Form990
Department of the TreasuryInternal 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)
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OMB No. 1545-0047
2019
Open to Public Inspection
A For the 2019 calendar year, or tax year beginning 07-01-2017 , and ending 06-30-2018
BCheck if applicable:
CName of organization
Mercy Foundation of Des Moines IA
 
 
Doing business as
 
 
Number and street (or P.O. box if mail is not delivered to street address)
1111 6th Avenue
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
Des Moines, IA50314
D Employer identification number

23-7358794
E Telephone number

G Gross receipts $ 10,823,360
F Name and address of principal officer:
Shannon Cofield
1111 6th Avenue
Des Moines,IA50314
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.foundation.mercydesmoines.org
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 MediumBullet0928
K Form of organization:  
L Year of formation: 1973
M State of legal domicile: IA
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: TO BE AN EXTENSION OF THE HEALING MINISTRY OF THE SISTERS OF MERCY. OUR PURPOSE IS TO SECURE VITAL FUNDING THAT ENSURES EQUAL ACCESS, CLINICAL EXCELLENCE AND HIGH QUALITY CARE FOR ALL. THE ORGANIZATION WAS, FOR THE YEAR ENDED 6/30/18, AFFILIATED WITH CATHOLIC HEALTH INITIATIVES ("CHI"). FOLLOWING THE CLOSE OF THE 6/30/2018 TAX YEAR, ON 2/1/19, IN CONNECTION WITH THE ALIGNMENT OF THE CATHOLIC MINISTRIES OF CHI AND DIGNITY HEALTH, CHI CHANGED ITS NAME TO COMMONSPIRIT HEALTH.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 22
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 21
5 Total number of individuals employed in calendar year 2019 (Part V, line 2a) ...... 5 0
6 Total number of volunteers (estimate if necessary) ............. 6 22
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 4,682
b Net unrelated business taxable income from Form 990-T, line 39 ......... 7b 3,682
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 5,799,995 6,636,769
9 Program service revenue (Part VIII, line 2g) ......... 0 0
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 1,722,659 4,171,045
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) -14,605 -99,511
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12) 7,508,049 10,708,303
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 13,136,442 10,725,817
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) 859,206 989,857
16a Professional fundraising fees (Part IX, column (A), line 11e) .....   0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet1,396,026    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 705,887 533,341
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 14,701,535 12,249,015
19 Revenue less expenses. Subtract line 18 from line 12....... -7,193,486 -1,540,712
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 40,067,504 37,319,673
21 Total liabilities (Part X, line 26)............. 1,431,575 2,375,553
22 Net assets or fund balances. Subtract line 21 from line 20..... 38,635,929 34,944,120
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 (2019)
Form 990 (2019)
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 MISSION OF THE CORPORATION IS TO NURTURE THE HEALING MINISTRY OF THE CHURCH, SUPPORTED BY EDUCATION AND RESEARCH. FIDELITY TO THE GOSPEL URGES THE CORPORATION TO EMPHASIZE HUMAN DIGNITY AND SOCIAL JUSTICE AS IT CREATES HEALTHIER COMMUNITIES. THE CORPORATION, SPONSORED BY A LAY-RELIGIOUS PARTNERSHIP, CALLS OTHER CATHOLIC SPONSORS AND SYSTEMS TO UNITE TO ENSURE THE FUTURE OF CATHOLIC HEALTH CARE. TO FULFILL THIS MISSION, THE CORPORATION, AS A VALUES-BASED ORGANIZATION, WILL ASSURE THE INTEGRITY OF THE MINISTRY IN BOTH CURRENT AND DEVELOPING ORGANIZATIONS AND ACTIVITIES; RESEARCH AND DEVELOP NEW MINISTRIES THAT INTEGRATE HEALTH, EDUCATION, PASTORAL, AND SOCIAL SERVICES; PROMOTE LEADERSHIP DEVELOPMENT AND FORMATION FOR MINISTRY THROUGHOUT THE ENTIRE ORGANIZATION; ADVOCATE FOR SYSTEMIC CHANGES WITH SPECIFIC CONCERN FOR PERSONS WHO ARE POOR, ALIENATED, AND UNDERSERVED; AND STEWARD RESOURCES BY GENERAL OVERSIGHT OF THE ENTIRE ORGANIZATION.
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 $ 10,725,817 including grants of $ 10,725,817 ) (Revenue $ 0 )
SEE SCHEDULE O.
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 expensesMediumBullet10,725,817
Form 990 (2019)
Form 990 (2019)
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
 
 
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 I.........................
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 II....
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes,"
complete Schedule D, Part IIIClick to see attachment..............
8
Yes
 
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 IV..............
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 V......
10
 
 
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
Yes
 
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 VIII.......
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 IX............
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
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If "Yes," complete
Schedule D, Parts XI and XII......................
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) ....
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...................
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
 
 
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.....Click to see attachment
21
Yes
 
Form 990 (2019)
Form 990 (2019)
Page 4
Part IV
Checklist of Required Schedules (continued)
Yes
No
22
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........Click to see attachment
22
Yes
 
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), 501(c)(4), and 501(c)(29) 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 or 22 for receivables from or payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part II...........
26
 
No
27
Did the organization provide a grant or other assistance to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or employee thereof, a grant selection committee member, or to a 35% controlled entity (including an employee thereof) 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, key employee, creator or founder, or substantial contributor? If "Yes," complete Schedule L, Part IV......................
28a
 
No
b
A family member of any individual described in line 28a? If "Yes," complete Schedule L, Part IV.....
28b
 
No
c
A 35% controlled entity of one or more individuals and/or organizations described in lines 28a or 28b? If "Yes," complete Schedule L, Part IV.....................
28c
 
 
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..Click to see attachment
29
Yes
 
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............
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
 
No
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 ...
35b
 
 
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.............
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 VI
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
 
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
 
 
Form 990 (2019)
Form 990 (2019)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance (continued)
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
Yes
 
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
Yes
 
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 FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
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
Yes
 
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. Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? ........
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the sponsoring organization make any taxable distributions under section 4966?........
9a
 
 
b
Did the sponsoring 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
 
 
15
Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or excess parachute payment(s) during the year? ....................
If "Yes," see instructions and file Form 4720, Schedule N.
15
 
 
16
Is the organization an educational institution subject to the section 4968 excise tax on net investment income? ..
If "Yes," complete Form 4720, Schedule O.
16
 
 
Form 990 (2019)
Form 990 (2019)
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
22
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
21
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-A 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, address, and telephone number of the person who possesses the organization's books and records:
MediumBulletRandall L Rubin1111 6th Avenue   Des Moines,IA50314 (515) 643-7860
Form 990 (2019)
Form 990 (2019)
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.

See instructions for the order in which to list the persons above.
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) FLORENCE BURCH
 
Vice Chair
 1.0
.................
0 		X   X       0 0 0
(2) BRIAN CHITTENDEN
 
Secretary
 1.0
.................
0 		X   X       0 0 0
(3) Chris Cornelius
 
Treasurer
 1.0
.................
0 		X   X       0 0 0
(4) BRIAN JOHNSON
 
Chair
 1.0
.................
0 		X   X       0 0 0
(5) THOMAS BECKER MD
 
Director
 1.0
.................
0 		X           0 0 0
(6) Dr THOMAS BROWN
 
Director
 1.0
.................
0 		X           0 0 0
(7) MICHAEL DEE
 
Director
 1.0
.................
1.0 		X           0 0 0
(8) BRAD DUFFY
 
Director
 1.0
.................
0 		X           0 0 0
(9) DENIS L FRISCHMEYER
 
DIRECTOR
 1.0
.................
1.0 		X           0 0 0
(10) Kyle Gamble
 
Director
 1.0
.................
0 		X           0 0 0
(11) DIXIE HARMEYER-KNOWLES
 
DIRECTOR
 1.0
.................
1.0 		X           0 0 0
(12) KARLTON KLEIS
 
Director
 1.0
.................
0 		X           0 0 0
(13) Diane MacArthur
 
Director - Affiliate Designee: Mercy Centerville Legacies Foundation Development Committee
 1.0
.................
0 		X           0 0 0
(14) CRAIG MAHONEY MD
 
Director
 1.0
.................
0 		X           0 0 0
(15) TOM MASS
 
Director
 1.0
.................
0 		X           0 0 0
(16) CHRIS NELSON
 
Director
 1.0
.................
0 		X           0 0 0
(17) TIM NEUGENT
 
Director
 1.0
.................
0 		X           0 0 0
Form 990 (2019)
Form 990 (2019)
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) MICHELLE PARKS
 
Director - Affiliate Designee: House of Mercy
 1.0
.......................1.0 		X           0 0 0
(19) SHARON PHILLIPS
 
DIRECTOR
 1.0
.......................41.0 		X           0 274,647 29,834
(20) MAUREEN ROACH TOBIN
 
Director
 1.0
.......................0 		X           0 0 0
(21) MARY SHELDAHL
 
Director - Affiliate Designee: Mercy College
 1.0
.......................1.0 		X           0 0 0
(22) Lois vogel
 
Director - Affiliate Designee: Skiff Medical Center Foundation
 1.0
.......................1.0 		X           0 0 0
(23) Dave Wingert
 
Director (Partial year)
 1.0
.......................0 		X           0 0 0
(24) Shannon Cofield
 
Foundation President
 1.0
.......................40.0 		    X       0 267,273 18,488
(25) RANDALL RUBIN
 
SVP, CFO - CHI Iowa Corp
 1.0
.......................41.0 		    X       0 482,920 35,990
(26) MICHAEL WEGNER
 
Interim CEO of CHI Iowa Corp (partial year)
 1.0
.......................50.0 		    X       0 620,188 36,549
(27) SHANNON DUVAL
 
Former Foundation President
 0.0
.......................50.0 		          X 0 423,595 42,891






1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)...........MediumBullet 0 2,068,623 163,752
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet0
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
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet0
Form 990 (2019)
Form 990 (2019)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII.............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512 - 514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a 0
b Membership dues..1b 0
c Fundraising events..1c 336,025
d Related organizations1d 1,261,180
e Government grants (contributions)1e 667,134
f All other contributions, gifts, grants, and similar amounts not included above1f 4,372,430
g Noncash contributions included in lines 1a - 1f:$ 1g 362,040
h Total. Add lines 1a-1f.......MediumBullet 6,636,769
Program Service RevenueAmt Business Code
2a     0 0 0 0
b     0 0 0 0
c     0 0 0 0
d     0 0 0 0
e     0 0 0 0
f All other program service revenue. 0 0 0 0
g Total. Add lines 2a–2f .....MediumBullet 0
OtherAmtRevenueAmt 3 Investment income (including dividends, interest, and othersimilar amounts) ......MediumBullet 1,476,168 0 4,682 1,471,486
4 Income from investment of tax-exempt bond proceedsMediumBullet 0 0 0 0
5 Royalties...........MediumBullet 0 0 0 0
(ii) Personal (i) Real
6a Gross rents 0 0 6a
b Less: rental expenses 0 0 6b
c Rental income or (loss) 0 0 6c
d Net rental income or (loss).......MediumBullet 0 0 0 0
(ii) Other (i) Securities
7a Gross amount from sales of assets other than inventory -1,496 2,696,373 7a
b Less: cost or other basis and sales expenses 0 0 7b
c Gain or (loss) -1,496 2,696,373 7c
d Net gain or (loss).........MediumBullet 2,694,877 0 0 2,694,877
8a Gross income from fundraising events (not including $ 336,025of contributions reported on line 1c). See Part IV, line 18 ....
8a 15,546
b Less: direct expenses ... 8b 115,057
c Net income or (loss) from fundraising events..MediumBullet -99,511 0 -99,511
9a Gross income from gaming activities.
See Part IV, line 19 ...
9a 0
b Less: direct expenses ... 9b 0
c Net income or (loss) from gaming activities..MediumBullet 0 0 0 0
10a Gross sales of inventory, less
returns and allowances ..
10a 0
b Less: cost of goods sold .. 10b 0
c Net income or (loss) from sales of inventory..MediumBullet 0 0 0 0
Business Code Miscellaneous Revenue
11a     0 0 0 0
b     0 0 0 0
c     0 0 0 0
d All other revenue .... 0 0 0 0
e Total. Add lines 11a–11d ...... MediumBullet 0
12 Total revenue. See instructions.....MediumBullet 10,708,303 0 4,682 4,066,852
Form 990 (2019)
Form 990 (2019)
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 domestic organizations and domestic governments. See Part IV, line 21 .... 10,292,820 10,292,820
2 Grants and other assistance to domestic individuals. See Part IV, line 22 ........... 432,997 432,997
3 Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. 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........ 822,374     822,374
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....        
9 Other employee benefits ....... 116,284     116,284
10 Payroll taxes ........... 51,199     51,199
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) 114,840 0 0 114,840
12 Advertising and promotion ....        
13 Office expenses ....... 39,770     39,770
14 Information technology ...... 28,143   28,143  
15 Royalties ..        
16 Occupancy ........... 77,653     77,653
17 Travel ............ 5,473     5,473
18 Payments of travel or entertainment expenses for any federal, state, or local public officials .        
19 Conferences, conventions, and meetings .... 10,372     10,372
20 Interest ...........        
21 Payments to affiliates ....... 52,806     52,806
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 CHI IA MBO Assessment 99,029   99,029  
b Miscellaneous Expenses 83,778     83,778
c Dues & subscriptions 18,864     18,864
d Education 2,169     2,169
e All other expenses 444 0 0 444
25 Total functional expenses. Add lines 1 through 24e 12,249,015 10,725,817 127,172 1,396,026
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 (2019)
Form 990 (2019)
Page 11
Part X
Balance Sheet
Check if Schedule O contains a response or note to any line in this Part IX..............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash–non-interest-bearing ........ 300 1 300
2 Savings and temporary cash investments ......... 2,574,913 2 1,205,933
3 Pledges and grants receivable, net ...... 8,055,517 3 8,159,773
4 Accounts receivable, net ............. 0 4 29,978
5 Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
0 5 0
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
  6 0
7 Notes and loans receivable, net ........... 0 7 0
8 Inventories for sale or use ............ 0 8 0
9 Prepaid expenses and deferred charges ...... 0 9 0
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 2,391,241
b Less: accumulated depreciation 10b 22,932 2,369,804 10c 2,368,309
11 Investments—publicly traded securities . 294,069 11 306,566
12 Investments—other securities. See Part IV, line 11 ..... 26,649,189 12 25,121,146
13 Investments—program-related. See Part IV, line 11 .. 0 13  
14 Intangible assets ............... 0 14 0
15 Other assets. See Part IV, line 11 ........... 123,712 15 127,668
16 Total assets. Add lines 1 through 15 (must equal line 33)... 40,067,504 16 37,319,673
Liabilities 17 Accounts payable and accrued expenses ..... 74,198 17 1,385
18 Grants payable ... 0 18 0
19 Deferred revenue ......... 0 19 -26,283
20 Tax-exempt bond liabilities ......... 0 20 0
21 Escrow or custodial account liability. Complete Part IV of Schedule D 0 21 0
22 Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
  22 0
23 Secured mortgages and notes payable to unrelated third parties .. 0 23 0
24 Unsecured notes and loans payable to unrelated third parties .. 0 24 0
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 1,357,377 25 2,400,451
26 Total liabilities. Add lines 17 through 25.. 1,431,575 26 2,375,553
Net Assets or Fund Balance Organizations that follow FASB ASC 958, check here MediumBullet and complete lines 27, 28, 32, and 33.
27 Net assets without donor restrictions ..........   27  
28 Net assets with donor restrictions ...........   28  
Organizations that do not follow FASB ASC 958, check here MediumBullet and complete lines 29 through 33.
29 Capital stock or trust principal, or current funds .....   29  
30 Paid-in or capital surplus, or land, building or equipment fund ...   30  
31 Retained earnings, endowment, accumulated income, or other funds   31  
32 Total net assets or fund balances ........... 38,635,929 32 34,944,120
33 Total liabilities and net assets/fund balances ........ 40,067,504 33 37,319,673
Form 990 (2019)
Form 990 (2019)
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
10,708,303
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
12,249,015
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
-1,540,712
4
Net assets or fund balances at beginning of year (must equal Part X, line 32, column (A)) ..
4
38,635,929
5
Net unrealized gains (losses) on investments ...............
5
-1,141,376
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
-1,009,721
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 32, column (B))
10
34,944,120
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
 
No
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
 
 
Form 990 (2019)
Form 990 (2019)
Additional Data


Software ID: 17005876
Software Version: 2017v2.2
Form 990, Special Condition Description:
Special Condition Description
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 Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2019
Open to Public
Inspection
Name of the organization
Mercy Foundation of Des Moines IA
 
Employer identification number

23-7358794
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 12, check only one box.)
1
2
3
4
5
6
7
8
9
10
11
12
a
b
c
d
e
f
Enter the number of supported organizations ...............................  
g
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 10 above (see instructions)) (iv) Is the organization listed in your governing document? (v) Amount of monetary support (see instructions) (vi) Amount of other support (see instructions)
Yes No
Total
 
   
For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2019

Schedule A (Form 990 or 990-EZ) 2019
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 failed 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) 2015 (b) 2016 (c) 2017 (d) 2018 (e) 2019 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. 6,606,960 10,088,387 7,066,628 5,799,995 6,636,769 36,198,739
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....           0
3 The value of services or facilities furnished by a governmental unit to the organization without charge..           0
4 Total. Add lines 1 through 3 6,606,960 10,088,387 7,066,628 5,799,995 6,636,769 36,198,739
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).. 7,223,736
6 Public support. Subtract line 5 from line 4. 28,975,003
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2015 (b) 2016 (c) 2017 (d) 2018 (e) 2019 (f) Total
7 Amounts from line 4.. 6,606,960 10,088,387 7,066,628 5,799,995 6,636,769 36,198,739
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... 758,303 678,822 725,399 582,869 1,471,486 4,216,879
9 Net income from unrelated business activities, whether or not the business is regularly carried on..         3,682 3,682
10 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. 133,189 150,498 155,339 102,014 15,546 556,586
11 Total support. Add lines 7 through 10 40,975,886
12
12
0
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
70.71 %
15
15
72.34 %
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) 2019

Schedule A (Form 990 or 990-EZ) 2019
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 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) 2015 (b) 2016 (c) 2017 (d) 2018 (e) 2019 (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) 2015 (b) 2016 (c) 2017 (d) 2018 (e) 2019 (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 VI.) ..            
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) 2019

Schedule A (Form 990 or 990-EZ) 2019
Page 4
Part IV
Supporting Organizations
(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)
Section A. All Supporting Organizations
Yes
No
1
Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.
1
 
 
2
Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).
2
 
 
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.
3a
 
 
b
Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.
3b
 
 
c
Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.
3c
 
 
4a
Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 12a or 12b in Part I, answer (b) and (c) below.
4a
 
 
b
Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.
4b
 
 
c
Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.
4c
 
 
5a
Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).
5a
 
 
b
Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.
6
 
 
7
Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .
7
 
 
8
Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).
8
 
 
9a
Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.
9a
 
 
b
Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.
9b
 
 
c
Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.
9c
 
 
10a
Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.
10a
 
 
b
Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).
10b
 
 
Schedule A (Form 990 or 990-EZ) 2019

Schedule A (Form 990 or 990-EZ) 2019
Page 5
Part IV
Supporting Organizations (continued)
Yes
No
11
Has the organization accepted a gift or contribution from any of the following persons?
a
A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?
11a
 
 
b
A family member of a person described in (a) above?
11b
 
 
c
A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.
11c
 
 
Section B. Type I Supporting Organizations
Yes
No
1
Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.
1
 
 
2
Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.
2
 
 
Section C. Type II Supporting Organizations
Yes
No
1
Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).
1
 
 
Section D. All Type III Supporting Organizations
Yes
No
1
Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?
1
 
 
2
Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).
2
 
 
3
By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer (a) and (b) below.
Yes
No
a
Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.
2a
 
 
b
Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.
2b
 
 
3
Parent of Supported Organizations. Answer (a) and (b) below.
a
Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.
3a
 
 
b
Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.
3b
 
 
Schedule A (Form 990 or 990-EZ) 2019

Schedule A (Form 990 or 990-EZ) 2019
Page 6
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations
1
Section A - Adjusted Net Income (A) Prior Year (B) Current Year
(optional)
1 Net short-term capital gain 1    
2 Recoveries of prior-year distributions 2    
3 Other gross income (see instructions) 3    
4 Add lines 1 through 3 4    
5 Depreciation and depletion 5    
6 Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) 6    
7 Other expenses (see instructions) 7    
8 Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) 8    
Section B - Minimum Asset Amount (A) Prior Year (B) Current Year
(optional)
1 Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): 1
a Average monthly value of securities 1a    
b Average monthly cash balances 1b    
c Fair market value of other non-exempt-use assets 1c    
d Total (add lines 1a, 1b, and 1c) 1d    
e Discount claimed for blockage or other factors
(explain in detail in Part VI):  
2 Acquisition indebtedness applicable to non-exempt use assets 2    
3 Subtract line 2 from line 1d 3    
4 Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). 4    
5 Net value of non-exempt-use assets (subtract line 4 from line 3) 5    
6 Multiply line 5 by .035 6    
7 Recoveries of prior-year distributions 7    
8 Minimum Asset Amount (add line 7 to line 6) 8    
Section C - Distributable Amount Current Year
1 Adjusted net income for prior year (from Section A, line 8, Column A) 1  
2 Enter 85% of line 1 2  
3 Minimum asset amount for prior year (from Section B, line 8, Column A) 3  
4 Enter greater of line 2 or line 3 4  
5 Income tax imposed in prior year 5  
6 Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) 6  
7
Schedule A (Form 990 or 990-EZ) 2019

Schedule A (Form 990 or 990-EZ) 2019
Page 7
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)
Section D - Distributions Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes  
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in
excess of income from activity		  
3 Administrative expenses paid to accomplish exempt purposes of supported organizations  
4 Amounts paid to acquire exempt-use assets  
5 Qualified set-aside amounts (prior IRS approval required)  
6 Other distributions (describe in Part VI). See instructions  
7Total annual distributions. Add lines 1 through 6.  
8 Distributions to attentive supported organizations to which the organization is responsive (provide
details in Part VI). See instructions		  
9 Distributable amount for 2019 from Section C, line 6  
10 Line 8 amount divided by Line 9 amount  
Section E - Distribution Allocations (see instructions) (i)
Excess Distributions 		(ii)
Underdistributions
Pre-2019 		(iii)
Distributable
Amount for 2019
1 Distributable amount for 2019 from Section C, line 6  
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI).
See instructions.		  
3 Excess distributions carryover, if any, to 2019:
a From 2014.......  
b From 2015.......  
c From 2016.......  
d From 2017.......  
e From 2018.......  
fTotal of lines 3a through e  
g Applied to underdistributions of prior years  
h Applied to 2019 distributable amount  
i Carryover from 2014 not applied (see
instructions) 		 
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.  
4Distributions for 2019 from Section D, line 7:
$  
a Applied to underdistributions of prior years  
b Applied to 2019 distributable amount  
c Remainder. Subtract lines 4a and 4b from 4.  
5 Remaining underdistributions for years prior to
2019, if any. Subtract lines 3g and 4a from line 2.
If the amount is greater than zero, explain in Part VI.
See instructions.		  
6 Remaining underdistributions for 2019. Subtract
lines 3h and 4b from line 1. If the amount is greater
than zero, explain in Part VI. See instructions.		  
7 Excess distributions carryover to 2020. Add lines
3j and 4c.		  
8 Breakdown of line 7:
a Excess from 2015.....  
b Excess from 2016.....  
c Excess from 2017.....  
d Excess from 2018.....  
e Excess from 2019.....  
Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019
Page 8
Part VI
Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Return Reference Explanation
Schedule A, Part II, Line 10 Other Income DESCRIPTION - FUNDRAISING EVENTS, COLUMN A - 133189.0, COLUMN B - 150498.0, COLUMN C - 125271.0, COLUMN D - 83419.0, COLUMN E - 15546.0, COLUMN F - 507923.0; DESCRIPTION - PRODUCT SALES, COLUMN A - , COLUMN B - , COLUMN C - 30068.0, COLUMN D - 18595.0, COLUMN E - , COLUMN F - 48663.0;
Schedule A (Form 990 or 990-EZ) 2019


Additional Data


Software ID: 17005876
Software Version: 2017v2.2
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 Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2019
Name of the organization
Mercy Foundation of Des Moines IA
 
Employer identification number

23-7358794
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 isn't covered by the General Rule and/or the Special Rules doesn't 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 doesn't 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) (2019)
Schedule B (Form 990, 990-EZ, or 990-PF) (2019) Page 2
Name of organization
Mercy Foundation of Des Moines IA
  		Employer identification number
23-7358794
Part I
Contributors
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
 
 
 
 

$  


(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) (2019)
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)
Page 3
Name of organization
Mercy Foundation of Des Moines IA
  		Employer identification number

23-7358794
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) (2019)
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)
Page 4
Name of organization
Mercy Foundation of Des Moines IA
  		Employer identification number

23-7358794
Part III
Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. 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) (2019)

Additional Data


Software ID: 17005876
Software Version: 2017v2.2
SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," on 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 Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2019
Open to Public Inspection
Name of the organization
Mercy Foundation of Des Moines IA
 
Employer identification number

23-7358794
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate value of contributions to (during year)    
3 Aggregate value of 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" on 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 7/25/06, 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, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, handling of violations, 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" on Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under FASB 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 FASB 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)
Revenue included on Form 990, Part VIII, line 1 .........................SchDMd Bullet $ 0
(ii)
Assets included in Form 990, Part X ...............................SchDMd Bullet $ 17,265
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 FASB ASC 958 relating to these items:
a
Revenue included on 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) 2019

Schedule D (Form 990) 2019
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" on 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, for escrow or custodial account liability? ...
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" on Form 990, Part IV, line 10.
(a) Current year (b) Prior year (c) Two years back (d) Three years back (e) Four years back
1a Beginning of year balance .... 9,222,288 9,086,110 8,321,580 7,220,614 6,601,081
b Contributions ... 16,853,901 435,107 900,061 523,592 53,815
c Net investment earnings, gains, and losses 3,176,758 554,160 114,712 686,279 642,049
d Grants or scholarships ... 991,777 282,609 250,243 108,905 76,331
e Other expenditures for facilities
and programs ... 		  570,480      
f Administrative expenses ....          
g End of year balance ...... 28,261,170 9,222,288 9,086,110 8,321,580 7,220,614
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet87 %
b
Permanent endowment SchDMd Bullet13 %
c
Term endowment SchDMd Bullet0 %
The percentages on 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)
 
No
b
If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
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" on 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 .....   2,276,694 2,276,694
b Buildings ....   0 0 0
c Leasehold improvements   0 0 0
d Equipment ....   114,547 22,932 91,615
e Other .....   0 0 0
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..SchDMdBullet 2,368,309
Schedule D (Form 990) 2019

Schedule D (Form 990) 2019
Page 3
Part VII
Investments—Other Securities.
Complete if the organization answered "Yes" on 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) CHI OIP		    

(B) CHI OIP		 25,121,146 F
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet 25,121,146
Part VIII
Investments—Program Related. Complete if the organization answered 'Yes' on 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
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
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' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description (b) Book value
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
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' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
(1) Federal income taxes  
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 2,400,451
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) 2019

Schedule D (Form 990) 2019
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on 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 (losses) 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' on 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
Schedule D, Part III, Line 4 Collections of art - description of collections THE DONATED ARTWORK IS DISPLAYED IN THE MERCY MEDICAL CENTER - CENTERVILLE HOSPITAL FOR PATIENTS TO ENJOY. THE EXEMPT PURPOSE OF THE FOUNDATION IS TO RAISE FUNDS IN SUPPORT OF ITS RELATED ORGANIZATIONS IN DES MOINES, IA INCLUDING MERCY MEDICAL CENTER - CENTERVILLE. THE DISPLAYED ARTWORK PROVIDES PATIENTS AND STAFF A MORE PLEASANT ENVIRONMENT TO PERFORM THE HOSPITAL'S HEALING MINISTRY.
Schedule D, Part V, Line 4 Intended uses of endowment funds MERCY FOUNDATION USES ENDOWMENT FUNDS AS DIRECTED BY THE ENDOWMENT DOCUMENTS. THESE ENDOWMENT FUNDS FURTHER MERCY'S EXEMPT PURPOSE BY FUNDING SCHOLARSHIPS FOR HEALTH CARE STUDENTS, FUNDING EQUIPMENT PURCHASES FOR TAX-EXEMPT HEALTHCARE NEEDS AND FUNDING HOSPITAL TAX-EXEMPT OPERATIONS.
Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote Mercy Foundation of Des Moines, IA's financial information is included in the consolidated audited financial statements of Catholic Health Initiatives (CHI), a related organization. CHI's FIN 48 (ASC 740) footnote for the year ended June 30, 2018, reads as follows: "CHI is a tax-exempt Colorado corporation and has been granted an exemption from federal income tax under Section 501(c)(3) of the Internal Revenue Code. CHI owns certain taxable subsidiaries and engages in certain activities that are unrelated to its exempt purpose and therefore subject to income tax. Management reviews its tax positions annually and has determined that there are no material uncertain tax positions that require recognition in the accompanying consolidated financial statements."
Schedule D (Form 990) 2019


Additional Data


Software ID: 17005876
Software Version: 2017v2.2




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" on 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 arrowGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2019
Open to Public Inspection
Name of the organization
Mercy Foundation of Des Moines IA
 
Employer identification number

23-7358794
Part I
Fundraising Activities.Complete if the organization answered "Yes" on 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 10 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 990 or 990-EZ.
Cat. No. 50083H
Schedule G (Form 990 or 990-EZ) 2019
Schedule G (Form 990 or 990-EZ) 2019
Page 2
Part II
Fundraising Events. Complete if the organization answered "Yes" on 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.









VerticalRevenue
(a) Event #1

HOM Game Show Gala
(event type) 		(b) Event #2

 
(event type) 		(c) Other events

 
(total number) 		(d) Total events
(add col. (a) through col. (c))

1
Gross receipts . . . . .
351,571
 
 
351,571

2
Less: Contributions . . . .
336,025
 
 
336,025
3 Gross income (line 1 minus
line 2) . . . . . .
15,546
0
0
15,546



VerticalDirectExpenses
4 Cash prizes . . . . .        
5 Noncash prizes . . . .        
6 Rent/facility costs . . . .        
7 Food and beverages . . . 46,080     46,080
8 Entertainment . . . . 51,873     51,873
9 Other direct expenses . . . 17,104     17,104
10 Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . . right arrow 115,057
11 Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . . right arrow -99,511
Part III
Gaming. Complete if the organization answered "Yes" on 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
Noncash 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 conducts gaming activities:
a
Is the organization licensed to conduct 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) 2019
Schedule G (Form 990 or 990-EZ) 2019
Page 3
11
Does the organization conduct 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 conducted 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
Address right arrow
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 provide any additional information. See instructions.
Return Reference Explanation
Schedule G (Form 990 or 990-EZ) 2019
Additional Data


Software ID: 17005876
Software Version: 2017v2.2

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

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," on Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990.
lBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2019
Open to Public
Inspection
Name of the organization
Mercy Foundation of Des Moines IA
 
Employer identification number
23-7358794
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 Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on 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 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
noncash assistance		 (h) Purpose of grant
or assistance
(1) CHI Iowa Corp
1111 6th Avenue
Des Moines,IA50314 		42-0680448 501 ( c ) 3 6,008,973       Program Support
(2) House of Mercy
1111 6th Avenue
Des Moines,IA50314 		42-1323808 501 ( c ) 3 1,389,689       Program Support
(3) Mercy College of Health Sciences
1111 6th Avenue
Des Moines,IA50314 		42-1511682 501 ( c ) 3 309,518       Program Support
(4) Mercy Clinics Inc
1111 6th Avenue
Des Moines,IA50314 		42-1193699 501 ( c ) 3 1,004,476       Program Support
(5) Mercy Medical Center Centerville
One St Josephs Drive
Centerville,IA52544 		42-0680308 501 ( c ) 3 531,035       Program Support
(6) Skiff Medical Center
204 N 4th Ave NE
Newton,IA50208 		42-1470935 501 ( c ) 3 924,942       Program Support
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
6
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) 2019

Schedule I (Form 990) 2019
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on 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
noncash assistance		 (e) Method of valuation (book,
FMV, appraisal, other)		 (f) Description of noncash assistance
(1) SCHOLARSHIPS 248 432,997      
(1)
(2)
(3)
(4)
(5)
(6)
(7)
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
Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. MERCY FOUNDATION OF DES MOINES, IA ENSURES THAT GIFTS ARE ADMINISTERED IN ACCORDANCE WITH DONORS' INTENTIONS BY ESTABLISHING RESTRICTED ACCOUNTS THAT ASSURE FUNDS ARE DEDICATED TO THE PURPOSE FOR WHICH THEY ARE GIVEN. SUPPORTED, CHARITABLE ORGANIZATIONS SUBMIT INVOICES TO THE FOUNDATION TO REQUEST REIMBURSEMENT OF CAPITAL AND OPERATING EXPENDITURES. THE FOUNDATION MATCHES THE EXPENDITURE TYPE WITH THE DONORS' RESTRICTIONS, AND REIMBURSES THOSE EXPENSES THAT MEET THE CRITERIA FOR BOTH THE USE RESTRICTIONS AND THE FOUNDATION'S OVERALL CHARITABLE PURPOSE.
Schedule I (Form 990) 2019



Additional Data


Software ID: 17005876
Software Version: 2017v2.2


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" on Form 990, Part IV, line 23.
SchJMediumBullet Attach to Form 990.
SchJMediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2019
Open to Public Inspection
Name of the organization
Mercy Foundation of Des Moines IA
 
Employer identification number

23-7358794
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 on 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 on 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 on 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 on 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
 
No
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), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.
5
For persons listed on 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," on line 5a or 5b, describe in Part III.
6
For persons listed on 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," on line 6a or 6b, describe in Part III.
7
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported on 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" on 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) 2019

Schedule J (Form 990) 2019
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 on 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 in column (B) reported as deferred on prior Form 990
(i) Base
compensation 		(ii) Bonus & incentive
compensation 		(iii) Other reportable compensation
1SHARON PHILLIPS
 
DIRECTOR 		(i)

(ii)		 0
-------------
247,202 		0
-------------
12,478 		0
-------------
14,967 		0
-------------
16,409 		0
-------------
13,425 		0
-------------
304,481 		0
-------------
0
2SHANNON DUVAL
 
Former Foundation President 		(i)

(ii)		 0
-------------
330,892 		0
-------------
64,458 		0
-------------
28,245 		0
-------------
16,068 		0
-------------
26,823 		0
-------------
466,486 		0
-------------
0
3Shannon Cofield
 
Foundation President 		(i)

(ii)		 0
-------------
228,607 		0
-------------
23,482 		0
-------------
15,184 		0
-------------
5,433 		0
-------------
13,055 		0
-------------
285,761 		0
-------------
0
4RANDALL RUBIN
 
SVP, CFO - CHI Iowa Corp 		(i)

(ii)		 0
-------------
407,767 		0
-------------
54,196 		0
-------------
20,957 		0
-------------
16,075 		0
-------------
19,915 		0
-------------
518,910 		0
-------------
0
5MICHAEL WEGNER
 
Interim CEO of CHI Iowa Corp (partial year) 		(i)

(ii)		 0
-------------
534,049 		0
-------------
65,182 		0
-------------
20,957 		0
-------------
16,075 		0
-------------
20,474 		0
-------------
656,737 		0
-------------
0
Schedule J (Form 990) 2019

Schedule J (Form 990) 2019
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
Schedule J, Part I, Line 4a SEVERANCE PAYMENTS POST-TERMINATION PAYMENTS ARE ADDRESSED IN EXECUTIVE EMPLOYMENT AGREEMENTS FOR CATHOLIC HEALTH INITIATIVES ("CHI") AND RELATED ORGANIZATIONS' EMPLOYEES AT THE LEVEL OF VICE PRESIDENT AND ABOVE, INCLUDING THE MBO CEOS. THESE EMPLOYMENT AGREEMENTS REQUIRE THAT IN ORDER FOR THE EXECUTIVE TO RECEIVE POST-TERMINATION PAYMENTS, THESE INDIVIDUALS MUST EXECUTE A GENERAL RELEASE AND SETTLEMENT AGREEMENT. POST-TERMINATION PAYMENT ARRANGEMENTS ARE PERIODICALLY REVIEWED FOR OVERALL REASONABLENESS IN LIGHT OF THE EXECUTIVE'S OVERALL COMPENSATION PACKAGE.
Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation COMPENSATION FOR THE TOP MANAGEMENT OFFICIAL WAS ESTABLISHED AND PAID BY CATHOLIC HEALTH INITIATIVES-IOWA CORP (CHI-IOWA CORP), A RELATED ORGANIZATION. CHI IOWA CORP USED THE FOLLOWING TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION: (1) COMPENSATION COMMITTEE; (2) INDEPENDENT COMPENSATION CONSULTANT; (3) WRITTEN EMPLOYMENT CONTRACTS; (4) COMPENSATION SURVEY OR STUDY; (5) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE.
Schedule J (Form 990) 2019

Additional Data


Software ID: 17005876
Software Version: 2017v2.2
SCHEDULE M
(Form 990)

Department of the Treasury
Internal Revenue Service
Noncash Contributions
Right pointing arrow large imageComplete if the organizations answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image Attach to Form 990.
Right pointing arrow large imageGo to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2019
Open to Public Inspection
Name of the organization
Mercy Foundation of Des Moines IA
 
Employer identification number

23-7358794
Part I
Types of Property
(a)
Check if applicable 		(b)
Number of contributions or items contributed 		(c)
Noncash contribution amounts reported on
Form 990, Part VIII, line 1g 		(d)
Method of determining
noncash contribution amounts
1 Art—Works of art ....        
2 Art—Historical treasures .        
3 Art—Fractional interests ..        
4 Books and publications ..      
5 Clothing and household
goods ....... 		     
6 Cars and other vehicles ..        
7 Boats and planes ....        
8 Intellectual property ...        
9 Securities—Publicly traded .        
10 Securities—Closely held stock .        
11 Securities—Partnership, LLC,
or trust interests .... 		       
12 Securities—Miscellaneous ..        
13 Qualified conservation
contribution—Historic
structures ..... 		       
14 Qualified conservation
contribution—Other ... 		       
15 Real estate—Residential . X 1 362,040 Market value
16 Real estate—Commercial ..        
17 Real estate—Other ...        
18 Collectibles .....        
19 Food inventory ...        
20 Drugs and medical supplies .        
21 Taxidermy ......        
22 Historical artifacts ....        
23 Scientific specimens ..        
24 Archeological artifacts ...        
25 Other Right pointing arrow large image ( )
26 Other Right pointing arrow large image ( )
27 Other Right pointing arrow large image ( )
28 Other Right pointing arrow large image ( )
29
Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement
29
0
Yes
No
30a
During the year, did the organization receive by contribution any property reported in Part I, lines 1 through 28, that it must hold for at least three years from the date of the initial contribution, and which isn't required to be used for exempt purposes for the entire holding period? ...................
30a
 
No
b
If "Yes," describe the arrangement in Part II.
31
Does the organization have a gift acceptance policy that requires the review of any nonstandard contributions?
31
Yes
 
32a
Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash
contributions? ..........................
32a
 
No
b
If "Yes," describe in Part II.
33
If the organization didn't report an amount in column (c) for a type of property for which column (a) is checked,
describe in Part II.
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 51227J
Schedule M (Form 990) (2019)
Schedule M (Form 990) (2019)
Page 2
Part IISupplemental Information. Provide the information required by Part I, lines 30b, 32b, and 33, and whether the organization is reporting in Part I, column (b), the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.
Return Reference Explanation
Schedule M, Part I Explanations of reporting method for number of contributions Real estate - Residential - number of contributions
Schedule M (Form 990) (2019)

Additional Data


Software ID: 17005876
Software Version: 2017v2.2
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 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2019
Open to Public
Inspection
Name of the organization
Mercy Foundation of Des Moines IA
 
Employer identification number

23-7358794
Return Reference Explanation
Form 990, Part III, Line 4a ORGANIZATION'S MISSION I. INTRODUCTION: ORGANIZATION'S MISSION, VISION, AND TAX-EXEMPT PURPOSE MERCY FOUNDATION IS AN EXTENSION OF THE HEALING MINISTRY OF CHRIST INSPIRED BY THE SISTERS OF MERCY. THROUGH THIS HERITAGE, WE CONNECT DONORS TO CRITICAL NEEDS. OUR PURPOSE IS TO SECURE VITAL FUNDING THAT ENSURES EQUAL ACCESS, CLINICAL EXCELLENCE AND HIGH QUALITY CARE FOR ALL. MERCY FOUNDATION IS THE PREFERRED CHANNEL OF GIVING TO MERCY COLLEGE OF HEALTH SCIENCES, HOUSE OF MERCY, MERCY MEDICAL CENTER-DES MOINES, WEST LAKES AND CENTERVILLE, AND BISHOP DRUMM RETIREMENT CENTER. ALL THE SUPPORTED ORGANIZATIONS ARE LISTED IN THE OFFICIAL CATHOLIC DIRECTORY AS TAX-EXEMPT. BY SUPPORTING MERCY FOUNDATION YOU ARE PROVIDING VITAL SUPPORT NECESSARY TO MEET THE NEEDS OF IOWANS FROM BIRTH TO END OF LIFE. MERCY AND ITS AFFILIATES SERVE THOSE IN ALL STAGES OF LIFE, INCLUDING PREMATURE INFANTS, DRUG-ADDICTED MOTHERS, COLLEGE STUDENTS WORKING TOWARDS A CAREER IN HEALTH CARE, THE ELDERLY, AND FAMILIES FACING A LOVED ONES' LAST DAYS. THE FOUNDATION IS GOVERNED BY AN INDEPENDENT BOARD IN WHICH THE MAJORITY OF THE MEMBERS ARE INDEPENDENT PERSONS, REPRESENTATIVE OF THE COMMUNITY. II. QUALITATIVE DESCRIPTION OF COMMUNITY BENEFIT THESE ENTITIES WERE PROVIDED FUNDING IN THE AMOUNT OF APPROXIMATELY $6.3 MILLION IN FISCAL YEAR 2018. THE MONIES WERE USED BY THE ENTITIES FOR CHARITABLE, COMMUNITY BENEFIT AND HEALTHCARE ACTIVITIES SUCH AS: HOUSE OF MERCY ONGOING OPERATION SUPPORT FOR THIS RESIDENTIAL CARE FACILITY FOR ADULT AND TEENAGE WOMEN, WHETHER SINGLE, PARENTING OR PREGNANT, TO HELP THEM DEVELOP PERSONAL RESPONSIBILITY AND BECOME INDEPENDENT MEMBERS OF THE COMMUNITY. COMPREHENSIVE SERVICES INCLUDE: TRANSITIONAL HOUSING, MEALS, TRANSPORTATION, COUNSELING AND SUPPORT, LICENSED CHILD CARE, PARENTING AND NUTRITION CLASSES, JOB SKILLS TRAINING AND EDUCATION/EMPLOYMENT ASSISTANCE. MERCY MEDICAL CENTER-DES MOINES MONEY USED FOR NUMEROUS ACTIVITIES INCLUDING: PROVIDING CHARITY AND OR SUBSIDIZED HEALTH CARE FOR NEEDY MEMBERS OF THE COMMUNITY, EQUIPMENT PURCHASES TO IMPROVE ACCESS AND QUALITY OF HEALTHCARE WITHIN THE COMMUNITY. MERCY MEDICAL CENTER-CENTERVILLE MONEY USED FOR ONGOING OPERATIONAL AND CAPITAL PURCHASES FOR HEALTHCARE AND OR CHARITABLE RELATED ACTIVITIES. MERCY CLINICS, INC. MONEY USED FOR OPERATIONAL HEALTHCARE/CHARITABLE PURCHASES SUCH AS: PROVIDING CHARITY AND OR SUBSIDIZED HEALTH CARE FOR NEEDY MEMBERS OF THE COMMUNITY, RESEARCH AND MEDICAL EDUCATION, AND DISEASE PREVENTION. SKIFF MEDICAL CENTER MONEY USED FOR ONGOING OPERATIONAL AND CAPITAL PURCHASES FOR HEALTHCARE AND OR CHARITABLE RELATED ACTIVITIES. MERCY COLLEGE OF HEALTH SCIENCES MONEY USED TO PROVIDE CHARITY OR SUBSIDIZED HEALTH CARE EDUCATION TO NEEDY MEMBERS OF THE COMMUNITY. MERCY AUXILLIARY OF CENTRAL IOWA MONEY USED FOR ONGOING OPERATIONAL AND CAPITAL PURCHASES FOR HEALTHCARE AND OR CHARITABLE RELATED ACTIVITIES.
Form 990, Part VI, Line 15 PROCESS USED TO ESTABLISH COMPENSATION DURING THE TAX YEAR ENDED 6/30/2018, NO OFFICERS, DIRECTORS OR TRUSTEES RECEIVED COMPENSATION FROM THE ORGANIZATION. ANY EXECUTIVE COMPENSATION PAID TO OFFICERS, DIRECTORS OR TRUSTEES BY RELATED ORGANIZATIONS WAS SET BY THE RELATED ORGANIZATION'S COMPENSATION COMMITTEE UTILIZING BOTH AN INDEPENDENT CONSULTANT AND COMPARABILITY STUDIES TO DETERMINE COMPENSATION. THEREFORE, THESE QUESTIONS ARE MORE APPROPRIATELY ANSWERED AS N/A.
Form 990, Part VI, Line 12c CONFLICT OF INTEREST POLICY THE BOARD CHAIR OR DESIGNEE SHALL MAKE SUCH FURTHER INVESTIGATION OF ANY CONFLICT OF INTEREST DISCLOSURES AS HE OR SHE MAY DEEM APPROPRIATE. IF THE CONFLICT INVOLVES THE BOARD CHAIR, THE VICE CHAIR WILL ASSUME THE CHAIR'S ROLE OUTLINED IN THE COI POLICY. BASED ON REVIEW AND EVALUATION OF THE RELEVANT FACTS AND CIRCUMSTANCES, THE BOARD CHAIR WILL MAKE AN INITIAL DETERMINATION AS TO WHETHER A CONFLICT OF INTEREST EXISTS AND WHETHER, PURSUANT TO THE COI POLICY, REVIEW AND APPROVAL OR OTHER ACTION BY THE BOARD IS REQUIRED. A WRITTEN RECORD OF THE BOARD CHAIR'S DETERMINATION, INCLUDING RELEVANT FACTS AND CIRCUMSTANCES, WILL BE MADE. THE BOARD CHAIR SHALL THEN MAKE AN APPROPRIATE REPORT TO THE EXECUTIVE COMMITTEE OF THE BOARD CONCERNING SUCH REVIEW, EVALUATION AND DETERMINATION. IF A DIFFERENCE OF OPINION EXISTS BETWEEN THE BOARD CHAIR AND ANOTHER TRUSTEE AS TO WHETHER THE FACTS AND CIRCUMSTANCES OF A GIVEN SITUATION CONSTITUTE A CONFLICT OF INTEREST OR WHETHER BOARD REVIEW AND APPROVAL OR OTHER ACTION IS REQUIRED WITHIN THE COI POLICY, THE MATTER SHALL BE SUBMITTED TO THE BOARD'S EXECUTIVE COMMITTEE, WHICH SHALL MAKE A FINAL DETERMINATION AS TO THE MATTER PRESENTED. SUCH DETERMINATION, INCLUDING RELEVANT FACTS AND CIRCUMSTANCES, WILL BE REFLECTED IN THE EXECUTIVE COMMITTEE MINUTES AND WILL BE REPORTED TO THE BOARD. THE BOARD SHALL CAREFULLY SCRUTINIZE AND MUST IN GOOD FAITH APPROVE OR DISAPPROVE ANY TRANSACTION IN WHICH CHI OR A CHI ENTITY IS A PARTY AND IN WHICH THE TRUSTEE OR CORPORATE OFFICER EITHER: * HAS A MATERIAL FINANCIAL INTEREST; OR * IS A TRUSTEE OR CORPORATE OFFICER OF THE OTHER PARTY (OTHER THAN A CHI-AFFILIATED ORGANIZATION). THE BOARD MUST APPROVE THE TRANSACTION BY A MAJORITY OF THE TRUSTEES ON THE BOARD, WITHOUT COUNTING THE VOTE OF ANY INDIVIDUAL WHO HAS AN INTEREST IN THE TRANSACTION. IN REVIEWING SUCH TRANSACTIONS BETWEEN CHI OR CHI ENTITIES AND VENDORS OR OTHER CONTRACTORS WHO ARE, OR ARE AFFILIATED WITH, TRUSTEES OR CORPORATE OFFICERS, THE BOARD SHALL ACT NO MORE OR LESS FAVORABLY THAN IT WOULD IN REVIEWING TRANSACTIONS WITH UNRELATED THIRD PARTIES. THE TRANSACTION WILL NOT BE APPROVED UNLESS THE BOARD DETERMINES THAT THE TRANSACTION IS FAIR TO CHI OR THE CHI ENTITY. THE BOARD SHALL CAREFULLY REVIEW AND SCRUTINIZE ANY NON-TRANSACTIONAL CONFLICT OF INTEREST (E.G., DISCLOSURE OF NONPUBLIC INFORMATION, COMPETITION WITH CHI OR A CHI ENTITY, FAILURE TO DISCLOSE A CORPORATE OPPORTUNITY, EXCESSIVE GIFTS OR ENTERTAINMENT, ETC.). BY A MAJORITY VOTE OF THE DISINTERESTED TRUSTEES, THE BOARD SHALL TAKE WHATEVER ACTION IS DEEMED APPROPRIATE WITH RESPECT TO THE TRUSTEE OR CORPORATE OFFICER UNDER THE CIRCUMSTANCES, INCLUDING POSSIBLE DISCIPLINARY OR CORRECTIVE ACTION, IN ORDER TO BEST PROTECT THE INTERESTS OF CHI OR THE CHI ENTITY. THE BOARD SHOULD CONSULT WITH THE GENERAL COUNSEL OF CHI OR HIS OR HER DESIGNEE WHEN CONSIDERING DISCIPLINARY OR CORRECTIVE ACTION. WHEN ANY CONFLICT OF INTEREST IS CONSIDERED BY THE BOARD, THE TRUSTEE OR CORPORATE OFFICER, AS APPROPRIATE, MUST DISCLOSE ALL OF THE MATERIAL FACTS TO THE BOARD. THE TRUSTEE SHALL NOT VOTE AND THE TRUSTEE OR CORPORATE OFFICER SHALL NOT USE HIS OR HER PERSONAL INFLUENCE ON THE MATTER. HOWEVER, IF REQUESTED, SUCH TRUSTEE OR CORPORATE OFFICER IS NOT PREVENTED FROM BRIEFLY STATING HIS OR HER POSITION IN THE MATTER, NOR FROM ANSWERING PERTINENT QUESTIONS FROM TRUSTEES, AS HIS OR HER KNOWLEDGE MAY BE OF SIGNIFICANT IMPORTANCE. THE TRUSTEE OR CORPORATE OFFICER SHALL BE EXCUSED FROM THE MEETING DURING DISCUSSION AND VOTE ON THE CONFLICT OF INTEREST. MINUTES OF THE BOARD SHALL REFLECT THE FOLLOWING: THE INDIVIDUAL MAKING THE DISCLOSURE, THE NATURE OF THE DISCLOSURE, DISCUSSION REGARDING ANY PROPOSED TRANSACTION, THE DECISION MADE BY THE BOARD, AND THAT THE INTERESTED TRUSTEE OR CORPORATE OFFICER WAS EXCUSED DURING THE DISCUSSION, AND THAT THE INTERESTED TRUSTEE ABSTAINED FROM VOTING. IF THE BOARD REASONABLY BELIEVES THAT A TRUSTEE OR CORPORATE OFFICER HAS FAILED TO DISCLOSE EITHER AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST, OR ALL MATERIAL FACTS SURROUNDING AN ACTUAL OR POSSIBLE CONFLICT AS REQUIRED BY THE COI POLICY, THE TRUSTEE OR CORPORATE OFFICER WILL BE GIVEN AN OPPORTUNITY TO EXPLAIN SUCH ALLEGED FAILURE TO DISCLOSE. AFTER HEARING THE RESPONSE OF THE TRUSTEE OR CORPORATE OFFICER, THE BOARD WILL CONDUCT SUCH ADDITIONAL INVESTIGATION AS MAY BE APPROPRIATE. IF THE BOARD DETERMINES THAT THE TRUSTEE OR CORPORATE OFFICER HAS IN FACT FAILED TO DISCLOSE AS REQUIRED BY THE COI POLICY, THE BOARD SHALL TAKE APPROPRIATE DISCIPLINARY OR CORRECTIVE ACTION. ALL DETERMINATIONS OF CONFLICTS OF INTEREST ARE REPORTED AS REQUIRED BY LAW, REGULATIONS, AND CHI POLICY.
Form 990, Part VI, Line 6 Classes of members or stockholders THE SOLE MEMBER OF THE ORGANIZATION IS CATHOLIC HEALTH INITIATIVES-IOWA, CORP. D/B/A MERCY MEDICAL CENTER-DES MOINES, AN IOWA NONPROFIT CORPORATION.
Form 990, Part VI, Line 7a Members or stockholders electing members of governing body THE SOLE MEMBER HAS THE POWER TO APPOINT AND/OR REMOVE THE MEMBERS OF THE BOARD OF DIRECTORS OF THIS CORPORATION OR ANY AFFILIATE OF THIS CORPORATION.
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders THE ORGANIZATION'S CORPORATE MEMBER IS CATHOLIC HEALTH INITIATIVES-IOWA CORP D/B/A MERCY MEDICAL CENTER - DES MOINES (CHI-IOWA CORP). PURSUANT TO SECTION X OF THE ORGANIZATION'S BYLAWS, BOTH CHI-IOWA CORP AND CATHOLIC HEALTH INITIATIVES ("CHI") (CHI-IOWA CORP'S SOLE CORPORATE MEMBER) HAVE RESERVED POWERS AS OUTLINED IN THE CHI GOVERNANCE MATRIX. PURSUANT TO THE GOVERNANCE MATRIX THE FOLLOWING RIGHTS ARE HELD BY THE CHI-IOWA CORP BOARD: *APPROVE MEMBERS OF THE MERCY FOUNDATION BOARD *AMENDMENT OF THE CORPORATE DOCUMENTS OF MERCY FOUNDATION *APPROVE REMOVAL OF A MEMBER OF THE GOVERNING BODY OF MERCY FOUNDATION *ADOPTION OF LONG RANGE AND STRATEGIC PLANS FOR MERCY FOUNDATION THE FOLLOWING RIGHTS ARE RESERVED TO THE CHI BOARD DIRECTLY OR THROUGH POWERS DELEGATED TO THE CHI CHIEF EXECUTIVE OFFICER: *SUBSTANTIAL CHANGE IN THE MISSION OR PHILOSOPHY OF MERCY FOUNDATION *REMOVAL OF A MEMBER OF THE GOVERNING BODY OF MERCY FOUNDATION *APPROVAL OF ISSUANCE OF DEBT BY MERCY FOUNDATION *APPROVAL OF PARTICIPATION OF MERCY FOUNDATION IN A JOINT VENTURE *APPROVAL OF FORMATION OF A NEW CORPORATION BY MERCY FOUNDATION *APPROVAL OF A MERGER INVOLVING MERCY FOUNDATION *APPROVAL OF THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF MERCY FOUNDATION *TO REQUIRE THE TRANSFER OF ASSETS BY MERCY FOUNDATION TO CHI TO ACCOMPLISH CHI'S GOALS AND OBJECTIVES, AND TO SATISFY CHI DEBTS. PURSUANT TO SECTION X OF THE ORGANIZATION'S BYLAWS, CHI-IOWA CORP OR CHI MAY, IN EXERCISE OF THEIR APPROVAL POWERS, GRANT OR WITHHOLD APPROVAL IN WHOLE OR IN PART, OR MAY, IN ITS COMPLETE DISCRETION, AFTER CONSULTATION WITH THE BOARD AND ITS PRESIDENT AND THE CHIEF EXECUTIVE OFFICER OF THE ORGANIZATION, RECOMMEND SUCH OTHER OR DIFFERENT ACTIONS AS IT DEEMS APPROPRIATE.
Form 990, Part VI, Line 11b Review of form 990 by governing body THE ORGANIZATION'S ACCOUNTING PERSONNEL WORK WITH CHI'S TAX DEPARTMENT PERSONNEL TO PREPARE THE FORM 990. THE CFO REVIEWS THE RETURN AND ANY NECESSARY REVISIONS ARE INCLUDED IN THE FINAL VERSION WHICH IS APPROVED FOR FILING WITH THE IRS. SUBSEQUENT TO REVIEW BY THE CHIEF FINANCIAL OFFICER, THE TAX DEPARTMENT FILES THE RETURN WITH THE APPROPRIATE FEDERAL AND STATE AGENCIES, MAKING ANY NON-SUBSTANTIVE CHANGES NECESSARY TO EFFECT E-FILING. SUBSEQUENT TO E-FILING, THE FINAL E-FILED FORM 990 IS PRESENTED TO THE BOARD AT A REGULARLY SCHEDULED BOARD MEETING.
Form 990, Part VI, Line 12c Conflict of interest policy CATHOLIC HEALTH INITIATIVES ("CHI") HAS A CONFLICTS OF INTEREST ("COI") POLICY (THE "POLICY") IN PLACE TO MAINTAIN THE INTEGRITY OF ALL OF ITS ACTIVITIES. THE POLICY APPLIES TO CHI BOARD OF STEWARDSHIP TRUSTEES AND MEMBERS OF ITS COMMITTEES; ALL CHI ENTITY BOARD AND BOARD COMMITTEE MEMBERS; ALL CHI EMPLOYEES; AND ALL CHI RESEARCH PERSONNEL (BOTH EMPLOYED AND NON-EMPLOYED). DISCLOSURE, REVIEW AND MANAGEMENT OF PERCEIVED, POTENTIAL OR ACTUAL CONFLICTS OF INTEREST ARE ACCOMPLISHED THROUGH A DEFINED COI DISCLOSURE REVIEW PROCESS. EACH PERSON MUST PROMPTLY AND FULLY DISCLOSE TO HIS/HER DIRECT MANAGER, SUPERVISOR, MEDICAL STAFF OFFICE, BOARD OR BOARD COMMITTEE CHAIR ANY SITUATION OR CIRCUMSTANCE THAT MAY CREATE A CONFLICT OF INTEREST. THE PERSON MUST DISCLOSE THE ACTUAL OR POTENTIAL CONFLICT AS SOON AS SHE/HE BECOMES AWARE OF IT. IN ANY SITUATION WHERE THE PERSON MAY BE IN DOUBT, A FULL DISCLOSURE SHOULD BE MADE TO PERMIT AN IMPARTIAL AND OBJECTIVE DETERMINATION. IN ADDITION TO THE GENERAL ONGOING OBLIGATION, THERE ARE INITIAL DISCLOSURE OBLIGATIONS. AT THE TIME OF INITIAL APPOINTMENT, A COPY OF THE POLICY SHALL BE DISTRIBUTED TO THE BOARD OR COMMITTEE MEMBER ALONG WITH A CONFLICT OF INTEREST DISCLOSURE. THE BOARD OR COMMITTEE MEMBER WILL COMPLETE AND SUBMIT THE DISCLOSURE. THE COMPLETED DISCLOSURE SHALL BE MAINTAINED IN CONFIDENCE AND ACCESS SHALL BE LIMITED TO PERSONS WHO HAVE A REASONABLE NEED TO KNOW THE CONTENTS. AT THE TIME OF HIRING, A COPY OF THE POLICY SHALL BE DISTRIBUTED TO ALL EMPLOYEES. IN ADDITION, A CONFLICT OF INTEREST DISCLOSURE WILL BE PROVIDED. THE EMPLOYEE MUST COMPLETE AND SUBMIT A CONFLICT OF INTEREST DISCLOSURE. THE COMPLETED DISCLOSURE SHALL BE MAINTAINED IN CONFIDENCE AND ACCESS SHALL BE LIMITED TO PERSONS WHO HAVE A REASONABLE NEED TO KNOW THE CONTENTS. IN ADDITION TO THE GENERAL ONGOING AND INITIAL DISCLOSURE OBLIGATIONS, THERE IS AN ANNUAL DISCLOSURE OBLIGATION. ON AN ANNUAL BASIS, THE FOLLOWING PERSONS MUST COMPLETE A NEW CONFLICT OF INTEREST DISCLOSURE: * BOARD AND BOARD COMMITTEE MEMBERS; * EMPLOYEES AT THE LEVEL OF VICE PRESIDENT AND ABOVE; * RESEARCHERS * SUPPLY CHAIN EMPLOYEES AT THE LEVEL OF VICE PRESIDENT AND ABOVE AND THOSE EMPLOYEES INVOLVED IN CONTRACTING REGARDLESS OF EMPLOYMENT LEVEL; * OTHER EMPLOYEES AS DEEMED APPLICABLE BY CHI LEADERSHIP DISCLOSURES OF PERCEIVED, POTENTIAL OR ACTUAL CONFLICTS INVOLVING FINANCIAL INTERESTS ARE FORWARDED TO THE CONFLICTS OF INTEREST REVIEW COMMITTEE ("C-CIRC"), NATIONAL OR REGIONAL LEGAL SERVICES, NATIONAL, ENTITY, OR RESEARCH CORPORATE RESPONSIBILITY PROGRAM, OR THE EXECUTIVE COMMITTEE OF THE BOARD OR BOARD CHAIR, FOR REVIEW DEPENDING ON THE POSITION OF THE PERSON INVOLVED. AMONG THE FACTORS THAT SHOULD BE CONSIDERED IN DETERMINING WHETHER A CONFLICT EXISTS ARE THE NATURE AND MAGNITUDE OF THE OPPORTUNITY, TRANSACTION OR ARRANGEMENT, THE DEGREE TO WHICH IT IS RELATED TO CHI'S BUSINESS, WHETHER THE PERSON WITH THE CONFLICT IS THE ULTIMATE DECISION-MAKER OR HOLDS SIGNIFICANT INFLUENCE OVER THE ULTIMATE DECISION-MAKER (I.E., DEGREE OF INDEPENDENCE OF THE DECISION-MAKING PROCESS), THE UNIQUE NATURE OF THE OPPORTUNITY, TRANSACTION OR ARRANGEMENT, THE EXISTENCE OF OTHER VIABLE ALTERNATIVES AND THE QUALITY OF THOSE ALTERNATIVES, AND WHAT IS CUSTOMARY AND REASONABLE IN THE HEALTH CARE OR RESEARCH INDUSTRY. WHEN A PERSON HAS, OR IS CONSIDERING INITIATING, A BUSINESS INTEREST OR RELATIONSHIP OUTSIDE OF CHI BUT IS UNCERTAIN WHETHER THE INTEREST CONSTITUTES A CONFLICT OF INTEREST REQUIRING DISCLOSURE UNDER THIS POLICY, THE PERSON SHOULD CONSULT WITH LOCAL CORPORATE RESPONSIBILITY PROGRAM (CRP) STAFF OR CHI LEGAL SERVICES GROUP (LSG) STAFF, AS APPROPRIATE. AS APPROPRIATE, A COI MANAGEMENT PLAN WILL BE DEVELOPED. WITH RESPECT TO THOSE AUDIENCES FOR WHICH THE C-CIRC HAS REVIEW RESPONSIBILITY, THE C-CIRC WILL FACILITATE DEVELOPMENT OF ANY SUCH COI MANAGEMENT PLAN IN COLLABORATION WITH LOCAL CRP STAFF OR CHI LSG STAFF, AS APPROPRIATE. THIS PLAN WILL INCLUDE DOCUMENTATION OF THE C-CIRC'S DETERMINATIONS AND RECOMMENDATIONS. AS NECESSARY, REPORTS TO AN APPROPRIATE GOVERNMENTAL AGENCY OR SPONSOR WILL BE MADE ACCORDING TO THE RELEVANT APPENDICES TO THIS POLICY TO PROVIDE REQUIRED INFORMATION REGARDING HOW THE CONFLICT OF INTEREST WILL BE MANAGED, REDUCED, OR ELIMINATED. DESIGNATED CHI ENTITY STAFF ARE RESPONSIBLE FOR MONITORING THE COI MANAGEMENT PLAN AND FOR DOCUMENTING MONITORING ACTIVITIES. AT ITS SOLE DISCRETION, A CHI ENTITY MAY REJECT A PERSON'S REQUEST TO ENTER INTO THE RELATIONSHIP IN QUESTION, OR REQUIRE THE RELATIONSHIP BE SUFFICIENTLY ALTERED TO AVOID A POTENTIAL CONFLICT OF INTEREST. THE C-CIRC WILL DETERMINE WHETHER A DISCLOSED OR OTHERWISE IDENTIFIED INTEREST IS A CONFLICT OF INTEREST. IF THE C-CIRC DETERMINES THAT A POTENTIAL OR ACTUAL CONFLICT OF INTEREST EXISTS THAT DOES NOT CURRENTLY HAVE APPROPRIATE CONTROLS TO ADDRESS THE CONFLICT OF INTEREST, IT MAY RECOMMEND THAT THE DISCLOSING PERSON BE ALLOWED TO PARTICIPATE IN THE ACTIVITY OR TRANSACTION SUBJECT TO RESTRICTIONS AS OUTLINED IN A WRITTEN COI MANAGEMENT PLAN. ALL DETERMINATIONS OF CONFLICTS OF INTEREST WILL BE REPORTED AS REQUIRED BY LAW, REGULATIONS, AND CHI POLICY. IF A PERSON, OTHER THAN A BOARD OR BOARD COMMITTEE MEMBER OR CORPORATE OFFICER, REQUIRED TO COMPLETE A COI DISCLOSURE DOES NOT AGREE WITH A DETERMINATION MADE BY THE C-CIRC, ITS INTERPRETATION OF THE COI POLICY, STILL SEEKS AN EXEMPTION OR EXCEPTION, OR SEEKS FURTHER CLARIFICATION OF THE C-CIRC'S DECISION, THE FOLLOWING STEPS SHOULD BE FOLLOWED. WITHIN A REASONABLE PERIOD OF TIME AFTER RECEIVING NOTICE OF THE C-CIRC'S DECISION, THE PERSON MUST PRESENT THE MATTER TO THE PERSON'S IMMEDIATE DIRECT MANAGER OR SUPERVISOR (OR IN THE CASE OF A RESEARCHER, TO [FILL IN THE TITLE OR POSITION TO WHOM RESEARCHERS REPORT]) AND REQUEST RECONSIDERATION, SUBMITTING AT THAT TIME ANY NEW OR ADDITIONAL INFORMATION THAT MAY SUPPORT OR RECOMMEND RECONSIDERATION. IF THE PERSON'S MANAGER INDIVIDUALLY OR IN CONSULTATION WITH THE MANAGER'S VICE PRESIDENT (OR HIGHER IF THE MANAGER IS A VICE PRESIDENT) FINDS THAT NEW INFORMATION SUPPORTING RECONSIDERATION HAS BEEN PRESENTED, THE MANAGER WILL CONTACT LOCAL OR NATIONAL CRP STAFF, AS APPROPRIATE, AND REQUEST THAT THE MATTER BE RE-PRESENTED TO THE C-CIRC. THE C-CIRC WILL BE RECONVENED FOR THIS PURPOSE AND, FOLLOWING SUCH RECONSIDERATION, ISSUE A FINAL DETERMINATION. THIS APPEALS PROCESS IS INTENDED TO BE NARROWLY APPLIED, AS PERSONS SEEKING CONFLICT OF INTEREST EXEMPTIONS OR EXCEPTIONS ARE EXPECTED TO OFFER ALL AVAILABLE INFORMATION SUPPORTING AN EXEMPTION OR EXCEPTION AT THE TIME THE MATTER IS FIRST PRESENTED TO THE C-CIRC. MANAGEMENT OF ACTUAL OR POTENTIAL CONFLICTS OF INTEREST OF BOARD OR BOARD COMMITTEE MEMBERS AND CORPORATE OFFICERS WILL BE DETERMINED BY THE APPROPRIATE BOARD, AS REFLECTED IN THE POLICY. REVIEWS AND DETERMINATIONS INVOLVING BOARD AND BOARD COMMITTEE MEMBERS AND CORPORATE OFFICERS WILL BE THE RESPONSIBILITY OF THE BOARD, BOARD EXECUTIVE COMMITTEE, OR BOARD CHAIR, WITH GUIDANCE FROM THE LEGAL SERVICES GROUP (LSG). EACH TRUSTEE AND CORPORATE OFFICER MUST PROMPTLY AND FULLY REPORT TO THE BOARD CHAIR SITUATIONS THAT MAY CREATE A CONFLICT OF INTEREST WHEN HE OR SHE BECOMES AWARE OF SUCH SITUATIONS. IN ANY SITUATION WHEN A TRUSTEE OR CORPORATE OFFICER IS IN DOUBT, FULL DISCLOSURE SHOULD BE MADE TO PERMIT AN IMPARTIAL AND OBJECTIVE DETERMINATION. A WRITTEN RECORD OF THE DISCLOSURE WILL BE MADE. IN ADDITION TO THE ONGOING DISCLOSURE OBLIGATION, ALL TRUSTEES AND CORPORATE OFFICERS SHALL COMPLETE A COI DISCLOSURE QUESTIONNAIRE ON AN ANNUAL BASIS. A COPY OF THE COI POLICY SHALL BE AVAILABLE TO TRUSTEES AND CORPORATE OFFICERS. DEFINITIONS OF TERMS USED IN THE DISCLOSURE QUESTIONNAIRE/FORM SHALL ALSO BE INCLUDED. EACH TRUSTEE AND CORPORATE OFFICER MUST PROMPTLY COMPLETE THE COI DISCLOSURE. COI DISCLOSURES THAT INVOLVE NO DISCLOSURES OF CONFLICTS OF INTEREST WILL NOT REQUIRE REVIEW. DISCLOSURES OF PERCEIVED, POTENTIAL OR ACTUAL CONFLICTS OF INTEREST ON THE COI QUESTIONNAIRE INVOLVING FINANCIAL INTERESTS WILL BE REVIEWED BY NATIONAL OR REGIONAL LSG. (CONTINUED ON SCHEDULE O)
Form 990, Part VI, Line 19 Required documents available to the public THE ORGANIZATION'S FINANCIAL STATEMENTS ARE INCLUDED IN CATHOLIC HEALTH INITIATIVES' CONSOLIDATED AUDITED FINANCIAL STATEMENTS THAT ARE AVAILABLE AT www.catholichealthinitiatives.org. THE CONFLICT OF INTEREST POLICY IS NOT PUBLICLY AVAILABLE. THE ORGANIZATION'S GOVERNING DOCUMENTS ARE AVAILABLE ON THE IOWA SECRETARY OF STATE'S WEBSITE.
Form 990, Part XI, Line 9 Other changes in net assets or fund balances Audit Adjustment - Pledge Balance - 348888; Other Temp and Unrestricted Changes - -1172704; Bad Debt Write-off - -185905;
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2019


Additional Data


Software ID: 17005876
Software Version: 2017v2.2
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 Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047
2019
Open to Public Inspection
Name of the organization
Mercy Foundation of Des Moines IA
 
Employer identification number

23-7358794
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)ALEGENT CREIGHTON CLINIC
12809 W DODGE RD

OMAHA,NE68154
47-0765154 		HEALTHCARE NE 501(c)(3) 3 ACH
 
Yes
 
(2)ALEGENT CREIGHTON HEALTH
12809 W DODGE RD

OMAHA,NE68154
47-0757164 		HEALTHCARE NE 501(c)(3) 3 CHI NEBRASKA
 
Yes
 
(3)ALEGENT CREIGHTON HEALTH FOUNDATION
12809 W DODGE RD

OMAHA,NE68154
47-0648586 		FUNDRAISING NE 501(c)(3) 7 ACH
 
Yes
 
(4)ALEGENT HEALTH - BERGAN MERCY HEALTH SYSTEM
7500 MERCY RD

OMAHA,NE68124
47-0484764 		HEALTHCARE NE 501(c)(3) 3 CHI NEBRASKA
 
Yes
 
(5)ALEGENT HEALTH - COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY IA
631 N 8TH ST

MISSOURI VALLEY,IA51555
42-0776568 		HEALTHCARE IA 501(c)(3) 3 CHI NEBRASKA
 
Yes
 
(6)ALEGENT HEALTH - IMMANUEL MEDICAL CENTER
6901 N 72ND ST

OMAHA,NE68122
47-0376615 		HEALTHCARE NE 501(c)(3) 3 CHI NEBRASKA
 
Yes
 
(7)ALEGENT HEALTH - MEMORIAL HOSPITAL SCHUYLER
104 W 17TH ST

SCHUYLER,NE68661
47-0399853 		HEALTHCARE NE 501(c)(3) 3 CHI NEBRASKA
 
Yes
 
(8)ALEGENT HEALTH - MERCY HOSPITAL CORNING IOWA
PO BOX 368

CORNING,IA50841
42-0782518 		HEALTHCARE IA 501(c)(3) 3 CHI NEBRASKA
 
Yes
 
(9)ALVERNA APARTMENTS
300 SE 8TH AVE

LITTLE FALLS,MN56345
41-1351177 		LTERM CARE MN 501(c)(3) 10 CHI
 
Yes
 
(10)APPLETREE COURT
601 OAK ST

BRECKENRIDGE,MN56520
41-1850500 		SENIOR LIVING MN 501(c)(3) 10 SFH
 
Yes
 
(11)BAYLOR ST LUKE'S HEALTH VENTURES
17200 ST LUKES WAY STE 170

THE WOODLANDS,TX77384
27-4499340 		PHYSICIANS TX 501(c)(3) Type I SLCHS
 
Yes
 
(12)BAYLOR ST LUKE'S MEDICAL GROUP
6624 FANNIN ST STE 1100

HOUSTON,TX77030
76-0458535 		PHYSICIANS TX 501(c)(3) 3 SLHS
 
Yes
 
(13)BELLEVILLE ST JOSEPH HEALTH CENTER
2801 FRANCISCAN DRIVE

BRYAN,TX77802
27-4005511 		HEALTHCARE TX 501(c)(3) 3 SHSC
 
Yes
 
(14)BISHOP DRUMM RETIREMENT CENTER
5837 Winwood Dr

Johnston,IA50131
42-0725196 		LTERM CARE IA 501(c)(3) 10 CHI-IA CORP
 
Yes
 
(15)BORNEMANN HEALTHCARE CORPORATION
198 INVERNESS DRIVE WEST

ENGLEWOOD,CO80112
23-2187242 		HEALTHCARE CO 501(c)(3) Type I CHI
 
Yes
 
(16)BRAZOSPORT HEALTH FOUNDATION INC
1 West Way Ct

LAKE JACKSON,TX77566
76-0080110 		FUNDRAISING TX 501(c)(3) Type I BRHS
 
Yes
 
(17)BRAZOSPORT REGIONAL PHYSICIAN SERVICES
100 MEDICAL DRIVE

LAKE JACKSON,TX77566
80-0240261 		HEALTHCARE TX 501(c)(3) 3 BRHS
 
Yes
 
(18)BURLESON ST JOSEPH HEALTH CENTER
2801 FRANCISCAN DRIVE

BRYAN,TX77802
74-2759890 		HEALTHCARE TX 501(c)(3) 3 SJSC
 
Yes
 
(19)BURLESON ST JOSEPH MANOR
2801 FRANCISCAN DRIVE

BRYAN,TX77802
74-2913931 		HEALTHCARE TX 501(c)(3) 10 SJSC
 
Yes
 
(20)CARRINGTON HEALTH CENTER
800 N 4TH ST

CARRINGTON,ND58421
45-0227311 		HEALTHCARE ND 501(c)(3) 3 CHI
 
Yes
 
(21)CATHOLIC HEALTH INITIATIVES - COLORADO
9100 East Mineral Circle

Centennial,CO80112
84-0405257 		HEALTHCARE CO 501(c)(3) 3 CHI
 
Yes
 
(22)CATHOLIC HEALTH INITIATIVES - IOWA CORP
1111 6TH AVE

DES MOINES,IA50314
42-0680448 		HEALTHCARE IA 501(c)(3) 3 CHI
 
Yes
 
(23)CATHOLIC HEALTH INITIATIVES COLORADO FOUNDATION
1150 Kelly Johnson Blvd 204

COLORADO SPRINGS,CO80920
84-0902211 		FUNDRAISING CO 501(c)(3) 7 CHIC
 
Yes
 
(24)CATHOLIC HEALTH INITIATIVES NATIONAL FOUNDATION
1150 Kelly Johnson Blvd 204

COLORADO SPRINGS,CO80920
27-0930004 		FUNDRAISING CO 501(c)(3) Type I CHI
 
Yes
 
(25)CATHOLIC HEALTH INITIATIVES VIRTUAL HEALTH SERVICES
198 INVERNESS DRIVE WEST

ENGLEWOOD,CO80112
46-0992796 		HEALTHCARE CO 501(c)(3) Type I CHINS
 
Yes
 
(26)CENTENNIAL MEDICAL GROUP INC
2700 STEWART PKWY

ROSEBURG,OR97471
26-3946191 		PHYSICIANS OR 501(c)(3) 10 MMC
 
Yes
 
(27)CENTRAL KANSAS MEDICAL CENTER
3515 BROADWAY

GREAT BEND,KS67530
48-0543724 		SURGERY CENTER KS 501(c)(3) 3 CHI
 
Yes
 
(28)CHI HEALTH CONNECT AT HOME - FARGO
4816 AMBER VALLEY PKWY S

FARGO,ND58104
27-1966847 		HEALTHCARE ND 501(c)(3) 10 CHI
 
Yes
 
(29)CHI INSTITUTE FOR RESEARCH AND INNOVATION
198 INVERNESS DRIVE WEST

ENGLEWOOD,CO80112
27-1050565 		HEALTHCARE CO 501(c)(3) Type I CHI
 
Yes
 
(30)CHI KENTUCKY INC
3900 OLYMPIC BLVD STE 400

ERLANGER,KY41018
20-2741651 		HEALTHCARE KY 501(c)(3) Type I CHI
 
Yes
 
(31)CHI LIVING COMMUNITIES
5942 RENAISSANCE PLACE STE A

TOLEDO,OH43623
34-1892096 		HEALTHCARE OH 501(c)(3) Type II SFH
 
Yes
 
(32)CHI Memorial Hospital - Georgia
100 GROSS CRESCENT CIRCLE

FORT OGLETHORPE,GA30742
82-2748395 		HEALTHCARE GA 501(c)(3) 3 MHCS
 
Yes
 
(33)CHI NATIONAL HOME CARE
198 INVERNESS DRIVE WEST

ENGLEWOOD,CO80112
45-1261716 		HEALTHCARE CO 501(c)(3) 10 CHI NS
 
Yes
 
(34)CHI NATIONAL SERVICES
198 INVERNESS DRIVE WEST

ENGLEWOOD,CO80112
45-2532084 		HEALTHCARE CO 501(c)(3) Type I CHI
 
Yes
 
(35)CHI NEBRASKA
12809 West Dodge Road

Omaha,NE68510
36-3233121 		HEALTHCARE NE 501(c)(3) Type I CHI
 
Yes
 
(36)CHI ST JOSEPH CHILDREN'S HEALTH
1929 LINCOLN HWY E STE 150

LANCASTER,PA17602
23-2342997 		HEALTHCARE PA 501(c)(3) Type I CHI
 
Yes
 
(37)CHI ST JOSEPH'S CHILDREN
1516 5TH ST NW

ALBUQUERQUE,NM87102
71-0897107 		COMMUNITY NM 501(c)(3) Type I CHI
 
Yes
 
(38)CHI ST LUKE'S HEALTH BAYLOR COLLEGE OF MEDICINE MEDICAL CENTER
6624 FANNIN ST 1100

HOUSTON,TX77030
74-1161938 		HEALTHCARE TX 501(c)(3) 3 SLHS
 
Yes
 
(39)CHI ST VINCENT HOSPITAL HOT SPRINGS
300 WERNER ST

HOT SPRINGS,AR71913
71-0236913 		HEALTHCARE AR 501(c)(3) 3 CHISVHS
 
Yes
 
(40)CHI ST VINCENT HOT SPRINGS
300 WERNER ST

HOT SPRINGS,AR71913
26-1125064 		HOLDING CO AR 501(c)(3) Type II SVIMC
 
Yes
 
(41)CHI ST VINCENT MEDICAL GROUP HOT SPRINGS
300 WERNER ST

HOT SPRINGS,AR71913
26-1125131 		HEALTHCARE AR 501(c)(3) 3 CHISVHS
 
Yes
 
(42)COMMONSPIRIT HEALTH
198 INVERNESS DRIVE WEST

ENGLEWOOD,CO80112
47-0617373 		HEALTHCARE CO 501(c)(3) Type I NA
 
Yes
 
(43)COMMUNITY LIMITED CARE DIALYSIS CENTER
619 OAK ST ACCOUNTING-3 W

CINCINNATI,OH45206
23-7419853 		HOLDING CO OH 501(c)(4)   GSH
 
Yes
 
(44)COMMUNITY MEMORIAL HOSPITAL MEDICAL SERVICE FOUNDATION
631 N 8TH ST

MISSOURI VALLEY,IA51555
42-1294399 		FUNDRAISING IA 501(c)(3) Type I AH-CMHMV
 
Yes
 
(45)CONTINUING CARE HOSPITAL
One Saint Joseph Drive

LEXINGTON,KY40504
61-1400619 		LT ACH KY 501(c)(3) 3 SJHS
 
Yes
 
(46)East Texas Clinical Services
2801 VIA FORTUNA SUITE 500

AUSTIN,TX78746
45-4736213 		HEALTHCARE TX 501(c)(3) Type I MHSET
 
Yes
 
(47)ENUMCLAW REGIONAL HOSPITAL ASSOCIATION
1455 BATTERSBY AVE

ENUMCLAW,WA98022
91-0715805 		HEALTHCARE WA 501(c)(3) 3 FHS
 
Yes
 
(48)FLAGET HEALTHCARE INC
4305 NEW SHEPHERDSVILLE RD

BARDSTOWN,KY40004
61-1345363 		HEALTHCARE KY 501(c)(3) 3 KOH
 
Yes
 
(49)FLAGET MEMORIAL HOSPITAL FOUNDATION INC
4305 NEW SHEPHERDSVILLE RD

BARDSTOWN,KY40004
56-2351341 		FUNDRAISING KY 501(c)(3) Type I FH
 
Yes
 
(50)FRANCISCAN CARE CENTER
4111 N HOLLAND-SYLVANIA RD

TOLEDO,OH43623
34-1931806 		HEALTHCARE OH 501(c)(3) 10 FLC
 
Yes
 
(51)FRANCISCAN FOUNDATION
1717 SOUTH J ST

TACOMA,WA98405
91-1145592 		FUNDRAISING WA 501(c)(3) 10 FHS
 
Yes
 
(52)FRANCISCAN HEALTH SYSTEM
1717 SOUTH J ST

TACOMA,WA98405
91-0564491 		HEALTHCARE WA 501(c)(3) 3 CHI
 
Yes
 
(53)FRANCISCAN HEALTH VENTURES FKA SJMGROUP
TACOMA FNC CTR BLDG 1145 BROADWAY

TACOMA,WA98402
43-1882377 		PHYSICIANS WA 501(c)(3) 10 CHI
 
Yes
 
(54)FRANCISCAN MEDICAL GROUP
1313 BROADWAY STE 200

TACOMA,WA98402
91-1939739 		HEALTHCARE WA 501(c)(3) 10 FHS
 
Yes
 
(55)FRANCISCAN VILLA OF SOUTH MILWAUKEE INC
3601 S CHICAGO AVE

SOUTH MILWAUKEE,WI53172
39-1093829 		HEALTHCARE WI 501(c)(3) 10 CHI
 
Yes
 
(56)GARRISON MEMORIAL HOSPITAL
407 THIRD AVENUE SOUTHEAST

GARRISON,ND58540
45-0227752 		HEALTHCARE ND 501(c)(3) 3 SAMC
 
Yes
 
(57)GLOBAL HEALTH INITIATIVES
198 INVERNESS DRIVE WEST

ENGLEWOOD,CO80112
20-1536108 		MINISTRIES CO 501(c)(3) Type I CHI
 
Yes
 
(58)GOOD SAMARITAN COLLEGE OF NURSING & HEALTH SCIENCE
619 OAK ST ACCOUNTING-3 W

CINCINNATI,OH45206
31-1778403 		EDUCATION OH 501(c)(3) 2 GSH
 
Yes
 
(59)GOOD SAMARITAN FOUNDATION OF CINCINNATI INC
619 OAK ST ACCOUNTING-3 W

CINCINNATI,OH45206
31-1206047 		FUNDRAISING OH 501(c)(3) Type I GSH
 
Yes
 
(60)GOOD SAMARITAN HOSPITAL
110 N MAIN ST STE 500

DAYTON,OH45402
31-0536981 		HEALTHCARE OH 501(c)(3) 3 SHP
 
Yes
 
(61)GOOD SAMARITAN HOSPITAL
PO BOX 1990

KEARNEY,NE68848
47-0379755 		HEALTHCARE NE 501(c)(3) 3 CHI NEBRASKA
 
Yes
 
(62)GOOD SAMARITAN HOSPITAL FOUNDATION
111 W 31ST ST

KEARNEY,NE68847
47-0659443 		FUNDRAISING NE 501(c)(3) 7 GSH
 
Yes
 
(63)GOOD SAMARITAN HOSPITAL FOUNDATION - DAYTON
110 N MAIN ST STE 500

DAYTON,OH45402
23-7296923 		FUNDRAISING OH 501(c)(3) 7 SHP
 
Yes
 
(64)HARRISON MEDICAL CENTER
2520 CHERRY AVE

BREMERTON,WA98310
91-0565546 		HEALTHCARE WA 501(c)(3) 3 FHS
 
Yes
 
(65)HARRISON MEDICAL CENTER FOUNDATION
2520 CHERRY AVE

BREMERTON,WA98310
91-1197626 		FUNDRAISING WA 501(c)(3) 7 HMC
 
Yes
 
(66)HEALTHCARE AND WELLNESS FOUNDATION
2400 ST FRANCIS DR

BRECKENRIDGE,MN56520
76-0761782 		FUNDRAISING MN 501(c)(3) Type I SFMC
 
Yes
 
(67)HIGHLINE MEDICAL CENTER
16251 SYLVESTER RD SW

BURIEN,WA98166
91-0712166 		HEALTHCARE WA 501(c)(3) 3 FHS
 
Yes
 
(68)HOUSE OF MERCY
1111 6TH AVE

DES MOINES,IA50314
42-1323808 		SHELTER IA 501(c)(3) 7 CHI-IA CORP
 
Yes
 
(69)JEWISH HOSPITAL AND ST MARY'S HEALTHCARE INC
250 E Liberty St Ste 500

LOUISVILLE,KY40202
61-1029768 		HEALTHCARE KY 501(c)(3) 3 KOH
 
Yes
 
(70)KENTUCKYONE HEALTH MEDICAL GROUP INC
100 E Liberty St Ste 800

LOUISVILLE,KY40202
61-1352729 		HEALTHCARE KY 501(c)(3) 10 JHSMH
 
Yes
 
(71)KENTUCKYONE HEALTH INC
200 ABRAHAM FLEXNER WAY

LOUISVILLE,KY40202
61-1029769 		HEALTHCARE KY 501(c)(3) Type II CHI
 
Yes
 
(72)LAKEWOOD HEALTH CENTER
600 MAIN AVE S

BAUDETTE,MN56623
41-0758434 		HEALTHCARE MN 501(c)(3) 3 CHI
 
Yes
 
(73)LAKEWOOD REGIONAL HEALTHCARE FOUNDATION
600 MAIN AVE S

BAUDETTE,MN56623
41-1893795 		FUNDRAISING MN 501(c)(3) 7 LHC
 
Yes
 
(74)LINUS OAKES INC
2700 STEWART PKWY

ROSEBURG,OR97471
93-0821381 		SENIOR LIVING OR 501(c)(3) 10 MMC
 
Yes
 
(75)LISBON AREA HEALTH SERVICES
905 MAIN ST

LISBON,ND58054
82-0558836 		HEALTHCARE ND 501(c)(3) 3 CHI
 
Yes
 
(76)LUFKIN VISION ACQUISITIONS
PO BOX 1447

LUFKIN,TX75901
82-0563768 		PROPERTY MGMT TX 501(c)(3) Type I MHSET
 
Yes
 
(77)MADISON ST JOSEPH HEALTH CENTER
2801 FRANCISCAN DRIVE

BRYAN,TX77802
74-2761145 		HEALTHCARE TX 501(c)(3) 3 SJSC
 
Yes
 
(78)MADONNA MANOR INC
2344 AMSTERDAM ROAD

VILLA HILLS,KY51017
61-0654635 		LIVING ASSIST KY 501(c)(3) 10 FLC
 
Yes
 
(79)MEMORIAL HEALTH CARE SYSTEM FOUNDATION INC
2525 DE SALES AVE

CHATTANOOGA,TN37404
62-1839548 		FUNDRAISING TN 501(c)(3) 7 MHCS
 
Yes
 
(80)MEMORIAL HEALTH CARE SYSTEM INC
2525 DE SALES AVE

CHATTANOOGA,TN37404
62-0532345 		HEALTHCARE TN 501(c)(3) 3 CHI
 
Yes
 
(81)MEMORIAL HEALTH PARTNERS FOUNDATION INC
5600 BRAINERD RD STE 500

CHATTANOOGA,TN37411
03-0417049 		HEALTHCARE TN 501(c)(3) 10 MHCS
 
Yes
 
(82)MEMORIAL HEALTH SYSTEM OF EAST TEXAS
PO BOX 1447

LUFKIN,TX75902
75-0755367 		HEALTHCARE TX 501(c)(3) 3 CHI
 
Yes
 
(83)MEMORIAL MEDICAL CENTER - LIVINGSTON
PO BOX 1447

LUFKIN,TX75902
76-0436439 		HEALTHCARE TX 501(c)(3) 3 MHSET
 
Yes
 
(84)MEMORIAL MEDICAL CENTER - SAN AUGUSTINE
PO BOX 1447

LUFKIN,TX75902
75-2663904 		HEALTHCARE TX 501(c)(3) 3 MHSET
 
Yes
 
(85)MEMORIAL MULTISPECIALTY ASSOCIATES
1201 FRANK AVE

LUFKIN,TX95904
75-2721155 		PHYSICIANS TX 501(c)(3) Type I MHSET
 
Yes
 
(86)MEMORIAL SPECIALTY HOSPITAL
PO BOX 1447

LUFKIN,TX95902
75-2492741 		HEALTHCARE TX 501(c)(3) 3 MHSET
 
Yes
 
(87)MERCY AUXILIARY OF CENTRAL IOWA
1111 6TH AVE

DES MOINES,IA50314
42-6076069 		AUXILIARY IA 501(c)(3) Type I MF-DM IA
 
Yes
 
(88)MERCY CLINICS INC
1111 6TH AVE

DES MOINES,IA50314
42-1193699 		PHYSICIANS IA 501(c)(3) 10 CHI-IA CORP
 
Yes
 
(89)MERCY COLLEGE OF HEALTH SCIENCES
1111 6TH AVE

DES MOINES,IA50314
42-1511682 		EDUCATION IA 501(c)(3) 2 CHI-IA CORP
 
Yes
 
(90)MERCY FOUNDATION OF DES MOINES IA
1111 6TH AVE

DES MOINES,IA50314
23-7358794 		FUNDRAISING IA 501(c)(3) 7 CHI-IA CORP
 
Yes
 
(91)MERCY FOUNDATION INC
2700 STEWART PKWY

ROSEBURG,OR97471
93-6088946 		FUNDRAISING OR 501(c)(3) 7 MMC
 
Yes
 
(92)MERCY HEALTH CARE FOUNDATION
PO BOX 368

CORNING,IA50841
42-1461064 		FUNDRAISING IA 501(c)(3) Type I AHMH-Corning
 
Yes
 
(93)MERCY HEALTHCARE FOUNDATION
570 CHAUTAUQUA BLVD

VALLEY CITY,ND58072
45-0435338 		FUNDRAISING ND 501(c)(3) Type I MHVC
 
Yes
 
(94)MERCY HOSPITAL FOUNDATION COUNCIL BLUFFS
800 MERCY DR

COUNCIL BLUFFS,IA51503
42-1178204 		FUNDRAISING IA 501(c)(3) Type I AHBMHS
 
Yes
 
(95)MERCY HOSPITAL OF DEVILS LAKE
1031 7TH ST NE

DEVILS LAKE,ND58301
45-0227012 		HEALTHCARE ND 501(c)(3) 3 CHI
 
Yes
 
(96)MERCY HOSPITAL OF DEVILS LAKE FOUNDATION
1031 7TH ST NE

DEVILS LAKE,ND58301
35-2367360 		FUNDRAISING ND 501(c)(3) 7 MHDL
 
Yes
 
(97)MERCY HOSPITAL OF VALLEY CITY
570 CHAUTAUQUA BLVD

VALLEY CITY,ND58072
45-0226553 		HEALTHCARE ND 501(c)(3) 3 CHI
 
Yes
 
(98)MERCY MEDICAL CENTER
1301 15TH AVE WEST

WILLISTON,ND58801
45-0231183 		HEALTHCARE ND 501(c)(3) 3 CHI
 
Yes
 
(99)MERCY MEDICAL CENTER - CENTERVILLE
ONE ST JOSEPHS DRIVE

CENTERVILLE,IA52544
42-0680308 		HEALTHCARE IA 501(c)(3) 3 CHI-IA CORP
 
Yes
 
(100)MERCY MEDICAL CENTER - NEWTON DBA SKIFF MEDICAL CENTER
204 N 4th Ave E

Newton,IA50314
42-1470935 		PHYSICIANS IA 501(c)(3) 3 CHI-IA CORP
 
Yes
 
(101)MERCY MEDICAL CENTER INC
2700 STEWART PKWY

ROSEBURG,OR97471
93-0386868 		HEALTHCARE OR 501(c)(3) 3 CHI
 
Yes
 
(102)MERCY MEDICAL FOUNDATION
1301 15TH AVE WEST

WILLISTON,ND58801
45-0381803 		FUNDRAISING ND 501(c)(3) Type I MMC
 
Yes
 
(103)NEBRASKA HEART HOSPITAL
7500 S 91ST ST

LINCOLN,NE68526
39-2031968 		HEALTHCARE NE 501(c)(3) 3 CHI NEBRASKA
 
Yes
 
(104)North Central Health Care Alliance dba PrimeCare Health Group
401 N 9th St

BISMARCK,ND585014507
45-0439894 		HEALTHCARE ND 501(c)(3) 7 NHCA
 
Yes
 
(105)OAKES COMMUNITY HOSPITAL
1200 N 7TH ST

OAKES,ND58474
45-0231675 		HEALTHCARE ND 501(c)(3) 3 CHI
 
Yes
 
(106)OAKES COMMUNITY HOSPITAL FOUNDATION
1200 N 7TH ST

OAKES,ND58474
71-0966606 		FUNDRAISING ND 501(c)(3) Type I OCH
 
Yes
 
(107)PINEYWOODS MEDICAL DEVELOPMENT CORP
PO BOX 1447

LUFKIN,TX75902
75-2493116 		PROPERTY MGMT TX 501(c)(3) Type I MHSET
 
Yes
 
(108)PROVIDENCE CARE CENTER
2025 HAYES AVENUE

SANDUSKY,OH44870
34-1658625 		HEALTHCARE OH 501(c)(3) 10 FLC
 
Yes
 
(109)PROVIDENCE CARE CENTERS
2025 HAYES AVENUE

SANDUSKY,OH44870
34-1826099 		HOLDING CO OH 501(c)(3) Type II FLC
 
Yes
 
(110)PROVIDENCE RESIDENTIAL COMMUNITY CORPORATION
5055 PROVIDENCE DRIVE

SANDUSKY,OH44870
34-1896807 		LIVING COMM OH 501(c)(3) 10 FLC
 
Yes
 
(111)PUEBLO STEPUP
1925 E ORMAN AVE STE G52

PUEBLO,CO81004
84-1234295 		COMMUNITY CO 501(c)(3) 7 CHIC
 
Yes
 
(112)REGIONAL HOSPITAL FOR RESPIRATORY AND COMPLEX CARE
16251 Sylvester Road SW

Burien,WA98166
91-1170040 		HEALTHCARE WA 501(c)(3) 3 FHS
 
Yes
 
(113)SET OF COLORADO SPRINGS INC
9100 E Mineral Circle

Centennial,CO80112
84-1183335 		LTERM CARE CO 501(c)(3) 7 CHIC
 
Yes
 
(114)SAINT CLARE'S COMMUNITY CARE INC
25 POCONO RD

DENVILLE,NJ07834
22-2876836 		HEALTHCARE NJ 501(c)(3) 10 SCHS
 
Yes
 
(115)SAINT CLARE'S FOUNDATION INC
25 POCONO RD

DENVILLE,NJ07834
22-2502997 		FUNDRAISING NJ 501(c)(3) 7 SCHS
 
Yes
 
(116)SAINT CLARE'S HEALTH SERVICES INC
25 POCONO RD

DENVILLE,NJ07834
22-3639733 		MANAGEMENT NJ 501(c)(3) 10 CHI
 
Yes
 
(117)SAINT CLARE'S HOSPITAL INC
25 POCONO RD

DENVILLE,NJ07834
22-3319886 		HEALTHCARE NJ 501(c)(3) 3 SCHS
 
Yes
 
(118)SAINT ELIZABETH FOUNDATION
555 S 70TH ST

LINCOLN,NE68510
47-0625523 		FUNDRAISING NE 501(c)(3) 7 SERMC
 
Yes
 
(119)SAINT ELIZABETH HEALTH SERVICES
555 S 70TH ST

LINCOLN,NE68510
36-3233120 		HEALTHCARE NE 501(c)(3) 3 SERMC
 
Yes
 
(120)SAINT ELIZABETH REGIONAL MEDICAL CENTER
555 S 70TH ST

LINCOLN,NE68510
47-0379836 		HEALTHCARE NE 501(c)(3) 3 CHI NEBRASKA
 
Yes
 
(121)SAINT FRANCIS MEDICAL CENTER
2620 W FAIDLEY

GRAND ISLAND,NE68803
47-0376601 		HEALTHCARE NE 501(c)(3) 3 CHI NEBRASKA
 
Yes
 
(122)SAINT FRANCIS MEDICAL CENTER FOUNDATION
PO BOX 9804

GRAND ISLAND,NE68802
47-0630267 		FUNDRAISING NE 501(c)(3) 7 SFMC
 
Yes
 
(123)SAINT JOSEPH BEREA HOSPITAL FOUNDATION INC
305 ESTILL ST

BEREA,KY40403
26-0152877 		FUNDRAISING KY 501(c)(3) 7 SJHS
 
Yes
 
(124)SAINT JOSEPH HEALTH SYSTEM INC
200 ABRAHAM FLEXNER WAY

LOUISVILLE,KY40202
61-1334601 		HEALTHCARE KY 501(c)(3) 3 KOH
 
Yes
 
(125)SAINT JOSEPH HOSPITAL FOUNDATION INC
701 Bob Olink Dr 200

LEXINGTON,KY40504
61-1159649 		FUNDRAISING KY 501(c)(3) Type I SJHS
 
Yes
 
(126)SAINT JOSEPH LONDON FOUNDATION INC
1001 SAINT JOSEPH LANE

LONDON,KY40741
26-0438748 		FUNDRAISING KY 501(c)(3) 7 SJHS
 
Yes
 
(127)SAINT JOSEPH MOUNT STERLING FOUNDATION INC
225 FALCON DR

MOUNT STERLING,KY40353
27-2884584 		FUNDRAISING KY 501(c)(3) 7 SJHS
 
Yes
 
(128)SAINT JOSEPH'S HOSPITAL FOUNDATION
2500 Fairway Street

DICKINSON,ND58601
36-3418207 		FUNDRAISING ND 501(c)(3) Type I SJHHC
 
Yes
 
(129)SAMARITAN BEHAVIORAL HEALTH INC
110 N MAIN ST STE 500

DAYTON,OH45402
02-0633634 		HEALTHCARE OH 501(c)(3) 7 SHP
 
Yes
 
(130)SAMARITAN HEALTH PARTNERS
110 N MAIN ST STE 500

DAYTON,OH45402
31-1107411 		HEALTHCARE OH 501(c)(3) Type I CHI
 
Yes
 
(131)SCHUYLER MEMORIAL HOSPITAL FOUNDATION INC
104 W 17TH ST

SCHUYLER,NE68661
36-3630014 		FUNDRAISING NE 501(c)(3) Type I AHMHS
 
Yes
 
(132)SJRMC JOPLIN MISSOURI
198 INVERNESS DRIVE WEST

ENGLEWOOD,CO80112
44-0545809 		HEALTHCARE CO 501(c)(3) 3 CHI
 
Yes
 
(133)ST ALEXIUS MEDICAL CENTER
900 EAST BROADWAY AVENUE

BISMARCK,ND58501
45-0226711 		HEALTHCARE ND 501(c)(3) 3 CHI
 
Yes
 
(134)ST ANTHONY HOSPITAL
2801 St Anthony Way

PENDLETON,OR97801
93-0391614 		HEALTHCARE OR 501(c)(3) 3 CHI
 
Yes
 
(135)ST ANTHONY HOSPITAL FOUNDATION
2801 St Anthony Way

PENDLETON,OR97801
93-0992727 		FUNDRAISING OR 501(c)(3) Type I SAH
 
Yes
 
(136)ST ANTHONY'S HOSPITAL ASSOCIATION
FOUR HOSPITAL DR

MORRILTON,AR72110
71-0245507 		HEALTHCARE AR 501(c)(3) 3 SVIMC
 
Yes
 
(137)ST CATHERINE HOSPITAL
401 EAST SPRUCE ST

GARDEN CITY,KS67846
48-0543721 		HEALTHCARE KS 501(c)(3) 3 CHI
 
Yes
 
(138)ST CATHERINE HOSPITAL DEVELOPMENT FOUNDATION
401 EAST SPRUCE ST

GARDEN CITY,KS67846
20-0598702 		FUNDRAISING KS 501(c)(3) Type I SCH
 
Yes
 
(139)ST CLARE COMMONS
12469 Five Point Road

TOLEDO,OH43551
27-0163752 		LIVING COMM OH 501(c)(3) 10 FLC
 
Yes
 
(140)ST DOMINIC OF ONTARIO OREGON
198 INVERNESS DRIVE WEST

ENGLEWOOD,CO80112
93-0433692 		HEALTHCARE CO 501(c)(4)   CHI
 
Yes
 
(141)ST FRANCIS HOME
2400 ST FRANCIS DR

BRECKENRIDGE,MN56520
41-0729978 		LTERM CARE MN 501(c)(3) 10 CHI
 
Yes
 
(142)ST FRANCIS LIFE CARE CORPORATION
19 POCONO RD

DENVILLE,NJ07834
22-2536017 		ELDERLY CARE NJ 501(c)(3) 10 SCHS
 
Yes
 
(143)ST FRANCIS MEDICAL CENTER
2400 ST FRANCIS DR

BRECKENRIDGE,MN56520
41-0695598 		HEALTHCARE MN 501(c)(3) 3 CHI
 
Yes
 
(144)ST JOSEPH FOUNDATION OF BRYAN TEXAS
2801 FRANCISCAN DRIVE

BRYAN,TX77802
74-2351158 		FUNDRAISING TX 501(c)(3) Type II SJSC
 
Yes
 
(145)ST JOSEPH MANOR
2801 FRANCISCAN DRIVE

BRYAN,TX77802
74-2847594 		HEALTHCARE TX 501(c)(3) 10 SJSC
 
Yes
 
(146)ST JOSEPH MEDICAL CENTER INC
201 INTERNATIONAL CIRCLE STE 212

HUNT VALLEY,MD21030
52-0591461 		HEALTHCARE MD 501(c)(3) 3 CHI
 
Yes
 
(147)ST JOSEPH PHYSICIAN ASSOCIATES
2801 FRANCISCAN DRIVE

BRYAN,TX77802
20-3159302 		HEALTHCARE TX 501(c)(3) 3 SJSC
 
Yes
 
(148)ST JOSEPH PHYSICIAN ENTERPRISE INC
201 INTERNATIONAL CIRCLE STE 212

HUNT VALLEY,MD21030
52-1311775 		PHYSICIANS MD 501(c)(3) Type I SJMC
 
Yes
 
(149)ST JOSEPH REGIONAL HEALTH CENTER
2801 FRANCISCAN DRIVE

BRYAN,TX77802
74-1282696 		HEALTHCARE TX 501(c)(3) 3 SJSC
 
Yes
 
(150)ST JOSEPH REGIONAL HEALTH PARTNERS
2801 FRANCISCAN DRIVE

BRYAN,TX77802
45-4088170 		HEALTHCARE TX 501(c)(3) 3 SJSC
 
Yes
 
(151)ST JOSEPH REGIONAL HEALTH PARTNERS ACO
2801 FRANCISCAN DRIVE

BRYAN,TX77802
46-3265423 		HEALTHCARE TX 501(c)(3) 10 SJSC
 
Yes
 
(152)ST JOSEPH SERVICES CORPORATION
2801 FRANCISCAN DRIVE

BRYAN,TX77802
74-2455161 		MANAGEMENT TX 501(c)(3) Type I SFH
 
Yes
 
(153)ST JOSEPH'S AREA HEALTH SERVICES
600 PLEASANT AVE

PARK RAPIDS,MN56470
41-0695603 		HEALTHCARE MN 501(c)(3) 3 CHI
 
Yes
 
(154)ST JOSEPH'S HOSPITAL AND HEALTH CENTER
2500 Fairway St

DICKINSON,ND58601
45-0226429 		HEALTHCARE ND 501(c)(3) 3 CHI
 
Yes
 
(155)ST LEONARD
8100 CLYO ROAD

CENTERVILLE,OH45458
34-1940863 		LIVING COMM OH 501(c)(3) 10 FLC
 
Yes
 
(156)ST LUKE'S COMMUNITY DEVELOPMENT CORPORATION - PMC
6624 FANNIN ST STE 2505

HOUSTON,TX77030
27-3733278 		HEALTHCARE TX 501(c)(3) 3 SLCDC
 
Yes
 
(157)ST LUKE'S COMMUNITY DEVELOPMENT CORPORATION - SUGAR LAND
6624 FANNIN ST STE 2505

HOUSTON,TX77030
26-1947374 		HEALTHCARE TX 501(c)(3) 3 SLHS
 
Yes
 
(158)ST LUKE'S COMMUNITY DEVELOPMENT CORPORATION - THE WOODLANDS
6624 FANNIN ST STE 2505

HOUSTON,TX77030
26-0335902 		HEALTHCARE TX 501(c)(3) 3 SLCDC
 
Yes
 
(159)ST LUKE'S COMMUNITY HEALTH SERVICES
6624 FANNIN ST STE 1100

HOUSTON,TX77030
76-0536234 		HEALTHCARE TX 501(c)(3) 3 SLHS
 
Yes
 
(160)ST LUKE'S FOUNDATION
1213 HERMANN DRIVE STE 855

HOUSTON,TX77004
45-3811485 		FUNDRAISING TX 501(c)(3) 7 SLHS
 
Yes
 
(161)ST LUKE'S HEALTH SYSTEM CORPORATION
PO Box 20269

HOUSTON,TX77225
76-0536232 		MANAGEMENT TX 501(c)(3) Type I CHI
 
Yes
 
(162)ST LUKE'S HOSPITAL AT THE VINTAGE
6624 FANNIN ST STE 2505

HOUSTON,TX77030
26-3734606 		HEALTHCARE TX 501(c)(3) 3 SLHS
 
Yes
 
(163)ST LUKE'S MEDICAL TOWER CORPORATION
6624 FANNIN ST STE 1100

HOUSTON,TX77030
76-0531713 		PROPERTY MGMT TX 501(c)(3) Type I CHI-SLH
 
Yes
 
(164)ST LUKE'S PROPERTIES CORPORATION
1213 Hermann Drive Ste 855

HOUSTON,TX77004
76-0531716 		PROPERTY MGMT TX 501(c)(3) Type I SLHS
 
Yes
 
(165)ST LUKE'S SUGAR LAND PROPERTIES CORPORATION
6624 FANNIN ST STE 2505

HOUSTON,TX77030
45-4120549 		PROPERTY MGMT TX 501(c)(3) Type I SLCDC-SL
 
Yes
 
(166)ST MARY'S COMMUNITY HOSPITAL
1301 Grundman Boulevard

NEBRASKA CITY,NE68410
47-0443636 		HEALTHCARE NE 501(c)(3) 3 CHI NEBRASKA
 
Yes
 
(167)ST MARY'S HOSPITAL FOUNDATION
1314 3RD AVE

NEBRASKA CITY,NE68410
47-0707604 		FUNDRAISING NE 501(c)(3) 7 SMCH
 
Yes
 
(168)ST VINCENT FOUNDATION
TWO ST VINCENT CIRCLE

LITTLE ROCK,AR72205
51-0169537 		FUNDRAISING AR 501(c)(3) Type I SVIMC
 
Yes
 
(169)ST VINCENT INFIRMARY MEDICAL CENTER
TWO ST VINCENT CIRCLE

LITTLE ROCK,AR72205
71-0236917 		HEALTHCARE AR 501(c)(3) 3 CHI
 
Yes
 
(170)ST VINCENT MEDICAL GROUP
TWO ST VINCENT CIRCLE

LITTLE ROCK,AR72205
71-0830696 		HEALTHCARE AR 501(c)(3) 10 SVIMC
 
Yes
 
(171)SYLVANIA FRANCISCAN HEALTH
1715 INDIAN WOOD CIR 200

MAUMEE,OH43537
34-1412964 		HEALTHCARE OH 501(c)(3) Type I CHI
 
Yes
 
(172)SYLVANIA FRANCISCAN HEALTH FOUNDATION
1715 INDIAN WOOD CIR 200

MAUMEE,OH43537
45-5357161 		FUNDRAISING OH 501(c)(3) Type I FLC
 
Yes
 
(173)THE COMMONS OF PROVIDENCE
5000 PROVIDENCE DRIVE

SANDUSKY,OH44870
34-1826097 		ASSIST LIVING OH 501(c)(3) 10 FLC
 
Yes
 
(174)THE COMMUNITY HOSPITAL OF BRAZOSPORT
100 MEDICAL DRIVE

LAKE JACKSON,TX77566
74-1385192 		HEALTHCARE TX 501(c)(3) 3 SLHS
 
Yes
 
(175)THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OH
619 OAK ST ACCOUNTING-3 W

CINCINNATI,OH45206
31-0537486 		HEALTHCARE OH 501(c)(3) 3 CHI
 
Yes
 
(176)THE HEART INSTITUTE OF DAYTON
110 N MAIN ST STE 500

DAYTON,OH45402
30-0502367 		HEALTHCARE OH 501(c)(3) 10 CHS
 
Yes
 
(177)THE PHYSICIAN NETWORK
2000 Q ST STE 500

LINCOLN,NE68503
47-0780857 		PHYSICIANS NE 501(c)(3) Type I CHI NEBRASKA
 
Yes
 
(178)TOTAL HEALTHCARE
9100 E Mineral Circle

Centennial,CO80112
84-0927232 		HEALTHCARE CO 501(c)(3) 3 CHIC
 
Yes
 
(179)TRINITY HEALTH FOUNDATION
380 SUMMIT AVENUE

STEUBENVILLE,OH43952
31-1329423 		FUNDRAISING OH 501(c)(3) Type I THS
 
Yes
 
(180)TRINITY HEALTH SYSTEM
380 SUMMIT AVENUE

STEUBENVILLE,OH43952
34-1818681 		HEALTHCARE OH 501(c)(3) Type I SFH
 
Yes
 
(181)TRINITY HEALTH SYSTEM GROUP
380 SUMMIT AVENUE

STEUBENVILLE,OH43952
30-0752920 		HEALTHCARE OH 501(c)(3) Type II THS
 
Yes
 
(182)TRINITY HOSPITAL TWIN CITY
819 NORTH FIRST STREET

DENNISON,OH44621
27-5401105 		HEALTHCARE OH 501(c)(3) 3 SFH
 
Yes
 
(183)TRI-STATE HEALTH SERVICES INC
ONE ROSS PARK BLVD

STEUBENVILLE,OH43952
34-1522484 		ASSIST LIVING OH 501(c)(3) 7 THS
 
Yes
 
(184)UNITY FAMILY HEALTHCARE
815 SE 2ND ST

LITTLE FALLS,MN56345
41-0721642 		HEALTHCARE MN 501(c)(3) 3 CHI
 
Yes
 
(185)VILLA NAZARETH INC
801 PAGE DR

FARGO,ND58103
45-0226714 		LTERM CARE ND 501(c)(3) 10 CHI
 
Yes
 
(186)VISITING NURSE ASSOCIATION OF ST CLARE'S INC
191 WOODPORT RD

SPARTA,NJ07871
22-1768334 		HOME HEALTH NJ 501(c)(3) 10 SCHS
 
Yes
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2019
Schedule R (Form 990) 2019
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) Audubon Land Company LLC

630 Southpointe Court 200
COLORADO SPRINGS,CO80906
84-1513085 		Real Estate CO CHIC
  		Related 298,037 20,270,617   No     No 73 %
(2) AVON EMERGENCY AND URGENT CARE CENTER LLC

9100 E Mineral Circle
Centennial,CO80112
81-1727282 		HEALTHCARE SRVC CO CHIC
  		Related -757,555 6,191,153   No   Yes   77 %
(3) BAYLOR CHI ST LUKES HEALTH SERVICES LLC

6624 Fannin St Ste 1100
HOUSTON,TX77030
47-2079184 		HEALTHCARE SRVC TX SLHS
  		Related 0 3,250,000   No   Yes   65 %
(4) BERGAN MERCY SURGERY CENTER LLC

7710 Mercy Rd Ste 200
OMAHA,NE68124
20-8671994 		AMBUL SURG CTR NE ACH
  		Related 1,187,048 2,549,504   No     No 53 %
(5) BERYWOOD OFFICE PROPERTIES LLC

2501 Citico Avenue
CHATTANOGA,TN37404
62-1875199 		PHYS OFFICE TN MHCS
  		Related 133,390 918,922   No   Yes   63 %
(6) BLUEGRASS REGIONAL IMAGING CENTER

1218 SOUTH BROADWAY STE 310
LEXINGTON,KY40504
61-1386736 		DIAGNOSTIC IMAGING KY SJHS
  		Related 122,291 3,216,558   No     No 65 %
(7) CATHOLIC HEALTH INITIATIVES PHYSICIAN SERVICES LLC

198 INVERNESS DRIVE WEST
ENGLEWOOD,CO80112
46-2945938 		PRACTICE MGMT SRVC CO CHI
  		Related 1,263,355 -272,620   No   Yes   100 %
(8) CENTRAL NEBRASKA REHABILITATION SERVICES LLC

3004 W FAIDLEY AVENUE
GRAND ISLAND,NE68803
81-0653461 		Physical Therapy NE SFMC
  		Related 3,422,589 3,722,591   No     No 51 %
(9) CENTURA-SCA HOLDINGS LLC

569 BROOK VILLAGE STE 901
BIRMINGHAM,AL35209
47-4823023 		OP SURGERY CENTER AL CHIC
  		Related 1,734,228 2,020,115   No   Yes   65 %
(10) CHI OPERATING INVESTMENT PROGRAM LP

198 INVERNESS DRIVE WEST
ENGLEWOOD,CO80112
47-0727942 		INVESTMENTS CO CHI
  		Unrelated 468,697,209 6,697,320,773   No 1,194,677 Yes   100 %
(11) CHICAMSURG Surgery Centers LLC

1A Burton Hills Blvd
Nashville,TN37215
46-5683027 		SURGERY CENTER TN CHIC
  		Related 76,843 134,172   No     No 51 %
(12) CHICLARKIN VENTURES LLC

9100 E Mineral Circle
Centennial,CO80112
47-4210888 		URGENT CARE CO CHIC
  		Related 167,285 7,823,355   No   Yes   87 %
(13) Colorado Springs CK Leasing LLC

630 Southpointe Court 200
COLORADO SPRINGS,CO80906
26-2982714 		REAL ESTATE CO CHIC
  		Related 668,738 -132,333   No   Yes   52 %
(14) FRANCISCAN SPECIALTY CARE LLC

680 SOUTH FOURTH STREET
LOUISVILLE,KY40202
81-3725123 		HEALTHCARE SRVC KY FHS
  		Related 0 101,598   No   Yes   51 %
(15) HC SL VINTAGE I LLC

18000 W SARAH LANE STE 250
BROOKFIELD,WI53045
27-0453767 		PROPERTY HOLDING WI SL HOSP-VINTAGE
  		Related 1,686,676 52,912,453   No     No 51 %
(16) HEALTHCARE SUPPORT SERVICES LLC

PO BOX 9804
GRAND ISLAND,NE68802
72-1546196 		LAUNDRY NE na
  		Related 376,035 4,358,356   No     No 100 %
(17) Heartland Oncology LLC

2337 E Crawford St
Salina,KS67401
46-4265403 		ONCOLOGY KS SCH
  		Related -403,368 850,579   No     No 51 %
(18) LAKESIDE AMBULATORY SURGICAL CENTER LLC

17031 LAKESIDE HILLS DR
OMAHA,NE68130
20-4267902 		AMBUL SURG CTR NE ACH
  		Related 3,108,510 2,029,071   No     No 60 %
(19) LAKESIDE ENDOSCOPY CENTER LLC

17001 LAKESIDE HILLS PLZ STE 201
OMAHA,NE68130
20-5544496 		ENDOSCOPY SRVC NE ACH
  		Related 699,620 777,431   No     No 51 %
(20) LINCOLN CK LEASING LLC

555 SOUTH 70TH STREET
Lincoln,NE68510
26-2496856 		Real Estate NE SERMC
  		Related 812,108 301,911   No     No 54 %
(21) Mercy Rehabilitation Hospital LLC

680 SOUTH FOURTH STREET
LOUISVILLE,KY40202
81-4437201 		HEALTHCARE SRVC KY CHI IA
  		Related 0 1,138,872   No     No 51 %
(22) NEBRASKA SPINE HOSPITAL LLC

6901 N 72ND ST STE 20300
OMAHA,NE68122
27-0263191 		SPINE HOSPITAL NE ACH
  		Related 11,039,563 19,771,159   No     No 51 %
(23) NORTH RIVER SURGERY CENTER LLC

2209 WILDWOOD AVE
SHERWOOD,AR72120
71-0799771 		AMBUL SURG CTR AR SVIMC
  		Related 279,520 1,700,868   No     No 67 %
(24) ORTHOCOLORADO LLC

11650 WEST 2ND PLACE
LAKEWOOD,CO80228
37-1577105 		ORTHO HOSPITAL CO CHIC
  		Related 15,065,598 3,364,245   No     No 60 %
(25) Pasadena Urgency Center LLC

4600 E SAM HOUSTON PKWY SOUTH
PASADENA,TX77505
81-2482854 		URGENT CARE TX SLHS
  		Related -1,031,166 1,686,969   No     No 57 %
(26) PENINSULA RADIATION ONCOLOGY LLC

314 MLK JR WAY STE 11
TACOMA,WA98405
87-0808610 		HEALTHCARE SRVC WA FHS
  		Related 377,689 1,738,875   No     No 60 %
(27) Penrad Imaging LLC

1390 Kelly Johnson Blvd
COLORADO SPRINGS,CO80920
84-1072619 		Medical Imaging CO CHIC
  		Related -2,396,662 1,744,893   No     No 70 %
(28) PMC HOSPITAL LLC

3100 MAIN ST STE 500
HOUSTON,TX77002
27-3280598 		HOSPITAL TX SL CDC-PMC
  		Related 3,630,803 64,361,393   No   Yes   51 %
(29) Pueblo Ambulatory Surgery Center LLC

25 Montebello Rd
Pueblo,CO81003
62-1488737 		SURGERY CENTER CO CHIC
  		Related -74,501 210,538   No     No 51 %
(30) Saint JOSEPH - PAML LLC

200 ABRAHAM FLEXNER WAY
LOUISVILLE,KY40202
45-2116736 		MGMT SVCS KY SJHS
  		Related -19,517 1,393,440   No   Yes   63 %
(31) SAINT JOSEPH - SCA HOLDINGS LLC

1451 Harrodsburg RD
LEXINGTON,KY40503
45-3801157 		OP SURGERY KY SJHS
  		Related 0 0   No   Yes   51 %
(32) SAINT JOSEPH-ANC HOME CARE SERVICES

1700 EDISON DR
MILFORD,OH45150
26-3330545 		HOME HEALTH OH CHINHC
  		Related 4,139,859 13,245,757   No     No 100 %
(33) ST FRANCIS LAND COMPANY

5390 N ACADEMY BLVD STE 300
COLORADO SPRINGS,CO80918
26-3134100 		REAL ESTATE CO CHIC
  		Related 151,050 13,285,935   No     No 59 %
(34) ST LUKE'S DIAGNOSTIC CATH LAB LLP

6624 FANNIN ST STE 800
HOUSTON,TX77030
71-0959365 		DIAGNOSTICS TX SLHS HOLDINGS
  		Related 469,596 609,938   No   Yes   45 %
(35) ST LUKE'S LAKESIDE HOSPITAL LLC

6624 FANNIN STE 2505
HOUSTON,TX77030
30-0427437 		HOSPITAL TX SL CDC-W
  		Related 1,269,122 36,450,234   No   Yes   51 %
(36) ST LUKE'S THE WOODLANDS SLEEP CENTER LLC

6624 FANNIN STE 800
HOUSTON,TX77030
46-2795726 		DIAGNOSTICS TX SLHSH
  		Related -76,895 1,135,073   No   Yes   51 %
(37) SURGERY CENTER OF LEXINGTON LLC

200 ABRAHAM FLEXNER WAY
LOUISVILLE,KY40202
62-1179539 		SURGERY CENTER KY SJHS
  		Related -108,052 0   No   Yes   51 %
(38) THREE SPRING IMAGING LLC

1 Mercado St STE 200A
DURANGO,CO81301
81-3571570 		HEALTHCARE SRVC CO CHIC
  		Related 76,753 84,093   No   Yes   51 %
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) Alegent HealthCreighton St Joseph Managed Care Services Inc

12809 West Dodge Rd
Omaha,NE68154
47-0802396 		Managed Care NE CHI Nebraska
  		C Corporation 9,217,638 22,568,323 100 % Yes  
(2) All Saints Insurance Company SPC Ltd

PO BOX 10073 APO
Georgetown,GRAND CAYMANKY11001
CJ
98-0556913 		Insurance CJ CHI
  		C Corporation 0 0 100 % Yes  
(3) ALLIANCE HEALTH PROVIDERS OF BRAZOS Valley Inc

2801 FRANCISCAN DRIVE
BRYAN,TX77802
74-2466914 		Healthcare TX SJSC
  		C Corporation 236,684 699,916 100 % Yes  
(4) Alternative Insurance Management Service Inc

3900 OLYMPIC BLVD STE 400
Erlanger,KY41018
84-1112049 		Management Services KY CHI
  		C Corporation 5,601 6,045,874 100 % Yes  
(5) AMERICAN NURSING CARE Inc

1700 EDISON DR
MILFORD,OH45150
31-1085414 		HOME HEALTH OH CHS
  		C Corporation 91,529,470 56,968,045 100 % Yes  
(6) AMERIMED INC

1700 EDISON DR
MILFORD,OH45150
31-1158699 		HOME HEALTH OH ANC
  		C Corporation 21,023,902 15,079,827 100 % Yes  
(7) BC HOLDING COMPANY INC

1850 BLUEGRASS AVE
LOUISVILLE,KY40215
31-1542851 		Fitness Club KY JHSMH
  		C Corporation 0 0 100 % Yes  
(8) BrazoSport Health Alliance

1 WEST WAY COURT
LAKE JACKSON,TX77566
76-0518376 		Health Care TX BRHS
  		C Corporation 134,400 35,529 100 % Yes  
(9) Caduceus Medical Associates INC

5600 Brainerd Road Ste 500
Chattanooga,TN37411
62-1570736 		Healthcare TN MHCS
  		C Corporation 0 1,008 100 % Yes  
(10) Captive Management Initiatives Ltd

PO BOX 10073 APO
Georgetown,GRAND CAYMANKY11001
CJ
98-0663022 		Captive Management CJ CHI
  		C Corporation 3,500 176,569 100 % Yes  
(11) Carmona-DeSoto Building Horizontal Property Regime Inc

300 Werner St
Hot Springs,AR71913
71-0771076 		Healthcare AR CHI-SVHS
  		C Corporation 0 0 100 % Yes  
(12) Catholic Health Initiatives Center for Translational Research

198 INVERNESS DRIVE WEST
Englewood,CO80112
27-2269511 		Research CO CIRI
  		C Corporation 497,688 1,989,262 100 % Yes  
(13) CHI St Luke's Health Baylor College of Medicine Medical Center Condominium
Assoc
6624 Fannin STE 1100
Houston,TX77030
46-5079545 		Condo Assoc TX CHI-SLHBCM
  		C Corporation 0 0 100 % Yes  
(14) ClearRiver Health

198 INVERNESS DRIVE WEST
Englewood,CO80112
46-4495960 		Insurance CO PHPSI
  		C Corporation 80,448 5,368,013 100 % Yes  
(15) Comcare Services Inc

5570 DTC Parkway
Englewood,CO80111
84-0904813 		Inactive CO CHIC
  		C Corporation 0 0 100 % Yes  
(16) CONSOLIDATED HEALTH SERVICES

1700 EDISON DR
MILFORD,OH45150
31-1378212 		HOME HEALTH OH CHI
  		C Corporation 1,295,835 52,264,929 100 % Yes  
(17) Des Moines Medical Center Inc

1111 6TH AVE
Des Moines,IA50314
42-0837382 		Real Estate IA CHI-IA Corp
  		C Corporation 71,628 1,079,124 93 % Yes  
(18) Diversified Health Resources Inc

100 MEDICAL DRIVE
LAKE JACKSON,TX77566
76-0222679 		Health Care TX BRHS
  		C Corporation 22,442 182,538 100 % Yes  
(19) First Initiatives Insurance LTD

PO BOX 10073 APO
Georgetown,GRAND CAYMANKY11001
CJ
98-0203038 		Insurance CJ CHI
  		C Corporation 0 0 100 % Yes  
(20) Franciscan City Urgent Care Services PS dba City MD - Franciscan Urgent Car
e
C/O CPGUSA 1345 AVE OF THE AMERICAS
NEW YORK,NY10105
81-2174959 		Healthcare NY FHS
  		C Corporation 3,755,671 1,106,230 100 % Yes  
(21) Franciscan Services Inc

198 INVERNESS DRIVE WEST
Englewood,CO80112
23-2487967 		Healthcare CO CHI
  		C Corporation 0 15,522,048 100 % Yes  
(22) Good Samaritan Outreach Services

PO Box 1990
Kearney,NE68848
47-0659440 		Medical Clinic NE CHI Nebraska
  		C Corporation 260,344 212,541 100 % Yes  
(23) HarvestPlains Health of Iowa

32129 Weyerhaeuser Way S STE 201
FEDERAL WAY,WA98001
47-3451750 		Insurance WA QCHPS
  		C Corporation 45,119 3,244,070 100 % Yes  
(24) Health Systems Enterprises Inc

PO BOX 1990
Kearney,NE68848
47-0664558 		MGMT NE GSH
  		C Corporation 150,551 1,318,274 100 % Yes  
(25) Healthcare MGMT Services Organization INC

1149 MARKET ST
Tacoma,WA98402
91-1865474 		Health Org. WA FHS
  		C Corporation 0 0 100 % Yes  
(26) HeartlandPlains Health

198 INVERNESS DRIVE WEST
Englewood,CO80112
46-4368223 		Insurance CO PHPSI
  		C Corporation 5,739,433 5,513,263 100 % Yes  
(27) Highline Medical Group

1717 S J Street
Tacoma,WA98405
91-1407026 		Medical Services WA HMC
  		C Corporation 0 0 100 % Yes  
(28) Medical Office Building Horizontal Property Regime Inc

300 Werner St
Hot Springs,AR71913
71-0720429 		Real Estate AR CHI-SVHS
  		C Corporation 177,558 81,158 77 % Yes  
(29) Medquest

1301 15TH AVENUE WEST
Williston,ND58801
45-0392137 		Sale of DME ND MMC Williston
  		C Corporation 561,543 852,276 100 % Yes  
(30) Memorial CV Service Line Management Company LLC

1201 W Frank Ave
Lufkin,TX75904
46-3622849 		Heath Care TX MHSET
  		C Corporation 0 0 100 % Yes  
(31) Mercy Park Apartments LTD

1111 6th AVE
Des Moines,IA50314
42-1202422 		Housing IA CHI-IA Corp
  		C Corporation 951,900 0 100 % Yes  
(32) Mercy Services Corp

2700 STEWART PARKWAY
Roseburg,OR97471
93-0824308 		Retail Sales OR MMC
  		C Corporation 34,601 126,694 100 % Yes  
(33) MHI Clinical Services

1201 W Frank Ave
Lufkin,TX75904
46-1967952 		Healthcare TX MHSET
  		C Corporation 11,048,138 1,739,550 100 % Yes  
(34) Mountain Management Services Inc

6028 Shallowford Rd
Chattanooga,TN37421
62-1570739 		MGMT SVC ORG TN MHCS
  		C Corporation 13,439,403 3,317,936 100 % Yes  
(35) PATIENT TRANSPORT SERVICES INC

1700 EDISON DR
MILFORD,OH45150
31-1100798 		HOME HEALTH OH ANC
  		C Corporation 10,173,794 6,744,244 100 % Yes  
(36) QCA Health Plan Inc

12615 Chenal Parkway STE 300
Little Rock,AR72211
71-0794605 		Insurance AR QCHI
  		C Corporation 193,555,136 75,365,153 100 % Yes  
(37) QualChoice Advantage

32129 WEYERHAEUSER WAY S STE 201
FEDERAL WAY,WA98001
47-3433912 		Insurance WA QCPS
  		C Corporation 11,810,605 6,432,511 100 % Yes  
(38) QualChoice Health Plan Services Inc (fka CollabHealth Plan Services Inc)

198 INVERNESS DRIVE WEST
Englewood,CO80112
46-1224037 		Admin Services CO QCHI
  		C Corporation 63,300,575 219,676,343 100 % Yes  
(39) QualChoice Health Inc (fka CollabHealth Managed Solutions Inc)

198 INVERNESS DRIVE WEST
Englewood,CO80112
46-1222808 		Holding Co CO CHI
  		C Corporation 308,157 1,222,966 100 % Yes  
(40) QualChoice Holdings Inc

198 INVERNESS DRIVE WEST
Englewood,CO80112
27-4075520 		Holding Co CO PHPS
  		C Corporation 0 9,944 100 % Yes  
(41) QualChoice Life and Health Insurance Company Inc

12615 Chenal Parkway STE 300
Little Rock,AR72211
71-0386640 		Insurance AR QCH
  		C Corporation 111,184,831 54,451,054 100 % Yes  
(42) QualChoice of Nebraska

2401 S 73rd St
Omaha,NE68124
81-0738827 		Insurance NE QCH
  		C Corporation 0 0 100 % Yes  
(43) RiverLink Health

198 INVERNESS DRIVE WEST
Englewood,CO80112
46-4380824 		Insurance CO PHPS
  		C Corporation 9,198,897 6,690,368 100 % Yes  
(44) RiverLink Health of Kentucky Inc

198 INVERNESS DRIVE WEST
Englewood,CO80112
46-4828332 		Insurance CO PHPS
  		C Corporation 8,666,516 6,927,980 100 % Yes  
(45) Ross Park Pharmacy Inc

380 SUMMIT AVE
STEUBENVILLE,OH43952
34-1832654 		Pharmacy OH THS
  		C Corporation 1,513,328 2,686,059 100 % Yes  
(46) Saint Clare's Primary Care Inc

198 INVERNESS DRIVE WEST
Englewood,CO80112
22-2441202 		Billing Services CO SCCC
  		C Corporation 0 0 100 % Yes  
(47) SAMARITAN FAMILY CARE INC

40 W FOURTH ST STE 1700
Dayton,OH45402
31-1299450 		Healthcare OH SHP
  		C Corporation 29,440,066 8,967,737 100 % Yes  
(48) SJH Services Corporation

198 INVERNESS DRIVE WEST
Englewood,CO80112
23-2307408 		Healthcare CO FSI
  		C Corporation 0 1,598,610 100 % Yes  
(49) SJL PHYSICIAN MANAGEMENT SERVICES INC

424 LEWIS HARGETT CR STE 160
Lexington,KY40503
27-0164198 		Mgmt KY SJHS
  		C Corporation 0 0 100 % Yes  
(50) SoundPath Health Inc

32129 Weyerhaeuser Way S STE 201
Federal Way,WA98001
42-1720801 		Insurance WA PHPS
  		C Corporation 181,743,407 66,769,322 100 % Yes  
(51) St Alexius Health Services Inc

900 East Broadway Avenue
Bismarck,ND58501
45-0402812 		Healthcare ND SAMC
  		C Corporation 0 0 100 % Yes  
(52) St Anthony Development Company

1415 Southgate
Pendleton,OR97801
93-1216943 		Athletic Club OR SAH
  		C Corporation 1,609,675 2,187,406 100 % Yes  
(53) St Joseph Development Company Inc

1717 SOUTH J ST
Tacoma,WA98405
91-1480569 		Rental WA FSI
  		C Corporation 4,387,694 34,715,309 100 % Yes  
(54) St Luke's Episcopal Hospital Physician Hospital Organization Inc

6720 Bertner MC4-262
Houston,TX77030
76-0377932 		PHO TX CHI-SLH
  		C Corporation 0 0 100 % Yes  
(55) St Luke's Health System Holdings Inc

6624 Fannin STE 800
Houston,TX77030
76-0637138 		Holding Co TX SLHS
  		C Corporation 3,074,493 39,559,748 100 % Yes  
(56) St Vincent Community Health Services Inc

TWO ST VINCENT CIRCLE
Little Rock,AR72205
71-0710785 		Healthcare AR SVIMC
  		C Corporation 4,768,531 29,679,087 100 % Yes  
(57) StableView Health Inc

198 INVERNESS DRIVE WEST
Englewood,CO80112
46-4373713 		Insurance CO PHPS
  		C Corporation 62,195 5,180,266 100 % Yes  
(58) STE Holdings

12809 West Dodge Rd
Omaha,NE68154
82-2383629 		Holding Co NE SERMC
  		C Corporation 334,599 2,195,538 100 % Yes  
(59) Sugar Land Doctor Group

1317 Lake Point Parkway
Sugar Land,TX77478
45-4270163 		Medical Clinic TX SLCDC-SL
  		C Corporation 0 0 100 % Yes  
(60) The Texas Heart Institute at St Luke's Episcopal Hospital Denton A Cooley B
uilding Comdominium Association
6624 Fannin STE 1100
Houston,TX77030
90-0064009 		Condo Assoc TX CHI-SLH
  		C Corporation 0 0 100 % Yes  
(61) Towson Management Inc

7601 OSLER DR
Towson,MD21204
52-1710750 		Mgmt Services MD FSI
  		C Corporation 0 0 100 % Yes  
(62) TRINITY MANAGEMENT SERVICES ORGANIZATION

380 SUMMIT AVE
STEUBENVILLE,OH43952
34-1471026 		Mgmt Services OH THS
  		C Corporation 13,543,963 184,008 100 % Yes  
Schedule R (Form 990) 2019
Schedule R (Form 990) 2019
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
Yes
 
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
 
No
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
 
No
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





Schedule R (Form 990) 2019
Schedule R (Form 990) 2019
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) 2019
Schedule R (Form 990) 2019
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) 2019

Additional Data


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