Form990
Click to see attachment
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)
MediumBullet Do not enter social security numbers on this form as it may be made public.
MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2019
Open to Public Inspection
A For the 2019 calendar year, or tax year beginning 01-01-2019 , and ending 12-31-2019
BCheck if applicable:
CName of organization
MERCY HEALTH PLANS INC
 
% SHERRY L CLOUSE DAY
Doing business as
 
 
Number and street (or P.O. box if mail is not delivered to street address)
3265 SOUTH NATIONAL AVENUE
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
SPRINGFIELD, MO65807
D Employer identification number

32-0486150
E Telephone number

G Gross receipts $ 13,688
F Name and address of principal officer:
SARAH ASPERGER
3265 SOUTH NATIONAL AVENUE
SPRINGFIELD,MO65807
I
Tax-exempt status: ( 4 ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.MERCY.NET
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:  
L Year of formation: 2016
M State of legal domicile: MO
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: AS THE SISTERS OF MERCY BEFORE US, WE BRING TO LIFE THE HEALING MINISTRY OF JESUS THROUGH OUR COMPASSIONATE CARE AND EXCEPTIONAL SERVICE.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 9
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 0
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 0
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 0
b Net unrelated business taxable income from Form 990-T, line 39 ......... 7b 0
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 0 0
9 Program service revenue (Part VIII, line 2g) ......... 0 0
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 11,414 13,688
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 0 0
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12) 11,414 13,688
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 0 0
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 0 0
16a Professional fundraising fees (Part IX, column (A), line 11e) ..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 33,445 22,788
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 33,445 22,788
19 Revenue less expenses. Subtract line 18 from line 12....... -22,031 -9,100
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 2,520,585 2,447,282
21 Total liabilities (Part X, line 26)............. 64,783 580
22 Net assets or fund balances. Subtract line 21 from line 20..... 2,455,802 2,446,702
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: AS THE SISTERS OF MERCY BEFORE US, WE BRING TO LIFE THE HEALING MINISTRY OF JESUS THROUGH OUR COMPASSIONATE CARE AND EXCEPTIONAL SERVICE.
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 $ 0 including grants of $ 0 ) (Revenue $ 0 )
THE CORPORATION, IN COMMITMENT TO THE GOSPEL AND IN SERVICE TO THE NEEDS OF PEOPLE, EXISTS TO ADVANCE THE MISSION AND VALUES OF MERCY HEALTH BY CREATING BENEFIT PLANS THAT LINK COMMUNITIES TO A HIGH QUALITY, PREFERRED HEALTH CARE NETWORK; BY ACCEPTING RISK, RESPONSIBILITY AND ACCOUNTABILITY FOR THE HEALTH STATUS, TREATMENT OUTCOMES AND COST EFFECTIVENESS OF CARE; BY TAKING RESPONSIBILITY FOR CONTRIBUTING TO THE LARGER COMMUNITY'S HEALTH AND WELL-BEING; AND BY OPERATING IN A MANNER THAT STEWARDS NEEDED RESOURCES, DEMONSTRATES VALUE AND TREATS ALL INDIVIDUALS WITH DIGNITY AND RESPECT. MERCY HEALTH PLANS, INC. HAS HAD MINIMAL ACTIVITY TO DATE. OPERATIONS CONSIST OF ADMINISTRATIVE COSTS RELATED TO FUTURE PLANS FOR OPERATING MEDICARE ADVANTAGE-PRESCRIPTION DRUG PLANS IN THE FUTURE. MHP CONTINUES TO EVALUATE OPTIONS AND ACTIVELY PLAN FOR FUTURE OPERATIONS.
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $ 0 including grants of $ 0 ) (Revenue $ 0 )
4e Total program service expensesMediumBullet0
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 A.....................
1
 
No
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? ...
2
 
No
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
 
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C, Part III..
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part IClick to see attachment.........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part IIClick to see attachment....
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes,"
complete Schedule D, Part IIIClick to see attachment..............
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi endowments? If "Yes," complete Schedule D, Part VClick to see attachment......
10
 
No
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10? If "Yes," complete
Schedule D, Part VI. Click to see attachment...................
11a
 
No
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIClick to see attachment.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment............
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If "Yes," complete
Schedule D, Parts XI and XIIClick to see attachment......................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States? .....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV.....
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I(see instructions) ....
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............
18
 
No
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.....
21
 
No
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........
22
 
No
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a...............
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds? ...............
24c
 
 
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3), 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
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M .................
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II........................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I............Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1.........................Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 ...Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2.............
36
 
 
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
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
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)? ..
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for 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
 
 
b
If "Yes," did the organization notify the donor of the value of the goods or services provided? .....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? .........................
7c
 
 
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
 
 
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ..
7f
 
 
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
 
No
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
 
No
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
9
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
0
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
 
No
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
Yes
 
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:
MediumBulletSHERRY L CLOUSE DAY3265 SOUTH NATIONAL AVENUE   SPRINGFIELD,MO65807 (417) 678-7827
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) James Rogers......................................................................
VP CHIEF ADULT PMRY CARE & BM
 0.2
.................
59.8 		X           0 1,106,943 66,604
(2) Michael Michetti......................................................................
COO Mercy Clinic & BM
 0.2
.................
59.8 		X           0 740,668 57,483
(3) Scott Reynolds......................................................................
CFO CENTRAL COMM & TREASURER
 0.2
.................
59.8 		X   X       0 567,650 110,425
(4) Stuart Stangeland......................................................................
VP - PHYS COMP COMPLIANCE & BM
 0.2
.................
59.8 		X           0 537,228 86,938
(5) John Brown......................................................................
Exec Dir Cl Strategies & BM
 0.2
.................
59.8 		X           0 355,961 37,074
(6) Alexander Hover......................................................................
PHYSICIAN & BOARD MEMBER
 0.2
.................
59.8 		X           0 297,571 63,534
(7) Sherry Clouse Day......................................................................
CFO Contracted Revenue & BM
 0.2
.................
59.8 		X           0 279,780 27,696
(8) William Hennessey......................................................................
VP MISSION & SECRETARY
 0.2
.................
59.8 		X   X       0 239,820 49,824
(9) Sarah Asperger START......................................................................
VP PAYOR REL CNTRCT & PRES
 1.0
.................
59.0 		X   X       0 165,117 30,318
(10) David Cane END 5151......................................................................
VP REGL PAYOR REL & PRESIDENT
 1.0
.................
59.0 		X   X       0 158,772 30,522
(11) Cesar Martinez END 5......................................................................
PRES CONTRACTED REVENUE & BM
 0.2
.................
59.8 		X           0 141,351 14,542












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;


























1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)...........MediumBullet 0 4,590,861 574,960
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
 
No
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
NONE,
 
  		   
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet0
Form 990 (2019)
Form 990 (2019)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII.............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512 - 514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues..1b  
c Fundraising events..1c  
d Related organizations1d  
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and similar amounts not included above1f  
g Noncash contributions included in lines 1a - 1f:$ 1g  
h Total. Add lines 1a-1f.......MediumBullet 0
Program Service RevenueAmt Business Code
2a
b
c
d
e
f All other program service revenue.        
g Total. Add lines 2a–2f .....MediumBullet 0
OtherAmtRevenueAmt 3 Investment income (including dividends, interest, and othersimilar amounts) ......MediumBullet 13,688     13,688
4 Income from investment of tax-exempt bond proceedsMediumBullet 0      
5 Royalties...........MediumBullet 0      
(ii) Personal (i) Real
6a Gross rents     6a
b Less: rental expenses     6b
c Rental income or (loss) 0 0 6c
d Net rental income or (loss).......MediumBullet 0      
(ii) Other (i) Securities
7a Gross amount from sales of assets other than inventory     7a
b Less: cost or other basis and sales expenses     7b
c Gain or (loss)     7c
d Net gain or (loss).........MediumBullet 0      
8a Gross income from fundraising events (not including $   of contributions reported on line 1c). See Part IV, line 18 ....
8a 0
b Less: direct expenses ... 8b 0
c Net income or (loss) from fundraising events..MediumBullet 0    
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      
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      
Business Code Miscellaneous Revenue
11a            
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet 0
12 Total revenue. See instructions.....MediumBullet 13,688     13,688
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 .... 0  
2 Grants and other assistance to domestic individuals. See Part IV, line 22 ........... 0  
3 Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. ............. 0  
4 Benefits paid to or for members ....... 0  
5 Compensation of current officers, directors, trustees, and key employees ........... 0      
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ......... 0      
7 Other salaries and wages........ 0      
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 0      
9 Other employee benefits ....... 0      
10 Payroll taxes ........... 0      
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 0      
c Accounting ........... 0      
d Lobbying ........... 0      
e Professional fundraising services. See Part IV, line 17 0  
f Investment management fees ...... 199   199  
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) 17,998   17,998  
12 Advertising and promotion .... 0      
13 Office expenses ....... 148   148  
14 Information technology ...... 0      
15 Royalties .. 0      
16 Occupancy ........... 0      
17 Travel ............ 0      
18 Payments of travel or entertainment expenses for any federal, state, or local public officials . 0      
19 Conferences, conventions, and meetings .... 0      
20 Interest ........... 0      
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization .. 0      
23 Insurance ... 0      
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 TAXES, LICENSE & FEES 4,443   4,443  
b
c
d
e All other expenses        
25 Total functional expenses. Add lines 1 through 24e 22,788 0 22,788 0
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 ........ 1,875,688 1 1,774,764
2 Savings and temporary cash investments ......... 643,272 2 672,518
3 Pledges and grants receivable, net ...... 0 3 0
4 Accounts receivable, net ............. 0 4 0
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) ...
0 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  
b Less: accumulated depreciation 10b   0 10c 0
11 Investments—publicly traded securities . 0 11 0
12 Investments—other securities. See Part IV, line 11 ..... 0 12 0
13 Investments—program-related. See Part IV, line 11 .. 0 13 0
14 Intangible assets ............... 0 14 0
15 Other assets. See Part IV, line 11 ........... 1,625 15 0
16 Total assets. Add lines 1 through 15 (must equal line 33)... 2,520,585 16 2,447,282
Liabilities 17 Accounts payable and accrued expenses ..... 0 17 0
18 Grants payable ... 0 18 0
19 Deferred revenue ......... 0 19 0
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 .........
0 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 64,783 25 580
26 Total liabilities. Add lines 17 through 25.. 64,783 26 580
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 ..... 600,000 29 600,000
30 Paid-in or capital surplus, or land, building or equipment fund ... 1,855,802 30 1,846,702
31 Retained earnings, endowment, accumulated income, or other funds 0 31 0
32 Total net assets or fund balances ........... 2,455,802 32 2,446,702
33 Total liabilities and net assets/fund balances ........ 2,520,585 33 2,447,282
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
13,688
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
22,788
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
-9,100
4
Net assets or fund balances at beginning of year (must equal Part X, line 32, column (A)) ..
4
2,455,802
5
Net unrealized gains (losses) on investments ...............
5
 
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
 
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 32, column (B))
10
2,446,702
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:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
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 HEALTH PLANS INC
 
Employer identification number

32-0486150
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 $  
(ii)
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under 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 ....          
b Contributions ...          
c Net investment earnings, gains, and losses          
d Grants or scholarships ...          
e Other expenditures for facilities
and programs ... 		         
f Administrative expenses ....          
g End of year balance ......          
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Term endowment SchDMd Bullet  
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)
 
 
(ii) Related organizations .................
3a(ii)
 
 
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 .....      
b Buildings ....        
c Leasehold improvements        
d Equipment ....        
e Other .....        
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..SchDMdBullet  
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
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
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 0
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 580
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
FORM 990, SCHEDULE D, PART X, LINE 2 ASC 740 FOOTNOTE PRIMARILY ALL OF THE HEALTH SYSTEM ENTITIES ARE RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(A) OF THE INTERNAL REVENUE CODE AS CHARITABLE ORGANIZATIONS QUALIFYING UNDER INTERNAL REVENUE CODE SECTION 501(C)(3), BY VIRTUE OF IRS DETERMINATION LETTERS OR INCLUSION IN THE OFFICIAL CATHOLIC DIRECTORY. THE HEALTH SYSTEM COMPLETED AN ANALYSIS OF ITS TAX POSITIONS IN ACCORDANCE WITH APPLICABLE ACCOUNTING GUIDANCE AND DETERMINED THAT NO AMOUNTS WERE REQUIRED TO BE RECOGNIZED ON THE CONSOLIDATED FINANCIAL STATEMENTS AT JUNE 30, 2019 OR 2018.
Schedule D (Form 990) 2019


Additional Data


Software ID:  
Software Version:  




Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" 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 HEALTH PLANS INC
 
Employer identification number

32-0486150
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
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3), 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
1David Cane END 51519
VP REGL PAYOR REL & PRESIDENT 		(i)

(ii)		 0
-------------
87,249 		0
-------------
0 		0
-------------
71,523 		0
-------------
26,246 		0
-------------
4,276 		0
-------------
189,294 		0
-------------
0
2William Hennessey
VP MISSION & SECRETARY 		(i)

(ii)		 0
-------------
174,282 		0
-------------
16,820 		0
-------------
48,718 		0
-------------
34,458 		0
-------------
15,366 		0
-------------
289,644 		0
-------------
0
3Scott Reynolds
CFO CENTRAL COMM & TREASURER 		(i)

(ii)		 0
-------------
392,239 		0
-------------
115,012 		0
-------------
60,399 		0
-------------
98,156 		0
-------------
12,269 		0
-------------
678,075 		0
-------------
0
4John Brown
Exec Dir Cl Strategies & BM 		(i)

(ii)		 0
-------------
301,810 		0
-------------
20,125 		0
-------------
34,026 		0
-------------
21,337 		0
-------------
15,737 		0
-------------
393,035 		0
-------------
0
5Alexander Hover
PHYSICIAN & BOARD MEMBER 		(i)

(ii)		 0
-------------
277,930 		0
-------------
196 		0
-------------
19,445 		0
-------------
51,366 		0
-------------
12,168 		0
-------------
361,105 		0
-------------
0
6James Rogers
VP CHIEF ADULT PMRY CARE & BM 		(i)

(ii)		 0
-------------
501,334 		0
-------------
538,026 		0
-------------
67,583 		0
-------------
49,843 		0
-------------
16,761 		0
-------------
1,173,547 		0
-------------
351,821
7Stuart Stangeland
VP - PHYS COMP COMPLIANCE & BM 		(i)

(ii)		 0
-------------
366,710 		0
-------------
124,619 		0
-------------
45,899 		0
-------------
70,697 		0
-------------
16,241 		0
-------------
624,166 		0
-------------
0
8Sarah Asperger START 51519
VP PAYOR REL CNTRCT & PRES 		(i)

(ii)		 0
-------------
142,612 		0
-------------
12,218 		0
-------------
10,287 		0
-------------
17,820 		0
-------------
12,498 		0
-------------
195,435 		0
-------------
0
9Cesar Martinez END 5119
PRES CONTRACTED REVENUE & BM 		(i)

(ii)		 0
-------------
128,102 		0
-------------
0 		0
-------------
13,249 		0
-------------
9,625 		0
-------------
4,917 		0
-------------
155,893 		0
-------------
0
10Michael Michetti
COO Mercy Clinic & BM 		(i)

(ii)		 0
-------------
478,582 		0
-------------
121,175 		0
-------------
140,911 		0
-------------
44,938 		0
-------------
12,545 		0
-------------
798,151 		0
-------------
0
11Sherry Clouse Day
CFO Contracted Revenue & BM 		(i)

(ii)		 0
-------------
196,882 		0
-------------
21,751 		0
-------------
61,147 		0
-------------
15,874 		0
-------------
11,822 		0
-------------
307,476 		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
FORM 990, SCHEDULE J, PART I, QUESTION 3 FOR THOSE CLASSIFIED AS OFFICERS (AND THUS DISQUALIFIED PERSONS), THE ORGANIZATION RELIES UPON MERCY HEALTH, WHICH USES THE FOLLOWING TO ESTABLISH THE COMPENSATION: EXTERNAL MARKET SALARY SURVEYS, EXTERNAL MARKET SALARY STUDIES, ENGAGEMENT OF AN INDEPENDENT COMPENSATION CONSULTANT, AND REVIEW/APPROVAL OF COMPENSATION BY THE COMPENSATION COMMITTEE OF THE BOARD OF MERCY HEALTH. COMPENSATION REVIEWS ARE COMPLETED ON AN ANNUAL BASIS, AND A REVIEW WAS COMPLETED DURING THE REPORTING YEAR.
FORM 990, SCHEDULE J, PART I, QUESTION 4B MERCY OFFERS SUPPLEMENTAL RETIREMENT PLANS TO CERTAIN EXECUTIVES WHICH PROVIDE BENEFITS UPON VESTING DATE BASED ON COMPENSATION, AGE AT THE TIME OF BENEFIT COMMENCEMENT, LENGTH OF SERVICE WITH THE COMPANY AND/OR ITS AFFILIATES, AND LENGTH OF TENURE IN THE PLAN. THE PLANS ARE CLOSED TO NEW ENTRANTS. THE INDIVIDUALS REPORTABLE ON THIS RETURN WHO PARTICIPATE IN THE SUPPLEMENTAL RETIREMENT PLANS INCLUDE: SCOTT REYNOLDS, WILLIAM HENNESSEY, ALEXANDER HOVER, JAMES ROGERS, AND STUART STANGELAND. THE AMOUNT OF ALL ACCRUED BENEFITS IS INCLUDED IN COMPENSATION AMOUNTS PROVIDED IN SCHEDULE J, PART II, COLUMN (C). MERCY HEALTH ALSO OFFERS INCENTIVE COMPENSATION PROGRAMS TO CERTAIN EXECUTIVES WHICH PROVIDE BENEFITS UPON VESTING DATES BASED ON COMPENSATION AND LENGTH OF TENURE IN THE PLAN. THE INDIVIDUALS REPORTABLE ON THIS RETURN WHO PARTICIPATE IN THE INCENTIVE COMPENSATION PROGRAMS INCLUDE: SCOTT REYNOLDS, JAMES ROGERS, AND STUART STANGELAND. THE ANNUAL ACCRUALS FOR THESE PROGRAMS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (C).
FORM 990, SCHEDULE J, PART II THE AMOUNT REPORTED FOR JAMES ROGERS IN COLUMN (F) IS INCLUDED IN COLUMN B (II). THIS IS A PAYOUT OF THE INCENTIVE COMPENSATION PROGRAM AND WAS INCLUDED IN COLUMN (C) OF PREVIOUSLY FILED FORMS 990.
Schedule J (Form 990) 2019

Additional Data


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

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

Complete to provide information for responses to specific questions on
Form 990 or 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 HEALTH PLANS INC
 
Employer identification number

32-0486150
Return Reference Explanation
FORM 990, PART V, QUESTION 1A FORM 1099/1096 FILING VENDORS FOR THE FILING ORGANIZATION ARE PAID BY MERCY HEALTH (EIN 43-1423050). AS SUCH, ALL REQUIRED FORM 1099 AND FORM 1096 REPORTING IS MADE FOR THE ENTIRE MERCY HEALTH SYSTEM (WITH LIMITED EXCEPTIONS) UNDER THE MERCY HEALTH EIN.
FORM 990, PART V, QUESTION 2A W-3 FILING EMPLOYEES ARE PAID BY A RELATED ORGANIZATION UNDER A COMMON PAYMASTER ARRANGEMENT. AS SUCH, REQUIRED PAYROLL FILING (INCLUDING W-2 AND W-3'S) IS REPORTED UNDER THE RELATED ORGANIZATION, MHM SUPPORT SERVICES, EIN 20-2553101.
FORM 990, PART VI, LINE 6A, LINE 7A, 7B CLASSES OF MEMBERS OR STOCKHOLDERS THE FILING ORGANIZATION HAS A SOLE CORPORATE MEMBER, MERCY HEALTH PLANS OF MISSOURI, INC. THE FOLLOWING CORPORATE POWERS AND RESPONSIBILITIES SHALL BE RESERVED SOLELY UNTO THE CORPORATE MEMBER: -TO APPROVE THE MISSION AND ESTABLISH THE PHILOSOPHY ACCORDING TO WHICH THE CORPORATION AND ANY CORPORATION CONTROLLED BY THE CORPORATION SHALL OPERATE; -TO AMEND THE ARTICLES OF INCORPORATION AND BYLAWS OF THE CORPORATION AND TO AMEND THE ARTICLES OF INCORPORATION AND BYLAWS OF ANY CORPORATION CONTROLLED BY THE CORPORATION; -TO APPOINT AND REMOVE MEMBERS OF THE BOARD OF DIRECTORS OF THE CORPORATION AND MEMBERS OF THE BOARD OF DIRECTORS OF ANY CORPORATION CONTROLLED BY THE CORPORATION; -TO NOMINATE FOR APPOINTMENT BY THE BOARD OR DIRECTORS, AND REMOVE, THE PRESIDENT OF THE CORPORATION AND THE PRESIDENT OF ANY CORPORATION CONTROLLED BY THE CORPORATION; -TO APPROVE OR AMEND THE STRATEGIC PLAN, GOALS, AND OBJECTIVES OF THE CORPORATION AND OF ANY CORPORATION CONTROLLED BY THE CORPORATION; -TO APPROVE AND AMEND THE OPERATING, CAPITAL AND CONSTRUCTION BUDGETS FOR THE CORPORATION AND OF ANY CORPORATION CONTROLLED BY THE CORPORATION; -TO LEASE OR SELL SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION OR ANY CORPORATION CONTROLLED BY THE CORPORATION; -TO ENCUMBER ANY OR ALL OF THE ASSETS OF THE CORPORATION OR ANY CORPORATION CONTROLLED BY THE CORPORATION; -TO AUTHORIZE AND APPROVE THE INCURRENCE OF DEBT BY THE CORPORATION OR ANY CORPORATION CONTROLLED BY THE CORPORATION (OTHER THAN DEBT INCURRED FOR THE ACQUISITION OF GOODS IN THE ORDINARY COURSE OF BUSINESS) AND TO GRANT ANY SECURITY INTERESTS, PLACE ANY ENCUMBRANCES, ENTER INTO ANY COVENANTS, AND EXECUTE ANY DOCUMENTS AND TAKE ANY ACTIONS NECESSARY OR APPROPRIATE IN CONNECTION WITH THE INCURRENCE OF SUCH DEBT; -TO MERGE, DISSOLVE, OR ABANDON THE CORPORATION OR ANY CORPORATION CONTROLLED BY THE CORPORATION; AND, -TO APPROVE THE CREATION, OWNERSHIP, OR ACQUISITION OF, OR AFFILIATION WITH, ANY OTHER ORGANIZATION BY THE CORPORATION.
FORM 990, PART VI, QUESTION 8B DESCRIPTION OF PRACTICE RE: DOCUMENTATION OF MTGS & ACTION OF COMMITTEES THE BYLAWS PROVIDE THE OPTION OF HAVING COMMITTEES. HOWEVER, FOR THE TAX YEAR ENDING 12/31/19, THERE WERE NO COMMITTEES OPERATING ON BEHALF OF THE GOVERNING BODY.
FORM 990, PART VI, QUESTION 11B DSCR THE PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990 THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM USING INFORMATION PROVIDED BY THE FILING ORGANIZATION. A DRAFT FORM 990 IS REVIEWED BY THE FILING ORGANIZATION'S FINANCE TEAM, INCLUDING THE VICE PRESIDENT OF FINANCE. THE DRAFT FORM 990 IS ALSO REVIEWED BY MERCY HEALTH'S TAX DEPARTMENT, TO ENSURE ACCURACY AND CONSISTENCY WITH OTHER RELATED ORGANIZATIONS' FORMS 990. AFTER QUESTIONS ARISING FROM THE REVIEWS ARE ADDRESSED AND INCORPORATED INTO THE FORM 990, A REVISED DRAFT IS PROVIDED TO THE FILING ORGANIZATION'S BOARD OF DIRECTORS FOR THEIR REVIEW. THE FORM 990 IS THEN SIGNED AND FILED WITH THE IRS.
FORM 990, PART VI, QUESTION 12C DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST OFFICERS, DIRECTORS, KEY EMPLOYEES AND OTHER DISQUALIFIED PERSONS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE ANNUALLY AND DID SO IN THE NORMAL COURSE FOR THE YEAR ENDED DECEMBER 31, 2019. THIS PROCESS IS ADMINISTERED AT THE MERCY HEALTH LEVEL BY MERCY'S CORPORATE COMPLIANCE DEPARTMENT. THE QUESTIONNAIRES ARE REVIEWED WITH LEADERSHIP AT THE LOCAL LEVEL AND POTENTIAL CONFLICTS DISCUSSED AND RESOLVED. THE CONFLICTS AND THEIR RESPECTIVE RESOLUTIONS ARE SHARED AT THE MERCY LEVEL WITH A TEAM INCLUDING MERCY'S CHIEF FINANCIAL OFFICER, CHIEF COMPLIANCE OFFICER AND OTHER MEMBERS OF FINANCE, LEGAL AND HR. SUMMARY RESULTS ARE REVIEWED WITH MERCY'S STEWARDSHIP COMMITTEE OF THE BOARD OF DIRECTORS.
FORM 990, PART VI, QUESTIONS 15A & 15B OFFICERS & POSITIONS FOR WHICH PROCESS WAS USED & YEAR PROCESS WAS BEGUN FOR THOSE CLASSIFIED AS OFFICERS (AND THUS DISQUALIFIED PERSONS), THE ORGANZATION RELIES UPON MERCY HEALTH, WHICH USES THE FOLLOWING TO ESTABLISH THE COMPENSATION: EXTERNAL MARKET SALARY SURVEYS, EXTERNAL MARKET SALARY STUDIES, ENGAGEMENT OF AN INDEPENDENT COMPENSATION CONSULTANT, AND REVIEW/APPROVAL OF COMPENSATION BY THE COMPENSATION COMMITTEE OF THE BOARD OF MERCY HEALTH. COMPENSATION REVIEWS ARE COMPLETED ON AN ANNUAL BASIS, AND A REVIEW WAS COMPLETED DURING THE REPORTING YEAR.
FORM 990, PART VI, QUESTION 19 AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMT TO GEN PUBLIC GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST AS REQUIRED.
FORM 990, PART XII, QUESTION 2C AUDIT OF FINANCIAL STATEMENTS THE FILING ORGANIZATION'S FINANCIAL STATEMENTS WERE INCLUDED IN THE MERCY HEALTH ANNUAL FINANCIAL STATEMENT AUDIT. MERCY HEALTH AND SUBSIDIARIES RECEIVED AN UNQUALIFIED OPINION FROM THE EXTERNAL AUDITORS FOR FISCAL 2019 (PARTS OF WHICH ARE INCLUDED IN THE TAX YEAR CURRENTLY BEING REPORTED). THE ULTIMATE RESPONSIBILITY FOR OVERSIGHT OF THE FINANCIAL STATEMENT AUDIT AND SELECTION OF THE EXTERNAL AUDITOR LIES WITH THE STEWARDSHIP COMMITTEE OF THE MERCY HEALTH BOARD OF DIRECTORS. AUDIT RESULTS ARE COMMUNICATED TO THIS COMMITTEE.
FORM 990 PART IX LINE 11G DESCRIPTION:CONSULTING FEES TOTAL FEES:17998
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:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990.
MediumBullet 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 HEALTH PLANS INC
 
Employer identification number

32-0486150
Part I
Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income


 		(e)
End-of-year assets


 		(f)
Direct controlling
entity










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


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section


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

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled entity?
Yes No
(1)Casa de Misericordia
1000 MIER STREET

Laredo,TX78040
74-2912461 		SHELTER TX 501c3 7 MM LAREDO
 
Yes
 
(2)McAuley Portfolio Management Company
14528 S Outer Forty Suite 100

Chesterfield,MO63017
26-1708048 		PORT MGMT MO 501c3 12b Mercy Health
 
Yes
 
(3)Mercy ACO Clinical Services Inc
14528 S Outer Forty Suite 100

Chesterfield,MO63017
46-4504901 		VIRTUAL CARE MO 501c3 3 Mercy Health
 
Yes
 
(4)Mercy Clinic East Communities
645 Maryville Ctr Ste 100

St Louis,MO63141
43-1771217 		PHYS GROUP MO 501c3 10 MH EAST COMM
 
Yes
 
(5)Mercy Clinic Fort Smith Communities
7301 Rogers Avenue

Fort Smith,AR72903
26-1318597 		PHYS CLINIC AR 501c3 3 MH FS COMM
 
Yes
 
(6)Mercy Clinic Oklahoma Communities Inc
4300 W Memorial Road

Oklahoma City,OK73120
27-0473057 		PHYS GROUP OK 501c3 3 MH OK COMM
 
Yes
 
(7)Mercy Clinic Springfield Communities
1965 Fremont Street Suite 2950

Springfield,MO65804
43-1560263 		PHYS GROUP MO 501c3 3 MH SF COMM
 
Yes
 
(8)Mercy Family Center
14528 S Outer Forty Suite 100

Chesterfield,MO63017
72-1069468 		COUNSELING LA 501c3 7 Mercy Health
 
Yes
 
(9)Mercy Health
14528 S Outer Forty Suite 100

Chesterfield,MO63017
43-1423050 		CORP OFFICE MO 501c3 1 NA
 
 
No
(10)Mercy Health East Communities
14528 S Outer Forty Suite 100

Chesterfield,MO63017
43-1718408 		HLTH SYSTEM MO 501c3 12a Mercy Health
 
Yes
 
(11)Mercy Health Fort Smith Communities
7301 Rogers Avenue

Fort Smith,AR72917
26-1318515 		Holding Co AR 501c3 12b Mercy Health
 
Yes
 
(12)Mercy Health Foundation
14528 S Outer Forty Suite 100

Chesterfield,MO63017
20-0901499 		Foundation MO 501c3 12b Mercy Health
 
Yes
 
(13)Mercy Health Foundation Ada
430 N Monte Vista Street

Ada,OK74820
46-3596274 		Foundation OK 501c3 12a MH ADA Inc
 
Yes
 
(14)Mercy Health Foundation Ardmore
1011 14th Avenue NW

Ardmore,OK73401
71-0962525 		Foundation OK 501c3 12a MH ARDMORE
 
Yes
 
(15)Mercy Health Foundation Berryville
214 Carter Street

Berryville,AR72616
71-0759301 		Foundation AR 501c3 12a MH BERRYVILL
 
Yes
 
(16)Mercy Health Foundation Fort Scott
401 Woodland Hills Blvd

Fort Scott,KS66701
48-1077073 		Foundation KS 501c3 7 M KS COMM
 
Yes
 
(17)Mercy Health Foundation Fort Smith
7301 Rogers Avenue

Fort Smith,AR72917
23-7330425 		Foundation AR 501c3 7 MH FS COMM
 
Yes
 
(18)Mercy Health Foundation Jefferson
1400 US Highway 61 South

Festus,MO63028
46-2797051 		Foundation MO 501c3 12b MH JEFFERSON
 
Yes
 
(19)Mercy Health Foundation Joplin
100 Mercy Way

Joplin,MO64804
27-0906136 		Foundation MO 501c3 7 MH SW MOKS
 
Yes
 
(20)Mercy Health Foundation Lebanon
100 Hospital Drive

Lebanon,MO65536
82-2514567 		Foundation MO 501c3 12b MH LEBANON
 
Yes
 
(21)Mercy Health Foundation Lincoln
1000 East Cherry Street

Troy,MO63379
81-1477159 		Foundation MO 501c3 12b MH EAST COMM
 
Yes
 
(22)Mercy Health Foundation Nw Arkansas
2710 Rife Medical Lane

Rogers,AR72758
71-0601687 		Foundation AR 501c3 7 MH ROGERS
 
Yes
 
(23)Mercy Health Foundation of Oklahoma
4300 W Memorial Road

Oklahoma City,OK73120
45-4732301 		Foundation OK 501c3 12a MH OK COMM
 
Yes
 
(24)Mercy Health Foundation Oklahoma City
4300 W Memorial Road

Oklahoma City,OK73120
46-3184231 		Foundation OK 501c3 12a MH OK City
 
Yes
 
(25)Mercy Health Foundation Springfield
1235 E Cherokee Street

Springfield,MO65804
32-0195818 		Foundation MO 501c3 12b MH SF COMM
 
Yes
 
(26)Mercy Health Foundation St Francis
100 W Highway 60

Mountain View,MO65548
43-1873914 		Foundation MO 501c3 12a M St Francis
 
Yes
 
(27)Mercy Health Foundation St Louis
14528 S Outer Forty Suite 100

Chesterfield,MO63017
56-2410020 		Foundation MO 501c3 12b MH EAST COMM
 
Yes
 
(28)Mercy Health Foundation Washington
901 E Fifth Street

Washington,MO63090
56-2410022 		Foundation MO 501c3 12b MH EAST COMM
 
Yes
 
(29)Mercy Health NW Arkansas Communities
2710 Rife Medical Lane

Rogers,AR72758
62-1684203 		PHYS GROUP AR 501c3 10 Mercy Health
 
Yes
 
(30)Mercy Health Oklahoma Communities Inc
4300 W Memorial Road

Oklahoma City,OK73120
73-1453048 		HLTH SYSTEM OK 501c3 12a Mercy Health
 
Yes
 
(31)Mercy Health Plans of Missouri Inc
3265 S National Avenue

Springfield,MO65807
32-0481419 		HMO MO 501c4 N/A Mercy Health
 
Yes
 
(32)Mercy Health SW MOKS Communities
100 Mercy Way

Joplin,MO64804
30-0584463 		HLTH SYSTEM MO 501c3 12b Mercy Health
 
Yes
 
(33)Mercy Health Springfield Communities
1235 E Cherokee Street

Springfield,MO65804
43-1856028 		HLTH SYSTEM MO 501c3 12b Mercy Health
 
Yes
 
(34)Mercy Home Health Berryville
804 W Freeman Suite 4

Berryville,AR72616
87-0781247 		Inactive AR 501c3 12a MH SPRINGFLD
 
Yes
 
(35)Mercy Hospital Ada Inc
430 N Monte Vista Street

Ada,OK74820
46-2288155 		Hospital OK 501c3 3 MH OK COMM
 
Yes
 
(36)Mercy Hospital Ardmore Inc
1011 14th Avenue NW

Ardmore,OK73401
73-1500629 		Hospital OK 501c3 3 MH OK COMM
 
Yes
 
(37)Mercy Hospital Aurora
500 Porter Avenue

Aurora,MO65605
43-1936696 		Hospital MO 501c3 3 MH SF COMM
 
Yes
 
(38)Mercy Hospital Berryville
214 Carter Street

Berryville,AR72616
71-0759299 		Hospital AR 501c3 3 MH NW AK COM
 
Yes
 
(39)Mercy Hospital Booneville
880 West Main Street

Booneville,AR72927
46-3851119 		Hospital AR 501c3 3 MH FT SMITH
 
Yes
 
(40)Mercy Hospital Carthage
3125 Dr Russell Smith Way

Carthage,MO64836
45-3808607 		Hospital MO 501c3 3 MH SW MOKS
 
Yes
 
(41)Mercy Hospital Cassville
94 Main Street

Cassville,MO65625
43-1936699 		Hospital MO 501c3 3 MH SF COMM
 
Yes
 
(42)Mercy Hospital Columbus
220 Pennsylvania Avenue

Columbus,KS66725
27-0842031 		Hospital KS 501c3 3 MH SW MOKS
 
Yes
 
(43)Mercy Hospital El Reno Inc
2115 Parkview Drive

El Reno,OK73036
27-2716065 		Hospital OK 501c3 3 MH OK City
 
Yes
 
(44)Mercy Hospital Fort Smith
7301 Rogers Avenue

Fort Smith,AR72903
71-0240352 		Hospital AR 501c3 3 MH FS COMM
 
Yes
 
(45)Mercy Hospital Healdton Inc
3462 Hospital Rd

Healdton,OK73438
26-3173902 		Hospital OK 501c3 3 MH ARDMORE
 
Yes
 
(46)Mercy Hospital Jefferson
1400 Highway 61 South

Festus,MO63028
43-0687077 		Hospital MO 501c3 3 MH EAST COMM
 
Yes
 
(47)Mercy Hospital Joplin
100 Mercy Way

Joplin,MO64804
27-0814858 		Hospital MO 501c3 3 MH SW MOKS
 
Yes
 
(48)Mercy Hospital Kingfisher Inc
1000 Kingfisher Regional Hospital C

Kingfisher,OK73750
46-3433074 		Hospital OK 501c3 3 MH OK City
 
Yes
 
(49)Mercy Hospital Lebanon
100 Hospital Drive

Lebanon,MO65536
43-1767432 		Hospital MO 501c3 3 MH SF COMM
 
Yes
 
(50)Mercy Hospital Lincoln
1000 East Cherry Street

Troy,MO63379
47-2219204 		Hospital MO 501c3 3 MH EAST COMM
 
Yes
 
(51)Mercy Hospital Logan County Inc
200 South Academy

Guthrie,OK73044
45-2998842 		Hospital OK 501c3 3 MH OK City
 
Yes
 
(52)Mercy Hospital Oklahoma City Inc
4300 W Memorial Road

Oklahoma City,OK73120
73-0579285 		Hospital OK 501c3 3 MH OK COMM
 
Yes
 
(53)Mercy Hospital Ozark
801 W River Street

Ozark,AR72949
71-0689680 		Hospital AR 501c3 3 MH FT Smith
 
Yes
 
(54)Mercy Hospital Paris
500 E Academy

Paris,AR72855
71-0655753 		Hospital AR 501c3 3 MH FT Smith
 
Yes
 
(55)Mercy Hospital Rogers
2710 Rife Medical Lane

Rogers,AR72758
71-0294390 		Hospital AR 501c3 3 MH NW AK COM
 
Yes
 
(56)Mercy Hospital Springfield
1235 E Cherokee Street

Springfield,MO65804
44-0552485 		Hospital MO 501c3 3 MH SF COMM
 
Yes
 
(57)Mercy Hospital Tishomingo Inc
1000 South Byrd

Tishomingo,OK73460
27-4433830 		Hospital OK 501c3 3 MH ADA Inc
 
Yes
 
(58)Mercy Hospital Waldron
1341 W 6th Street

Waldron,AR72958
71-0557895 		Hospital AR 501c3 3 MH FT Smith
 
Yes
 
(59)Mercy Hospital Watonga Inc
500 Clarence Nash Blvd

Watonga,OK73772
45-5199762 		Hospital OK 501c3 3 MH OK City
 
Yes
 
(60)Mercy Hospitals East Communities
615 S New Ballas Road

St Louis,MO63141
43-0653493 		Hospital MO 501c3 3 MH EAST COMM
 
Yes
 
(61)Mercy Kansas Communities Inc
401 Woodland Hills Blvd

Ft Scott,KS66701
48-0956045 		Hospital KS 501c3 3 MH SW MOKS
 
Yes
 
(62)Mercy Ministries of Laredo
2500 Zacatecas

Laredo,TX78046
20-0198462 		Outreach TX 501c3 7 Mercy Health
 
Yes
 
(63)Mercy Research
524 North Booneville Avenue

Springfield,MO65802
87-0796305 		Research MO 501c3 4 Mercy Health
 
Yes
 
(64)Mercy St Francis HosPital
100 W Highway 60

Mountain View,MO65548
44-0607149 		Hospital MO 501c3 3 MH SF COMM
 
Yes
 
(65)MHM Support Services
14528 S Outer Forty Suite 100

Chesterfield,MO63017
20-2553101 		CTRL SYS FUNC MO 501c3 12a Mercy Health
 
Yes
 
(66)Mission Clinical Services
300 Werner Street

Hot Springs,AR71913
13-4239691 		CHILD ADVOC AR 501c3 3 Mercy Health
 
Yes
 
(67)Mercy Hlth Fdn S-fka St Anthonys Ch FDN
10010 Kennerly Road

St Louis,MO63128
26-1516789 		Fundraising MO 501c3 12a MH SOUTH
 
Yes
 
(68)MERCY HOSP SOUTH-FKA ST ANTHONY MED CTR
10010 Kennerly Road

St Louis,MO63128
43-0980256 		Hospital MO 501c3 3 MH EAST COMM
 
Yes
 
(69)St Anthony's Physician Organization
10010 Kennerly Road

St Louis,MO63128
43-1784536 		Health care MO 501c3 3 MH SOUTH
 
Yes
 
(70)St Mary's Hospital of Enid Oklahoma Inc
14528 S Outer Forty Suite 100

Chesterfield,MO63017
73-0614655 		Inactive OK 501c3 3 MH OK COMM
 
Yes
 
(71)Unity Ambulatory Care
14528 S Outer Forty Suite 100

Chesterfield,MO63017
43-1861745 		Inactive MO 501c3 12c MH EAST COMM
 
Yes
 
(72)Mercy Specialty Hosp Southeast Kansas
14528 S Outer Forty Suite 100

Chesterfield,MO63017
84-3730625 		HOSPITAL KS 501C3 3 MH SW MOKS
 
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) Fort Smith Emergency Medical Services

1701 S Greenwood
FT SMITH,AR72901
71-0416615 		Emergency Medical AR NA
  		                 
(2) Mercy Ambulatory Surgery Center LLC

7301 Rogers
FT SMITH,AR72917
71-0827721 		AMBUL SURG CT AR NA
  		                 
(3) Plaza Surgery Services Company LLC

12700 Southfork RD
St Louis,MO63128
20-4709312 		INACTIVE MO NA
  		                 
(4) Resource Optimization & Innovation LLC

645 Maryville
St Louis,MO63141
46-0468368 		CENTRAL DIST. MO NA
  		                 
(5) St Edward Mercy Med Ctr Multi-Purp BLDG

7301 Rogers
FT SMITH,AR72903
71-0554050 		OFFICE BUILDING AR NA
  		                 




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) Frontenac Properties Inc

14528 S Outer Forty Suite 100
Chesterfield,MO63017
52-1914421 		Holding co DE NA
  		C-Corp          
(2) Inveno Health Inc

1235 E Cherokee Street
Springfield,MO65804
26-4509571 		Product Commerce MO NA
  		C-Corp          
(3) Mercy Commercial Services Inc

14528 South Outer Forty Suite 100
Chesterfield,MO63017
46-4953543 		PARENT OF VCC MO NA
  		C-Corp          
(4) Mercy Health Center Condominium Inc

4300 W Memorial Rd
Oklahoma City,OK73120
68-0640970 		Real estate OK NA
  		C-Corp          
(5) Mercy Health Network of the Southern Reg

14528 S Outer Forty Suite 100
Chesterfield,MO63017
73-1580607 		HOLDING CO OK NA
  		C-Corp          
(6) Mercy Health Network Inc

14528 S Outer Forty Suite 100
Chesterfield,MO63017
73-1381689 		HOLDING CO OK NA
  		C-Corp          
(7) Mercy Managed Care Corporation

14528 S Outer Forty Suite 100
Chesterfield,MO63017
73-1441665 		HOLDING CO OK NA
  		C-Corp          
(8) UHL Corp Inc

645 Maryville Centre Drive Suite 1
St Louis,MO63141
74-2499535 		Holding co MO NA
  		C-Corp          
(9) Unity Support Services Inc

645 Maryville Centre Drive Suite 1
St Louis,MO63141
43-1797042 		Inactive MO NA
  		C-Corp          
(10) St Anthony's Physician Org of Illinois

10010 Kennerly Road
St Louis,MO63128
32-0457168 		Health Care MO NA
  		C-Corp          
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
 
No
c Gift, grant, or capital contribution from related organization(s) ............................
1c
 
No
d Loans or loan guarantees to or for related organization(s) ............................
1d
 
No
e Loans or loan guarantees by related organization(s) ............................
1e
 
No
f Dividends from related organization(s) ............................
1f
 
No
g Sale of assets to related organization(s) ............................
1g
 
No
h Purchase of assets from related organization(s) ............................
1h
 
No
i Exchange of assets with related organization(s) ............................
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) .......................
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) ......................
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) .....................
1l
 
No
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
 
No
o Sharing of paid employees with related organization(s) ............................
1o
 
No
p Reimbursement paid to related organization(s) for expenses ............................
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses ............................
1q
Yes
 
r Other transfer of cash or property to related organization(s) ............................
1r
 
No
s Other transfer of cash or property from related organization(s) ............................
1s
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved





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
FORM 990, SCHEDULE R, PART II MERCY HOSPITALS EAST COMMUNITIES MERCY HOSPITALS EAST COMMUNITIES CONSISTS OF MERCY HOSPITAL ST. LOUIS, EIN 43-0653493, AND MERCY HOSPITAL WASHINGTON, EIN 43-1066883.
Schedule R (Form 990) 2019

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