| 1 | Government Employees Health Association INC Lees Summit | $6.2B | $6.1B | $2.5B |
| 2 | Ascension Seton Saint Louis | $3.3B | $3.3B | $3.2B |
| 3 | Ascension Health Alliance Saint Louis | $2.4B | $2.4B | $24.0B |
| 4 | Mhm Support Services Chesterfield | $1.5B | $1.5B | $848.9M |
| 5 | Ascension Health-is INC Saint Louis | $1.3B | $1.3B | $695.3M |
| 6 | Ssm-sluh INC Saint Louis | $948.3M | $947.9M | $708.1M |
| 7 | Delta Dental of Missouri St. Louis | $805.5M | $805.5M | $229.1M |
| 8 | Mercy Clinic East Communities Chesterfield | $739.7M | $739.7M | $136.1M |
| 9 | St. Vincents Medical Center INC Saint Louis | $454.8M | $453.8M | $323.5M |
| 10 | Missouri Valley Line Constructors Kansas City | $350.7M | $350.7M | $3.0M |
| 11 | Ministry Health Care INC Saint Louis | $330.1M | $190.8M | $18.3M |
| 12 | St. Vincent Medical Group INC Saint Louis | $315.0M | $315.0M | $141.1M |
| 13 | National Electrical Contractors Association INC Kansas City | $306.7M | $306.7M | $4.7M |
| 14 | Concordia Health Plan Saint Louis | $285.8M | $285.8M | $215.8M |
| 15 | Ibew-1 Health & Welfare Fund Saint Louis | $284.4M | $85.1M | $185.7M |
| 16 | St. Vincent Carmel Hospital INC Saint Louis | $277.6M | $277.3M | $183.5M |
| 17 | Central Electric Power Cooperative Jefferson Cty | $269.6M | $269.6M | $560.0M |
| 18 | Burrell INC Springfield | $254.6M | $242.6M | $227.3M |
| 19 | Enterprise Holdings Foundation Saint Louis | $213.4M | $0 | $545.5M |
| 20 | Alvin Goldfarb Foundation Saint Louis | $198.2M | $0 | $293.5M |
| 21 | William T Kemper Foundation Commerce Bank of Kansas City N a T Kansas City | $179.9M | $0 | $288.5M |
| 22 | Veterans of Foreign Wars of the United States Kansas City | $176.3M | $103.3M | $292.8M |
| 23 | Cuivre River Electric Cooperative Incorporated Troy | $162.0M | $161.9M | $373.7M |
| 24 | Charles K Blandin Residuary Trust 30/15962 Saint Louis | $160.3M | $0 | $382.3M |
| 25 | Acension St. Vincent South Side Saint Louis | $154.7M | $154.7M | $120.1M |
| 26 | Citizens Electric Corporation Perryville | $142.4M | $142.4M | $317.9M |
| 27 | Muriel McBrien Kauffman Foundation Kansas City | $141.5M | $0 | $277.8M |
| 28 | N W Electric Power Cooperative INC Cameron | $126.5M | $126.4M | $322.4M |
| 29 | M & a Electric Power Cooperative Poplar Bluff | $122.8M | $32.7M | $255.7M |
| 30 | St. Vincents Ambulatory Care INC Saint Louis | $122.2M | $121.9M | $43.8M |
| 31 | Greater St. Louis Construction Laborers Welfare Fund Saint Louis | $121.7M | $67.1M | $105.2M |
| 32 | Plumbers and Pipefitters Welfare Educational Fund Earth City | $114.4M | $93.4M | $203.9M |
| 33 | International Brotherhood of Eletrl Workers Hlth & Wlfr Fnd Local 124 Kansas City | $110.9M | $59.6M | $65.3M |
| 34 | Welfare Fund of Engineers Local 513 Bridgeton | $108.9M | $75.7M | $147.2M |
| 35 | Arc of the Ozarks Springfield | $108.1M | $108.1M | $53.4M |
| 36 | Easter Seals Midwest Saint Louis | $106.7M | $105.5M | $95.0M |
| 37 | International Academy of Science Kansas City | $106.6M | $106.6M | $359.3M |
| 38 | Northeast Missouri Electric Power Cooperative Palmyra | $106.2M | $106.1M | $221.3M |
| 39 | St. Louis Area Food Bank INC Bridgeton | $105.3M | $95.9M | $57.3M |
| 40 | Saint Thomas Regional Hospitals Saint Louis | $105.0M | $105.0M | $72.7M |
| 41 | Central Indiana Health System Cardiac Services INC Saint Louis | $103.1M | $102.9M | $732.9M |
| 42 | Internatonal Assoc of Machinists Bridgeton | $97.3M | $69.8M | $189.4M |
| 43 | Construction Industry Laborers Welfare Fund Kansas City | $96.0M | $86.5M | $188.4M |
| 44 | National Insurance Producer Registry Kansas City | $95.8M | $89.8M | $128.4M |
| 45 | St. Lukes Medical Group Chesterfield | $93.2M | $93.2M | $20.6M |
| 46 | International Assn of Sheet Metal Air Rail and Transportation Worker Saint Louis | $85.3M | $36.1M | $61.0M |
| 47 | Ozark Border Electric Cooperative INC Poplar Bluff | $83.7M | $34.4M | $276.1M |
| 48 | Laclede Electric Cooperative Lebanon | $82.6M | $82.6M | $241.3M |
| 49 | Southwest Electric Cooperative INC Bolivar | $82.0M | $81.7M | $206.2M |
| 50 | Mercy Hospital Carthage Carthage | $80.8M | $80.8M | $32.7M |