| COLUMBIA ST MARY'S INC | St Louis | E21 Health Care | $195.2M | 9 |
| Ascension Welfare Benefits Trust | St Louis | Y43 Mutual & Membership Benefit | $191.4M | 1 |
| MINISTRY HEALTH CARE INC | St Louis | — | $190.8M | 7 |
| Dell Children's Medical Group | St Louis | E24 Health Care | $184.2M | 10 |
| Maryville University - St Louis | St Louis | B430 Education | $180.5M | 8 |
| HORIZON HOUSING FOUNDATION | Saint Louis | L20 Housing & Shelter | $179.7M | 0 |
| PREFERRED FAMILY HEALTHCARE INC | Kirksville | F20Z Mental Health & Crisis Intervention | $177.5M | 16 |
| St Joseph Hospital & Health Center Inc | St Louis | E220 Health Care | $177.3M | 16 |
| Mercy Health | Chesterfield | E02 Health Care | $172.9M | 16 |
| ST VINCENT ANDERSON REGIONAL HOSPITAL INC | St Louis | E22 Health Care | $171.4M | 15 |
| Webster University | St Louis | B430 Education | $170.8M | 11 |
| JOHNNY MORRIS' OZARKS HERITAGE PRESERVE | Springfield | D30 Animal-Related | $168M | 5 |
| ASCENSION MICHIGAN | St Louis | P750 Human Services | $166.3M | 14 |
| LINDENWOOD EDUCATION SYSTEM | St Charles | B43 Education | $165.5M | 17 |
| Ameren Active Employee Healthcare Trust | Saint Louis | Y43 Mutual & Membership Benefit | $164.6M | 1 |
| Cuivre River Electric Cooperative Inc | Troy | — | $161.9M | 23 |
| MISSOURI DELTA MEDICAL CENTER | Sikeston | E22 Health Care | $160.6M | 9 |
| ST LOUIS CHILDREN'S HOSPITAL FOUNDATION | St Louis | E110 Health Care | $159.1M | 2 |
| Alvin Goldfarb Foundation | Saint Louis | T20 Philanthropy, Voluntarism & Grantmaking Foundations | $159M | 1 |
| Together Credit Union | Saint Louis | — | $158.8M | 27 |
| ALEXIAN BROTHERS HEALTH SYSTEM | St Louis | E210 Health Care | $157.7M | 14 |
| STOWERS RESOURCE MANAGEMENT INC | Kansas City | G11 Diseases, Disorders & Medical Disciplines | $157.1M | 18 |
| St Vincent's Medical Center-Clay County Inc | St Louis | — | $154.7M | 15 |
| St Vincent's Health System Inc | St Louis | E210 Health Care | $154M | 13 |
| SSM REGIONAL HEALTH SERVICES | St Louis | E220 Health Care | $147.3M | 18 |
| Presence Healthcare Services | St Louis | E320 Health Care | $147.2M | 4 |
| ST LOUIS MUNICIPAL FINANCE CORPORATION | Saint Louis | W190 Public & Societal Benefit | $147.1M | 0 |
| CITIZENS ELECTRIC CORPORATION | Perryville | — | $142.4M | 17 |
| Enterprise Holdings Foundation | Saint Louis | T20 Philanthropy, Voluntarism & Grantmaking Foundations | $142.3M | 0 |
| HARVESTERS - THE COMMUNITY FOOD NETWORK | Kansas City | K300 Food, Agriculture & Nutrition | $142M | 9 |
| Jane Phillips Memorial Medical Center Inc | St Louis | E220 Health Care | $139.2M | 13 |
| Kansas City University | Kansas City | B500 Education | $136.9M | 10 |
| St John Health System Inc | St Louis | E210 Health Care | $135.5M | 6 |
| Ascension Texas | St Louis | E22 Health Care | $132.6M | 4 |
| NW Electric Power Cooperative | Cameron | — | $126.4M | 24 |
| Capital Region Medical Center | Jefferson City | E220 Health Care | $125.7M | 12 |
| ASCENSION ST FRANCIS HOSPITAL INC | St Louis | E220 Health Care | $124.4M | 20 |
| OSBA EMPLOYEE BENEFITS TRUST | Bolivar | Y44 Mutual & Membership Benefit | $123.9M | 14 |
| ST MARY'S HOSPITAL CENTRALIA ILLINOIS | St Louis | E220 Health Care | $123.8M | 24 |
| ST VINCENT HEALTH INC | St Louis | E20 Health Care | $123.2M | 6 |
| St Vincent's Ambulatory Care Inc | St Louis | — | $121.9M | 22 |
| MERCY ACO CLINICAL SERVICES | Chesterfield | E32 Health Care | $121.3M | 10 |
| The Against Malaria Foundation | Kansas City | G12 Diseases, Disorders & Medical Disciplines | $119.4M | 0 |
| ASCENSION MEDICAL GROUP-FOX VALLEY WISCONSIN INC | St Louis | E30 Health Care | $118.5M | 17 |
| Saint Thomas Health | St Louis | E21Z Health Care | $118.1M | 15 |
| MRIGlobal | Kansas City | U200 Science & Technology | $118M | 35 |
| LUTHERAN SENIOR SERVICES EAST | St Louis | L22 Housing & Shelter | $116.6M | 17 |
| COLLEGE OF THE OZARKS | Point Lookout | B420 Education | $115.9M | 14 |
| ROCKHURST UNIVERSITY | Kansas City | B430 Education | $115.6M | 7 |
| The Principia Corporation | St Louis | B200 Education | $111.3M | 20 |
