 MARYVILLE CTR DR STE 100

ST LOUIS,MO63141
43-1718408 		HEALTH SYSTEM MO 501C3 11-II MERCY HEALTH
 
Yes
 
(16) MERCY HEALTH EAST COMMUNITIES - SR

645 MARYVILLE CTR DR STE 100

ST LOUIS,MO63141
46-1412322 		HEALTH SYSTEM MO 501C3 11-II MERCY HEALTH EAST COMMUNITIES
 
Yes
 
(17) MERCY HEALTH FORT SMITH COMM

7301 ROGERS AVENUE

FORT SMITH,AR72917
26-1318515 		HOLDING COMPANY AR 501C3 11-II MERCY HEALTH
 
Yes
 
(18) MERCY HEALTH FOUNDATION ADA

430 N MONTE VISTA STREET

ADA,OK74820
45-3596274 		FOUNDATION OK 501C3 11-I MERCY HOSPITAL ADA
 
Yes
 
(19) MERCY HEALTH FOUNDATION ARDMORE

1011 14TH AVENUE NW

ARDMORE,OK73401
71-0962525 		FOUNDATION OK 501C3 11-I MERCY HOSPITAL ARDMORE
 
Yes
 
(20) MERCY HEALTH FOUNDATION BERRYVILLE

214 CARTER STREET

BERRYVILLE,AR72616
71-0759301 		FOUNDATION AR 501C3 11-I MERCY HOSPITAL BERRYVILLE
 
Yes
 
(21) MERCY HEALTH FOUNDATION FT SCOTT

401 WOODLAND HILLS BLVD

FORT SCOTT,KS66701
48-1077073 		FOUNDATION KS 501C3 11-III MERCY KANSAS COMMUNITIES INC
 
Yes
 
(22) MERCY HEALTH FOUNDATION HOT SPRINGS

300 WERNER STREET

HOT SPRINGS,AR71913
71-0804718 		FOUNDATION AR 501C3 11-II MISSION CLINICAL SERVICES
 
Yes
 
(23) MERCY HEALTH FOUNDATION INDEPENDENCE

800 W MYRTLE

INDEPENDENCE,KS67301
48-1079981 		FOUNDATION KS 501C3 11-I MERCY KANSAS COMMUNITIES INC
 
Yes
 
(24) MERCY HEALTH FOUNDATION JEFFERSON

1400 US HIGHWAY 61 SOUTH

FESTUS,MO63028
46-2797051 		FOUNDATION MO 501C3 11-II MERCY HEALTH EAST COMMUNITIES - SR
 
Yes
 
(25) MERCY HEALTH FOUNDATION JOPLIN

100 MERCY WAY

JOPLIN,MO64804
27-0906136 		FOUNDATION MO 501C3 11-I MERCY HEALTH SW MOKS COMM
 
Yes
 
(26) MERCY HEALTH FOUNDATION NW ARK

2710 RIFE MEDICAL LN

ROGERS,AR72858
71-0601687 		FOUNDATION AR 501C3 11-III MERCY HOSPITAL ROGERS
 
Yes
 
(27) MERCY HEALTH FOUNDATION OF OK

4300 W MEMORIAL ROAD

OKLAHOMA CITY,OK73120
45-4732301 		FOUNDATION OK 501C3 11-I MERCY HEALTH OK COMMUNITIES
 
Yes
 
(28) MERCY HEALTH FOUNDATION OK CITY

4300 W MEMORIAL ROAD

OKLAHOMA CITY,OK73120
46-3184231 		FOUNDATION OK 501C3 11-I MERCY HOSPITAL OKLAHOMA CITY
 
Yes
 
(29) MERCY HEALTH FOUNDATION SPRINGFIELD

1235 E CHEROKEE STREET

SPRINGFIELD,MO65804
32-0195818 		FOUNDATION MO 501C3 11-II MERCY HEALTH SPRINGFIELD COMM
 
Yes
 
(30) MERCY HEALTH FOUNDATION WASHINGTON

901 E FIFTH STREET

WASHINGTON,MO63090
56-2410022 		FOUNDATION MO 501C3 11-II MERCY HEALTH EAST COMMUNITIES
 
Yes
 
(31) MERCY HEALTH HOT SPRINGS COMM

300 WERNER STREET

HOT SPRINGS,AR71913
26-1125064 		SOLD TO CHI 3/31/2014 AR 501C3 11-II MERCY HEALTH
 
Yes
 
(32) MERCY HEALTH NW ARK COMMUNITIES

2710 RIFE MEDICAL LN

ROGERS,AR72758
62-1684203 		PHYSICIAN GROUP AR 501C3 11-II MERCY HEALTH
 
Yes
 
(33) MERCY HEALTH OK COMMUNITIES

4300 W MEMORIAL ROAD

OKLAHOMA CITY,OK73120
73-1453048 		HOLDING COMPANY OK 501C3 11-II MERCY HEALTH
 
Yes
 
(34) MERCY HEALTH SW MOKS COMM

100 MERCY WAY

JOPLIN,MO64804
30-0584463 		HEALTH SYSTEM MO 501C3 11-II MERCY HEALTH
 
Yes
 
(35) MERCY HEALTH SPRINGFIELD COMM

1235 E CHEROKEE STREET

SPRINGFIELD,MO65804
43-1856028 		HOLDING COMPANY MO 501C3 11-II MERCY HEALTH
 
Yes
 
(36) MERCY HEALTH SYSTEM TX

14528 S OUTER FORTY ST 100

CHESTERFIELD,MO63017
74-2764727 		DISSOLVED 5/15/2014 TX 501C3 11-II MERCY HEALTH
 
Yes
 
(37) MERCY HOME HEALTH BERRYVILLE

804 W FREEMAN SUITE 4

BERRYVILLE,AR72616
87-0781247 		HOME HEALTH AND HOSPICE OPERATIONS AR 501C3 11-III MERCY HOSPITAL SPRINGFIELD
 
Yes
 
(38) MERCY HOSPITAL ADA INC

430 N MONTE VISTA STREET

ADA,OK74820
46-2288155 		HOSPITAL OK 501C3 3 MERCY HEALTH OK COMMUNITIES
 
Yes
 
(39) MERCY HOSPITAL ARDMORE

1011 14TH AVENUE NW

ARDMORE,OK73401
73-1500629 		HOSPITAL OK 501C3 3 MERCY HEALTH OK COMMUNITIES
 
Yes
 
(40) MERCY HOSPITAL AURORA

500 PORTER AVENUE

AURORA,MO65605
43-1936696 		HOSPITAL MO 501C3 3 MERCY HEALTH SPRINGFIELD COMM
 
Yes
 
(41) MERCY HOSPITAL BERRYVILLE

214 CARTER STREET

BERRYVILLE,AR72616
71-0759299 		HOSPITAL AR 501C3 3 MERCY HEALTH SPRINGFIELD COMM
 
Yes
 
(42) MERCY HOSPITAL BOONEVILLE

880 WEST MAIN STREET

BOONEVILLE,AR72927
46-3851119 		HOSPITAL AR 501C3 3 MERCY HOSPITAL FORT SMITH
 
Yes
 
(43) MERCY HOSPITAL CARTHAGE

3125 DR RUSSELL SMITH WAY

CARTHAGE,MO64836
45-3808607 		HOSPITAL MO 501C3 3 MERCY HEALTH SW MOKS COMM
 
Yes
 
(44) MERCY HOSPITAL CASSVILLE

94 MAIN STREET

CASSVILLE,MO65625
43-1936699 		HOSPITAL MO 501C3 3 MERCY HEALTH SPRINGFIELD COMM
 
Yes
 
(45) MERCY HOSPITAL COLUMBUS

220 PENNSYLVANIA AVENUE

COLUMBUS,KS66725
27-0842031 		HOSPITAL MO 501C3 9 MERCY HEALTH SW MOKS COMM
 
Yes
 
(46) MERCY HOSPITAL EL RENO

2115 PARKVIEW DRIVE

EL RENO,OK73036
27-2716065 		HOSPITAL OK 501C3 3 MERCY HEALTH OK COMMUNITIES
 
Yes
 
(47) MERCY HOSPITAL FORT SMITH

7301 ROGERS AVENUE

FORT SMITH,AR72917
71-0240352 		HOSPITAL AR 501C3 3 MERCY HEALTH FORT SMITH COMM
 
Yes
 
(48) MERCY HOSPITAL HEALDTON INC

918 SOUTH 8TH STREET

HEALDTON,OK73438
26-3173902 		HOSPITAL OK 501C3 3 MERCY HOSPITAL ARDMORE INC
 
Yes
 
(49) MERCY HOSPITAL HOT SPRINGS

300 WERNER STREET

HOT SPRINGS,AR71913
71-0236913 		SOLD TO CHI 3/31/2014 AR 501C3 3 MERCY HEALTH HOT SPRINGS COMM
 
Yes
 
(50) MERCY HOSPITAL JEFFERSON

1400 HIGHWAY 61 SOUTH

FESTUS,MO63028
43-0687077 		HOSPITAL MO 501C3 3 MERCY HEALTH EAST COMMUNITIES - SR
 
Yes
 
(51) MERCY HOSPITAL JOPLIN

100 MERCY WAY

JOPLIN,MO64804
27-0814858 		HOSPITAL MO 501C3 3 MERCY HEALTH SW MOKS COMM
 
Yes
 
(52) MERCY HOSPITAL KINGFISHER INC

1000 KINGFISHER REGIONAL HOSPITAL D

KINGFISHER,OK73750
46-3433074 		HOSPITAL OK 501C3 3 MERCY HOSPITAL OKLAHOMA CITY
 
Yes
 
(53) MERCY HOSPITAL LEBANON

100 HOSPITAL DRIVE

LEBANON,MO65536
43-1767432 		HOSPITAL MO 501C3 3 MERCY HEALTH SPRINGFIELD COMM
 
Yes
 
(54) MERCY HOSPITAL LOGAN COUNTY INC

200 SOUTH ACADEMY

GUTHRIE,OK73044
45-2998842 		HOSPITAL OK 501C3 3 MERCY HEALTH OK COMMUNITIES
 
Yes
 
(55) MERCY HOSPITAL OF LAREDO

14528 S OUTER FORTY ST 100

CHESTERFIELD,MO63017
74-1189682 		DISSOLVED 5/15/2014 TX 501C3 3 MERCY HEALTH SYSTEM TX
 
Yes
 
(56) MERCY HOSPITAL OKLAHOMA CITY

4300 W MEMORIAL ROAD

OKLAHOMA CITY,OK73120
73-0579285 		HOSPITAL OK 501C3 3 MERCY HEALTH OK COMMUNITIES
 
Yes
 
(57) MERCY HOSPITAL OZARK

801 W RIVER STREET

OZARK,AR72949
71-0689680 		HOSPITAL AR 501C3 3 MERCY HOSPITAL FORT SMITH
 
Yes
 
(58) MERCY HOSPITAL PARIS

500 E ACADEMY

PARIS,AR72855
71-0655753 		HOSPITAL AR 501C3 3 MERCY HOSPITAL FORT SMITH
 
Yes
 
(59) MERCY HOSPITAL ROGERS

2710 RIFE MEDICAL LN

ROGERS,AR72758
71-0294390 		HOSPITAL AR 501C3 3 MERCY HEALTH NW ARK COMMUNITIES
 
Yes
 
(60) MERCY HOSPITAL SPRINGFIELD

1235 E CHEROKEE STREET

SPRINGFIELD,MO65804
44-0552485 		HOSPITAL MO 501C3 3 MERCY HEALTH SPRINGFIELD COMM
 
Yes
 
(61) MERCY HOSPITAL TISHOMINGO

1000 SOUTH BYRD

TISHOMINGO,OK73460
27-4433830 		HOSPITAL OK 501C3 3 MERCY HOSPITAL ARDMORE
 
Yes
 
(62) MERCY HOSPITAL WALDRON

1341 W 6TH STREET

WALDRON,AR72958
71-0557895 		HOSPITAL AR 501C3 3 MERCY HOSPITAL FORT SMITH
 
Yes
 
(63) MERCY HOSPITAL WATONGA INC

500 CLARENCE NASH BLVD

WATONGA,OK73772
45-5199762 		LEASED HOSPITAL OK 501C3 3 MERCY HEALTH OK COMMUNITIES
 
Yes
 
(64) MERCY HOSPITALS EAST COMM

645 MARYVILLE CTR DR STE 100

ST LOUIS,MO63141
43-0653493 		HOSPITAL MO 501C3 3 MERCY HEALTH EAST COMMUNITIES
 
Yes
 
(65) MERCY KANSAS COMMUNITIES INC

401 WOODLAND HILLS BLVD

FT SCOTT,KS66701
48-0956045 		HOSPITAL KS 501C3 3 MERCY HEALTH SW MOKS COMM
 
Yes
 
(66) MERCY MEDICAL RESEARCH INST

1235 E CHEROKEE STREET

SPRINGFIELD,MO65804
87-0796305 		RESEARCH - CLINICAL TRIALS MO 501C3 4 MERCY HEALTH SPRINGFIELD COMM
 
Yes
 
(67) MERCY MINISTRIES OF LAREDO

2500 ZACATECAS

LAREDO,TX78043
20-0198462 		HEALTHCARE SERVICES,OUTREACH EDUCATION PROGRAM TX 501C3 7 MERCY HEALTH
 
Yes
 
(68) MERCY ST FRANCIS HOSPITAL

100 W HIGHWAY 60

MOUNTAIN VIEW,MO65548
44-0607149 		HOSPITAL MO 501C3 3 MERCY HEALTH SPRINGFIELD COMM
 
Yes
 
(69) MERCY SUPPORT SERVICES

615 S NEW BALLAS ROAD

ST LOUIS,MO63141
43-1677952 		INACTIVE MO 501C3 11-III MERCY HOSPITALS EAST COMM
 
Yes
 
(70) MHM SUPPORT SERVICES

14528 S OUTER FORTY ST 100

CHESTERFIELD,MO63017
20-2553101 		CENTRALIZED HEALTH SYSTEM FUNCTIONS MO 501C3 11-II MERCY HEALTH
 
Yes
 
(71) MISSION CLINICAL SERVICES

300 WERNER STREET

HOT SPRINGS,AR71913
13-4239691 		CHILD ADVOCACY CENTER AR 501C3 9 MERCY HEALTH
 
Yes
 
(72) ST EDWARD MERCY FOUNDATION

7301 ROGERS AVENUE

FORT SMITH,AR72917
23-7330425 		FOUNDATION AR 501C3 7 MERCY HOSPITAL FORT SMITH
 
Yes
 
(73) ST JOHNS CHILDRENS HOSP

1235 E CHEROKEE STREET

SPRINGFIELD,MO65804
 INACTIVE MO 501C3 3 MERCY HEALTH SPRINGFIELD COMM
 
Yes
 
(74) ST MARYS HOSP ENID OK

14528 S OUTER FORTY ST 100

CHESTERFIELD,MO63017
73-0614655 		INACTIVE OK 501C3 3 MERCY HEALTH OK COMMUNITIES
 
Yes
 
(75) THE SR M CORNELIA BLASKO FN

100 W HIGHWAY 60

MOUNTAIN VIEW,MO65548
43-1873914 		FOUNDATION MO 501C3 11-I MERCY ST FRANCIS HOSPITAL
 
Yes
 
(76) UNITY AMBULATORY CARE

14528 S OUTER FORTY ST 100

CHESTERFIELD,MO63017
43-1861745 		INACTIVE MO 501C3 11-III MERCY HEALTH EAST COMMUNITIES
 
Yes
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) SOUTHERN OKLAHOMA DIAG CTR LLC

1011 FOURTEENTH AVENUE NW
ARDMORE,OK73401
43-1971232 		MRI SERVICES OK MERCY HOSPITAL ARDMORE INC
  		N/A       No     No  
(2) RESOURCE OPTIMIZ & INNOVLLC

645 MARYVILLE CTR DRSTE 200
ST LOUIS,MO63141
46-0468368 		CENTRAL DISTRIBUTION CENTER MO MHN INC - MHNSR INC
  		N/A       No     No  
(3) MERCY AMBULATORY SURGERY CENTER LLC

7301 ROGERS AVENUE
FORT SMITH,AR72917
71-0827721 		AMBULATORY SURGERY CENTER AR MERCY HOSPITAL FORT SMITH
  		N/A       No     No  
(4) FORT SMITH EMERGENCY MEDICAL SERVICES

1701 SOUTH GREENWOOD
FORT SMITH,AR72901
71-0416615 		EMERGENCY MEDICAL SERVICES AR MERCY HOSPITAL FORT SMITH
  		N/A       No     No  
(5) ST EDWARD MERCY MC M-P OFFICE BLDG

7301 ROGERS AVENUE
FORT SMITH,AR72903
71-0554050 		OFFICE BUILDING AR MERCY HOSPITAL FORT SMITH
  		N/A       No     No  




Part IV
Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
 		(b)
Primary activity
 		(c)
Legal
domicile
(state or foreign
country)
 		(d)
Direct controlling
entity
 		(e)
Type of entity
(C corp, S corp,
or trust) 		(f)
Share of total income
 		(g)
Share of end-of-year
assets
 		(h)
Percentage
ownership
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) MERCY COMM SERVICES INC

401 WOODLAND HILLS BLVD
FORT SCOTT,KS66701
48-1078101 		RETAIL PHARMACY KS MERCY KANSAS COMM INC
  		C         No
(2) FRONTENAC PROPERTIES INC

14528 S OUTER FORTY SUITE 100
CHESTERFIELD,MO63017
52-1914421 		HOLDS ANCILLARY ASSETS & OWNS AIRCRAFT DE MERCY HEALTH
  		C         No
(3) INVENO HEALTH INC

1235 E CHEROKEE STREET
SPRINGFIELD,MO65804
26-4509571 		TECHNOLOGY TRANSFER COMPANY MO MERCY HEALTH SPRINGFIELD COMM
  		C         No
(4) UNITY SUPPORT SERVICES INC

645 MARYVILLE CENTRE DRIVE SUITE 10
ST LOUIS,MO63141
43-1797042 		INACTIVE MO MERCY HEALTH EAST COMMUNITIES
  		C         No
(5) UH L CORP INC

645 MARYVILLE CENTRE DRIVE SUITE 10
ST LOUIS,MO63141
74-2499535 		HOLDING COMPANY MO MERCY HEALTH SERVICES LLC
  		C         No
(6) MHN OF THE SOUTHERN REGION INC

1011 14TH AVENUE NW
ARDMORE,OK73401
73-1580607 		HOLDING COMPANY OK MERCY MANAGED CARE CORP
  		C         No
(7) MERCY HEALTH CENTER CONDOMINIUM INC

4300 W MEMORIAL RD
OKLAHOMA CITY,OK73120
68-0640970 		ADMINISTRATOR OF CERTAIN REAL PROPERTY AND IMPROVEMENTS OK MERCY HOSPITAL OKLAHOMA CITYINC
  		C         No
(8) MERCY MANAGED CARE CORPORATION

4300 W MEMORIAL ROAD
OKLAHOMA CITY,OK73120
73-1441665 		HOLDING COMPANY OK MERCY HEALTH
  		C         No
(9) MERCY HEALTH NETWORK INC

4300 W MEMORIAL ROAD
OKLAHOMA CITY,OK73120
73-1381689 		HOLDING COMPANY OK MERCY MANAGED CARE CORP
  		C         No
(10) APOTHECARY SERVICES INC

PO BOX 350
CRYSTAL CITY,MO63019
43-1627267 		RETAIL PHARMACY MO MERCY HOSPITAL JEFFERSON
  		C         No
(11) MERCY COMMERCIAL SERVICES INC

14528 SOUTH OUTER FORTY SUITE 100
CHESTERFIELD,MO63017
46-4953543 		CORP PARENT OF VCC TAXABLE COMMERCIALIZ SVCS OK MHN INC AND MHNSR INC
  		C         No
(12) ST JOHNS MERCY MAIL ORDER INC

645 MARYVILLE CENTRE DRIVE SUITE 10
ST LOUIS,MO63141
43-1014222 		INACTIVE MO UH HOLDINGS INC
  		C         No
(13) ST JOHNS MERCY PBM INC

645 MARYVILLE CENTRE DRIVE SUITE 10
ST LOUIS,MO63141
74-3089567 		INACTIVE MO UH L CORP INC
  		C         No
(14) UH HOLDINGS INC

645 MARYVILLE CENTRE DRIVE SUITE 10
ST LOUIS,MO63141
43-1845682 		INACTIVE MO UH L CORP INC
  		C         No
Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 3
Part V
Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) MERCY HOSPITALS EAST COMMUNITIES ST LOUIS

 B 6,125,647 FMV
(2) MERCY HOSPITALS EAST COMMUNITIES ST LOUIS

 C 65,000 FMV
(3) MERCY HOSPITALS EAST COMMUNITIES WASHINGTON

 C 9,800 FMV
(4) MERCY HEALTH FOUNDATION WASHINGTON

 B 25,000 FMV
(5) MERCY HOSPITALS EAST COMMUNITIES ST LOUIS

 C 365,472 FMV

Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(e)
Are all partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V?UBI
amount in box 20
of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference Explanation
Schedule R (Form 990) 2013
Additional Data


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