Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2010
Open to Public Inspection
A For the calendar year, or tax year beginning 07-01-2010 and ending 06-30-2011
BCheck if applicable:
CName of organization
MERCY HEALTH SERVICES - IOWA CORP
 
Doing Business As
SEE SCHEDULE O FOR LIST
 
Number and street (or P.O. box if mail is not delivered to street address)
1000 4TH STREET SW
 
Room/suite
City or town, state or country, and ZIP + 4
MASON CITY, IA50401
D Employer identification number

31-1373080
E Telephone number

G Gross receipts $ 652,735,180
F Name and address of principal officer:
JOSEPH SWEDISH
34605 W 12 MILE RD
FARMINGTON HILLS,MI48331
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.TRINITY-HEALTH.ORG
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1993
M State of legal domicile: DE
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: HEALTH CARE SERVICES
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) .... 3 5
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 3
5 Total number of individuals employed in calendar year 2010 (Part V, line 2a) ... 5 5,903
6 Total number of volunteers (estimate if necessary) .... 6 758
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b 0
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 2,834,217 2,752,838
9 Program service revenue (Part VIII, line 2g) ......... 584,716,343 594,512,963
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 7,425,617 13,925,192
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 37,417,845 38,506,676
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 632,394,022 649,697,669
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 574,500 785,503
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) 279,442,126 288,394,581
16a Professional fundraising fees (Part IX, column (A), line 11e).... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet774,906    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 333,261,948 342,909,212
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 613,278,574 632,089,296
19 Revenue less expenses. Subtract line 18 from line 12...... 19,115,448 17,608,373
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............ 721,360,643 785,655,787
21 Total liabilities (Part X, line 26)............ 274,174,559 286,395,955
22 Net assets or fund balances. Subtract line 21 from line 20 ..... 447,186,084 499,259,832
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's Use Only Preparer's
signatureBig Right Arrow 		Date
right pointing bullet image Preparer’s taxpayer identification number
(see instructions)
Firm’s name (or yours
if self-employed),
address, and ZIP + 4Big Right Arrow




 		EIN right pointing bullet image
Phone no. right pointing bullet image
May the IRS discuss this return with the preparer shown above? (see instructions) .........
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2010)
Form 990 (2010)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III . . . . . . . . . .
1
Briefly describe the organization’s mission: HEALTH CARE SERVICES - SEE SCHEDULE H FOR MORE INFORMATION
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 exempt purpose achievements for each of the organization’s three largest program services by expenses.
Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts 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 $ 565,999,242 including grants of $ 785,503 ) (Revenue $ 590,150,351 )
MERCY HEALTH SERVICES-IOWA, CORP. OPERATED FOUR HOSPITAL DIVISIONS IN THE STATE OF IOWA THAT PROVIDED 161,750 PATIENT DAYS OF HEALTHCARE SERVICES TO THEIR COMMUNITIES. THE MISSION STATEMENT OF MERCY HEALTH SERVICES-IOWA CORP. IS AS FOLLOWS:WE SERVE TOGETHER IN TRINITY HEALTHIN THE SPIRIT OF THE GOSPELTO HEAL BODY, MIND, AND SPIRITTO IMPROVE THE HEALTH OF OUR COMMUNITIESAND TO STEWARD THE RESOURCES ENTRUSTED TO US.
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services. (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet$ 565,999,242
Form 990 (2010)
Form 990 (2010)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment........
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part IIClick to see attachment.........................
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part III........................
5
 
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts where donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete
Schedule D, Part IClick to see attachment.......................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; 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 term, permanent,or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
Yes
 
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
Yes
 
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click 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 IX.Click to see attachment
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click 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 X.Click 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, XII, and XIII Click to see attachment
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII 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, and program service activities outside the United States? If “Yes,” complete Schedule F, Part I.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II..
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III..
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
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
Yes
 
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
Form 990 (2010)
Form 990 (2010)
Page 4
Part IV
Checklist of Required Schedules (continued)
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H..... Click to see attachment
20a
Yes
 
b
Did the organization attach its audited financial statement to this return? Note: All Form 990 filers that operate one or more hospitals must attach audited financial statements. ..... Click to see attachment
20b
Yes
 
21
Did the organization report more than $5,000 of grants and other assistance to governments and organizations in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.. Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III..... Click to see attachment
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, questions 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 questions 24b–24d and complete Schedule K. If “No,” go to line 25................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
 
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I...... Click to see attachment
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................ Click to see attachment
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II........................... Click to see attachment
26
Yes
 
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor, or a grant selection committee member, or to a person related to such an individual? If “Yes,” complete Schedule L, Part III............... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ......................... Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV................... Click to see attachment
28b
Yes
 
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV.. Click to see attachment
28c
Yes
 
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, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35
Is any related organization a controlled entity within the meaning of section 512(b)(13)? .....
35
Yes
 
a
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
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2........... Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2010)
Form 990 (2010)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V . . . . . . . . . .
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
582
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
26
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
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
5,903
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
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
 
No
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 or securities account)?.......................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
Yes
 
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
Yes
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate 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 aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2010)
Form 990 (2010)
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 to any question 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
5
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
3
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
Yes
 
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
Does the organization have members or stockholders? ................
6
Yes
 
7a
Does the organization have members, stockholders, or other persons who may elect one or more members of the governing body? .........................
7a
Yes
 
b
Are any decisions of the governing body subject to approval by members, stockholders, or other persons? ..
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Does the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” does the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with those of the organization? ....
10b
 
 
11a
Has the organization provided a 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 the Form 990. .....
12a
Does the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Are officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ...........................
12b
Yes
 
c
Does the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this is done ....................
12c
Yes
 
13
Does the organization have a written whistleblower policy? ...............
13
Yes
 
14
Does 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
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line a or b, 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
Yes
 
b
If “Yes,” has the organization adopted a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and taken steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
No
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
IA
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you make these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization makes its governing documents, conflict of interest policy, and financial statements available to the public.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
BETH GDOWIK
34605 W TWELVE MILE RD
FARMINGTON HILLS,MI48331
(248) 489-6000
Form 990 (2010)
Form 990 (2010)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question 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, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

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

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

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

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(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; Officer; Key Employee; Highest compensated employee; Former;
(1) JOSEPH SWEDISH
TRINITY PRES & CEO
 5.00 X   X       0 2,853,932 791,453
(2) MARY MOLLISON CSA
CHAIR
 2.00 X   X       0 0 0
(3) MELANIE DREHER
VICE CHAIR
 2.00 X   X       0 25,000 0
(4) SUZANNE BRENNAN CSC
TRUSTEE
 2.00 X           0 0 0
(5) ROBERT LADENBURGER
TRUSTEE
 2.00 X           0 22,000 0
(6) PAUL NEUMANN
SECRETARY, TRIN SVP & GEN COUNSEL
 5.00     X       0 686,026 82,938
(7) AGNES HAGERTY
ASST SEC/MANAGING CSL TRINITY HEALTH
 2.00     X       0 418,922 50,773
(8) JAMES BOSSCHER
TREAS THRU 12/10,ASST TRS 1/11, SVP
 2.00     X       0 558,096 98,578
(9) BENJAMIN CARTER
TREAS AS OF 1/11, SVP & CFO
 5.00     X       0 574,987 73,155
(10) MARIANNE CUNNINGHAM
ASST TREAS UNTIL 12/10; TH DIR DEBT
 2.00     X       0 161,043 29,898
(11) KEDRICK ADKINS
TRINITY PRES INTEGRATED SVCS
 5.00       X     0 1,160,870 198,248
(12) MICHAEL SLUBOWSKI
TRIN PRES HOSP&HLTH NTWKS TIL 12/10
 5.00       X     0 1,153,164 271,732
(13) MICHAEL MURPHY
TRINITY HLTH EVP HEALTH NETWORKS
 5.00       X     0 539,823 68,542
(14) RICHARD O'CONNELL
TRINITY COO-HOSPITAL NETWORKS
 5.00       X     0 761,373 137,960
(15) JAMES FITZPATRICK
CEO-MASON CITY (MC)
 50.00       X     0 584,600 105,129
(16) RUSSELL KNIGHT
CEO-DUBUQUE (DUB)
 50.00       X     0 459,209 91,619
(17) ROBERT PEEBLES
CEO-SIOUX CITY (SC)
 50.00       X     0 471,772 26,049
Form 990 (2010)
Form 990 (2010)
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 (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(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; Officer; Key Employee; Highest compensated employee; Former;
(18) MARY EBELING
VP, PAT. SERVICES (MC)
 50.00       X     0 224,390 74,332
(19) DIANE FISCHELS
VP OPERATIONS (MC)
 50.00       X     0 237,015 53,387
(20) F SCOTT LEIGHTY
COO-MASON CITY (MC)
 50.00       X     0 313,247 30,483
(21) PAUL MANTERNACH
SVP, PHYS. INTEG. (MC)
 50.00       X     0 349,056 39,391
(22) TERESA MOCK
SVP MERCY CLINICS (MC)
 50.00       X     297,968 0 86,424
(23) RODNEY SCHLADER
CFO, VP FISCAL SVCS (MC)
 50.00       X     0 277,975 51,662
(24) BERNARD FOX
VP PROF & SUPP SVCS (DUB)
 50.00       X     0 186,432 48,477
(25) GARY GUETZKO
VP BUS. DEV. (DUB)
 50.00       X     0 226,952 53,412
(26) KAY TAKES
VP, PATIENT CARE (DUB)
 50.00       X     0 200,839 36,771
(27) MARILYN KAPTAIN-DAHLEN
COO-SIOUX CITY (SC)
 50.00       X     0 288,123 80,541
(28) STEVEN EAVENSON TATUM LLC
INTERIM CFO (SC) UNTIL 3/11; CFO
 50.00       X     453,600 0 0
(29) LINDA KREI
VP, HR & ORG. INTG. (SC)
 50.00       X     0 212,355 42,325
(30) LARRY SELLERS
CMO-SIOUX CITY (SC)
 50.00       X     0 422,873 67,062
(31) JAMES KARKOS
PHYSICIAN, DERMATOLOGY
 50.00         X   612,002 0 112,645
(32) ALIREZA YARAHMADI
PHYSICIAN, NEUROLOGY
 50.00         X   607,700 0 64,156
(33) PHILLIP ALSCHER
PHYSICIAN, NEPHROLOGY
 50.00         X   603,396 0 104,636
(34) CARL PLANK
PHYSICIAN, DERMATOLOGY
 50.00         X   581,802 0 138,454
(35) ARVIND PERATHUR
PHYSICIAN, INTERNAL MED.
 50.00         X   527,731 0 87,302
(36) DANIEL HALE
FORMER OFFICER
 5.00           X 0 789,942 220,882
(37) PAUL DOUGHERTY
FORMER KEY EMPLOYEE
 0.00           X 0 343,327 28,504
(38) PAUL BROWNE
FORMER KEY EMPLOYEE
 5.00           X 0 699,671 107,716
(39) DEBRA CANALES
FORMER KEY EMPLOYEE
 5.00           X 0 720,373 92,327
(40) VELOIS BOWERS
FORMER KEY EMPLOYEE
 5.00           X 0 360,170 11,408
(41) PAUL CONLON
FORMER KEY EMPLOYEE
 5.00           X 0 408,070 103,830
(42) LOUIS FIERENS
FORMER KEY EMPLOYEE
 5.00           X 0 484,981 58,236
(43) PRESTON GEE
FORMER KEY EMPLOYEE
 5.00           X 0 490,180 75,992
(44) MICHAEL HOLPER
FORMER KEY EMPLOYEE
 5.00           X 0 386,168 59,654
(45) TERRENCE O'ROURKE
FORMER KEY EMPLOYEE
 5.00           X 0 812,420 59,048
(46) MARIA SZYMANSKI
FORMER KEY EMPLOYEE
 5.00           X 0 601,911 161,699
(47) SCOTT E WELLS
FORMER KEY EMPLOYEE
 0.00           X 0 157,538 37,250
(48) DOUGLAS MORSE
FORMER KEY EMPLOYEE
 0.00           X 0 153,491 18,248
(49) KIM PRICE
FORMER KEY EMPLOYEE
 0.00           X 0 107,516 31,839
(50) ROBERT SHAFER
KEY EMP (NOT IN TOP 20)
 50.00           X 0 186,208 74,359
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 3,684,199 20,072,040 4,338,526
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 in reportable compensation from the organizationMediumBullet230
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
Yes
 
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.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
UNITED CLINICAL LABORATORIES
205 BLUFF STREET
DUBUQUE,IA52001 		LABORATORY SERVICES 5,405,210
MASON CITY CLINIC PC
250 S CRESCENT DRIVE
MASON CITY,IA50401 		MEDICAL SERVICES 4,804,196
MILLER PURCELL INC
1920 ELM STREET
DUBUQUE,IA52001 		MANAGEMENT SERVICES 4,608,929
RASMUSSEN MECHANICAL SERVICES
2425 E 4TH STREET
SIOUX CITY,IA51101 		HVAC MAINTENANCE 3,191,651
AIR METHODS
7211 S PEORIA STREET
ENGLEWOOD,CO80112 		AIR AMUBULANCE SVCS 2,589,389
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization MediumBullet80
Form 990 (2010)
Form 990 (2010)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, gifts, grants and other similar amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c 19,300
d Related organizations...1d 2,126,811
e Government grants (contributions)1e 234,762
f All other contributions, gifts, grants, and
similar amounts not included above1f 		371,965
g Noncash contributions included in lines 1a-1f:$ 5,180
h Total. Add lines 1a-1f.......MediumBullet 2,752,838
Program Service Revenue Business Code
2a NET PATIENT SVC REV 900,099 554,418,482 554,418,482    
b PHARMACY REVENUE 446,110 40,055,427     40,055,427
c LABORATORY REVENUE 621,500 39,054     39,054
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 594,512,963
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 4,998,657     4,998,657
4 Income from investment of tax-exempt bond proceeds..MediumBullet        
5 Royalties............MediumBullet        
(i) Real (ii) Personal
6a Gross Rents 1,719,810  
b Less: rental expenses 2,178,096  
c Rental income or (loss) -458,286  
d Net rental income or (loss).......MediumBullet -458,286     -458,286
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 9,008,709 716,730
b Less: cost or other basis and sales expenses   798,904
c Gain or (loss) 9,008,709 -82,174
d Net gain or (loss)..........MediumBullet 8,926,535     8,926,535
8a Gross income from fundraising events (not including
$ 19,300
of contributions reported on line 1c). See Part IV, line 18 ...
a 206,413
b Less: direct expenses ...b 60,511
c Net income or (loss) from fundraising events..MediumBullet 145,902   145,902
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet        
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet        
Miscellaneous Revenue Business Code
11a OTHER REVENUE 900,099 35,731,869 35,731,869    
b CAFETERIA REVENUE 900,099 3,087,191     3,087,191
c            
d All other revenue ....        
e Total. Add lines 11a–11d ......MediumBullet 38,819,060
12 Total revenue. See Instructions....MediumBullet 649,697,669 590,150,351 0 56,794,480
Form 990 (2010)
Form 990 (2010)
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) but are not required to complete columns (B), (C), and (D).
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the U.S. See Part IV, line 21 785,503 785,503
2 Grants and other assistance to individuals in the U.S. See Part IV, line 22    
3 Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 15 and 16    
4 Benefits paid to or for members    
5 Compensation of current officers, directors, trustees, and key employees .... 5,985,960   5,985,960  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 706,102 98,333 607,769  
7 Other salaries and wages 225,023,348 200,089,581 24,417,497 516,270
8 Pension plan contributions (include section 401(k) and section 403(b) employer contributions) .... 19,152,385 17,219,644 1,932,741  
9 Other employee benefits ....... 21,594,098 18,978,867 2,527,537 87,694
10 Payroll taxes ........... 15,932,688 13,847,023 2,052,648 33,017
11 Fees for services (non-employees):        
a Management ...... 753,243   753,243  
b Legal ......... 406,879   406,879  
c Accounting ...........        
d Lobbying ...........        
e Professional fundraising. See Part IV, line 17..    
f Investment management fees ......        
g Other .......... 35,685,753 31,415,518 4,226,774 43,461
12 Advertising and promotion .... 1,458,785 1,269,942 188,253 590
13 Office expenses ....... 23,119,606 20,091,444 2,978,305 49,857
14 Information technology ...... 27,496,487 23,946,691 3,549,796  
15 Royalties ..        
16 Occupancy ........... 11,523,674 10,946,348 576,124 1,202
17 Travel ............ 1,470,062 1,277,420 189,361 3,281
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ......        
19 Conferences, conventions, and meetings .... 160,754 140,001 20,753  
20 Interest ........... 7,424,757 7,424,757    
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization ..... 33,274,351 31,610,577 1,663,715 59
23 Insurance .............. 3,842,731 3,650,594 192,137  
24 Other expenses. Itemize expenses not covered above. (Expenses grouped together and labeled miscellaneous may not exceed 5% of total expenses shown on line 25 below.)
a MEDICAL SUPPLIES 113,834,587 108,133,990 5,691,263 9,334
b BAD DEBT 26,304,010 26,304,010    
c INTERCO. PURCHASED SVCS 21,826,806 19,008,965 2,817,841  
d CONTRACT LABOR 16,208,288 14,115,798 2,092,490  
e UNRELATED BUSINESS TAX 125,000   125,000  
f All other expenses 17,993,439 15,644,236 2,319,062 30,141
25 Total functional expenses. Add lines 1 through 24f 632,089,296 565,999,242 65,315,148 774,906
26 Joint costs. Check here MediumBullet if following
SOP 98-2 (ASC 958-720). Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation 		       
Form 990 (2010)
Form 990 (2010)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .......... 10,051,439 1 10,534,564
2 Savings and temporary cash investments ....... 114,812 2 140,450
3 Pledges and grants receivable, net ......... 26,225 3 103
4 Accounts receivable, net ......... 71,564,672 4 76,226,060
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L .......... 6,072 5 1,108
6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
Schedule L ..........   6  
7 Notes and loans receivable, net ............. 2,352,573 7 2,550,376
8 Inventories for sale or use .............. 15,275,133 8 14,719,435
9 Prepaid expenses and deferred charges ............ 1,776,105 9 1,324,122
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 515,636,531
b Less: accumulated depreciation. ..... 10b 352,407,651 156,169,988 10c 163,228,880
11 Investments—publicly traded securities .......... 185,989,404 11 148,017,953
12 Investments—other securities. See Part IV, line 11 ...... 89,296,859 12 159,896,944
13 Investments—program-related. See Part IV, line 11 ..   13  
14 Intangible assets ......... 1,156,680 14  
15 Other assets. See Part IV, line 11 ........... 187,580,681 15 209,015,792
16 Total assets. Add lines 1 through 15 (must equal line 34)... 721,360,643 16 785,655,787
Liabilities 17 Accounts payable and accrued expenses . 56,490,192 17 61,333,329
18 Grants payable ..........   18  
19 Deferred revenue .......... 127,592 19 260,654
20 Tax-exempt bond liabilities ..........   20  
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22  
23 Secured mortgages and notes payable to unrelated third parties ..   23  
24 Unsecured notes and loans payable to unrelated third parties ....   24  
25 Other liabilities. Complete Part X of Schedule D..... 217,556,775 25 224,801,972
26 Total liabilities. Add lines 17 through 25..... 274,174,559 26 286,395,955
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets ..... 446,838,183 27 499,098,319
28 Temporarily restricted net assets ..... 322,901 28 136,513
29 Permanently restricted net assets ..... 25,000 29 25,000
Organizations that do not follow SFAS 117, check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ..... 447,186,084 33 499,259,832
34 Total liabilities and net assets/fund balances ..... 721,360,643 34 785,655,787
Form 990 (2010)
Form 990 (2010)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI . . . . . . . . . .
1
Total revenue (must equal Part VIII, column (A), line 12) . . .
1
649,697,669
2
Total expenses (must equal Part IX, column (A), line 25) . . . . .
2
632,089,296
3
Revenue less expenses. Subtract line 2 from line 1 . . . .
3
17,608,373
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) . .
4
447,186,084
5
Other changes in net assets or fund balances (explain in Schedule O) . . . .
5
34,465,375
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) . . . . . .
6
499,259,832
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question 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
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 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?
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O............................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
Yes
 
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
Yes
 
Form 990 (2010)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
MERCY HEALTH SERVICES - IOWA CORP
 
Employer identification number

31-1373080
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization? ................
11g(i)
 
 
(ii) a family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
(i)
Name of supported organization 		(ii)
EIN 		(iii)
Type of organization (described on lines 1- 9 above or IRC section (see instructions)) 		(iv)
Is the organization in col. (i) listed in your governing document? 		(v)
Did you notify the organization in col. (i) of your support? 		(vi)
Is the organization in col. (i) organized in the U.S.? 		(vii)
Amount of support?
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3..            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..            
6 Public Support. Subtract line 5 from line 4.            
Section B. Total Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public Support (Subtract line 7c from line 6.)            
Section B. Total Support
Calendar year (or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)            
13 Total support (Add lines 9, 10c, 11 and 12.).            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2010
Name of organization
MERCY HEALTH SERVICES - IOWA CORP
 
Employer identification number

31-1373080
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule—
Special Rules
......................... Arrow Bullet   $    
Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990, or check the box in the heading of its
Form 990-EZ, or on line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part I
Name of organization
MERCY HEALTH SERVICES - IOWA CORP
  		Employer identification number

31-1373080
Part I
Contributors (see Instructions)
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part II
Name of organization
MERCY HEALTH SERVICES - IOWA CORP
  		Employer identification number

31-1373080
Part II
Noncash Property (see Instructions)
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part III
Name of organization
MERCY HEALTH SERVICES - IOWA CORP
  		Employer identification number

31-1373080
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
aggregating more than $1,000 for the year. (Complete columns (a) through (e) and the following line entry.)
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet $  
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Additional Data


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

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.
SchCMd Bullet Attach to Form 990 or Form 990-EZ. SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
If the organization answered “Yes,” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes,” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes,” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35a (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
MERCY HEALTH SERVICES - IOWA CORP
 
Employer identification number

31-1373080
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization's direct and indirect political campaign activities on behalf of or in opposition to candidates for public office in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c) except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt funtion activities ....................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2010

Schedule C (Form 990 or 990-EZ) 2010
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check
B Check
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
Organization's
Totals 		(b) Affiliated Group
Totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) Total
             
2a Lobbying non-taxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots non-taxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2010


Schedule C (Form 990 or 990-EZ) 2010
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
(a)
Yes
No
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
Yes
 
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
Yes
 
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
Yes
 
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
Yes
 
88,915
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
Yes
 
45,540
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? If "Yes," describe in Part IV ..........................
Yes
 
1,545
j
Total. lines 1c through 1i ...................................
136,000
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carryover lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) if BOTH Part III-A, lines 1 and 2 are answered “No” OR if Part III-A, line 3 is answered “Yes”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) non-deductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ...........................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; and Part ll-B, line 1i.
Also, complete this part for any additional information.
Identifier Return Reference Explanation
EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: LOBBYING ACTIVITY INCLUDED ENCOURAGING ASSOCIATES TO WRITE LETTERS TO PUBLIC OFFICIALS AND THE USE OF PAID STAFF MEMBERS AND MANAGEMENT PERSONNEL. MANAGEMENT PERSONNEL REGULARLY ISSUE MAILINGS TO LEGISLATORS ATTEMPTING TO INFLUENCE LEGISLATIVE MATTERS AND REFERENDUM, AND ORGANIZE AND HOST MEETINGS AMONG HOSPITAL EXECUTIVES AND THEIR LEGISLATORS. PAID STAFF MEMBERS HAVE ON LIMITED OCCASIONS WRITTEN LETTERS TO LEGISLATORS. MERCY HEALTH SERVICES - IOWA, CORP (MHS-IA) HAS MADE GRANTS TO OTHER ORGANIZATIONS FOR LOBBYING PURPOSES IN THE FORM OF MEMBERSHIP DUES PAID TO REGIONAL AND NATIONAL HEALTH CARE ORGANIZATIONS. THESE ORGANIZATIONS HAVE PROVIDED MHS-IA WITH AN ESTIMATED PERCENTAGE OF DUES PAYMENTS THAT ARE USED FOR LOBBYING ACTIVITIES. SIMILARLY, THESE HEALTH CARE ORGANIZATIONS WILL ARRANGE CONFERENCES AND SEMINARS FOR MEMBER ORGANIZATIONS AND THEIR EXECUTIVES THAT WILL INVOLVE LEGISLATORS OR OTHER POLITICAL FIGURES AS GUEST SPEAKERS. FEDERAL AND STATE ADVOCACY PRIORITIES FOR FY11 INCLUDED: (1) SECURE COVERAGE AND ACCESS FOR ALL (2) ACHIEVE COORDINATED CARE: PROMOTE SAFE, HIGH-QUALITY COORDINATED CARE ACROSS THE HEALTH CARE CONTINUUM (3) ACHIEVE HIGH-VALUE CARE, INCLUDING: - ADVOCATE FOR MEDICARE AND MEDICAID SAVINGS THROUGH PAYMENT AND DELIVERY REDESIGN - REFORM MEDICARE TO INCLUDE SUSTAINABLE SOLUTIONS TO ADDRESS GEOGRAPHIC PAYMENT DISPARITIES - SECURE ADEQUATE FUNDING FOR IMPLEMENTATION OF HEALTH CARE REFORM RULES - ENCOURAGE USE OF SAFETY/QUALITY MEASUREMENTS - PROMOTE IDEAS TO REDUCE HEALTH CARE COSTS LOBBYING ACTIVITY PERFORMED BY MERCY HEALTH SERVICES-IOWA, CORP. INCLUDED: - AN "ADVOCACY ACTION" WEBSITE TO ENGAGE ASSOCIATES IN FEDERAL ADVOCACY - DESIGNATE AN ADVOCACY LIAISON - ENGAGEMENT OF A LOBBYIST IN WASHINGTON, D.C. BY TRINITY HEALTH CORPORATION - LEGISLATOR VISITS - COLLABORATION WITH THE CATHOLIC HOSPITAL ASSOCIATION (CHA), AND THE AMERICAN HOSPITAL ASSOCIATION (AHA) - GRANTS FOR LOBBYING PURPOSES IN THE FORM OF MEMBERSHIP DUES PAID TO HEALTHCARE ORGANIZATIONS - ADVOCACY ACTION DAYS ADVOCACY ACTION DAYS WERE HELD IN MARCH 2011 IN WASHINGTON, D.C. OVER 50 MEETINGS WERE HELD WITH MEMBERS OF THE HOUSE AND SENATE DELIVERING A MESSAGE ABOUT TRANSFORMING AMERICA'S HEALTH. PARTICIPANTS INCLUDED TRINITY HEALTH EXECUTIVES, MINISTRY ORGANIZATION CEO'S, INCLUDING CEO'S OF THE MERCY HEALTH SERVICES - IOWA, CORP. HOSPITALS, LOCAL BOARD MEMBERS AND ADVOCACY LEADERS. THE FOCUS OF THE MEETINGS WAS TO DISCUSS WHAT POLICYMAKERS CAN AND SHOULD DO TO ACHIEVE THE TRINITY HEALTH VISION OF AN ALL-INCLUSIVE, NATIONAL AFFORDABLE HEALTH CARE SYSTEM THAT DELIVERS HIGH VALUE AND CLINICAL EXCELLENCE ACROSS THE CONTINUUM OF CARE.
Schedule C (Form 990 or 990EZ) 2010

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11, or 12.
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
MERCY HEALTH SERVICES - IOWA CORP
 
Employer identification number

31-1373080
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .......    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) ...    
4 Aggregate value at end of year .......    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds may be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit. ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a–2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06 ........ 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the taxable year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................
9
In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116, 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 XIV, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116, to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 52283D
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s 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 XIV.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIV.
Part V
Endowment Funds. Complete if the organization answered "Yes" to 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 .... 25,000 25,000 25,000
b Contributions ........      
c Investment earnings or losses ...      
d Grants or scholarships .....      
e Other expenditures for facilities
and programs ........ 		     
f Administrative expenses ....      
g End of year balance ...... 25,000 25,000 25,000
2
Provide the estimated percentage of the year end balance held as:
a
Board designated or quasi-endowment: SchDMd Bullet  
b
Permanent endowment: SchDMd Bullet100.000 %
c
Term endowment: SchDMd Bullet  
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)
Yes
 
(ii) related organizations ........................
3a(ii)
Yes
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
Yes
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Investments—Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of investment (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   10,460,234 10,460,234
b Buildings ................   294,802,420 197,892,560 96,909,860
c Leasehold improvements ............        
d Equipment ................   196,811,003 154,204,540 42,606,463
e Other .................   13,562,874 310,551 13,252,323
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........SchDMdBullet 163,228,880
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
(3)Other
(A) ABSOLUTE RETURN STRATEGY FUNDS 		74,026,363 F

(B) COMMINGLED FUNDS DIRECTLY HOLDING SECURITIES 		20,727,382 F

(C) BOND FUND 		65,143,199 F






Total. (Column (b) should equal Form 990, Part X, col.(B) line 12.)Small Bullet 159,896,944
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) should equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) OTHER RECEIVABLES 11,446,569
(2) INTERCOMPANY ACCOUNTS RECEIVABLE 413,366
(3) INVESTMENT IN AFFILIATES 160,462,780
(4) OTHER ASSETS 2,513,318
(5) INTERCOMPANY OTHER LT ASSETS 34,179,759




Total. (Column (b) should equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 209,015,792
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Amount
Federal Income Taxes  
INTERCOMPANY ACCOUNTS PAYABLE 6,208,324
DEFERRED COMPENSATION 11,324,992
LONG TERM ASSET RETIREMENT OBLIGATION (FIN 47) 3,159,407
INTERCOMPANY NOTES PAYABLE 200,243,788
OTHER LIABILITIES 3,280,358
LEASE OBLIGATION 521,123
ANNUITY PAYABLE 63,980


Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)Small Bullet 224,801,972
2. Fin 48 (ASC 740) Footnote. In Part XIV, 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 (ASC740).
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1  
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2  
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3  
4 Net unrealized gains (losses) on investments .......................... 4  
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV) ................................. 8  
9 Total adjustments (net). Add lines 4 - 8 ............................. 9  
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10  
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV): ............ 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 XIV): ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total Revenue. Add lines 3 and 4c. (This should equal Form 990, Part I, line 12.) ...... 5  
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
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 XIV): ............ 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 XIV): ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This should equal Form 990, Part I, line 18.) ...... 5  
Part XIV
Supplemental Information
Complete this part to 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; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE ENDOWMENT FUNDS OF MERCY HEALTH SERVICES - IOWA, CORP. INCLUDE $25,000 KNOWN AS THE VIANNA HOLSCHLAG SCHOLARSHIP FUND. INTEREST INCOME FROM THE FUND IS MADE AVAILABLE FOR NURSING SCHOLARSHIPS.
Schedule D (Form 990) 2010

Additional Data


Software ID:  
Software Version:  




SCHEDULE G
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Supplemental Information Regarding
Fundraising or Gaming Activities
Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19,
or if the organization entered more than $15,000 on Form 990-EZ, line 6a.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
MERCY HEALTH SERVICES - IOWA CORP
 
Employer identification number

31-1373080
Part I
Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17.
1
Indicate whether the organization raised funds through any of the following activities. Check all that apply.
a e
b f
c g
d
2a
Did the organization have a written or oral agreement with any individual (including officers, directors, trustees
or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?
b
If “Yes,” list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization. Form 990-EZ filers are not required to complete this table.
(i) Name and address of individual
or entity (fundraiser) 		(ii) Activity (iii) Did fundraiser have custody or control of contributions? (iv) Gross receipts
from activity 		(v) Amount paid to
(or retained by)
fundraiser listed in
col. (i) 		(vi) Amount paid to
(or retained by)
organization
Yes No
Total .................right arrow      
3
List all states in which the organization is registered or licensed to solicit funds or has been notified it is exempt from registration or licensing.
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50083H
Schedule G (Form 990 or 990-EZ) 2010
Schedule G (Form 990 or 990-EZ) 2010
Page 2
Part II
Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 on Form 990-EZ, line 6a. List events with gross receipts greater than $5,000.
(a) Event #1

GALA
(event type) 		(b) Event #2

FESTIVAL OF TREES
(event type) 		(c) Other Events

1
(total number) 		(d) Total Events
(Add col. (a) through col. (c))
VerticalRevenue 1 Gross receipts . . . 135,504 65,024 25,185 225,713
2 Less: Charitable
contributions . . . 		17,000 2,300   19,300
3 Gross income (line 1
minus line 2) . . . 		118,504 62,724 25,185 206,413
VerticalDirectExpenses 4 Cash prizes . . .     1,250 1,250
5 Non-cash prizes . .        
6 Rent/facility costs . .   6,300 325 6,625
7 Food and beverages . .        
8 Entertainment . . .        
9 Other direct expenses . 23,878 23,107 5,651 52,636
10 Direct expense summary. Add lines 4 through 9 in column (d) ........... right arrow 60,511
11 Net income summary. Combine lines 3 and 10 in column (d)............ right arrow 145,902
Part III
Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.
VerticalRevenue (a) Bingo (b) Pull tabs/Instant
bingo/progressive bingo 		(c) Other gaming (d) Total gaming (Add col. (a) through col. (c))
1 Gross revenue . . . .        
VerticalDirectExpenses 2 Cash prizes . . . .        
3 Non-cash prizes . . .        
4 Rent/facility costs . . .        
5 Other direct expenses . .        
6 Volunteer labor . . .
 
 
 
7 Direct expense summary. Add lines 2 through 5 in column (d) ........... right arrow  
8 Net gaming income summary. Combine lines 1 and 7 in column (d) .......... right arrow  
9
Enter the state(s) in which the organization operates gaming activities:
a
Is the organization licensed to operate gaming activities in each of these states? ............
b
If "No," Explain:
 
10a
Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? .....
b
If "Yes," Explain:
 
11
Does the organization operate gaming activities with nonmembers? .................
12
Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity
formed to administer charitable gaming? ...........................
Schedule G (Form 990 or 990-EZ) 2010
Schedule G (Form 990 or 990-EZ) 2010
Page 3
13
Indicate the percentage of gaming activity operated in:
a
The organization's facility ......................
13a
 
b
An outside facility ........................
13b
 
14
Provide the name and address of the person who prepares the organization's gaming/special events books and records:
Name right arrow
Address right arrow
15a
Does the organization have a contract with a third party from whom the organization receives gaming
revenue? ......................................
b
If "Yes," enter the amount of gaming revenue received by the organization right arrow $   and the
amount of gaming revenue retained by the third party right arrow $   .
c
If "Yes," enter name and address:
Name right arrow
Address right arrow
 
 
16
Gaming manager information:
Name right arrow
Gaming manager compensation right arrow $  
Description of services provided right arrow
 
17
Mandatory distributions:
a
Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license? ............................
b
Enter the amount of distributions required under state law distributed to other exempt organizations or spent
in the organization's own exempt activities during the tax year right arrow$  
Part IV
Complete this part to provide additional information for responses to quuestion on Schedule G (see instructions.)
Identifier ReturnReference Explanation
Schedule G (Form 990 or 990-EZ) 2010
Additional Data


Software ID:  
Software Version:  
SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
MERCY HEALTH SERVICES - IOWA CORP
 
Employer identification number

31-1373080
Part I
Charity Care and Certain Other Community Benefits at Cost
Yes
No
1a
Does the organization have a charity care policy? If "No," skip to question 6a...........
1a
Yes
 
b
If "Yes," is it a written policy? .......................
1b
Yes
 
2
If the organization has multiple hospitals, indicate which of the following best describes application of the charity care policy to the various hospitals.
3
Answer the following based on the charity care eligibility criteria that applies to the largest number of the organization's patients.
a
Does the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care to low
income individuals? If "Yes," indicate which of the following is the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Does the organization use FPG to determine eligibility for providing discounted care to low income individuals? If
"Yes," indicate which of the following is the family income limit for eligibility for discounted care: .....
3b
Yes
 
c
If the organization does not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization uses an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.
4
Does the organization's policy provide free or discounted care to the "medically indigent"? ......
4
Yes
 
5a
Does the organization budget amounts for free or discounted care provided under its charity care policy? ...
5a
Yes
 
b
If "Yes," did the organization's charity care expenses exceed the budgeted amount?.........
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discounted
care to a patient who was eligibile for free or discounted care?...............
5c
 
No
6a
Does the organization prepare an annual community benefit report?.............
6a
Yes
 
6b
If "Yes," does the organization make it available to the public? ..............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Charity Care and Certain Other Community Benefits at Cost
Charity Care and
Means-Tested Government Programs		 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Charity care at cost (from
Worksheets 1 and 2) .. 		5 16,905 13,821,380   13,821,380 2.280 %
b Unreimbursed Medicaid (from
Worksheet 3, column a) . 		41 41,123 41,910,570 35,326,977 6,583,593 1.090 %
c Unreimbursed costs—other means-tested government programs (from Worksheet 3, column b) ....            
dTotal Charity Care and
Means-Tested Government Programs ..... 		46 58,028 55,731,950 35,326,977 20,404,973 3.370 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) .... 		71 255,766 4,056,987 272,485 3,784,502 0.620 %
f Health professions education
(from Worksheet 5) .. 		18 21,541 6,882,172 3,215,652 3,666,520 0.610 %
g Subsidized health services
(from Worksheet 6) .. 		29 76,329 18,097,309 12,109,862 5,987,447 0.990 %
h Research (from Worksheet 7) 3 882 248,042   248,042 0.040 %
i Cash and in-kind contributions
to community groups
(from Worksheet 8) .. 		29 104,052 1,320,311 166,928 1,153,383 0.190 %
jTotal Other Benefits ... 150 458,570 30,604,821 15,764,927 14,839,894 2.450 %
kTotal. Add lines 7d and 7j. .. 196 516,598 86,336,771 51,091,904 35,244,867 5.820 %
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 2
Part II
Community Building Activities Complete this table if the organization conducted any community building activities.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing 1 414 71,437   71,437 0.010 %
2 Economic development 7 628 20,180   20,180 0 %
3 Community support 4 249 28,458   28,458 0 %
4 Environmental improvements 1 145 473   473 0 %
5 Leadership development and training for community members     0      
6 Coalition building 1   670,459 5,798 664,661 0.110 %
7 Community health improvement advocacy 1   45,973   45,973 0.010 %
8 Workforce development 3 62 178,886   178,886 0.030 %
9 Other     0      
10 Total 18 1,498 1,015,866 5,798 1,010,068 0.160 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Does the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
 
No
2
Enter the amount of the organization's bad debt expense (at cost).....
2
8,703,247
3
Enter the estimated amount of the organization's bad debt expense (at cost) attributable to patients eligible under the organization's charity care policy ..
3
1,645,782
4
Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
206,779,797
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
202,204,364
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
4,575,433
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.
Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.
Check the box that describes the method used:
Section C. Collection Practices
9a
Does the organization have a written debt collection policy? ...............
9a
Yes
 
b
If "Yes," does the organization's collection policy contain provisions on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance? Describe in Part VI......
9b
Yes
 
Part IV
Management Companies and Joint Ventures
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership% 		(e) Physicians'
profit % or stock
ownership %
11 DUBUQUE REGIONAL AMBULATORY SURGICAL CENTER LLC
  		AMBULATORY SURGICAL SERVICES 50.000 %   50.000 %
22 MEDICAL ASSOCIATESMERCY FAMILY CARE NETWORK LLC
  		PRIMARY CARE PHYSICIAN SERVICES 50.000 %   50.000 %
33 TRI-STATE OCCUPATIONAL HEALTH LLC
  		OCCUPATIONAL HEALTH SERVICES 50.000 %   50.000 %
44 FOREST PARK IMAGING LLC
  		IMAGING SERVICES 52.890 %   47.110 %
55 MAGNETIC RESONANCE SERVICES PARTNERSHIP
  		MRI SERVICES 49.000 %   51.000 %
66 MASON CITY AMBULATORY SURGERY CENTER LLC
  		AMBULATORY SURGICAL SERVICES 51.000 %   49.000 %
77 MERCY HEART CENTER OUTPATIENT SERVICES LLC
  		OUTPATIENT ECHOCARDIOGRAPHY AND NUCLEAR MEDICINE SERVICES 51.000 %   49.000 %
88 SURGICAL CENTER BUILDING ASSOCIATES LLC
  		OWNS AND LEASES SURGICAL CENTER BUILDING 35.000 %   65.000 %
99 SIOUXLAND SURGERY CENTER
  		AMBULATORY SURGICAL SERVICES 31.290 %   68.710 %
1010 MERCY WEIGHT LOSS CENTER LLC
  		PRE-OP AND POST-OP COUNSELING SERVICES TO BARIATRIC PATIENTS 25.000 %   75.000 %
11
12
13
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 3
Part VFacility Information
Section A. Hospital Facilities
(list in order of size, measured by total revenue per facility, from largest to smallest)
How many hospital facilities did the organization operate during the tax year?6
Name and address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe)
1 MERCY MEDICAL CENTER-NORTH IOWA
1000 FOURTH STREET SW
MASON CITY,IA50401 		X X   X   X X    
2 MERCY MEDICAL CENTER-SIOUX CITY
801 FIFTH STREET
SIOUX CITY,IA51102 		X X         X   EMPLOYED PHYSICIANS, SKILLED CARE UNIT
3 MERCY MEDICAL CENTER - DUBUQUE
250 MERCY DRIVE
DUBUQUE,IA52001 		X X         X   REHAB,LAB,PHARM, X-RAY,HOME CARE
4 SIOUXLAND SURGERY CENTER
600 SIOUX POINT ROAD
DAKOTA DUNES,SD57049 		X X              
5 MERCY MEDICAL CENTER-NEW HAMPTON
308 NORTH MAPLE AVE
NEW HAMPTON,IA50659 		X       X   X   EMPLOYED PHYSICIANS
6 MERCY MEDICAL CENTER - DYERSVILLE
1111 THIRD STREET SW
DYERSVILLE,IA52040 		X X     X   X   REHAB,LAB,PHARM, X-RAY,HOME CARE
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:NOT REQUIRED
Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 7
Part VFacility Information (continued)

Section C. Other Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, measured by total revenue per facility, from largest to smallest)
How many non-hospital facilities did the organization operate during the tax year?15
Name and address Type of Facility (Describe)
1 MEDICAL ASSOCIATES WEST CAMPUS
1500 ASSOCIATES DRIVE
DUBUQUE,IA52001 		OCC. HEALTH, PHYS THER, AMBULATORY SURGERY
2 MEDICAL ASSOCIATES WEST CAMPUS
1500 ASSOCIATES DRIVE
DUBUQUE,IA52001 		OCC. HEALTH, PHYS THER, AMBULATORY SURGERY
3 MEDICAL ASSOCIATES WEST CAMPUS
1500 ASSOCIATES DRIVE
DUBUQUE,IA52001 		OCC. HEALTH, PHYS THER, AMBULATORY SURGERY
4 MEDICAL ASSOCIATES WEST CAMPUS
1500 ASSOCIATES DRIVE
DUBUQUE,IA52001 		OCC. HEALTH, PHYS THER, AMBULATORY SURGERY
5 MEDICAL ASSOCIATES WEST CAMPUS
1500 ASSOCIATES DRIVE
DUBUQUE,IA52001 		OCC. HEALTH, PHYS THER, AMBULATORY SURGERY
6 MEDICAL ASSOCIATES WEST CAMPUS
1500 ASSOCIATES DRIVE
DUBUQUE,IA52001 		OCC. HEALTH, PHYS THER, AMBULATORY SURGERY
7 MEDICAL ASSOCIATES WEST CAMPUS
1500 ASSOCIATES DRIVE
DUBUQUE,IA52001 		OCC. HEALTH, PHYS THER, AMBULATORY SURGERY
8 MEDICAL ASSOCIATES WEST CAMPUS
1500 ASSOCIATES DRIVE
DUBUQUE,IA52001 		OCC. HEALTH, PHYS THER, AMBULATORY SURGERY
9 MEDICAL ASSOCIATES WEST CAMPUS
1500 ASSOCIATES DRIVE
DUBUQUE,IA52001 		OCC. HEALTH, PHYS THER, AMBULATORY SURGERY
10 MEDICAL ASSOCIATES WEST CAMPUS
1500 ASSOCIATES DRIVE
DUBUQUE,IA52001 		OCC. HEALTH, PHYS THER, AMBULATORY SURGERY
11 MEDICAL ASSOCIATES WEST CAMPUS
1500 ASSOCIATES DRIVE
DUBUQUE,IA52001 		OCC. HEALTH, PHYS THER, AMBULATORY SURGERY
12 MEDICAL ASSOCIATES WEST CAMPUS
1500 ASSOCIATES DRIVE
DUBUQUE,IA52001 		OCC. HEALTH, PHYS THER, AMBULATORY SURGERY
13 MEDICAL ASSOCIATES WEST CAMPUS
1500 ASSOCIATES DRIVE
DUBUQUE,IA52001 		OCC. HEALTH, PHYS THER, AMBULATORY SURGERY
14 MEDICAL ASSOCIATES WEST CAMPUS
1500 ASSOCIATES DRIVE
DUBUQUE,IA52001 		OCC. HEALTH, PHYS THER, AMBULATORY SURGERY
15 MEDICAL ASSOCIATES WEST CAMPUS
1500 ASSOCIATES DRIVE
DUBUQUE,IA52001 		OCC. HEALTH, PHYS THER, AMBULATORY SURGERY
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 8
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the description required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 2, 4c, 6i, 7, 11i, 13i, 17l, 18l, 19e, 21d, 25, and 26.
2 Community health needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any community health needs assessments reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Identifier ReturnReference Explanation
    PART I, LINE 6A: MERCY HEALTH SERVICES-IOWA REPORTS ITS COMMUNITY BENEFIT INFORMATION AS PART OF THE CONSOLIDATED COMMUNITY BENEFIT INFORMATION REPORTED BY TRINITY HEALTH IN ITS ANNUAL REPORT, AVAILABLE AT WWW.TRINITY-HEALTH.ORG.IN ADDITION, THE HOSPITAL DIVISIONS OF MERCY HEALTH SERVICES-IOWA (MHS-IA) INCLUDE A COPY OF THEIR MOST RECENT SCHEDULE H ON THEIR RESPECTIVE WEBSITES. TRINITY HEALTH ALSO INCLUDES MHS-IA'S MOST RECENTLY FILED SCHEDULE H ON ITS WEBSITE.
    PART I, LINE 7: THE BEST AVAILABLE DATA WAS USED TO CALCULATE THE COST AMOUNTS REPORTED IN ITEM 7. FOR CERTAIN CATEGORIES, PRIMARILY TOTAL CHARITY CARE AND MEANS-TESTED GOVERNMENT PROGRAMS, SPECIFIC COST-TO-CHARGE RATIOS WERE CALCULATED AND APPLIED TO THOSE CATEGORIES. THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. IN OTHER CATEGORIES, THE BEST AVAILABLE DATA WAS DERIVED FROM THE HOSPITALS' COST ACCOUNTING SYSTEMS.
    PART I, L7 COL(F): THE FOLLOWING NUMBER, $26,304,010, REPRESENTS THE AMOUNT OF BAD DEBT EXPENSE INCLUDED IN TOTAL FUNCTIONAL EXPENSES IN FORM 990, PART IX, LINE 25. PER IRS INSTRUCTIONS, THIS AMOUNT WAS EXCLUDED FROM THE DENOMINATOR WHEN CALCULATING THE PERCENT OF TOTAL EXPENSE FOR SCHEDULE H, PART I, LINE 7, COLUMN (F).
    PART II: COMMUNITY BUILDING ACTIVITIES -MERCY MEDICAL CENTER- SIOUX CITYMERCY MEDICAL CENTER GIFTED/SOLD PROPERTY IN THE DOWNTOWN AREA TO A LOCAL FOUNDATION FOR USE AS A PUBLIC SPIRITUAL GARDEN/GREEN SPACE. THE LOCATION IS NEXT TO THE DOWNTOWN PRESBYTERIAN CHURCH. THE DOWNTOWN PARTNERS AND THE LOCAL CHURCH BELIEVE THE PROPERTY WILL BENEFIT THE COMMUNITY. DONATION OF THE PROPERTY IS VALUED $200,000 BELOW INVESTMENT. MERCY MEDICAL CENTER-SIOUX CITY STAFF IS ALSO INVOLVED IN THE NW IOWA AMERICAN HEART TASK FORCE, SIOUXLAND INFECTIOUS DISEASE COMMITTEE, TRI-STATE DISASTER COMMITTEE, IOWA DISASTER MEDICAL ASSISTANCE TEAM, EMERGENCY CONFERENCE COMMITTEE (MERCY COMMITTEE), MERCY EMERGENCY PLANNING COMMITTEE AND HEALTH RESOURCE SERVICE ADMINISTRATION (HRSA).MERCY IS WORKING WITH THE MIDTOWN COMMUNITY CENTER AND AMERICORPS WORKERS ON BENEFITS ENROLLMENT OF LOCAL RESIDENTS OFF SITE (AT A NON HEALTH CARE SITE). THE AMERICORPS WORKERS ARE FAMILIAR WITH PEOPLE IN THE AREA AND THE ENVIRONMENT IS LESS INTIMIDATING/ OVERWHELMING THAN THE HOSPITAL ENVIRONMENT. IT IS BELIEVED THAT MANY PATIENTS IN THE LOCAL NEIGHBORHOOD QUALIFY FOR BENEFITS, BUT ARE NOT ENROLLING IN PROGRAMS. THIS LEADS TO INABILITY TO PAY, AND LACK OF ACCESS TO PRIMARY AND PREVENTATIVE HEALTH CARE. MERCY PROVIDED A TOTAL OF 300 COMPUTERS TO MARY TREGLIA COMMUNITY HOUSE AND THE MIDTOWN COMMUNITY CENTER. LOCAL COLLEGES WILL PROVIDE SOFTWARE UPDATES AND EDUCATION TO RESIDENTS IN THE 51103 AND 51105 ZIP CODES. ACCESS TO INTERNET SERVICES (FOR HELP WITH HEALTH INFORMATION, OTHER EDUCATION AND EMPLOYMENT) IS BEING EXPLORED WITH THE CITY OF SIOUX CITY.MERCY MEDICAL CENTER-NORTH IOWACOMMUNITY BASED CLINICAL SERVICES: WITH THE ENTIRE STATE BEING UNDERSERVED BY MENTAL HEALTH SERVICES, MERCY'S BEHAVIORAL SERVICES IS PLEASED TO COLLABORATE WITH CERRO GORDO AND MITCHELL COUNTY SCHOOL SYSTEMS AS WELL AS THE MENTAL HEALTH CENTER OF NORTH IOWA AND PRAIRIE RIDGE ADDICTION AND TREATMENT SERVICES TO ASSESS ADOLESCENTS IN SCHOOL SETTINGS FOR DEPRESSION. THE TEENS THEN RECEIVE APPROPRIATE INTERVENTIONS. MERCY'S BEHAVIORAL SERVICES IS ALSO ACTIVE IN THE AREA YOUTH TASK FORCE.COALITION BUILDING: THE BUILDING AND CONTINUED OPERATION OF THE YMCA & REHABILITATION CENTER WAS IN RESPONSE TO AN IDENTIFIED COMMUNITY HEALTH NEED. THE NORTHERN CLIMATE ONLY UNDERSCORES THE IMPORTANCE FOR PROVIDING THE ONLY YEAR-ROUND OVERALL EXERCISE, FITNESS, WELLNESS PROGRAMS, AND AQUATIC REHAB FACILITY IN NORTH IOWA THAT IS OPEN TO CHILDREN OF ALL AGES. IN ADDITION TO REGULAR PROGRAMMING, THE YMCA CONDUCTS A VARIETY OF PROGRAMS AND ACTIVITIES THAT ARE FREE AND/OR SUBSIDIZED. MERCY MEDICAL CENTER-NORTH IOWA AND THE YMCA PARTICIPATE IN A JOINT VENTURE THAT OWNS THE LAND, CONSTRUCTED THE FACILITY, AND ENABLES THE ONGOING OPERATION OF SUCH. WORKFORCE DEVELOPMENT: NORTH IOWA IS NOT ALWAYS THE PREFERRED LOCATION OF CHOICE FOR MEDICAL PROFESSIONALS. FOR THIS REASON, MERCY MEDICAL CENTER-NORTH IOWA ACTIVELY RECRUITS PHYSICIANS IN AN EFFORT TO PROMOTE ACCESSIBLE HEALTH CARE TO THE RESIDENTS OF THE COMMUNITIES WE SERVE THAT HAVE BEEN DESIGNATED AS A HEALTH PROFESSIONAL SHORTAGE AREA (HPSA) AND/OR MEDICALLY UNDERSERVED AREA (MUA). THESE EFFORTS SUPPORT THE COMMUNITIES BY PROVIDING EXPERTISE AND HEALTHCARE SERVICES, AND AS A CLAUSE IN THEIR CONTRACT STATES, SPECIAL CARE FOR INDIGENT AND UNDERSERVED POPULATIONS. AS THE LARGEST EMPLOYER IN OUR 14-COUNTY AREA, MERCY MEDICAL CENTER-NORTH IOWA TAKES ITS CIVIC RESPONSIBILITY VERY SERIOUSLY. THERE ARE OTHER ENDEAVORS IN WHICH MERCY PARTICIPATES TO IMPACT THE UPSTREAM HEALTH OF THE COMMUNITY IN WAYS THAT ARE NOT CURRENTLY ELIGIBLE FOR COMMUNITY BENEFIT REPORTING. ONE EXAMPLE OF THIS IS OUR SIGNIFICANT FINANCIAL CONTRIBUTION TO THE NORTH IOWA CORRIDOR ECONOMIC DEVELOPMENT CORP. TO STRENGTHEN THE ECONOMY OF OUR CATCHMENT COUNTIES, WHICH ENCOURAGES EMPLOYMENT OPPORTUNITIES, WHICH ENHANCES HEALTH AND WELL-BEING ON MULTIPLE FRONTS.MERCY MEDICAL CENTER-NEW HAMPTON (MMC-NH)AS ONE OF THE LARGEST EMPLOYERS IN THE AREA, MMC-NH TAKES ITS CIVIC RESPONSIBILITY VERY SERIOUSLY. SUPPORT OF AND CONTRIBUTIONS TO COMMUNITY ORGANIZATIONS, EVENTS, AND PROGRAMS, SUCH AS THE CHAMBER, HELP IMPROVE THE ECONOMY OF MMC-NH'S CATCHMENT COUNTIES. BY PROMOTING ECONOMIC DEVELOPMENT, MMC-NH HELPS CREATE A COMMUNITY THAT CONTINUES TO BUILD ITSELF THROUGH THE LEADERS WHO WORK AND VOLUNTEER AT THE HOSPITAL. ECONOMIC STABILITY IS INTRINSICALLY LINKED TO THE PREVENTION OF HEALTH PROBLEMS ASSOCIATED WITH POVERTY, HOMELESSNESS, AND ENVIRONMENTAL CHALLENGES, AND IS CRUCIAL IF THE COMMUNITY HOPES TO MAINTAIN A VIABLE HOSPITAL COMPLEX WITH A BROAD SPECTRUM OF ESSENTIAL SERVICES. IN ADDITION TO SUPPORTING ECONOMIC DEVELOPMENT IN OUR REGION, MMC-NH ENCOURAGES ITS LEADERSHIP STAFF TO SUPPORT AND PROVIDE LEADERSHIP TO NON-PROFIT ORGANIZATIONS THROUGHOUT THE AREA. FOLLOWING THE 9/11 ATTACKS AND HURRICANE KATRINA, THE U.S. GOVERNMENT PROVIDED GRANT MONEY TO HELP COMMUNITIES BETTER PREPARE FOR DISASTER. MMC-NH IS NOW PART OF A MULTI-DISCIPLINARY GROUP, WHICH INCLUDES STATE, COUNTY, CITY EMPLOYEES, PUBLIC HEALTH, HOSPITALS AND PHYSICIANS, AND VOLUNTEERS THAT MEETS TO STRATEGIZE FOR A REAL DISASTER USING TABLETOP EVENTS AND SIMULATIONS. IN ORDER TO CREATE AWARENESS OF THE OPPORTUNITIES IN HEALTH CARE IN RURAL IOWA, MMC-NH COLLABORATES WITH THE HIGH SCHOOL TO PROVIDE THE SERVICE TO BRING IN STUDENTS TO SHADOW A VARIETY OF HEALTH-RELATED OCCUPATIONS IN ORDER TO SPARK INTEREST IN CONSIDERING A HEALTH CARE CAREER. MMC-NH ALSO IDENTIFIED A NEED FOR MEMBERS OF THE COMMUNITY TO MORE SAFELY DISPOSE OF THEIR SHARPS AND CONTAINERS. THE HOSPITAL NOW COLLABORATES WITH PHARMACIES IN NEW HAMPTON TO COLLECT THE CONTAINERS.MERCY MEDICAL CENTER-DUBUQUEMERCY MEDICAL CENTER-DUBUQUE, DURING ITS FISCAL YEAR ENDING JUNE 30, 2011, WAS ENGAGED IN THREE ACTIVITIES THAT WERE DOCUMENTED IN OUR COMMUNITY BENEFIT EXPENSES AS COMMUNITY BUILDING ACTIVITIES:MERCY SUBSIDIZES THE WAGES OF SEVERAL DEVELOPMENTALLY DISABLED YOUNG ADULTS WHO WORK AT MERCY IN THE ENVIRONMENTAL SERVICES DEPARTMENT. THIS PROGRAM IS IN PARTNERSHIP WITH GOODWILL INDUSTRIES. THE PARTNERS IN EMPLOYMENT ALLIANCE PROGRAM CONTRIBUTES TO THE ECONOMIC DEVELOPMENT OF THE COMMUNITY, IN A SMALL BUT VERY MEANINGFUL WAY, BY PROVIDING AN OPPORTUNITY FOR SKILL BUILDING AND JOB READINESS TO PEOPLE WHO HAVE THE POTENTIAL TO BECOME PRODUCTIVE MEMBERS OF THE COMMUNITY.MERCY OCCASIONALLY LENDS ITS EXPERTISE IN STRATEGIC PLANNING THROUGH FREE CONSULTING SERVICES TO OTHER COMMUNITY NOT-FOR-PROFIT ORGANIZATIONS THAT SHARE MERCY'S MISSION PRINCIPLES. FINALLY, MERCY SUBSIDIZES, FULLY, OR PARTIALLY, THE FEES ASSOCIATED WITH ITS LIFELINE EMERGENCY RESPONSE SYSTEM FOR SENIORS AND HANDICAPPED INDIVIDUALS. THE PROGRAM EXTENDS THE PERIOD OF TIME THAT AN INDIVIDUAL CAN CONTINUE LIVING AT HOME OR WITH MINIMUM DIRECT SUPERVISION, BY PROVIDING A RELIABLE MEANS OF EMERGENCY COMMUNICATION. THIS IMPROVES THE COMMUNITY BY INCREASING THE NUMBER OF PEOPLE WHO ARE ABLE TO AGE IN THE LEAST RESTRICTIVE ENVIRONMENT.
    PART III, LINE 4: MERCY HEALTH SERVICES - IOWA, CORP. IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH. THE FOLLOWING IS THE TEXT OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOOTNOTE FROM THOSE STATEMENTS: "SUBSTANTIALLY ALL OF THE CORPORATION'S RECEIVABLES ARE RELATED TO PROVIDING HEALTHCARE SERVICES TO PATIENTS. ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR AMOUNTS THAT COULD BECOME UNCOLLECTIBLE IN THE FUTURE. THE CORPORATION'S ESTIMATE FOR ITS ALLOWANCE FOR DOUBTFUL ACCOUNTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS BY PAYOR."COSTING METHODOLOGY FOR LINES 2 AND 3: AMOUNTS ARE CALCULATED ON LINE 2 USING A COST TO CHARGE RATIO METHODOLOGY.ANY DISCOUNTS PROVIDED OR PAYMENTS MADE TO A PARTICULAR PATIENT ACCOUNT ARE APPLIED TO THAT PATIENT ACCOUNT PRIOR TO ANY BAD DEBT WRITE-OFF AND ARE THUS NOT INCLUDED IN BAD DEBT EXPENSE. AS A RESULT OF THE PAYMENT AND ADJUSTMENT ACTIVITY BEING POSTED TO BAD DEBT ACCOUNTS, WE ARE ABLE TO REPORT BAD DEBT EXPENSE NET OF THESE TRANSACTIONS.THE AMOUNT ON LINE 3 WAS CALCULATED BASED ON THE INFORMATION SUPPLIED BY A THIRD PARTY VENDOR, H&R COLLECTION AGENCY, WHO USES THE FASTAG PROGRAM WHICH IDENTIFIES FINANCIAL ASSISTANCE BASED ON A PROPRIETARY PROCESS. FASTAG COMBINES ACCOUNT DATA, EXTERNAL INFORMATION AND THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY TO ARRIVE AT A DISCOUNT RECOMMENDATION FOR EACH ACCOUNT.
    PART III, LINE 8: MERCY HEALTH SERVICES - IOWA, CORP. DOES NOT BELIEVE ANY MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT. THIS IS SIMILAR TO CHA RECOMMENDATIONS, WHICH STATE THAT SERVING MEDICARE PATIENTS IS NOT A DIFFERENTIATING FEATURE OF TAX-EXEMPT HEALTHCARE ORGANIZATIONS AND THAT THE EXISTING COMMUNITY BENEFIT FRAMEWORK ALLOWS COMMUNITY BENEFIT PROGRAMS THAT SERVE THE MEDICARE POPULATION TO BE COUNTED IN OTHER COMMUNITY BENEFIT CATEGORIES.PART III, LINE 8: COSTING METHODOLOGY FOR LINE 6 - MEDICARE COSTS WERE OBTAINED FROM THE FILED MEDICARE COST REPORT. THE COSTS ARE BASED ON MEDICARE ALLOWABLE COSTS AS REPORTED ON WORKSHEET B, COLUMN 27, WHICH EXCLUDE DIRECT MEDICAL EDUCATION COSTS. INPATIENT MEDICARE COSTS ARE CALCULATED BASED ON A COMBINATION OF ALLOWABLE COST PER DAY TIMES MEDICARE DAYS FOR ROUTINE SERVICES AND COST TO CHARGE RATIO TIMES MEDICARE CHARGES FOR ANCILLARY SERVICES. OUTPATIENT MEDICARE COSTS ARE CALCULATED BASED ON COST TO CHARGE RATIO TIMES MEDICARE CHARGES BY ANCILLARY DEPARTMENT.
    PART III, LINE 9B: MERCY HEALTH SERVICES - IOWA, CORP'S COLLECTION POLICY CONTAINS THE CRITERIA FOR FINANCIAL ASSISTANCE, AND CONTAINS THE FOLLOWING VERBIAGE FOR ARRANGEMENTS WITH OUTSIDE COLLECTION AGENCIES: THE AGREEMENT MUST DEFINE THE STANDARDS AND SCOPE OF PRACTICES TO BE USED BY OUTSIDE COLLECTION AGENTS ACTING ON BEHALF OF THE MINISTRY ORGANIZATION, ALL OF WHICH MUST BE IN COMPLIANCE WITH THIS POLICY.
    PART VI, LINE 2: NEEDS ASSESSMENT - MERCY HEALTH SERVICES-IOWA (MHS-IA) ASSESSES THE HEALTH NEEDS OF THE COMMUNITY THROUGH COMMUNITY NEEDS ASSESSMENTS EVERY THREE YEARS. MHS-IA IS COMPRISED OF FOUR ENTITIES: MERCY MEDICAL CENTER-DUBUQUE, MERCY MEDICAL CENTER-NEW HAMPTON, MERCY MEDICAL CENTER-NORTH IOWA AND MERCY MEDICAL CENTER-SIOUX CITY. EACH MEDICAL CENTER COMPLETES ITS OWN NEEDS ASSESSMENT.A COMMUNITY NEEDS ASSESSMENT IS A POINT-IN-TIME EFFORT TO MEASURE THE HEALTH AND WELL BEING OF THE COMMUNITY. IT SERVES AS THE BASIS FOR MERCY HEALTH SERVICES - IOWA'S STRATEGIC AND SUBSEQUENT ACTION PLANNING TO DEVELOP HEALTH POLICY, ALLOCATE RESOURCES, IMPROVE OR EXPAND EXISTING SERVICES, IMPLEMENT NEW PROGRAMS AND COLLABORATE WITH OTHER COMMUNITY HEALTHCARE PROVIDERS. A COMMUNITY NEEDS ASSESSMENT ALSO SERVES AS A BENCHMARK FOR FUTURE ASSESSMENT OF RELATIVE PROGRESS TOWARD ESTABLISHED COMMUNITY HEALTH OBJECTIVES.MERCY HEALTH SERVICES - IOWA'S COMMUNITY NEEDS ASSESSMENT PROVIDES THE OPPORTUNITY TO:- GAIN INSIGHTS INTO THE NEEDS AND ASSETS OF THE COMMUNITIES SERVED - IDENTIFY AND ADDRESS THE NEEDS OF VULNERABLE POPULATIONS WITHIN THE COMMUNITY- ENHANCE HOSPITAL/COMMUNITY RELATIONSHIPS AND THE OPPORTUNITY FOR COLLABORATIVE COMMUNITY ACTION, INCLUDING INVOLVEMENT WITH COALITIONS, PARTNERSHIPS, BOARDS, COMMITTEES, COMMISSIONS, ADVISORY GROUPS AND PANELS- PROVIDE THE INFORMATION REQUIRED FOR COMMUNITY OUTREACH PLANNINGTHE MERCY HEALTH SERVICES-IOWA COMMUNITY NEEDS ASSESSMENT PROCESS INVOLVES THE GATHERING OF TWO TYPES OF DATA: QUANTITATIVE (DEMOGRAPHICS, HEALTH INDICATORS, ETC.) AND QUALITATIVE (PUBLIC SURVEYS, FORUMS, FOCUS GROUPS). THE DATA HELPS SUPPORT SHORT-TERM AND LONG-TERM DECISIONS ABOUT ALLOCATION OF COMMUNITY HUMAN AND CAPITAL RESOURCES. THE MERCY HEALTH SERVICES-IOWA COMMUNITY NEEDS ASSESSMENTS ARE CURRENT AS OF 2010 FOR NORTH IOWA AND NEW HAMPTON, 2009 FOR SIOUX CITY AND TO BE COMPLETED AND PUBLISHED FOR DUBUQUE IN 2011.THE MERCY MEDICAL CENTER-NORTH IOWA COMMUNITY HEALTH CARE NEEDS ASSESSMENT INCLUDES ACTION PLANS TO ADDRESS IDENTIFIED COMMUNITY NEEDS HAVE BEEN DEVELOPED THROUGH JUNE 2013. THE ASSESSMENT COVERED THE 14-COUNTY SERVICE AREA OF MERCY-NORTH IOWA. THERE CONTINUES TO BE COORDINATION WITH CERRO GORDO PUBLIC HEALTH, NORTH IOWA COMMUNITY ACTION ORGANIZATION AND THE NORTH CENTRAL IOWA REGIONAL PLANNING COALITION, COMPRISED OF OTHER NOT-FOR-PROFIT AND GOVERNMENTAL AGENCIES AND ORGANIZATIONS REPRESENTING 14 NORTH IOWA COUNTIES: BUTLER, CERRO GORDO, CHICKASAW, FLOYD, FRANKLIN, HANCOCK, HARDIN, HOWARD, KOSSUTH, MITCHELL, PALO ALTO, WINNEBAGO, WORTH, AND WRIGHT. OUTSIDE REFERENCES SUCH AS THE DHS REPORT "HEALTHY PEOPLE 2020" AND IOWA DEPARTMENT OF PUBLIC HEALTH'S "PUBLIC HEALTH DATA WAREHOUSE" AS WELL AS OTHER RELEVANT RESOURCES SUCH AS UNIVERSITY OF IOWA'S "2009 IOWA HEALTH FACT BOOK" WERE REFERENCED. TECHNICAL ASSISTANCE WAS PROVIDED BY A DES MOINES-BASED CONSULTING AND SERVICE FIRM.THE MERCY MEDICAL CENTER-DUBUQUE COMMUNITY HEALTH NEEDS ASSESSMENT WAS UNDERWAY IN FY 2011. THE COMMUNITY NEEDS ASSESSMENT WAS CONDUCTED AS PART OF A COUNTY-WIDE HEALTH CARE ASSESSMENT PROCESS MANDATED FOR ALL COUNTIES BY THE STATE OF IOWA. PARTNERS INCLUDE LOCAL HOSPITALS, COMMUNITY AGENCIES, SOCIAL SERVICES, AND LOCAL BUSINESSES. MORE THAN 50 INDIVIDUALS MET IN SIX SEPARATE SUBCOMMITTEES TO EVALUATE NEEDS AND IDENTIFY STRATEGIES IN SIX CATEGORIES: PROMOTING HEALTHY BEHAVIORS, INJURY PREVENTION, PROTECT AGAINST ENVIRONMENTAL HAZARDS, PREPARE FOR, RESPOND TO AND RECOVER FROM PUBLIC HEALTH EMERGENCIES, PREVENT EPIDEMICS AND THE SPREAD OF DISEASE, AND STRENGTHEN PUBLIC HEALTH INFRASTRUCTURE. RESPONSIBILITY FOR COMPLETING VARIOUS ASPECTS OF THE HEALTH IMPROVEMENT PLAN ASSOCIATED WITH THIS HEALTH NEEDS ASSESSMENT ARE SHARED BY THE DUBUQUE COUNTY BOARD OF HEALTH AND LOCAL HOSPITALS, COMMUNITY AGENCIES, SOCIAL SERVICES, AND LOCAL BUSINESSES. SOME ADDITIONAL OBJECTIVES WILL BE CONSIDERED AND ADDED BY MERCY'S COMMUNITY BENEFITS MINISTRY GRANT FUND COMMITTEE BEFORE THE PLAN IS FINALIZED IN FY 2012.THE MERCY MEDICAL CENTER-SIOUX CITY COMMUNITY NEEDS ASSESSMENT PROCESS INVOLVES THE GATHERING OF TWO TYPES OF DATA: QUANTITATIVE (DEMOGRAPHICS, HEALTH INDICATORS, ETC.) AND QUALITATIVE (PUBLIC SURVEYS, FORUMS, FOCUS GROUPS). THE DATA HELPS SUPPORT SHORT-TERM AND LONG-TERM DECISIONS ABOUT ALLOCATION OF COMMUNITY HUMAN AND CAPITAL RESOURCES.
    PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE - MERCY HEALTH SERVICES-IOWA IS COMMITTED TO:- PROVIDING ACCESS TO QUALITY HEALTHCARE SERVICES WITH COMPASSION, DIGNITY AND RESPECT FOR THOSE WE SERVE, PARTICULARLY THE POOR AND THE UNDERSERVED IN OUR COMMUNITIES- CARING FOR ALL PERSONS, REGARDLESS OF THEIR ABILITY TO PAY FOR SERVICES- ASSISTING PATIENTS WHO CANNOT PAY FOR PART OR ALL OF THE CARE THEY RECEIVE - BALANCING NEEDED FINANCIAL ASSISTANCE FOR SOME PATIENTS WITH BROADER FISCAL RESPONSIBILITIES IN ORDER TO SUSTAIN VIABILITY AND PROVIDE THE QUALITY AND QUANTITY OF SERVICES FOR ALL WHO MAY NEED CARE IN A COMMUNITYIN ACCORDANCE WITH AHA RECOMMENDATIONS, MERCY HEALTH SERVICES-IOWA HAS ADOPTED THE FOLLOWING GUIDING PRINCIPLES WHEN HANDLING THE BILLING, COLLECTION AND FINANCIAL SUPPORT FUNCTIONS FOR OUR PATIENTS: - PROVIDE EFFECTIVE COMMUNICATIONS WITH PATIENTS REGARDING HOSPITAL BILLS- MAKE AFFIRMATIVE EFFORTS TO HELP PATIENTS APPLY FOR PUBLIC AND PRIVATE FINANCIAL SUPPORT PROGRAMS- OFFER FINANCIAL SUPPORT TO PATIENTS WITH LIMITED MEANS- IMPLEMENT POLICIES FOR ASSISTING LOW-INCOME PATIENTS IN A CONSISTENT MANNER- IMPLEMENT FAIR AND CONSISTENT BILLING AND COLLECTION PRACTICES FOR ALL PATIENTS WITH PATIENT PAYMENT OBLIGATIONSMERCY HEALTH SERVICES-IOWA COMMUNICATES EFFECTIVELY WITH PATIENTS REGARDING PATIENT PAYMENT OBLIGATIONS. FINANCIAL COUNSELING IS PROVIDED TO PATIENTS ABOUT THEIR PAYMENT OBLIGATIONS AND HOSPITAL BILLS. INFORMATION ON HOSPITAL-BASED FINANCIAL SUPPORT POLICIES AND EXTERNAL PROGRAMS THAT PROVIDE COVERAGE FOR SERVICES ARE MADE AVAILABLE TO PATIENTS DURING THE PRE-REGISTRATION AND REGISTRATION PROCESSES AND/OR THROUGH COMMUNICATIONS WITH PATIENTS SEEKING FINANCIAL ASSISTANCE. EVERY EFFORT IS MADE TO DETERMINE A PATIENT'S ELIGIBILITY PRIOR TO OR AT THE TIME OF ADMISSION OR SERVICE. HOWEVER, DETERMINATION FOR FINANCIAL SUPPORT CAN BE MADE DURING ANY STAGE OF THE PATIENT'S STAY AFTER STABILIZATION OR COLLECTION CYCLE.MERCY MEDICAL CENTER-SIOUX CITYMERCY MEDICAL CENTER-SIOUX CITY NOT ONLY COMMUNICATES FINANCIAL ASSISTANCE POLICIES VIA TRADITIONAL CHANNELS (REGISTRATION, AND BILLING); THE ORGANIZATION SHARES ITS FINANCIAL ASSISTANCE POLICY WITH OTHER SERVICE AGENCIES AND NOT-FOR PROFIT ORGANIZATIONS. FOR EXAMPLE, THROUGH THE MISSION HEALTH PROGRAM, A COLLABORATION BETWEEN THE SIOUXLAND COMMUNITY HEALTH CENTER AND MERCY AND ST. LUKE'S HOSPITALS, MERCY MEDICAL CENTER-SIOUX CITY REACHES OUT TO CHURCHES AND SCHOOLS TO FIND THOSE WHO MAY BE IN NEED OF FINANCIAL ASSISTANCE. PARTICIPANTS ARE PRE-QUALIFIED FOR FINANCIAL ASSISTANCE AT BOTH LOCAL HOSPITALS, AND ARE INVITED TO CHOOSE A MEDICAL HOME. THE MISSION HEALTH PROGRAM HAS OVER 1400 ENROLLED PATIENTS, ALL OF WHOM HAVE A BETTER UNDERSTANDING AND REDUCED ANXIETY CONCERNING FINANCIAL OBLIGATIONS AND ASSISTANCE IF HOSPITALIZATION IS NEEDED. EVERY EFFORT IS MADE TO DETERMINE A PATIENT'S ELIGIBILITY PRIOR TO OR AT THE TIME OF ADMISSION OR SERVICE. HOWEVER, DETERMINATION FOR FINANCIAL SUPPORT CAN BE MADE DURING ANY STAGE OF THE PATIENT'S STAY AFTER STABILIZATION OR COLLECTION CYCLE.FINANCIAL COUNSELORS MAKE AFFIRMATIVE EFFORTS TO HELP PATIENTS APPLY FOR PUBLIC AND PRIVATE PROGRAMS FOR WHICH THEY MAY QUALIFY AND THAT MAY HELP THEM OBTAIN AND PAY FOR HEALTHCARE SERVICES. MERCY MEDICAL CENTER-SIOUX CITY SOCIAL WORKERS PROVIDE ASSISTANCE AND COUNSELING REGARDING FINANCIAL ASSISTANCE OPPORTUNITIES WITHIN THE ORGANIZATION, AND REFER PATIENTS AND FAMILIES TO APPROPRIATE AGENCIES FOR COVERAGE. MERCY ALSO WORKS WITH THE MIDLANDS GROUP TO ENLIST PATIENTS IN QUALIFYING PROGRAMS. MERCY UTILIZES A COMMUNITY NEEDS INDEX (CNI) TO TARGET SPECIFIC ZIP CODES WHERE PATIENTS IN NEED OF FINANCIAL ASSISTANCE OFTEN RESIDE. MERCY MEDICAL CENTER-DUBUQUEMERCY MEDICAL CENTER-DUBUQUE CONTRACTS WITH A FIRM WITH A LONG TRACK RECORD OF COMPASSIONATE SERVICE TO PROVIDE COUNSELING, REFERRALS, AND ASSISTANCE TO PATIENTS IN DETERMINING ELIGIBILITY AND ENROLLING IN A WIDE VARIETY OF PUBLIC AND PRIVATE ASSISTANCE PROGRAMS, SUCH AS MEDICARE, MEDICAID, HAWK-I (AND THE CORRESPONDING SCHIPS PROGRAMS FOR ILLINOIS AND WISCONSIN) AND IOWA CARE, IOWA'S STATE ASSISTANCE PROGRAM FOR INDIGENT PERSONS. EVERY EFFORT IS MADE TO DETERMINE A PATIENT'S ELIGIBILITY PRIOR TO OR AT THE TIME OF ADMISSION OR SERVICE. HOWEVER, DETERMINATION FOR FINANCIAL SUPPORT CAN BE MADE DURING ANY STAGE OF THE PATIENT'S STAY AFTER STABILIZATION OR COLLECTION CYCLE.MERCY MEDICAL CENTER-NORTH IOWA (INCLUDING NEW HAMPTON)INFORMATION ABOUT MERCY MEDICAL CENTER-NORTH IOWA'S FINANCIAL ASSISTANCE PROGRAM IS DISPLAYED IN VARIOUS ADMISSION AREAS THROUGHOUT THE HOSPITAL AND CLINICS. A "PATIENT FINANCIAL GUIDELINES" BROCHURE IS ALSO AVAILABLE AT EACH ADMISSION AREA. THIS BROCHURE PROVIDES INFORMATION REGARDING PAYMENT OPTIONS, FINANCIAL ASSISTANCE AND BILLING QUESTIONS. FINANCIAL COUNSELING IS ALSO PROVIDED TO PATIENTS ABOUT THEIR PAYMENT OBLIGATIONS AND HOSPITAL BILLS. AT TIME OF ADMISSION, THE NAMES OF UNINSURED AND UNDERINSURED PATIENTS ARE GIVEN TO THE PUBLIC BENEFITS FINANCIAL SERVICES COUNSELOR WHO MAKES AFFIRMATIVE EFFORTS TO HELP PATIENTS APPLY FOR PUBLIC AND PRIVATE PROGRAMS FOR WHICH THEY MAY QUALIFY AND THAT MAY ASSIST THEM IN OBTAINING AND PAYING FOR HEALTHCARE SERVICES. THE PUBLIC BENEFIT FINANCIAL COUNSELOR HAS A GOOD WORKING RELATIONSHIP WITH THE DEPARTMENT OF HUMAN SERVICES, STATE DISABILITY OFFICES, AND VARIOUS COUNTY AND COMMUNITY PROGRAMS. CONTACT WITH THESE OFFICES OCCURS ALMOST DAILY. MERCY HEALTH SERVICES-IOWA OFFERS FINANCIAL SUPPORT TO PATIENTS WITH LIMITED MEANS. THIS SUPPORT IS AVAILABLE TO UNINSURED AND UNDERINSURED PATIENTS WHO DO NOT QUALIFY FOR PUBLIC PROGRAMS OR OTHER ASSISTANCE. NOTIFICATION ABOUT FINANCIAL ASSISTANCE, INCLUDING CONTACT INFORMATION, IS AVAILABLE THROUGH VARIOUS MEANS, WHICH INCLUDE, BUT ARE NOT LIMITED TO, THE PUBLICATION OF PATIENT BROCHURES, NOTICES OR MESSAGING INCLUDED ON PATIENT BILLS, POSTING OF NOTICES IN PUBLIC REGISTRATION AREAS INCLUDING EMERGENCY ROOMS, URGENT CARE CENTERS, ADMITTING AND REGISTRATION DEPARTMENTS, HOSPITAL PATIENT ACCOUNTING DEPARTMENTS, AND OTHER PATIENT FINANCIAL SERVICES OFFICES LOCATED ON FACILITY CAMPUSES. SUMMARIES OF HOSPITAL PROGRAMS ARE MADE AVAILABLE THROUGHOUT THE COMMUNITIES SERVED BY MERCY HEALTH SERVICES-IOWA, TO PUBLIC HEALTH CENTERS, CATHOLIC CHARITABLE ORGANIZATIONS AND OTHER COMMUNITY OUTREACH SERVICES.INFORMATION REGARDING FINANCIAL ASSISTANCE PROGRAMS IS ALSO AVAILABLE IN ADMISSION PACKAGES DURING INTAKE. IN ADDITION TO ENGLISH, THIS INFORMATION IS ALSO AVAILABLE IN SPANISH, REFLECTING THE OTHER PRIMARY LANGUAGE SPOKEN BY THE POPULATION SERVICED BY OUR HOSPITALS. IN SIOUX CITY, INTERPRETERS OF MULTIPLE LANGUAGES ARE AVAILABLE ON-SITE THROUGH INTERPRETIVE SERVICES OR AT THE SIOUXLAND COMMUNITY HEALTH CENTER FOR QUESTIONS REGARDING FINANCIAL ASSISTANCE. MERCY MEDICAL CENTER-NORTH IOWA ALSO PROVIDES FINANCIAL ASSISTANCE FOR PRESCRIBED MEDICATIONS. THERE ARE SEVERAL SHORT-TERM ASSISTANCE PROGRAMS AS WELL AS A SOCIAL WORKER FACILITATING THE APPLICATION PROCESS FOR LONG-TERM ASSISTANCE FROM PHARMACEUTICAL PROGRAMS. MERCY HEALTH SERVICES-IOWA HAS ESTABLISHED A WRITTEN POLICY FOR THE BILLING, COLLECTION AND SUPPORT FOR PATIENTS WITH PAYMENT OBLIGATIONS. MERCY HEALTH SERVICES - IOWA MAKES EVERY EFFORT TO ADHERE TO THE POLICY AND IS COMMITTED TO IMPLEMENTING AND APPLYING THE POLICY FOR ASSISTING PATIENTS WITH LIMITED MEANS IN A PROFESSIONAL, CONSISTENT MANNER. THE MEDICAL CENTER EDUCATES STAFF MEMBERS WHO WORK CLOSELY WITH PATIENTS (INCLUDING THOSE WORKING IN PATIENT REGISTRATION AND ADMITTING, FINANCIAL ASSISTANCE, CUSTOMER SERVICE, BILLING AND COLLECTIONS) ABOUT THESE POLICIES, WITH AN EMPHASIS ON TREATING ALL PATIENTS WITH DIGNITY AND RESPECT REGARDLESS OF THEIR INSURANCE STATUS OR THEIR ABILITY TO PAY FOR SERVICES. PATIENT REGISTRATION STAFF, FINANCIAL ASSISTANCE STAFF, SOCIAL WORKERS, CASE MANAGERS, AND CLINIC MANAGERS RECEIVE TRAINING REGARDING FINANCIAL ASSISTANCE POLICIES.
    PART VI, LINE 4: COMMUNITY INFORMATION -MERCY MEDICAL CENTER-SIOUX CITY (MMC-SC) SERVES A 33-COUNTY AREA OF WESTERN IOWA, EASTERN NEBRASKA AND SOUTHEASTERN SOUTH DAKOTA, AN AREA WITH A HIGH COMMUNITY NEED. IN ADDITION TO THE MAIN HOSPITAL IN SIOUX CITY, MMC-SC OWNS RURAL HOSPITALS IN PRIMGHAR, IOWA, AND OAKLAND, NEBRASKA; MANAGES HOSPITALS IN PENDER, NEBRASKA AND HAWARDEN, IOWA; AND OPERATES A PRIMARY CARE CLINIC NETWORK, SPECIALTY CARE CLINICS AND HOME HEALTH SERVICES. MERCY ALSO PARTNERS WITH OTHER COMMUNITY HEALTHCARE PROVIDERS TO SPONSOR A REGIONAL CANCER CENTER, PARAMEDIC SERVICES, HOSPICE SERVICES, A FREESTANDING SURGERY CENTER AND A VARIETY OF OTHER HEALTH SERVICES.THE PRIMARY SERVICE AREA IS CONSIDERED URBAN (WITHIN SIOUX CITY). HOWEVER, MERCY SERVES MANY RURAL COMMUNITIES THROUGHOUT THE 33 COUNTY AREA, AND MANY DISTINCT ETHNIC AND CULTURAL GROUPS, INCLUDING HISPANIC, VIETNAMESE, SOMALI, AND NATIVE AMERICAN.THE AVERAGE HOUSEHOLD INCOME FOR THE 14 COUNTY SIOUX CITY AREA IS $57,046. ACCORDING TO THE STATE HEALTH ACCESS DATA ASSISTANCE CENTER, IN 2007, 27.9% PERCENT OF RESIDENTS WERE BELOW THE FEDERAL POVERTY GUIDELINES. MORE THAN 8.7% OF THE COMMUNITY IS UNINSURED, AND APPROXIMATELY 35.1% OF FAMILIES ARE ON MEDICAID OR OTHER ASSISTANCE PROGRAMS.ACCORDING TO 2009 CLARITAS DATA, THE 14 COUNTY COMMUNITY HAS A POPULATION OF 297,730. EIGHTY-FIVE PERCENT OF THE POPULATION IS WHITE, 9% HISPANIC, 1.7% ASIAN & PACIFIC ISLANDER AND 1% BLACK. THIRTY-SIX PERCENT ARE HIGH SCHOOL GRADUATES WITH NO ADDITIONAL EDUCATION, WHILE 28% HAVE SOME COLLEGE OR ASSOCIATES DEGREE, AND 18% HAVE A BACHELOR'S, GRADUATE OR PROFESSIONAL DEGREE. THE CURRENT UNEMPLOYMENT RATE IS 3.5%.SIMILAR TRENDS ARE FOUND IN BOTH NEBRASKA AND SOUTH DAKOTA. MEDICAID ENROLLMENT IS 34% IN NEBRASKA AND 37.5% IN SOUTH DAKOTA. THE PERCENT OF POPULATIONS IN EACH STATE BELOW 200% OF THE FEDERAL POVERTY LEVEL (FPL) IS 28.8% IN NEBRASKA AND 30.9% IN SOUTH DAKOTA. MMC-SC IS LOCATED IN A HEALTH PROFESSIONAL SHORTAGE AREA; SHORTAGES EXIST IN PRIMARY CARE, INTERNAL MEDICINE, ANESTHESIOLOGY, DENTISTRY AND PHARMACY, AMONG OTHER AREAS. MANY COMMUNITY HOSPITALS AND CRITICAL ACCESS HOSPITALS ARE LOCATED IN THE SECONDARY SERVICE AREA.THE TOP THREE HEALTH RISKS FOR THE AREA ARE: SMOKING, HIGH BLOOD PRESSURE AND HIGH CHOLESTEROL, WHILE THE TOP THREE HEALTH RISKS FOR THE LOW INCOME POPULATION AND THE UNINSURED, MEDICARE AND MEDICAID POPULATIONS ARE: HIGH BLOOD PRESSURE, DEPRESSION/ANXIETY DISORDER, AND HIGH CHOLESTEROL.ACCESS TO PRIMARY CARE (A MEDICAL HOME) IS AN IDENTIFIED COMMUNITY NEED, AS ARE ACCESS TO DENTAL CARE AND AFFORDABILITY OF PRESCRIPTION MEDICATIONS. FIFTY PERCENT OF THE PATIENTS PRESENTING TO MMC-SC EMERGENCY DEPARTMENT EITHER HAVE NO MEDICAL HOME OR THE MEDICAL HOME IS LOCATED AT THE SIOUXLAND COMMUNITY HEALTH CENTER.MERCY MEDICAL CENTER-NORTH IOWA (MMC-NI) SERVES A 14-COUNTY SERVICE AREA WITHIN A 70-MILE RADIUS STRETCHING IN EVERY DIRECTION FROM MASON CITY. THE PRIMARY SERVICE AREA CONSISTS OF CERRO GORDO AND WORTH COUNTIES IN IOWA, WHILE THE SECONDARY SERVICE AREA IS COMPRISED OF AN ADDITIONAL 12 CONTIGUOUS COUNTIES IN IOWA (BUTLER, CHICKASAW, FLOYD, FRANKLIN, HANCOCK, HARDIN, HOWARD, KOSSUTH, MITCHELL, PALO ALTO, WINNEBAGO, AND WRIGHT). IN 2010 THE 14-COUNTY SERVICE AREA HAD AN ESTIMATED POPULATION OF 194,162. 94.9 PERCENT OF RESIDENTS ARE WHITE. THERE ARE 11 CRITICAL ACCESS HOSPITALS WITHIN MMC-NI'S SERVICE AREA PROVIDING PRIMARY HEALTH CARE SERVICES, EIGHT OF WHICH ARE MMC-NI AFFILIATES. PATIENTS FROM THE REMAINING IOWA COUNTIES UTILIZE MMC-NI FOR TERTIARY LEVEL CARE. THE UNIVERSITY OF IOWA HOSPITALS IN IOWA CITY AND MAYO CLINIC IN ROCHESTER, MINNESOTA ALSO PROVIDE TERTIARY CARE FOR THIS AREA.MMC-NI'S MARKET SHARE FOR THE 14-COUNTY SERVICE AREA IS STABLE AT 50 PERCENT, WHILE THE PRIMARY SERVICE AREA HAS 93.15 PERCENT OF THE MARKET, AS REPORTED BY IOWA HOSPITAL ASSOCIATION DATA.ACCORDING TO THE U.S. CENSUS BUREAU, MMC-NI'S SERVICE AREA EXPERIENCED A 6.6 PERCENT DECLINE IN POPULATION FROM 2000-2009; THE 2014 POPULATION PROJECTION DOCUMENTS AN ADDITIONAL 3.2 PERCENT DECLINE. THE STRESS THAT THIS TREND PLACES ON THE PROVISION OF SERVICES IS COMPOUNDED BY THE HIGHER THAN AVERAGE PROPORTION OF ELDERLY IN THE AREA. ABOUT 19.8 PERCENT OF THE POPULATION IN THE SERVICE AREA WAS OVER AGE 65 IN 2010, COMPARED TO 17 PERCENT FOR THE STATE AND 13.2 PERCENT FOR THE NATION.THE AVERAGE INCOME IN MMC-NI'S SERVICE AREA IN 2010 WAS ESTIMATED TO BE BETWEEN $25,000 AND $50,000; INDIVIDUALS EARNING LESS THAN $15,000 COMPRISE 11.2 PERCENT OF THE POPULATION. MMC-NI IS A DISPROPORTIONATE SHARE HOSPITAL. IN FY 2010, OUR GENERAL ADMITTANCE INSURANCE PAYOR MIX FOR MEDICARE WAS 53.2 PERCENT AND 12.2 PERCENT FOR THE POOR AND UNDERSERVED. THE INSURANCE PAYOR MIX FOR THE POOR AND UNDERSERVED IN EMERGENCY DEPARTMENT ADMITTANCE WAS 34 PERCENT.THE ENTIRE 14-COUNTY SERVICE AREA IS DESIGNATED AS A MENTAL HEALTH PROFESSIONAL SHORTAGE AREA, AND SEVERAL COUNTIES ARE CONSIDERED PRIMARY CARE HEALTH PROFESSIONAL SHORTAGE AREAS OR MEDICALLY UNDERSERVED AREAS.MERCY MEDICAL CENTER-NEW HAMPTON (MMC-NH) SERVES THE CHICKASAW AREA AND SURROUNDING COUNTIES WITHIN A 20-MILE RADIUS STRETCHING IN EVERY DIRECTION FROM NEW HAMPTON. THE PRIMARY SERVICE AREA CONSISTS OF THE TOWNS OF NEW HAMPTON, FREDERICKSBURG, ALTA VISTA, IONIA, ELMA, WAUCOMA, LAWLER AND NASHUA. THE ESTIMATED POPULATION OF THIS AREA IS 13,500. ACCORDING TO THE U.S. CENSUS BUREAU, CHICKASAW COUNTY HAD AN ESTIMATED POPULATION OF 12,439 IN 2010. CHICKASAW COUNTY EXPERIENCED AN ESTIMATED 5.0% PERCENT DECLINE IN POPULATION FROM 2000-2010. THE STRESS THAT THIS TREND PLACES ON THE PROVISION OF SERVICES IS COMPOUNDED BY THE HIGHER THAN AVERAGE PROPORTION OF ELDERLY IN THE AREA. NINETEEN PERCENT OF THE POPULATION IN THE CHICKASAW AREA WAS OVER AGE 65 IN 2010.THE MEDIAN HOUSEHOLD INCOME IN CHICKASAW COUNTY WAS ESTIMATED AT $43,990 IN 2009. INDIVIDUALS BELOW THE POVERTY LEVEL COMPRISE 9.3% OF THE POPULATION. THE FISCAL YEAR 2011 PAYER MIX AT POINT OF REGISTRATION INCLUDES 57% COVERED BY MEDICARE, 5% COVERED BY MEDICAID AND 4% SELF-PAY.MERCY MEDICAL CENTER-DUBUQUE (MMC-D)FOR PURPOSES OF ITS COMMUNITY HEALTH NEEDS ASSESSMENT, MMC-D'S PRIMARY SERVICE AREA IS DUBUQUE COUNTY, IOWA. IN FY 2011 (ENDING JUNE 30, 2011), MORE THAN 61% OF MERCY'S INPATIENT CASES AND MORE THAN 75% OF MERCY'S EMERGENCY DEPARTMENT CASES WERE FOR DUBUQUE COUNTY RESIDENTS.DUBUQUE COUNTY'S POPULATION IS 89,143. IT INCLUDES ONE URBAN COMMUNITY, THE CITY OF DUBUQUE. ITS 65+ POPULATION IS ALMOST AS HIGH AS IOWA'S, AND SIGNIFICANTLY HIGHER THAN THE US AVERAGE FOR THIS AGE RANGE. CONVERSELY, THE 16-24 POPULATION IS NOTICEABLY LOWER THAN THE US AVERAGE. ALTHOUGH MINORITY POPULATIONS IN DUBUQUE COUNTY HAVE INCREASED DURING THE LAST DECADE, THE POPULATION IS STILL 97.1% WHITE, WITH NO OTHER SINGLE RACIAL GROUP ACCOUNTING FOR MORE THAN 1%. THE COUNTY'S HISPANIC OR LATINO POPULATION IS 1.2%CONSIDERING ONLY THE POPULATION OF DUBUQUE COUNTY RESIDENTS WHO ARE 25 OR OLDER, DUBUQUE COUNTY HAS A HIGHER PERCENTAGE OF RESIDENTS WITH ONLY A HIGH SCHOOL DIPLOMA OR EQUIVALENT THAN IOWA AND THE US. THERE IS A SMALLER PERCENTAGE OF DUBUQUE COUNTY RESIDENTS WITH SOME COLLEGE THAN IOWA OR THE US.MEDIAN INCOME IN DUBUQUE COUNTY IS $39,582, SLIGHTLY HIGHER THAN IOWA, BUT LOWER THAN THE US MEDIAN. IN THE COUNTY, HOUSEHOLDERS UNDER 25 AND OLDER THAN 65 ARE BELOW THAT MEDIAN, WHICH IS ALSO TRUE FOR IOWA AND THE US. PER CAPITA INCOME IN DUBUQUE COUNTY IS $19,600, EQUAL TO IOWA AND SOMEWHAT LOWER THAN THE US. DUBUQUE COUNTY BLACK PER CAPITA INCOME IS 51% OF WHITE PER CAPITA INCOME, COMPARED TO 61% IN IOWA AND 60% NATIONALLY. DUBUQUE COUNTY HISPANIC PER CAPITA INCOME IS 58% OF WHITE PER CAPITA INCOME, COMPARED TO 54% IN IOWA AND 51% NATIONALLY. THE GROWING ELDERLY POPULATION IS OF CONCERN TO THE COMMUNITY. WE ANTICIPATE A SHORTAGE OF HEALTH CARE WORKERS TO CARE FOR THE ELDERLY, LIMITED TRANSPORTATION OPTIONS, LIMITED ADULT DAY CARE OPTIONS AND LIMITED FUNDING FOR SERVICES FOR THE ELDERLY. THE HIGH COST OF PRESCRIPTION MEDICATIONS AND CHRONIC ILLNESSES CAUSING LONG-TERM DISABILITY PRESENT FINANCIAL CONCERNS AS WELL.
    PART VI, LINE 6: OTHER INFORMATION -MERCY MEDICAL CENTER-SIOUX CITY IS HOME TO THE ONLY LEVEL II TRAUMA CENTER IN WESTERN IOWA, AND PROVIDES A VITAL, LIFESAVING LINK TO RURAL AREAS VIA MERCY AIR CARE, THE HOSPITAL'S HELICOPTER AMBULANCE SERVICE.MERCY MEDICAL CENTER-SIOUX CITY IS INVOLVED IN A NUMBER OF COMMUNITY VENTURES, AND SUPPORTS THE SIOUXLAND MEDICAL EDUCATION FOUNDATION (FAMILY PRACTICE RESIDENCY). WE ALSO WORK CLOSELY WITH WINNEBAGO INDIAN HEALTH SERVICES TO CLOSE HEALTH OUTCOMES DISPARITIES. IN ADDITION, THE MEDICAL CENTER COLLABORATES WITH ST. LUKE'S COLLEGE OF NURSING, WITCC SCHOOL OF NURSING, AND BRIAR CLIFF UNIVERSITY SCHOOL OF NURSING (REPLICATING THE RAIN PROGRAM, WHICH IS INTENDED TO INCREASE THE NUMBER OF AMERICAN INDIAN NURSES).ST. LUKE'S HOSPITAL, FAMILY SERVICES, COMMUNITY MENTAL HEALTH CENTER, MERCY MEDICAL CENTER AND COMMUNITY PSYCHIATRISTS MEET BI-MONTHLY TO ASSESS AND PLAN FOR IMPROVED ACCESS AND SERVICES. THE PLAN INVOLVES COLLABORATION/CONSOLIDATION TO BETTER SERVE PATIENTS WITH MENTAL ILLNESS, MOST OF WHOM ARE UNDER-SERVED. THE PLAN SHOULD IMPROVE SERVICES AND SAVE COSTS, INCLUDING COSTS INCURRED BY GOVERNMENT PAYER SOURCES. MERCY IS PARTICIPATING IN THE STATE WIDE REORGANIZATION OF MENTAL HEALTH SERVICES. ASSOCIATES FROM MERCY'S EMERGENCY DEPARTMENT, SOCIAL SERVICES, MISSION SERVICES, NURSING, BEHAVIORAL HEALTH, AND PHARMACY ARE COLLABORATING TO IMPROVE ACCESS TO PHARMACEUTICALS. LACK OF MEDICATIONS AND REFILL AUTHORIZATIONS OFTEN LEAD TO VISITS TO THE EMERGENCY DEPARTMENT. TIMELY ACCESS TO MEDICATION COULD RESOLVE (DECREASE) SOME OF THESE VISITS THROUGH DIRECTION TO COMMUNITY PHYSICIANS AND ACCESS TO MEDICATIONS.MERCY MEDICAL CENTER-NORTH IOWAMERCY MEDICAL CENTER-NORTH IOWA HAS BEEN PROVIDING MANAGEMENT SERVICES FOR RURAL HOSPITALS SINCE 1978. THESE COMMUNITY HOSPITALS OFFER QUALITY HEALTH CARE AND YET ARE STILL ABLE TO TAKE ADVANTAGE OF ALL THE RESOURCES MERCY MEDICAL CENTER-NORTH IOWA HAS TO OFFER AS A MAJOR REFERRAL CENTER. AS A TEACHING HOSPITAL, MERCY MEDICAL CENTER-NORTH IOWA HOSTS A FAMILY PRACTICE RESIDENCY PROGRAM, PHARMACY RESIDENCY, PALLIATIVE CARE FELLOWSHIP, CARDIOLOGY FELLOWSHIP, AND A SCHOOL OF RADIOLOGIC TECHNOLOGY. IT ALSO IS A CLINICAL SITE FOR STUDENTS STUDYING TO BECOME MEDICAL LABORATORY TECHNICIANS, NURSES, PARAMEDICS, REHABILITATION TECHNICIANS AND PERFUSIONISTS. IN ADDITION, THE MEDICAL CENTER MANAGES AN ADULT DAY CARE CENTER AND HOMELESS SHELTERS FOR MEN AND WOMEN IN COLLABORATION WITH OTHER NON-PROFITS. AS A SOLE COMMUNITY PROVIDER, SPECIALIZED SERVICES INCLUDE A HEART CENTER, CANCER CENTER, DIABETES CENTER, STROKE CENTER, BARIATRIC CENTER, LEVEL II BIRTH CENTER AND A LEVEL II EMERGENCY CENTER. EMERGENCY SERVICES ARE AVAILABLE TO ALL REGARDLESS OF THEIR ABILITY TO PAY. BECAUSE OF THE NEED BY INDIGENT ADULTS FOR DENTAL CARE, MERCY-NORTH IOWA HAS FULLY FURNISHED TWO ROOMS TO ACCOMMODATE EMERGENT DENTAL NEEDS. HALF-DAY CLINICS ARE MANNED BY AREA DENTISTS AND DENTAL ASSISTANTS WHO VOLUNTEER THEIR TIME AND GUIDANCE. BEING A RURAL AREA OFTEN CREATES A TRANSPORTATION BARRIER FOR ACCESS TO MEDICAL APPOINTMENTS. MERCY MEDICAL CENTER-NORTH IOWA HAS THREE SUBSIDIZED PROGRAMS THAT FACILITATE TRANSPORTATION FOR INDIVIDUALS WHO, BECAUSE OF AGE, DISABILITY, ECONOMICS AND/OR TREATMENT, NEED ASSISTANCE. THIS SERVES THOSE WHO LIVE IN MASON CITY AS WELL AS THROUGHOUT SURROUNDING NORTH IOWA COMMUNITIES. MERCY FAMILY HEALTH LINE, A 24-HOUR/7-DAY A WEEK TELEPHONE INFORMATION SERVICE, FIELDS NEARLY 30,000 CALLS A YEAR. REGISTERED NURSES PROVIDE MEDICAL TRIAGE AS WELL AS REFERRALS TO INTERNAL AND COMMUNITY HUMAN SERVICES RESOURCES. IN COLLABORATION WITH THE COMMUNITY KITCHEN, OUR HOSPITAL KITCHEN HANDLES THE PREPARATION OF MEALS ON WHEELS MONDAY THROUGH FRIDAY AND DONATES DELIVERY COORDINATION. IN CALENDAR YEAR 2010, OVER 22,000 MEALS WERE PREPARED AND DELIVERED.THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED COMMUNITY HEALTHCARE PROVIDERS IN ORDER TO BEST MEET THE NEEDS OF THOSE WHO LIVE IN NORTH IOWA COMMUNITIES.MERCY MEDICAL CENTER-NORTH IOWA HAS ABOUT 400 VOLUNTEERS, WHO SERVE IN NEARLY EVERY DEPARTMENT OF THE HOSPITAL. FROM CLERICAL WORK TO PROVIDING PATIENT AND VISITOR SERVICES, MERCY VOLUNTEERS TRULY DO MAKE A DIFFERENCE. THROUGH FUNDRAISERS, THEY ALSO PROVIDE FINANCIAL SUPPORT TO A VARIETY OF AREAS WITHIN THE HOSPITAL. MERCY AMBASSADORS AWARD SCHOLARSHIPS TO STUDENTS PURSUING EDUCATION IN THE HEALTHCARE FIELD. THE AMBASSADORS RENT OUT INFANT SAFETY SEATS TO ENSURE THAT ALL BABIES LEAVE OUR HEALTH CARE CENTER IN A PROPER SAFETY SEAT, AND CO-SPONSOR FREE MONTHLY CHILD SAFETY SEAT INSPECTION SERVICES FOR THE COMMUNITY. THEY ALSO FACILITATE HEALTH SCREENINGS AT SEVERAL LOCATIONS.MERCY MEDICAL CENTER-NEW HAMPTONAS A SOLE COMMUNITY PROVIDER, MMC-NH PROVIDES A RANGE OF SPECIALIZED SERVICES, DIABETES EDUCATION AND NUTRITION AND AN EMERGENCY CENTER. EMERGENCY SERVICES ARE AVAILABLE TO ALL REGARDLESS OF THEIR ABILITY TO PAY. THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED COMMUNITY HEALTH CARE PROVIDERS, IN ORDER TO BEST MEET THE NEEDS OF OUR NORTHEAST IOWA COMMUNITIES.MMC-NH HAS ABOUT 200 VOLUNTEERS, WHO SERVE IN NEARLY EVERY DEPARTMENT OF THE HOSPITAL. FROM CLERICAL WORK TO PROVIDING PATIENT AND VISITOR SERVICES, MERCY VOLUNTEERS TRULY DO MAKE A DIFFERENCE. THROUGH FUNDRAISERS, THE VOLUNTEERS ALSO PROVIDE FINANCIAL SUPPORT TO A VARIETY OF AREAS WITHIN THE HOSPITAL. MERCY AUXILIARY AWARDS SCHOLARSHIPS TO HIGH SCHOOL AND NON-TRADITIONAL STUDENTS PURSUING EDUCATION IN THE HEALTH CARE FIELD. THE AUXILIARY ALSO SPONSORS NUMEROUS BLOOD DRIVES AND LUNCH-AND-LEARN EVENTS ON HEALTH CARE SUBJECTS. THEY ALSO PROVIDE WIGS AND TURBANS TO THOSE INDIVIDUALS WHO HAVE LOST THEIR HAIR DUE TO ILLNESS. MMC-NH HAS RE-OPENED ITS OBSTETRICS DEPARTMENT TO PROVIDE MEMBERS OF THE COMMUNITY A PLACE TO RECEIVE CHILDBIRTH EDUCATION AND SERVICES, AND CARE FOR NEW MOTHER AND BABY NEEDS.MMC-NH PROVIDES A DIETICIAN WHO IS ACCREDITED BY THE AMERICAN DIETETIC ASSOCIATION COMMISSION FOR DIABETES SELF-MANAGEMENT TRAINING TO MEMBERS OF THE COMMUNITY WHO HAVE DEVELOPED THIS GROWING HEALTH CONCERN. AN ANNUAL DIABETES HEALTH FAIR IS OFFERED.MMC-NH MAINTAINS A 24-HOUR EMERGENCY DEPARTMENT TO PROVIDE ACCESSIBLE HEALTH CARE TO THE RESIDENTS OF THE COMMUNITIES WE SERVE, WHICH IS DESIGNATED AS A HEALTH PROFESSIONAL SHORTAGE AREA (HPSA) AND/OR MEDICALLY UNDERSERVED AREA (MUA). THESE EFFORTS SUPPORT THE COMMUNITY BY PROVIDING EXPERTISE AND HEALTH CARE SERVICES, AND SPECIAL CARE FOR INDIGENT AND UNDERSERVED POPULATIONS.MMC-NH ALSO ISSUES A QUARTERLY HEALTH WATCH NEWSLETTER TO ALL RESIDENTS AND MAINTAINS A WEBSITE WHICH OFFERS FREE ACCESS TO HEALTHY RECIPES AND OTHER HEALTHY LIVING IDEAS, AND A CALENDAR OF UPCOMING CLASSES AND EVENTS FOR COMMUNITY MEMBERS TO PARTICIPATE IN.MERCY MEDICAL CENTER-DUBUQUE PROVIDES SEVERAL SERVICES THAT ARE UNIQUE TO THE COMMUNITY, INCLUDING OPEN HEART SURGERY, NEONATAL INTENSIVE CARE AND INPATIENT COMMUNITY PSYCHIATRIC SERVICES. IN ADDITION, THE HOSPITAL OPERATES AN EMERGENCY ROOM AVAILABLE TO ALL REGARDLESS OF ABILITY TO PAY.
    PART VI, LINE 7: MERCY HEALTH SERVICES-IOWA IS A MEMBER ORGANIZATION OF TRINITY HEALTH, ONE OF THE LARGEST CATHOLIC HEALTH CARE SYSTEMS IN THE COUNTRY. BASED IN NOVI, MICHIGAN, TRINITY HEALTH ANNUALLY REQUIRES THAT ALL MEMBER ORGANIZATIONS DEVELOP, AND ARE HELD ACCOUNTABLE FOR ACHIEVING, COMMUNITY BENEFIT GOALS THAT INCLUDE DEVELOPING NEEDED SERVICES OR EXPANDING ACCESS TO SERVICES FOR LOW-INCOME INDIVIDUALS. AS A NOT-FOR-PROFIT HEALTH SYSTEM, TRINITY HEALTH REINVESTS ITS PROFITS BACK INTO THE COMMUNITY THROUGH PROGRAMS TO SERVE THE POOR AND UNINSURED, MANAGE CHRONIC CONDITIONS LIKE DIABETES, HEALTH EDUCATION AND PROMOTION INITIATIVES, AND OUTREACH FOR THE ELDERLY. IN FISCAL YEAR 2011, THIS INCLUDED NEARLY $453 MILLION IN SUCH COMMUNITY BENEFITS. THEREFORE, TRINITY HEALTH TAKES A SYSTEMS APPROACH IN ITS COMMUNITY BENEFIT PLANNING AND IMPLEMENTATION, AND IS CONSEQUENTLY ABLE TO ENSURE THAT ITS MEMBER HOSPITALS AND OTHER ENTITIES/AFFILIATES ARE HELPING PROMOTE AND ADDRESS THE HEALTH NEEDS OF THEIR RESPECTIVE COMMUNITIES.FOR MORE INFORMATION ABOUT TRINITY HEALTH, VISIT WWW.TRINITY-HEALTH.ORG.
Schedule H (Form 990) 2010
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
MERCY HEALTH SERVICES - IOWA CORP
 
Employer identification number
31-1373080
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) NORTHEAST IOWA COMMUNITY ACTION CORP305 MONTGOMERY ST
DECORAH,IA52101 		42-6092713 501(C)3 6,000       COMMUNITY SUPPORT
(2) NORTHWESTERN YOUTH SERVICES INC2069 500TH STREET
CHEROKEE,IA51012 		20-4538859   6,000       COMMUNITY SUPPORT
(3) NORTH CENTRAL IOWA GROWTH PARTNERSHIP INC25 WEST STATE STREET
MASON CITY,IA50401 		75-3190471 501(C)6 25,000       PLEDGE
(4) BISHOP HEELAN CATHOLIC SCHOOLS1018 GRANDVIEW BLVD
SIOUX CITY,IA51103 		42-0698209 501(C)3 50,000       THIRD INSTALLMENT OF A FIVE YEAR PLEDGE FOR HEELAN'S NEW SCHOOL
(5) BRIAR CLIFF UNIVERSITY3303 REBECCA STREET
SIOUX CITY,IA51104 		42-0707124 501(C)3 82,500       SCHOLARSHIP FUND
(6) NORTH IOWA AREA COMMUNITY COLLEGE500 COLLEGE DRIVE
MASON CITY,IA50401 		42-0930155 501(C)3 60,000       NURSING PLEDGE
(7) SIOUX CITY SYMPHONY ORCHESTRA520 PIERCE STREET
SIOUX CITY,IA51101 		42-6006580 501(C)3 5,000       PROGRAM SUPPORT - SPONSORSHIP OF IOWA PIANO COMPETITION
(8) NEWMAN CATHOLIC SCHOOL SYSTEM FOUNDATION2445 - 19TH STREET
MASON CITY,IA50401 		42-1078829 501(C)3 33,700       PLEDGES FOR EDUCATION AND CHILDCARE
(9) SIOUXLAND HERITAGE FOUNDATION2901 JACKSON ST
SIOUX CITY,IA51104 		42-1516734 501(C)3 10,000       CAPITAL CAMPAIGN SUPPORT - THIRD AND FOURTH OF A FIVE PLEDGE FOR SIOUX CITY'S NEW MUSEUM
(10) SIOUXLAND COMMUNITY HEALTH CENTER1021 NEBRASKA STREET
SIOUX CITY,IA51102 		42-1374894 501(C)3 152,364       COMMUNITY SUPPORT
(11) CRESCENT COMMUNITY HEALTH CENTER1789 ELM STREET
DUBUQUE,IA52001 		48-1302204 501(C)3 51,734       DIABETES MANAGEMENT PROGRAM SUPPORT
(12) UNITED WAY OF SIOUXLAND INCPO BOX 204
SIOUX CITY,IA51102 		42-0680395 501(C)3 6,925       PLEDGE
(13) THE CRITTENTON CENTER303 WEST 24TH STREET
SIOUX CITY,IA51104 		42-0698246 501(C)3 22,627       COMMUNITY SUPPORT
(14) PENDER COMMUNITY HEALTH CARE FOUNDATION INCPO BOX 490
PENDER,NE68047 		47-0750036 501(C)3 5,625       COMMUNITY SUPPORT AND SCHOLARSHIPS
(15) SAINT GABRIEL COMMUNICATIONS LTD705 DOUGLAS ST STE 238
SIOUX CITY,IA51101 		42-1516853 501(C)3 6,000       COMMUNITY SUPPORT
(16) ST MICHAEL'S SCHOOL1315 1ST AVE
SOUTH SIOUX CITY,NE68776 		47-0457873 501(C)3 8,900       COMMUNITY SUPPORT
(17) WINNEBAGO TRIBE OF NEBRASKAPO BOX 687
WINNEBAGO,NE68071 		47-0489118 TRIBAL GOVERNMENT 6,500       SUPPORT WELLNESS AND DIABETES PROGRAM
(18) LEGENDS OF GOLD INCPO BOX 287
BERESFORD,SD57004 		27-3794971 501(C)3 6,000       CAMP SCHOLARSHIP
(19) NORTHWEST IOWA HOSPITAL CORPORATION DBA ST LUKE'S COLLEGE2720 STONE PARK BLVD
SIOUX CITY,IA51104 		42-1019872 501(C)3 20,975       CLINICAL PASTORAL EDUCATION SUPPORT
2
Enter total number of section 501(c)(3) and government organizations ......................... Bullet Image
17
3
Enter total number of other organizations ................................ . Bullet Image
2
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2010

Schedule I (Form 990) 2010
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance













Part IV
Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.
Identifier Return Reference Explanation
PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: DONATIONS MADE BY MERCY HEALTH SERVICES - IOWA, CORP. TO CHARITABLE ORGANIZATIONS ARE MADE IN FURTHERANCE OF THE RECIPIENT ORGANIZATION'S EXEMPT PURPOSE AND ARE CONSIDERED UNRESTRICTED WITH REGARD TO THE USE OF THE FUNDS.
Schedule I (Form 990) 2010


Additional Data


Software ID:  
Software Version:  


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
MERCY HEALTH SERVICES - IOWA CORP
 
Employer identification number

31-1373080
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement orprovision of all 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
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....
2
 
 
3
Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ...............
4a
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regs. section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use Schedule J-1 if additional space needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) must equal the applicable column (D) or column (E) amounts on Form 990, Part VII, line 1a.
(A) Name (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported in prior
Form 990 or
Form 990-EZ
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) JOSEPH SWEDISH (i)
(ii)		 0
1,240,774 		0
645,161 		0
967,997 		0
763,945 		0
27,508 		0
3,645,385 		0
690,161
(2) PAUL NEUMANN (i)
(ii)		 0
453,650 		0
133,218 		0
99,158 		0
60,389 		0
22,549 		0
768,964 		0
0
(3) AGNES HAGERTY (i)
(ii)		 0
316,857 		0
75,909 		0
26,156 		0
38,171 		0
12,602 		0
469,695 		0
0
(4) JAMES BOSSCHER (i)
(ii)		 0
294,168 		0
115,448 		0
148,480 		0
87,903 		0
10,675 		0
656,674 		0
101,733
(5) BENJAMIN CARTER (i)
(ii)		 0
410,595 		0
113,318 		0
51,074 		0
49,689 		0
23,466 		0
648,142 		0
0
(6) MARIANNE CUNNINGHAM (i)
(ii)		 0
160,274 		0
0 		0
769 		0
13,623 		0
16,275 		0
190,941 		0
0
(7) KEDRICK ADKINS (i)
(ii)		 0
717,356 		0
326,029 		0
117,485 		0
184,461 		0
13,787 		0
1,359,118 		0
0
(8) MICHAEL SLUBOWSKI (i)
(ii)		 0
701,008 		0
291,561 		0
160,595 		0
246,925 		0
24,807 		0
1,424,896 		0
42,832
(9) MICHAEL MURPHY (i)
(ii)		 0
343,184 		0
68,618 		0
128,021 		0
47,238 		0
21,304 		0
608,365 		0
0
(10) RICHARD O'CONNELL (i)
(ii)		 0
533,392 		0
113,794 		0
114,187 		0
116,680 		0
21,280 		0
899,333 		0
0
(11) JAMES FITZPATRICK (i)
(ii)		 0
381,816 		0
151,717 		0
51,067 		0
83,040 		0
22,089 		0
689,729 		0
0
(12) RUSSELL KNIGHT (i)
(ii)		 0
293,715 		0
107,078 		0
58,416 		0
74,936 		0
16,683 		0
550,828 		0
13,185
(13) ROBERT PEEBLES (i)
(ii)		 0
415,553 		0
0 		0
56,219 		0
25,137 		0
912 		0
497,821 		0
0
(14) MARY EBELING (i)
(ii)		 0
186,683 		0
35,129 		0
2,578 		0
61,810 		0
12,522 		0
298,722 		0
0
(15) DIANE FISCHELS (i)
(ii)		 0
198,741 		0
37,309 		0
965 		0
44,501 		0
8,886 		0
290,402 		0
0
(16) F SCOTT LEIGHTY (i)
(ii)		 0
261,987 		0
50,403 		0
857 		0
16,369 		0
14,114 		0
343,730 		0
0
(17) PAUL MANTERNACH (i)
(ii)		 0
293,884 		0
54,520 		0
652 		0
22,724 		0
16,667 		0
388,447 		0
0
(18) TERESA MOCK (i)
(ii)		 151,575
0 		115,576
0 		30,817
0 		49,967
0 		36,457
0 		384,392
0 		0
0
(19) RODNEY SCHLADER (i)
(ii)		 0
232,175 		0
44,619 		0
1,181 		0
31,760 		0
19,902 		0
329,637 		0
0
(20) BERNARD FOX (i)
(ii)		 0
146,658 		0
35,965 		0
3,809 		0
38,884 		0
9,593 		0
234,909 		0
0
(21) GARY GUETZKO (i)
(ii)		 0
180,778 		0
44,525 		0
1,649 		0
36,307 		0
17,105 		0
280,364 		0
0
(22) KAY TAKES (i)
(ii)		 0
161,265 		0
39,077 		0
497 		0
22,358 		0
14,413 		0
237,610 		0
0
(23) MARILYN KAPTAIN-DAHLEN (i)
(ii)		 0
229,618 		0
56,369 		0
2,136 		0
64,851 		0
15,690 		0
368,664 		0
0
(24) STEVEN EAVENSON TATUM LLC (i)
(ii)		 453,600
0 		0
0 		0
0 		0
0 		0
0 		453,600
0 		0
0
(25) LINDA KREI (i)
(ii)		 0
169,710 		0
41,365 		0
1,280 		0
25,985 		0
16,340 		0
254,680 		0
0
(26) LARRY SELLERS (i)
(ii)		 0
316,563 		0
67,137 		0
39,173 		0
45,468 		0
21,594 		0
489,935 		0
0
(27) JAMES KARKOS (i)
(ii)		 336,816
0 		211,564
0 		63,622
0 		74,375
0 		38,270
0 		724,647
0 		0
0
(28) ALIREZA YARAHMADI (i)
(ii)		 335,180
0 		251,887
0 		20,633
0 		29,696
0 		34,460
0 		671,856
0 		0
0
(29) PHILLIP ALSCHER (i)
(ii)		 420,306
0 		127,333
0 		55,757
0 		41,220
0 		63,416
0 		708,032
0 		0
0
(30) CARL PLANK (i)
(ii)		 475,270
0 		45,201
0 		61,331
0 		72,434
0 		66,020
0 		720,256
0 		0
0
(31) ARVIND PERATHUR (i)
(ii)		 338,854
0 		139,458
0 		49,419
0 		48,813
0 		38,489
0 		615,033
0 		0
0
(32) DANIEL HALE (i)
(ii)		 0
451,341 		0
207,437 		0
131,164 		0
201,869 		0
19,013 		0
1,010,824 		0
52,144
(33) PAUL DOUGHERTY (i)
(ii)		 0
0 		0
0 		0
343,327 		0
18,658 		0
9,846 		0
371,831 		0
343,327
(34) PAUL BROWNE (i)
(ii)		 0
460,911 		0
174,224 		0
64,536 		0
87,030 		0
20,686 		0
807,387 		0
6,099
(35) DEBRA CANALES (i)
(ii)		 0
453,678 		0
194,272 		0
72,423 		0
79,191 		0
13,136 		0
812,700 		0
0
(36) VELOIS BOWERS (i)
(ii)		 0
228,935 		0
96,129 		0
35,106 		0
1,801 		0
9,607 		0
371,578 		0
0
(37) PAUL CONLON (i)
(ii)		 0
251,101 		0
100,416 		0
56,553 		0
81,742 		0
22,088 		0
511,900 		0
15,062
(38) LOUIS FIERENS (i)
(ii)		 0
317,250 		0
123,808 		0
43,923 		0
44,110 		0
14,126 		0
543,217 		0
0
(39) PRESTON GEE (i)
(ii)		 0
296,889 		0
111,712 		0
81,579 		0
50,787 		0
25,205 		0
566,172 		0
0
(40) MICHAEL HOLPER (i)
(ii)		 0
251,970 		0
97,178 		0
37,020 		0
39,654 		0
20,000 		0
445,822 		0
0
(41) TERRENCE O'ROURKE (i)
(ii)		 0
464,591 		0
205,751 		0
142,078 		0
32,195 		0
26,853 		0
871,468 		0
0
(42) MARIA SZYMANSKI (i)
(ii)		 0
374,739 		0
104,539 		0
122,633 		0
147,379 		0
14,320 		0
763,610 		0
66,282
(43) SCOTT E WELLS (i)
(ii)		 0
114,556 		0
42,441 		0
541 		0
27,866 		0
9,384 		0
194,788 		0
0
(44) DOUGLAS MORSE (i)
(ii)		 0
114,181 		0
38,613 		0
697 		0
16,186 		0
2,062 		0
171,739 		0
0
(45) KIM PRICE (i)
(ii)		 0
77,486 		0
27,691 		0
2,339 		0
22,682 		0
9,157 		0
139,355 		0
0
(46) ROBERT SHAFER (i)
(ii)		 0
148,383 		0
36,509 		0
1,316 		0
59,762 		0
14,597 		0
260,567 		0
0
Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
  PART I, LINES 4A-B THE FOLLOWING INDIVIDUAL RECEIVED SEVERANCE PAYMENTS IN CALENDAR 2010. THESE AMOUNTS ARE INCLUDED IN COLUMN B(III): PAUL DOUGHERTY - $343,327 IN ADDITION, COLUMN C OF SCHEDULE J, PART II INCLUDES $18,658 OF SEVERANCE FOR PAUL DOUGHERTY WHICH WAS UNPAID AS OF 12/31/10. THE $18,658 WAS PAID AND INCLUDED IN PAUL DOUGHERTY'S TAXABLE INCOME IN 2011. THE FOLLOWING ARE PARTICIPANTS IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). THE FOLLOWING SERP ACCRUALS FOR 2010 ARE INCLUDED IN COLUMN C OF SCHEDULE J, PART II: KEDRICK ADKINS - $49,977 MICHAEL SLUBOWSKI - $77,185 JOSEPH SWEDISH - $511,613 THE FOLLOWING ARE PARTICIPANTS IN THE TRINITY HEALTH PENSION RESTORATION PLAN, A NONQUALIFIED PLAN, WHICH PROVIDES RETIREMENT BENEFITS FOR CERTAIN ASSOCIATES WITH EARNINGS ABOVE THE IRS PAY CAP FOR QUALIFIED PLANS ($245,000 FOR 2010). THE FOLLOWING ACCRUALS FOR 2010 FOR THIS PLAN ARE INCLUDED IN COLUMN C OF SCHEDULE J, PART II: KEDRICK ADKINS - $113,498 JAMES BOSSCHER - $52,983 PAUL BROWNE - $66,672 DEBRA CANALES - $59,431 BENJAMIN CARTER - $33,040 PAUL CONLON - $34,248 LOUIS FIERENS - $24,986 JAMES FITZPATRICK - $54,892 PRESTON GEE - $29,232 DANIEL HALE - $155,414 MICHAEL HOLPER - $17,612 RUSSELL KNIGHT - $45,100 MICHAEL MURPHY - $26,316 PAUL NEUMANN - $41,143 RICHARD O'CONNELL - $83,058 ROBERT PEEBLES - $5,481 MICHAEL SLUBOWSKI - $136,445 JOSEPH SWEDISH - $223,342 MARIA SZYMANSKI - $101,730 THE FOLLOWING ARE PARTICIPANTS IN A MERCY HEALTH SERVICES-IOWA CORP. NON-QUALIFIED ELECTIVE DEFERRED COMPENSATION PLAN. THE FOLLOWING DEFERRALS FOR 2010 FOR THIS PLAN ARE INCLUDED IN COLUMN C OF SCHEDULE J, PART II: TERESA MOCK - $17,404 PHILLIP ALSCHER - $17,810 JAMES KARKOS - $40,533 ARVIND PERATHUR - $36,156 CARL PLANK - $29,605 ALIREZA YARAHMADI - $15,867 PART II: STEVEN EAVENSON - THE AMOUNT LISTED IN COLUMN B(I) OF SCHEDULE J, PART II REPRESENTS THE AMOUNT PAID BY MERCY HEALTH SERVICES - IOWA, CORP. (MHS-IA) IN CALENDAR 2010 TO TATUM, LLC FOR MR. EAVENSON'S SERVICES AS INTERIM CFO FOR MHS-IA'S SIOUX CITY FACILITY. MHS-IA DOES NOT KNOW HOW MUCH MR. EAVENSON RECEIVED AS WAGES FROM TATUM, LLC IN CALENDAR 2010.
Schedule J (Form 990) 2010

Additional Data


Software ID:  
Software Version:  
Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBulletSee separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
MERCY HEALTH SERVICES - IOWA CORP
 
Employer identification number

31-1373080
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Description of transaction (c) Corrected?
Yes No





2
Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.
(a) Name of interested person and purpose (b) Loan to or from the organization? (c)Original principal amount (d)Balance due (e) In default? (f) Approved by board or committee? (g)Written agreement?
To From Yes No Yes No Yes No
(1) KIM PRICE
EDUCATION LOAN 		  X 18,000 1,108   No   No Yes  
Total ...............Small Bullet $ 1,108
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b)Relationship between interested person and the organization (c)Amount of grant or type of assistance
For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2010
Schedule L (Form 990 or 990-EZ) 2010
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) UNITED CLINICAL LABORATORIES (UCL)
  		BERNARD FOX, KEY EMP & ROBERT SHAFER,FORMER KEY EMP, SERVE ON THE BD OF UCL 5,296,712 PAYMENTS MADE BY MERCY HEALTH SERVICES - IOWA, CORP. TO UNITED CLINICAL LABORATORIES FOR LABORATORY SERVICES.   No
(2) BARBARA SHAFER FAMILY MEMBER OF ROBERT SHAFER, FORMER KEY EMPLOYEE 64,042 EMPLOYMENT ARRANGEMENT   No
(3) PREFERRED HEALTH CHOICES LLC (PHC)
  		RUSSELL KNIGHT, KEY EMPLOYEE, ALSO SERVES ON THE BOARD OF PHC 10,480,437 PAYMENTS MADE BY PREFERRED HEALTH CHOICES TO MERCY HEALTH SERVICES - IOWA, CORP. FOR MEDICAL SERVICES PROVIDED.   No
(4) WELLMARK BLUE CROSS BLUE SHIELD OF IOWA AND SOUTH DAKOTA
  		MELANIE DREHER, BOARD MEMBER, ALSO SERVES ON THE BOARD OF WELLMARK BCBS 114,198,107 PAYMENTS MADE BY WELLMARK BCBS TO MERCY HEALTH SERVICES - IOWA, CORP FOR MEDICAL SERVICES PROVIDED.   No
(5) DUBUQUE REGIONAL AMBULATORY SURGERY CENTER LLC (DRASC)
  		RUSSELL KNIGHT & KAY TAKES, KEY EMPLOYEES, ALSO SERVE ON THE BOARD OF DRASC 2,350,000 PARTNERSHIP DISTRIBUTION MADE BY DRASC TO MHS-IA (MHS-IA IS A 50% PARTNER IN DRASC)   No
(6) MEDICAL ASSOCIATESMERCY FAMILY CARE NETWORK LLC (MAMFCN)
  		RUSSELL KNIGHT & KAY TAKES, KEY EMPLOYEES, ALSO SERVE ON THE BD OF MA/MFCN 150,000 PARTNERSHIP CAPITAL CONTRIBUTION MADE TO MA/MFCN BY MHS-IA (MHS-IA IS A 50% PARTNER IN MA/MFCN)   No
(7) TATUM LLC
  		STEVEN EAVENSON, SIOUX CITY INTERIM CFO, IS A KEY EMPLOYEE OF TATUM, LLC. 359,100 FEES PAID TO TATUM, LLC FOR MR. EAVENSON'S SERVICES AS INTERIM CFO. SEE SCHEDULE J, PART III.   No
(8) RODGER MOCK FAMILY MEMBER OF TERESA MOCK, KEY EMPLOYEE 30,790 EMPLOYMENT ARRANGEMENT   No
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
Schedule L (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  




SCHEDULE O
(Form 990 or 990-EZ)

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

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
MERCY HEALTH SERVICES - IOWA CORP
 
Employer identification number

31-1373080
Identifier Return Reference Explanation
EXPLANATION FOR NOT FILING FORM 990-T FORM 990, PART V, LINE 3B CONTACT TAXPAYER FOR ADDITIONAL INFORMATION ON FORM 990-T.
FORM 990, PART VI, SECTION A, LINE 3   MERCY HEALTH SERVICES - IOWA, CORP. (MHS-IA) HAS CONTRACTED WITH TATUM, LLC FOR THE PROVISION OF INTERIM CFO SERVICES AT ITS SIOUX CITY FACILITY. SEE SCHEDULE J, PART III FOR ADDITIONAL INFORMATION.
FORM 990, PART VI, SECTION A, LINE 6   THE SOLE MEMBER OF MERCY HEALTH SERVICES - IOWA, CORP. IS TRINITY HEALTH - MICHIGAN. SEE LINE 7 FOR ADDITIONAL INFORMATION.
FORM 990, PART VI, SECTION A, LINE 7A   TRINITY HEALTH - MICHIGAN IS THE SOLE MEMBER OF MERCY HEALTH SERVICES - IOWA, CORP. TRINITY HEALTH - MICHIGAN HAS THE RIGHT TO APPOINT ALL PERSONS TO THE BOARD OF TRUSTEES OF MERCY HEALTH SERVICES - IOWA, CORP.
FORM 990, PART VI, SECTION A, LINE 7B   AS SOLE MEMBER, TRINITY HEALTH - MICHIGAN MUST APPROVE CERTAIN DECISIONS OF THE GOVERNING BODY, INCLUDING THE STRATEGIC PLAN, ANNUAL CAPITAL PLAN, AND ANNUAL OPERATING BUDGET. TRINITY HEALTH - MICHIGAN MUST ALSO APPROVE SIGNIFICANT CHANGES SUCH AS A MERGER, DISSOLUTION, SALE OF ASSETS IN EXCESS OF CERTAIN LIMITS, A MATERIAL CHANGE IN MISSION, AND MODIFICATIONS TO GOVERNING DOCUMENTS.
FORM 990, PART VI, SECTION B, LINE 11   PRIOR TO FILING, THE FORM 990 FOR MERCY HEALTH SERVICES - IOWA, CORP. IS REVIEWED BY SENIOR MANAGEMENT. IN ADDITION, CERTAIN KEY SECTIONS ARE REVIEWED BY THE BOARD OF TRUSTEES. THE BOARD RECEIVES A COPY OF THE RETURN BEFORE IT IS FILED WITH THE INTERNAL REVENUE SERVICE.
  FORM 990, PART VI, SECTION B, LINE 12C MERCY HEALTH SERVICES - IOWA, CORP. HAS ADOPTED A CONFLICT OF INTEREST POLICY WHICH CONTAINS THE ELEMENTS IN THE MODEL CONFLICT OF INTEREST POLICY ISSUED BY THE IRS. IT APPLIES TO ALL "INTERESTED PERSONS" OF MERCY HEALTH SERVICES - IOWA, CORP., WHICH INCLUDES TRUSTEES, PRINCIPAL OFFICERS AND EXECUTIVES, AND MEMBERS OF COMMITTEES WITH BOARD DESIGNATED POWERS. INTERESTED PERSONS ARE REQUIRED TO ACT AT ALL TIMES IN A MANNER CONSISTENT WITH MERCY HEALTH SERVICES - IOWA, CORP.'S CHARITABLE PURPOSE AND SERVICE TO THE COMMUNITY AND TO AVOID CONFLICTS OF INTEREST. INTERESTED PERSONS ARE REQUIRED TO MAKE FULL DISCLOSURE TO MERCY HEALTH SERVICES - IOWA, CORP. OF ANY FINANCIAL OR BUSINESS INTERESTS THAT MIGHT RESULT IN OR HAVE THE APPEARANCE OF A CONFLICT OF INTEREST. INTERESTED PERSONS ARE REQUIRED TO RECUSE THEMSELVES FROM DISCUSSION AND VOTING ON MATTERS INVOLVING A CONFLICT OF INTEREST. THE BOARD OF TRUSTEES OF MERCY HEALTH SERVICES - IOWA, CORP. IS RESPONSIBLE FOR THE REVIEW AND APPROVAL OF TRANSACTIONS WITH INTERESTED PERSONS, INCLUDING DETERMINING THAT SUCH TRANSACTIONS ARE FAIR AND REASONABLE TO MERCY HEALTH SERVICES - IOWA, CORP. ON AN ANNUAL BASIS, INTERESTED PERSONS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT AND TO AFFIRM THEIR RECEIPT OF THE CONFLICT OF INTEREST POLICY, COMPLIANCE WITH ITS REQUIREMENTS, AND AGREE TO NOTIFY THE ORGANIZATION OF CHANGES IMPACTING THEIR ANNUAL DISCLOSURE IN ACCORDANCE WITH THE POLICY. THE ANNUAL DISCLOSURES ARE REVIEWED WITH THE BOARD OF TRUSTEES OF MERCY HEALTH SERVICES - IOWA, CORP. ON AN ANNUAL BASIS.
  FORM 990, PART VI, SECTION B, LINE 15 TRINITY HEALTH FOLLOWS A PROCESS AND POLICY THAT IS INTENDED TO MIRROR THE IRC SECTION 4958 GUIDELINES FOR OBTAINING A "REBUTTABLE PRESUMPTION OF REASONABLENESS" WITH REGARD TO COMPENSATION AND BENEFITS. AS PART OF THAT PROCESS, THE COMPENSATION AND BENEFITS OF CERTAIN OFFICERS AND KEY MANAGEMENT OFFICIALS OF MERCY HEALTH SERVICES - IOWA, CORP. ARE REVIEWED AT LEAST ANNUALLY BY THE TRINITY HEALTH BOARD OR THE TRINITY HEALTH HUMAN RESOURCES AND COMPENSATION COMMITTEE (HRCC) OF THE BOARD, AUTHORIZED TO ACT ON BEHALF OF THE BOARD WITH RESPECT TO CERTAIN COMPENSATION MATTERS. AS PART OF ITS REVIEW PROCESS, THE HRCC RETAINS AN INDEPENDENT FIRM EXPERIENCED IN COMPENSATION AND BENEFIT MATTERS FOR NOT-FOR-PROFIT HEALTHCARE ORGANIZATIONS TO ADVISE IT IN THE DETERMINATIONS IT MAKES ON THE REASONABLENESS OF PROPOSED COMPENSATION AND BENEFITS ARRANGEMENTS.
  FORM 990, PART VI, SECTION C, LINE 19 MERCY HEALTH SERVICES - IOWA, CORP. IS A SUBSIDIARY ORGANIZATION IN THE TRINITY HEALTH SYSTEM. TRINITY HEALTH MAKES CERTAIN OF ITS KEY DOCUMENTS AVAILABLE TO THE PUBLIC ON ITS WEBSITE, WWW.TRINITY-HEALTH.ORG, IN THE "ABOUT US" SECTION. IN THIS SECTION, THE ANNUAL REPORT (WHICH INCLUDES COMMUNITY BENEFIT MINISTRY INFORMATION) AND CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE PUBLICLY AVAILABLE. IN ADDITION, THE HOSPITAL DIVISIONS OF MHS-IA INCLUDE A COPY OF THEIR MOST RECENT SCHEDULE H ON THEIR RESPECTIVE WEBSITES. TRINITY HEALTH ALSO INCLUDES MHS-IA'S MOST RECENTLY FILED SCHEDULE H ON ITS WEBSITE.
ESTIMATE OF THE AVERAGE HOURS PER WEEK DEVOTED TO RELATED ORGANIZATIONS: FORM 990, PART VII, SECTION A, LINE 1, COLUMN B: THE HOURS LISTED IN COLUMN B OF PART VII, SECTION A, LINE 1 REFLECT ONLY THE INDIVIDUALS' AVERAGE WEEKLY HOURS SPENT DIRECTLY ON THE ACTIVITIES OF THE REPORTING ORGANIZATION. IN ADDITION, THESE ARE THE AVERAGE HOURS PER WEEK DEVOTED TO RELATED ORGANIZATIONS: KEDRICK ADKINS - 50 HOURS JAMES BOSSCHER - 48 HOURS VELOIS BOWERS - 45 HOURS PAUL BROWNE - 45 HOURS DEBRA CANALES - 45 HOURS BENJAMIN CARTER - 45 HOURS PAUL CONLON - 45 HOURS MARIANNE CUNNINGHAM - 43 HOURS LOUIS FIERENS - 45 HOURS PRESTON GEE - 45 HOURS AGNES HAGERTY - 48 HOURS DANIEL HALE - 45 HOURS MICHAEL HOLPER - 45 HOURS MICHAEL MURPHY - 50 HOURS PAUL NEUMANN - 45 HOURS RICHARD O'CONNELL - 50 HOURS TERRENCE O'ROURKE - 45 HOURS MICHAEL SLUBOWSKI - 50 HOURS JOSEPH SWEDISH - 50 HOURS MARIA SZYMANSKI - 45 HOURS
TRUSTEES: FORM 990, PART VII, SECTION A, LINE 1: SR. SUZANNE BRENNAN, CSC, IS A MEMBER OF THE CONGREGATION OF THE SISTERS OF THE HOLY CROSS. HAVING TAKEN A VOW OF POVERTY, SR. SUZANNE BRENNAN DID NOT RECEIVE COMPENSATION FOR THE SERVICES SHE PROVIDED TO MERCY HEALTH SERVICES - IOWA, CORP. INSTEAD, A TOTAL OF $25,000 WAS PAID BY TRINITY HEALTH CORPORATION DIRECTLY TO THE CONGREGATION OF THE SISTERS OF THE HOLY CROSS FOR SR. SUZANNE BRENNAN'S SERVICES AS A TRUSTEE FOR TRINITY HEALTH CORPORATION, MERCY HEALTH SERVICES - IOWA, CORP. AND TRINITY HEALTH - MICHIGAN. SR. MARY MOLLISON, CSA, IS A MEMBER OF THE CONGREGATION OF SAINT AGNES. HAVING TAKEN A VOW OF POVERTY, SR. MARY MOLLISON DID NOT RECEIVE COMPENSATION FOR THE SERVICES SHE PROVIDED TO MERCY HEALTH SERVICES - IOWA, CORP. INSTEAD, A TOTAL OF $50,000 WAS PAID BY TRINITY HEALTH CORPORATION DIRECTLY TO THE CONGREGATION OF SAINT AGNES FOR SR. MARY MOLLISON'S SERVICES AS BOARD CHAIR FOR TRINITY HEALTH CORPORATION, MERCY HEALTH SERVICES - IOWA, CORP. AND TRINITY HEALTH - MICHIGAN.
CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 20,361,324. NET EQUITY TRANSFERS TO AFFILIATES: -17,442,126. NET CUMULATIVE EFFECT OF CHANGE IN ACCOUNTING PRINCIPLE: -1,156,680. EQUITY EARNINGS IN UNCONSOLIDATED AFFILIATES: 34,086,477. OTHER TRANSACTIONS: -1,383,620. TOTAL TO FORM 990, PART XI, LINE 5: 34,465,375.
  FORM 990, PART XII, LINE 2: MERCY HEALTH SERVICES -IOWA, CORP.'S FINANCIAL STATEMENTS WERE INCLUDED IN THE FY11 CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH, WHICH WERE AUDITED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM.
  FORM 990, PAGE 1, DOING BUSINESS AS NAMES: FOREST PARK PHARMACY, MARIAN HEALTH CENTER, MERCY HEALTH CENTER-DUBUQUE (ST. JOSEPH'S), MERCY HEALTH CENTER-DYERSVILLE (ST. MARY'S), MERCY HOME CARE-NORTH IOWA, MERCY MEDICAL CENTER-DUBUQUE, MERCY MEDICAL CENTER-NEW HAMPTON, MERCY MEDICAL CENTER-NORTH IOWA, MERCY MEDICAL CENTER-SIOUX CITY, NORTH IOWA MERCY HEALTH CENTER, NORTH IOWA MERCY HOME HEALTHCARE, SHEFFIELD PHARMACY, ST. JOSEPH COMMUNITY HOSPITAL
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2010

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" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
MERCY HEALTH SERVICES - IOWA CORP
 
Employer identification number

31-1373080
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)
(a)
Name, address, and EIN 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 organization
Yes No
(1) ADVANTAGE HEALTHSAINT MARY'S MEDICAL GROUP

245 STATE ST SE

GRAND RAPIDS,MI49503
27-2491974 		HEALTHCARE SERVICES MI 501(C)(3) 9 TRINITY HEALTH-MICHIGAN
 
 
No
(2) AMICARE HOSPICE SERVICES INC

27870 CABOT DRIVE

NOVI,MI483772920
38-2949053 		PROVIDE HOSPICE SERVICES MI 501(C)(3) 11, TYPE I TRINITY HOME HEALTH SERVICES INC
 
 
No
(3) AUXILIARY OF HOLY ROSARY HOSPITAL

351 SW 9TH STREET

ONTARIO,OR97914
94-3059469 		SUPPORTS SERVICES OF RELATED HOSPITAL OR 501(C)(3) 9 SAINT ALPHONSUS MEDICAL CENTER-ONTARIO
 
 
No
(4) BATTLE CREEK HEALTH SYSTEM

300 NORTH AVENUE

BATTLE CREEK,MI49016
38-2776791 		HEALTHCARE SERVICES MI 501(C)(3) 3 TRINITY HEALTH - MICHIGAN
 
 
No
(5) BATTLE CREEK HEALTH SYSTEM AUXILIARY

300 NORTH AVENUE

BATTLE CREEK,MI49016
38-3355520 		SUPPORT OF TAX EXEMPT HEALTH ORGANIZATION MI 501(C)(3) 11, TYPE I BATTLE CREEK HEALTH SYSTEM
 
 
No
(6) BAUM HARMON MERCY HOSPITAL

255 NORTH WELCH AVENUE

PRIMGHAR,IA51245
42-1500277 		ACUTE/AMBULATORY HEALTHCARE SERVICES IA 501(C)(3) 3 MERCY HEALTH SERVICES-IOWA CORP
 
Yes
 
(7) BAUM HARMON MERCY HOSPITAL & CLINICS FOUNDATION

255 NORTH WELCH AVENUE

PRIMGHAR,IA51245
26-2973307 		SUPPORT THE SERVICES OF RELATED HOSPITAL IA 501(C)(3) 11, TYPE I BAUM HARMON MERCY HOSPITAL
 
Yes
 
(8) CAPITAL PARK FAMILY HEALTH CENTER INC

6150 EAST BROAD STREET

COLUMBUS,OH43213
31-1387838 		OPERATION OF A FEDERALLY QUALIFIED HEALTH CENTER (FORMERLY) OH 501(C)(3) 3 MOUNT CARMEL HEALTH SYSTEM
 
 
No
(9) CATHERINE MCAULEY HEALTH SERVICES CORP

PO BOX 995

ANN ARBOR,MI48106
38-2507173 		FURTHER TRINITY HEALTH ACTIVITIES, ORGANIZE AND DEVELOP MEDICAL SERVICES MI 501(C)(3) 11, TYPE II TRINITY HEALTH-MICHIGAN
 
 
No
(10) COMMUNITY HEALTH PARTNERS OF SOUTH BEND

PO BOX 3998

SOUTH BEND,IN46619
26-3051440 		HEALTHCARE SERVICES IN 501(C)(3) 3 SAINT JOSEPH REGIONAL MEDICAL CENTER INC
 
 
No
(11) CRANBROOK HOSPICE CARE

281 ENTERPRISE COURT

BLOOMFIELD HILLS,MI48302
38-3320699 		PROVIDE HOSPICE HEALTH SERVICES MI 501(C)(3) 11, TYPE I TRINITY HOME HEALTH SERVICES INC
 
 
No
(12) DILEY RIDGE MEDICAL CENTER

6150 EAST BROAD STREET

COLUMBUS,OH43213
34-2032340 		HOSPITAL CAMPUS IN FAIRFIELD COUNTY OHIO OH 501(C)(3) 3 MOUNT CARMEL HEALTH SYSTEM
 
 
No
(13) DUBUQUE MERCY HEALTH FOUNDATION INC

250 MERCY DRIVE

DUBUQUE,IA52001
26-2227941 		SUPPORT THE SERVICES OF RELATED HOSPITAL IA 501(C)(3) 11, TYPE I MERCY HEALTH SERVICES-IOWA CORP
 
Yes
 
(14) DYERSVILLE HEALTH FOUNDATION INC

1111 3RD STREET SW

DYERSVILLE,IA52040
20-5383271 		SUPPORT THE SERVICES OF RELATED HOSPITAL IA 501(C)(3) 11, TYPE I MERCY HEALTH SERVICES-IOWA CORP
 
Yes
 
(15) HACKLEY HOSPITAL

1700 CLINTON ST PO BOX 3302

MUSKEGON,MI494433302
38-1358196 		HEALTHCARE SERVICES MI 501(C)(3) 3 MERCY HEALTH PARTNERS
 
 
No
(16) HACKLEY HOSPITAL SELF INSURANCE PROFESSIONAL LIABILITY TRUST

PO BOX 3302

MUSKEGON,MI494433302
38-2299878 		SELF INSURANCE FOR GENERAL AND MALPRACTICE LIABILITY MI 501(C)(3) 11, TYPE III-FI MERCY HEALTH PARTNERS
 
 
No
(17) HACKLEY LIFE COUNSELING

1352 TERRACE ST

MUSKEGON,MI494423545
38-1386362 		COUNSELING, EDUCATION, AND SUPPORT MI 501(C)(3) 9 MERCY HEALTH PARTNERS
 
 
No
(18) HACKLEY VISITING NURSE SERVICES AND HOSPICE INC

888 TERRACE ST

MUSKEGON,MI49440
38-1359598 		PROVIDE HOME HEALTH CARE SERVICES MI 501(C)(3) 7 MERCY HEALTH PARTNERS
 
 
No
(19) HOLY CROSS CARENET INC

PO BOX 9184

FARMINGTON HILLS,MI48333
52-1945054 		LONG-TERM CARE AND REHABILITATION FOR THE ELDERLY MD 501(C)(3) 9 TRINITY CONTINUING CARE SERVICES
 
 
No
(20) HOLY CROSS HOSPITAL FOUNDATION INC

11801 TECH ROAD

SILVER SPRING,MD20904
20-8428450 		CHARITABLE FUNDRAISING MD 501(C)(3) 11, TYPE I HOLY CROSS HOSPITAL OF SILVER SPRING INC
 
 
No
(21) HOLY CROSS HOSPITAL OF SILVER SPRING INC

1500 FOREST GLEN RD

SILVER SPRING,MD209101484
52-0738041 		HEALTHCARE SERVICES MD 501(C)(3) 3 TRINITY HEALTH CORPORATION
 
 
No
(22) HOLY CROSS MEDICAL CENTER

27870 CABOT DRIVE

NOVI,MI483772920
95-1985442 		HEALTHCARE SERVICES (FORMERLY) CA 501(C)(3) 3 TRINITY HEALTH CORPORATION
 
 
No
(23) HOLY ROSARY MEDICAL CENTER FOUNDATION

351 SW 9TH STREET

ONTARIO,OR97914
20-2683560 		SUPPORT THE SERVICES OF RELATED HOSPITAL OR 501(C)(3) 11, TYPE I SAINT ALPHONSUS MEDICAL CENTER-ONTARIO
 
 
No
(24) HOSPICE OF NORTH IOWA

232 SECOND STREET SE

MASON CITY,IA504016208
42-1173708 		HOSPICE HEALTH CARE SERVICES IA 501(C)(3) 7 MERCY HEALTH SERVICES-IOWA CORP
 
Yes
 
(25) HOSPICE OF WASHTENAW II

806 AIRPORT BLVD

ANN ARBOR,MI48108
38-3320707 		HOSPICE HEALTH CARE SERVICES MI 501(C)(3) 11, TYPE I TRINITY HEALTH-MICHIGAN
 
 
No
(26) HPCN

1675 LEAHY STREET

MUSKEGON,MI49442
30-0207909 		HEALTHCARE SERVICES MI 501(C)(3) 11, TYPE II MERCY HEALTH PARTNERS
 
 
No
(27) IHA HEALTH SERVICES CORPORATION

24 FRANK LLOYD WRIGHT DR LOBBY J

ANN ARBOR,MI48106
38-3316559 		PROVIDES OFFICE-BASED MEDICAL CARE MI 501(C)(3) 9 TRINITY HEALTH-MICHIGAN
 
 
No
(28) LAKESHORE COMMUNITY HOSPITAL INC

72 S STATE STREET

SHELBY,MI494551228
38-2549295 		ACUTE HEALTHCARE SERVICES MI 501(C)(3) 3 MERCY HEALTH PARTNERS
 
 
No
(29) LIFESPAN INC

166 EAST GOODALE AVE

BATTLE CREEK,MI490372728
38-3298476 		PROVIDE HOSPICE HEALTH SERVICES MI 501(C)(3) 9 BATTLE CREEK HEALTH SYSTEM
 
 
No
(30) MARIAN HOME HEALTHCARE

801 5TH STREET

SIOUX CITY,IA51101
38-3320705 		PROVIDE HOME HEALTH CARE SERVICES IA 501(C)(3) 11, TYPE I MERCY HEALTH SERVICES-IOWA CORP
 
Yes
 
(31) MCAULEY CLINIC CORPORATION

PO BOX 992

ANN ARBOR,MI48106
38-2561013 		HEALTHCARE SERVICES (FORMERLY) MI 501(C)(3) 3 CATHERINE MCAULEY HEALTH SERVICES CORP
 
 
No
(32) MERCY AMICARE HOME HEALTHCARE OAKLAND

281 ENTERPRISE COURT

BLOOMFIELD HILLS,MI483020312
38-3320698 		PROVIDE HOME HEALTH CARE SERVICES MI 501(C)(3) 11, TYPE I TRINITY HOME HEALTH SERVICES INC
 
 
No
(33) MERCY AMICARE HOME HEALTHCARE PORT HURON

505 HURON AVENUE

PORT HURON,MI48060
38-3320701 		PROVIDE HOME HEALTH CARE SERVICES MI 501(C)(3) 11, TYPE I TRINITY HOME HEALTH SERVICES INC
 
 
No
(34) MERCY GENERAL HEALTH PARTNERS AMICARE HOMECARE

684 HARVEY STREET

MUSKEGON,MI49442
38-3321856 		PROVIDE HOME HEALTH CARE SERVICES MI 501(C)(3) 11, TYPE I TRINITY HOME HEALTH SERVICES INC
 
 
No
(35) MERCY HEALTH PARTNERS

1415 LEAHY STREET

MUSKEGON,MI49442
38-2589966 		HEALTHCARE SYSTEM SUPPORT MI 501(C)(3) 11, TYPE I TRINITY HEALTH-MICHIGAN
 
 
No
(36) MERCY HEALTH SERVICES - IOWA CORP

1000 4TH STREET SW

MASON CITY,IA50401
31-1373080 		HEALTHCARE SERVICES DE 501(C)(3) 3 TRINITY HEALTH-MICHIGAN
 
Yes
 
(37) MERCY HEALTHCARE FOUNDATION

1410 N 4TH ST

CLINTON,IA52732
42-1316126 		FUNDRAISING AND FINANCIAL ASSISTANCE FOR HOSPITAL CHARITABLE SERVICES IA 501(C)(3) 11, TYPE I MERCY MEDICAL CENTER-CLINTON
 
Yes
 
(38) MERCY HOSP & HEALTH SERVICES OF DETROITMARSHALL PARK HEALTH SERVICES INC

27870 CABOT DRIVE

NOVI,MI483772920
38-1562325 		SUPPORTS MALPRACTICE CONTINGENCIES OF CLOSED HOSPITAL MI 501(C)(3) 11, TYPE I TRINITY HEALTH-MICHIGAN
 
 
No
(39) MERCY HOSPITAL CADILLAC FOUNDATION

400 HOBART

CADILLAC,MI496012331
20-3357131 		SUPPORT THE SERVICES OF RELATED HOSPITAL MI 501(C)(3) 11, TYPE I TRINITY HEALTH-MICHIGAN
 
 
No
(40) MERCY HOSPITAL GIFT SHOP

2601 ELECTRIC AVE

PORT HURON,MI48060
38-1630480 		VOLUNTEER SERVICE AUXILIARY MI 501(C)(3) 11, TYPE I TRINITY HEALTH-MICHIGAN
 
 
No
(41) MERCY MEDICAL CENTER - CLINTON INC

1410 NORTH 4TH ST

CLINTON,IA527322940
42-1336618 		TO PROVIDE QUALITY HEALTH CARE DE 501(C)(3) 3 MERCY HEALTH SERVICES-IOWA CORP
 
Yes
 
(42) MERCY MEDICAL CENTER - SIOUX CITY FOUNDATION

801 5TH STREET

SIOUX CITY,IA51102
14-1880022 		SUPPORT THE SERVICES OF RELATED HOSPITAL IA 501(C)(3) 7 MERCY HEALTH SERVICES-IOWA CORP
 
Yes
 
(43) MERCY MEDICAL CENTER FOUNDATION - NORTH IOWA

1000 4TH STREET SW

MASON CITY,IA504012800
42-1229151 		SUPPORT THE SERVICES OF RELATED HOSPITAL IA 501(C)(3) 11, TYPE III-FI MERCY HEALTH SERVICES-IOWA CORP
 
 
No
(44) MERCY MEDICAL CENTER FOUNDATION INC

1512 12TH AVENUE ROAD

NAMPA,ID83686
26-1737256 		SUPPORT THE SERVICES OF RELATED HOSPITAL ID 501(C)(3) 7 SAINT ALPHONSUS MEDICAL CENTER-NAMPA
 
 
No
(45) MERCY NORTH HOMECARE AND HOSPICE

7985 MACKINAW TRAIL

CADILLAC,MI49601
38-3313897 		HOME HEALTH AND HOSPICE SERVICES MI 501(C)(3) 11, TYPE I TRINITY HOME HEALTH SERVICES INC
 
 
No
(46) MERCY PAVILION OF BATTLE CREEK

300 NORTH AVENUE

BATTLE CREEK,MI49016
38-2783350 		PROVIDES LONG-TERM CARE FOR THE ELDERLY MI 501(C)(3) 9 BATTLE CREEK HEALTH SYSTEM
 
 
No
(47) MERCY PHYSICIAN GROUP INC

1512 12TH AVENUE ROAD

NAMPA,ID83686
20-8192593 		TO PROVIDE QUALITY HEALTH CARE ID 501(C)(3) 9 SAINT ALPHONSUS MEDICAL CENTER-NAMPA
 
 
No
(48) MERCY SERVICES FOR AGING NON-PROFIT HOUSING CORPORATION

PO BOX 9184

FARMINGTON HILLS,MI483339184
38-2719605 		PROVIDES LONG-TERM CARE FOR THE ELDERLY MI 501(C)(3) 11, TYPE II TRINITY CONTINUING CARE SERVICES INC
 
 
No
(49) MIDWEST MEDFLIGHT

1300 VICTORS WAY

ANN ARBOR,MI48108
38-2684671 		AEROMEDICAL TRANSPORT MI 501(C)(3) 9 TRINITY HEALTH-MICHIGAN
 
 
No
(50) MOUNT CARMEL CARE CONTINUUM SERVICES CORP

793 WEST STATE STREET

COLUMBUS,OH43222
31-1126211 		COOPERATIVE HOSPITAL SERVICE ORGANIZATION OH 501(C)(3) 3 MOUNT CARMEL HEALTH SYSTEM
 
 
No
(51) MOUNT CARMEL COLLEGE OF NURSING

6150 EAST BROAD STREET

COLUMBUS,OH43213
31-1308555 		COLLEGE OF NURSING OH 501(C)(3) 2 MOUNT CARMEL HEALTH
 
 
No
(52) MOUNT CARMEL HEALTH

6150 EAST BROAD STREET

COLUMBUS,OH43213
31-4379602 		HEALTHCARE SERVICES OH 501(C)(3) 3 MOUNT CARMEL HEALTH SYSTEM
 
 
No
(53) MOUNT CARMEL HEALTH INSURANCE COMPANY

6150 EAST BROAD STREET

COLUMBUS,OH43213
25-1912781 		HEALTH INSURANCE OH 501(C)(4) N/A MOUNT CARMEL HEALTH SYSTEM
 
 
No
(54) MOUNT CARMEL HEALTH PLAN INC

6150 EAST BROAD STREET

COLUMBUS,OH43213
31-1471229 		MEDICARE HMO FOR SENIORS OH 501(C)(4) N/A MOUNT CARMEL HEALTH SYSTEM
 
 
No
(55) MOUNT CARMEL HEALTH SYSTEM

6150 EAST BROAD STREET

COLUMBUS,OH43213
31-1439334 		HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT OH 501(C)(3) 11, TYPE I TRINITY HEALTH CORPORATION
 
 
No
(56) MOUNT CARMEL HEALTH SYSTEM FOUNDATION

6150 EAST BROAD STREET

COLUMBUS,OH43213
31-1113966 		SUPPORT THE SERVICES OF RELATED HOSPITAL OH 501(C)(3) 11, TYPE I MOUNT CARMEL HEALTH SYSTEM
 
 
No
(57) MOUNT CARMEL HOME CARE LLC

1144 DUBLIN ROAD SUITE B

COLUMBUS,OH43215
26-2729300 		PROVIDE HOME HEALTH CARE SERVICES OH 501(C)(3) 9 TRINITY HOME HEALTH SERVICES INC
 
 
No
(58) MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL

7333 SMITHS MILL RD

NEW ALBANY,OH43054
87-0790288 		HEALTHCARE SERVICES OH 501(C)(3) 3 MOUNT CARMEL HEALTH SYSTEM
 
 
No
(59) MRI MOBILE SERVICES OF WEST MICHIGAN

1820 - 44TH STREET

KENTWOOD,MI49508
38-3073745 		OPERATE MAGNETIC IMAGING RESONANCE (FORMERLY) MI 501(C)(3) 9 TRINITY HEALTH-MICHIGAN
 
 
No
(60) MUSKEGON COMMUNITY HEALTH PROJECT

565 W WESTERN AVENUE

MUSKEGON,MI49440
91-1932918 		FACILITATE AND COORDINATE HEALTHCARE AND RELATED SERVICES MI 501(C)(3) 7 MERCY HEALTH PARTNERS
 
 
No
(61) OAKLAND MERCY HOSPITAL

601 EAST 2ND STREET

OAKLAND,NE68045
20-8072234 		HEALTHCARE SERVICES NE 501(C)(3) 3 MERCY HEALTH SERVICES-IOWA CORP
 
Yes
 
(62) OAKLAND MERCY HOSPITAL FOUNDATION

601 E 2ND STREET

OAKLAND,NE68045
31-1678345 		SUPPORTS SERVICES OF RELATED HOSPITAL NE 501(C)(3) 11, TYPE III-FI OAKLAND MERCY HOSPITAL
 
Yes
 
(63) PORT HURON MERCY FAMILY CARE INC

2601 ELECTRIC AVE

PORT HURON,MI48060
20-1855647 		HEALTHCARE SERVICES MI 501(C)(3) 11, TYPE I TRINITY HEALTH-MICHIGAN
 
 
No
(64) PROFESSIONAL MED TEAM

965 FORK STREET

MUSKEGON,MI494423257
38-2638284 		MEDICAL CARE, TRANSPORTATION AND EDUCATION MI 501(C)(3) 9 TRINITY HEALTH-MICHIGAN
 
 
No
(65) PROFESSIONAL OFFICE CORPORATION

1303 EAST HERNDON AVE

FRESNO,CA93720
94-2839324 		HEALTHCARE SERVICES CA 501(C)(3) 11, TYPE I SAINT AGNES MEDICAL CENTER
 
 
No
(66) SAINT AGNES MEDICAL CENTER

1303 EAST HERNDON AVE

FRESNO,CA93720
94-1437713 		HEALTHCARE SERVICES CA 501(C)(3) 3 TRINITY HEALTH CORPORATION
 
 
No
(67) SAINT ALPHONSUS BUILDING COMPANY INC

1055 NORTH CURTIS RD

BOISE,ID83706
82-0401011 		SUPPORTS SERVICES OF RELATED HOSPITAL ID 501(C)(3) 11, TYPE I SAINT ALPHONSUS REGIONAL MEDICAL CENTER INC
 
 
No
(68) SAINT ALPHONSUS DIVERSIFIED CARE INC

1055 NORTH CURTIS RD

BOISE,ID83706
94-3028978 		SUPPORTS SERVICES OF RELATED HOSPITAL ID 501(C)(3) 11, TYPE I SAINT ALPHONSUS REGIONAL MEDICAL CENTER INC
 
 
No
(69) SAINT ALPHONSUS HEALTH SYSTEM INC

1055 N CURTIS ROAD

BOISE,ID83706
27-1929502 		HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT ID 501(C)(3) 11, TYPE I TRINITY HEALTH CORPORATION
 
 
No
(70) SAINT ALPHONSUS MEDICAL CENTER-BAKER CITY

3325 POCAHONTAS ROAD

BAKER CITY,OR97814
27-1790052 		TO PROVIDE QUALITY HEALTH CARE OR 501(C)(3) 3 SAINT ALPHONSUS HEALTH SYSTEM INC
 
 
No
(71) SAINT ALPHONSUS MEDICAL CENTER-NAMPA

1512 12TH AVENUE ROAD

NAMPA,ID83686
82-0200896 		TO PROVIDE QUALITY HEALTH CARE ID 501(C)(3) 3 SAINT ALPHONSUS HEALTH SYSTEM INC
 
 
No
(72) SAINT ALPHONSUS MEDICAL CENTER-ONTARIO

351 SW 9TH STREET

ONTARIO,OR97914
27-1789847 		TO PROVIDE QUALITY HEALTH CARE OR 501(C)(3) 3 SAINT ALPHONSUS HEALTH SYSTEM INC
 
 
No
(73) SAINT ALPHONSUS REGIONAL MEDICAL CENTER

1055 NORTH CURTIS RD

BOISE,ID83706
82-0200895 		HEALTHCARE SERVICES ID 501(C)(3) 3 SAINT ALPHONSUS HEALTH SYSTEM INC
 
 
No
(74) SAINT JOSEPH REGIONAL MEDICAL CENTER - PLYMOUTH CAMPUS INC

1915 LAKE AVENUE PO BOX 670

PLYMOUTH,IN46563
35-1142669 		HEALTHCARE SERVICES IN 501(C)(3) 3 SAINT JOSEPH REGIONAL MEDICAL CENTER INC
 
 
No
(75) SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS INC

PO BOX 1935

SOUTH BEND,IN466341935
35-0868157 		HEALTHCARE SERVICES IN 501(C)(3) 3 SAINT JOSEPH REGIONAL MEDICAL CENTER INC
 
 
No
(76) SAINT JOSEPH REGIONAL MEDICAL CENTER INC

801 EAST LASALLE AVE

SOUTH BEND,IN46617
35-1568821 		HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT IN 501(C)(3) 11, TYPE I TRINITY HEALTH CORPORATION
 
 
No
(77) SAINT JOSEPH'S AUXILIARY OF MARSHALL COUNTY

1915 LAKE AVENUE

PLYMOUTH,IN46563
35-6043563 		HOSPITAL SERVICE AUXILIARY IN 501(C)(3) 11, TYPE II SAINT JOSEPH REGIONAL MEDICAL CENTER - PLYMOUTH CAMPUS INC
 
 
No
(78) SAINT JOSEPH'S TOWER INC

PO BOX 9184

FARMINGTON HILLS,MI483339184
31-1040468 		PROVIDES HOUSING FOR LOW INCOME ELDERLY INDIVIDUALS IN 501(C)(3) 9 TRINITY CONTINUING CARE SERVICES-INDIANA
 
 
No
(79) SAINT MARY'S AMICARE HOME HEALTHCARE

1430 MONROE NW

GRAND RAPIDS,MI49505
38-3320700 		PROVIDE HOME HEALTH CARE SERVICES MI 501(C)(3) 11, TYPE I TRINITY HOME HEALTH SERVICES INC
 
 
No
(80) SAINT MARY'S DORAN FOUNDATION CO SAINT MARY'S HEALTH CARE

200 JEFFERSON ST SE

GRAND RAPIDS,MI49503
38-1779602 		SUPPORTS SERVICES OF RELATED HOSPITAL MI 501(C)(3) 7 TRINITY HEALTH-MICHIGAN
 
 
No
(81) ST JOHN'S HEALTH SYSTEM

27870 CABOT DRIVE

NOVI,MI483772920
35-0877584 		HEALTHCARE SERVICES (FORMERLY) IN 501(C)(3) 3 TRINITY HEALTH CORPORATION
 
 
No
(82) ST JOSEPH MERCY OAKLAND FOUNDATION

44405 WOODWARD AVE

PONTIAC,MI48341
35-2356789 		SUPPORTS SERVICES OF RELATED HOSPITAL MI 501(C)(3) 11, TYPE I TRINITY HEALTH-MICHIGAN
 
 
No
(83) ST ANN'S HOSPITAL

500 SOUTH CLEVELAND AVE

WESTERVILLE,OH43081
31-4412701 		HEALTHCARE SERVICES OH 501(C)(3) 3 MOUNT CARMEL HEALTH SYSTEM
 
 
No
(84) ST ELIZABETH HEALTH CARE FOUNDATION

3325 POCAHONTAS ROAD

BAKER CITY,OR97814
94-3164869 		SUPPORT THE SERVICES OF RELATED HOSPITAL OR 501(C)(3) 7 SAINT ALPHONSUS MEDICAL CENTER - BAKER CITY
 
 
No
(85) ST JOSEPH'S MEDICAL CENTER AUXILIARY

801 E LASALLE AVE PO BOX 1935

SOUTH BEND,IN466341935
35-6033285 		HOSPITAL SERVICE AUXILIARY IN 501(C)(4) N/A SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS INC
 
 
No
(86) THE FOUNDATION OF SAINT JOSEPH REGIONAL MEDICAL CENTER

4215 EDISON LAKES PARKWAY

MISHAWAKA,IN46545
35-1654543 		SUPPORTS SERVICES OF RELATED HOSPITAL IN 501(C)(3) 11, TYPE I SAINT JOSEPH REGIONAL MEDICAL CENTER INC
 
 
No
(87) TRINITY CONTINUING CARE SERVICES

PO BOX 9184

FARMINGTON HILLS,MI483339184
38-2559656 		MANAGEMENT SERVICES FOR LONG TERM CARE AND SENIOR LIVING FACILITIES MI 501(C)(3) 11, TYPE I TRINITY HEALTH CORPORATION
 
 
No
(88) TRINITY CONTINUING CARE SERVICES - INDIANA INC

PO BOX 9184

FARMINGTON HILLS,MI483339184
93-0907047 		PROVIDES LONG-TERM CARE AND RESIDENTIAL HOUSING IN 501(C)(3) 9 TRINITY CONTINUING CARE SERVICES
 
 
No
(89) TRINITY HEALTH - MICHIGAN

27870 CABOT DRIVE

NOVI,MI483772920
38-2113393 		HEALTHCARE SERVICES MI 501(C)(3) 3 TRINITY HEALTH CORPORATION
 
 
No
(90) TRINITY HEALTH CORPORATION

27870 CABOT DRIVE

NOVI,MI483772920
35-1443425 		HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT IN 501(C)(3) 11, TYPE I N/A
 
No
(91) TRINITY HEALTH INTERNATIONAL

27870 CABOT DRIVE

NOVI,MI483772920
42-1253527 		HEALTHCARE TRAINING AND SUPPORT SERVICES MI 501(C)(3) 11, TYPE I TRINITY HEALTH CORPORATION
 
 
No
(92) TRINITY HEALTH WELFARE BENEFIT TRUST

27870 CABOT DRIVE

NOVI,MI483772920
20-8151733 		RETIREE MEDICAL AND RETIREE LIFE INSURANCE COVERAGE MI 501(C)(9) N/A TRINITY HEALTH CORPORATION
 
 
No
(93) TRINITY HOME HEALTH SERVICES INC

17410 COLLEGE PARKWAY

LIVONIA,MI48152
38-2621935 		HOME HEALTH CARE SYSTEM MANAGEMENT SERVICES MI 501(C)(3) 11, TYPE I TRINITY HEALTH CORPORATION
 
 
No
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
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) ADVANCED IMAGING SERVICES OF BATTLE CREEK

5352 BECKLEY ROAD STE A
BATTLE CREEK,MI49015
20-4594297 		RADIOLOGY/IMAGING MI N/A
 N/A       No     No 0 %
(2) ADVENT REHABILITATION LLC

607 DEWEY AVENUE SUITE 300
GRAND RAPIDS,MI49504
38-3306673 		REHABILITATION THERAPY SERVICES MI N/A
 N/A       No     No 0 %
(3) BIG RUN MEDICAL OFFICE BUILDING LIMITED PARTNERSHIP

793 W STATE STREET
COLUMBUS,OH43222
31-1608125 		MEDICAL OFFICE BUILDING RENTAL OH N/A
 N/A       No     No 0 %
(4) CENTER FOR DIGESTIVE CARE LLC

5300 ELLIOTT DRIVE
YPSILANTI,MI48197
03-0447062 		PROVIDE GASTROINTESTINAL SERVICES MI N/A
 N/A       No     No 0 %
(5) CENTRAL OHIO SLEEP MEDICINE LTD

5955 EAST BROAD ST
COLUMBUS,OH43213
31-1701029 		SLEEP MEDICINE SERVICES OH N/A
 N/A       No     No 0 %
(6) CLINTON IMAGING SERVICES LLC

615 VALLEY VIEW DR STE 202
MOLINE,IL61265
41-2044739 		MRI DIAGNOSTIC SERVICES IA N/A
 N/A       No     No 0 %
(7) FOREST PARK IMAGING LLC

1000 4TH STREET SW
MASON CITY,IA50401
13-4365966 		X-RAY AND MAMMOGRAPHY SERVICES IA MERCY HEALTH SERVICES-IOWA CORP
  		RELATED 1,081,595 307,605   No   Yes   52.889 %
(8) FRANCES WARDE MEDICAL LABORATORY

300 WEST TEXTILE ROAD
ANN ARBOR,MI48104
38-2648446 		LABORATORY MI N/A
 N/A       No     No 0 %
(9) FRESNO IMAGING CENTER

1303 E HERNDON AVE
FRESNO,CA93720
77-0363563 		DIAGNOSTIC IMAGING CA N/A
 N/A       No     No 0 %
(10) HAWARDEN COMMUNITY CLINIC LLC

1122 AVENUE L
HAWARDEN,IA51023
20-1444339 		MEDICAL CLINIC IA N/A
 N/A       No     No 0 %
(11) IDAHO GYNONCOLOGY SERVICES LLC

1055 N CURTIS RD
BOISE,ID83706
20-2975807 		PROVIDE GYN ONCOLOGY SERVICES ID N/A
 N/A       No     No 0 %
(12) INTERMOUNTAIN MEDICAL IMAGING LLC

877 WEST MAIN ST STE 603
BOISE,ID83702
82-0514422 		PROVIDE IMAGING SERVICES ID N/A
 N/A       No     No 0 %
(13) MAGNETIC RESONANCE SERVICES PARTNERSHIP

1416 SIXTH STREET SW
MASON CITY,IA50401
42-1328388 		MRI SERVICES IA MERCY HEALTH SERVICES-IOWA CORP DBA MERCY MEDICAL CENTER-N IA
  		RELATED 1,264,535 2,863   No   Yes   49.000 %
(14) MASON CITY AMBULATORY SURGERY CENTER LLC

990 4TH STREET SW
MASON CITY,IA50401
20-1960348 		SURGERY-SAME DAY IA MERCY HEALTH SERVICES-IOWA CORP DBA MERCY MEDICAL CENTER-N IA
  		RELATED 2,385,459 2,075,596   No   Yes   51.000 %
(15) MCE MOB IV LIMITED PARTNERSHIP

793 W STATE STREET
COLUMBUS,OH43222
42-1544707 		MEDICAL OFFICE BUILDING RENTAL OH N/A
 N/A       No     No 0 %
(16) MCMC POB III LIMITED PARTNERSHIP

793 W STATE STREET
COLUMBUS,OH43222
31-1392994 		MEDICAL OFFICE BUILDING RENTAL OH N/A
 N/A       No     No 0 %
(17) MEDILUCENT MOB I

793 W STATE STREET
COLUMBUS,OH43222
20-4911370 		MEDICAL OFFICE BUILDING RENTAL OH N/A
 N/A       No     No 0 %
(18) MERCY HEART CTR OP SERVICES LLC

1000 4TH STREET SW
MASON CITY,IA50401
13-4237594 		CARDIOVASCULAR SERVICES IA MERCY HEALTH SERVICES-IOWA CORP DBA MERCY MEDICAL CENTER-N IA
  		RELATED 956,951 978,407   No     No 51.000 %
(19) MERCY OUTPATIENT SURGERY CENTER LLC

1512 12TH AVENUE ROAD
NAMPA,ID83686
84-1380439 		OUTPATIENT SURGERY ID N/A
 N/A       No     No 0 %
(20) MICHIANA HEALTH INFORMATION NETWORK LLC

215 WEST MADISON STREET
SOUTH BEND,IN46601
35-2050128 		COMMUNITY BASED CLINICAL INFORMATION SYSTEM AND DATA DEPOSITORY IN N/A
 N/A       No     No 0 %
(21) MOUNT CARMEL EAST POB III LIMITED PARTNERSHIP

793 W STATE STREET
COLUMBUS,OH43222
31-1369473 		MEDICAL OFFICE BUILDING RENTAL OH N/A
 N/A       No     No 0 %
(22) NEWCO AMBULATORY SURGERY CTR LLP

4190 24TH AVENUE
FORT GRATIOT,MI48059
30-0136708 		OUTPATIENT SURGERY CENTER MI N/A
 N/A       No     No 0 %
(23) RIVERVIEW MEDICAL OFFICE BUILDING LIMITED PARTNERSHIP

793 W STATE STREET
COLUMBUS,OH43222
31-1531135 		MEDICAL OFFICE BUILDING RENTAL OH N/A
 N/A       No     No 0 %
(24) ROSENBERG & BRUNO PROPERTIES LLC (FKA BSV MEDICAL OFFICE BUILDING II LLC)

855 M STREET TENTH FLOOR
FRESNO,CA93721
20-2673839 		MEDICAL OFFICE BUILDING RENTAL CA N/A
 N/A       No     No 0 %
(25) SARMED OUTPATIENT PHARMACY LLC

999 N CURTIS RD STE 102
BOISE,ID83706
51-0483218 		PHARMACY ID N/A
 N/A       No     No 0 %
(26) SIXTY FOURTH STREET LLC

2373 64TH ST STE 2200
BYRON CENTER,MI49315
20-2443646 		PROVIDE OUTPATIENT SURGICAL CARE MI N/A
 N/A       No     No 0 %
(27) ST ALPHONSUS CALDWELL CANCER CTR LLC

3123 MEDICAL DR
CALDWELL,ID83605
82-0526861 		RADIATION ONCOLOGY ID N/A
 N/A       No     No 0 %
(28) ST ANN'S MEDICAL OFFICE BLDG II LIMITED PARTNERSHIP

793 W STATE STREET
COLUMBUS,OH43222
31-1603660 		MEDICAL OFFICE BUILDING RENTAL OH N/A
 N/A       No     No 0 %
(29) TAMARACK MEDICAL CLINIC LLC

610 VILLAGE DRIVE
DONNELLY,ID83615
20-1637921 		OUTPATIENT MEDICAL SERVICES ID N/A
 N/A       No     No 0 %
(30) WESTAR MEDICAL OFFICE BUILDING LIMITED PARTNERSHIP

793 W STATE STREET
COLUMBUS,OH43222
31-1784409 		MEDICAL OFFICE BUILDING RENTAL OH N/A
 N/A       No     No 0 %
(31) WOODLAND IMAGING CENTER LLC

5301 E HURON RIVER DR
ANN ARBOR,MI48106
76-0820959 		RADIOLOGY/IMAGING MI N/A
 N/A       No     No 0 %
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
(1) COMMUNITY HEALTH VENTURES INC
565 W WESTERN AVE
MUSKEGON,MI49440
38-3522260 		SOFTWARE MARKETING MI N/A
 C      
(2) HACKLEY HEALTH MANAGEMENT CENTER
1415 LEAHY ST
MUSKEGON,MI49442
38-2961814 		WEIGHT MANAGEMENT MI N/A
 C      
(3) HACKLEY HEALTH VENTURES INC
1415 LEAHY ST
MUSKEGON,MI49442
38-2589959 		OTHER MEDICAL SERVICES MI N/A
 C      
(4) HACKLEY HEALTHCARE EQUIPMENT
1415 LEAHY ST
MUSKEGON,MI49442
38-2578569 		HOME MEDICAL EQUIPMENT MI N/A
 C      
(5) HACKLEY PROFESSIONAL CENTER
1415 LEAHY ST
MUSKEGON,MI49442
38-3024797 		REAL ESTATE RENTAL MI N/A
 C      
(6) HACKLEY PROFESSIONAL PHARMACY
1415 LEAHY ST
MUSKEGON,MI49442
38-2447870 		PHARMACY MI N/A
 C      
(7) HEF INC
1415 LEAHY ST
MUSKEGON,MI49442
38-3086401 		OFFICE STAFFING MI N/A
 C      
(8) HOLY CROSS PRIVATE HOME SERVICES CORP
11801 TECH ROAD
SILVER SPRING,MD20904
52-1986562 		HOME CARE SERVICES MD N/A
 C      
(9) HPC CO-OWNERS ASSOCIATION
1700 CLINTON
MUSKEGON,MI49442
27-0734448 		CONDOMINIUM ASSOCIATION MI N/A
 C      
(10) HURON ARBOR CORPORATION
5301 EAST HURON RIVER DR PO BOX 992
ANN ARBOR,MI48106
38-2475644 		PROVIDES OFFICE RENTAL SPACE MI N/A
 C      
(11) INTEGRATED HEALTH ASSOCIATES INC
24 FRANK LLOYD WRIGHT DR LOBBY J
ANN ARBOR,MI48106
38-3126920 		MEDICAL MANAGEMENT MI N/A
 C      
(12) IHA AFFILIATION CORPORATION
24 FRANK LLOYD WRIGHT DR LOBBY J
ANN ARBOR,MI48106
38-3188895 		MEDICAL MANAGEMENT MI N/A
 C      
(13) IHA HEALTH SERVICES CORPORATION
24 FRANK LLOYD WRIGHT DR LOBBY J
ANN ARBOR,MI48106
38-3316559 		MEDICAL SERVICES MI N/A
 C      
(14) MARYLAND CARE GROUP INC
11801 TECH ROAD
SILVER SPRING,MD20904
52-1815313 		HEALTHCARE HOLDING MD N/A
 C      
(15) MEDNOW INC
1512 12TH AVENUE ROAD
NAMPA,ID83686
82-0389927 		OUTPATIENT PHARMACY ID N/A
 C      
(16) MERCY COMMUNITY PHYSICIANS
363 FREMONT STREET
BATTLE CREEK,MI49017
26-4252468 		HEALTHCARE SERVICES MI N/A
 C      
(17) MERCY MEDICAL SERVICES
801 5TH STREET
SIOUX CITY,IA51101
42-1283849 		PRIMARY CARE PHYSICIANS IA MERCY HEALTH SERVICES - IOWA CORP DBA MERCY MEDICAL CENTER - SIOUX CITY
  		C -8,127,346 11,467,575 100.000 %
(18) MICHIGAN PHYSICIAN SERVICES
44405 WOODWARD AVENUE H-5
PONTIAC,MI48341
38-3293125 		PHYSICIAN SERVICES MI N/A
 C      
(19) MICHIGAN ATHLETIC CLUB
2500 BURTON
GRAND RAPIDS,MI49546
38-2647304 		ATHLETIC CLUB MI N/A
 C      
(20) MOUNT CARMEL BEHAVIORAL HEALTHCARE SERVICES INC
6150 EAST BROAD STREET
COLUMBUS,OH43213
31-0971510 		BEHAVIORAL HEALTHCARE SERVICES OH N/A
 C      
(21) MOUNT CARMEL HEALTH HORIZONS CORP
6150 EAST BROAD STREET
COLUMBUS,OH43213
31-1177652 		MEDICAL SERVICES/RENT OH N/A
 C      
(22) MOUNT CARMEL HEALTH PROVIDERS INC
6150 EAST BROAD STREET
COLUMBUS,OH43213
31-1382442 		MEDICAL SERVICES OH N/A
 C      
(23) NORTH IOWA MERCY MEDICAL SERVICES INC
1000 4TH ST SW
MASON CITY,IA50401
42-1382308 		MEDICAL SERVICES IA MERCY HEALTH SERVICES - IOWA CORP
  		C     100.000 %
(24) PRIMARY CARE NETWORK OF OHIO INC
6150 EAST BROAD STREET
COLUMBUS,OH43213
31-1422486 		HEALTH MANAGEMENT SERVICES OH N/A
 C      
(25) PRIORITY PLUS OF CALIFORNIA
PO BOX 27230
FRESNO,CA93729
77-0395267 		FORMERLY HEALTH MANAGEMENT NOW DISCONTINUED SUBSTANTIALLY ALL OPERATIONS CA N/A
 C      
(26) SAINT ALPHONSUS PHYSICIANS PA
1055 NORTH CURTIS ROAD
BOISE,ID837061370
33-1078261 		PHYSICIANS ID N/A
 C      
(27) SAINT MARY'S HEALTH MANAGEMENT COMPANY
1640 EAST PARIS SE
GRAND RAPIDS,MI49546
38-3450733 		ATHLETIC CLUB MI N/A
 C      
(28) SURGERY CENTER FINANCING CORPORATION
6150 EAST BROAD STREET
COLUMBUS,OH43213
31-1531102 		FINANCE, INSURANCE AND REAL ESTATE OH N/A
 C      
(29) TRINITY HEALTH EMPLOYEE BENEFIT TRUST
27870 CABOT DRIVE
NOVI,MI483772920
38-3410377 		GRANTOR TRUST MI N/A
 T      
(30) VENZKE INSURANCE COMPANY LTD
PO BOX 1051 GRAND CAYMAN
GRAND CAYMAN    
CJ
98-0453602 		PROVISION OF INSURANCE COVERAGE CJ N/A
 C      
(31) WESTSHORE HEALTH NETWORK
1820 44TH STREET
KENTWOOD,MI49508
38-3280200 		PHYSICIAN HOSPITAL ORGANIZATION MI N/A
 C      
(32) WORKPLACE HEALTH OF GRAND HAVEN
1415 LEAHY ST
MUSKEGON,MI49442
38-3112035 		OCCUPATIONAL HEALTH MI N/A
 C      
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III or IV.
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 (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
Yes
 
b Gift, grant, or capital contribution to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
Yes
 
c Gift, grant, or capital contribution from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
Yes
 
f Sale of assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
Yes
 
j Lease of facilities, equipment, or other assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
Yes
 
k Performance of services or membership or fundraising solicitations for other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1k
Yes
 
l Performance of services or membership or fundraising solicitations by other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Sharing of facilities, equipment, mailing lists, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of paid employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Reimbursement paid to other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid by other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Other transfer of cash or property to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
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 other organization 		(b)
Transaction
type(a-r) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) TRINITY HEALTH CORPORATION

 J 861,805 PER BOOKS
(2) TRINITY HEALTH CORPORATION

 B 15,470,711 PER BOOKS
(3) TRINITY HEALTH CORPORATION

 C 176,474 PER BOOKS
(4) TRINITY HEALTH CORPORATION

 K 253,185 PER BOOKS
(5) TRINITY HEALTH CORPORATION

 L 49,424,218 PER BOOKS
(6) TRINITY HEALTH CORPORATION

 O 46,137,427 PER BOOKS
(7) TRINITY HEALTH CORPORATION

 P 566,858 PER BOOKS
(8) TRINITY HEALTH CORPORATION

 E 7,000,000 PER BOOKS
(9) TRINITY HEALTH CORPORATION

 Q 8,291,320 PER BOOKS
(10) DUBUQUE MERCY HEALTH FOUNDATION

 C 1,087,963 PER BOOKS
(11) MERCY HEART CTR OP SERVICES LLC

 A 103,952 PER BOOKS
(12) MERCY HEART CTR OP SERVICES LLC

 C 982,373 PER BOOKS
(13) MERCY HEART CTR OP SERVICES LLC

 K 1,717,035 PER BOOKS
(14) MERCY HEART CTR OP SERVICES LLC

 P 413,612 PER BOOKS
(15) MASON CITY AMBULATORY SURGERY CENTER LLC

 C 2,168,266 PER BOOKS
(16) MASON CITY AMBULATORY SURGERY CENTER LLC

 K 286,421 PER BOOKS
(17) FOREST PARK IMAGING LLC

 A 185,668 PER BOOKS
(18) FOREST PARK IMAGING LLC

 C 1,272,549 PER BOOKS
(19) FOREST PARK IMAGING LLC

 K 2,569,682 PER BOOKS
(20) FOREST PARK IMAGING LLC

 P 364,168 PER BOOKS
(21) HOSPICE OF NORTH IOWA

 P 618,866 PER BOOKS
(22) HOSPICE OF NORTH IOWA

 L 168,300 PER BOOKS
(23) OAKLAND MERCY HOSPITAL

 A 2,114 PER BOOKS
(24) OAKLAND MERCY HOSPITAL

 C 1,363,361 PER BOOKS
(25) MERCY MEDICAL SERVICES

 A 49,760 PER BOOKS
(26) MERCY MEDICAL SERVICES

 P 1,495,962 PER BOOKS
(27) MERCY MEDICAL SERVICES

 B 8,506,174 PER BOOKS
(28) MERCY MEDICAL SERVICES

 K 345,213 PER BOOKS
(29) MERCY MEDICAL SERVICES

 L 65,860 PER BOOKS
(30) MERCY MEDICAL SERVICES

 O 1,221,031 PER BOOKS
(31) BAUM HARMON MERCY HOSPITAL

 A 15,101 PER BOOKS
(32) BAUM HARMON MERCY HOSPITAL

 C 1,495,842 PER BOOKS
(33) BAUM HARMON MERCY HOSPITAL

 O 109,889 PER BOOKS
(34) BAUM HARMON MERCY HOSPITAL

 P 155,417 PER BOOKS
(35) MERCY MEDICAL CENTER-SIOUX CITY FOUNDATION

 B 606,698 PER BOOKS
(36) MERCY MEDICAL CENTER-SIOUX CITY FOUNDATION

 C 155,029 PER BOOKS
(37) MERCY MEDICAL CENTER-CLINTON INC

 K 215,605 PER BOOKS
(38) TRINITY HOME HEALTH SERVICES INC

 P 82,221 PER BOOKS
(39) MERCY MEDICAL CENTER FOUNDATION-NORTH IOWA

 B 551,578 PER BOOKS
(40) MERCY MEDICAL CENTER FOUNDATION-NORTH IOWA

 C 368,255 PER BOOKS
(41) MAGNETIC RESONANCE SERVICES PARTNERSHIP

 C 1,270,828 PER BOOKS
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
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)
Are all
partners
section
501(c)(3)
organizations? 		(e)
Share of
end-of-year
assets 		(f)
Disproprtionate allocations? 		(g)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065) 		(h)
General or
managing
partner?
Yes No Yes No Yes No






























Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation
Additional Data


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