TY 2010 Form 990

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	0
2	Grants and other assistance to individuals in the U.S. See Part IV, line 22	0
3	Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 15 and 16	0
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	0
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	0
7	Other salaries and wages	0
8	Pension plan contributions (include section 401(k) and section 403(b) employer contributions) ....	0
9	Other employee benefits .......	0
10	Payroll taxes ...........	0
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	0
c	Accounting ...........	0
d	Lobbying ...........	0
e	Professional fundraising. See Part IV, line 17..	0
f	Investment management fees ......	0
g	Other ..........	4,198,923	4,185,540	13,383
12	Advertising and promotion ....	0
13	Office expenses .......	561,689	515,229	46,460
14	Information technology ......	0
15	Royalties ..	0
16	Occupancy ...........	221,988	206,570	15,418
17	Travel ............	20,160	16,427	3,733
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0
19	Conferences, conventions, and meetings ....	0
20	Interest ...........	0
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization .....	48,881	48,881
23	Insurance ..............	0
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	CHI IOWA MBO ASSESSMENT	225,156		225,156
b	REPAIRS AND MAINTENANCE	187,863	141,598	46,265
c	COMMUNITY SUPPORT	8,678	8,678
d	Education	8,134	6,430	1,704
e	Dues & subscriptions	797	797
f	All other expenses	145,610	131,505	14,105
25	Total functional expenses. Add lines 1 through 24f	5,627,879	5,261,655	366,224	0
26	Joint costs. Check here 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

Part X Balance Sheet
	1	Cashnon-interest-bearing ..........	3,000	1	3,000
2	Savings and temporary cash investments .......	299,719	2	36,442
3	Pledges and grants receivable, net .........		3
4	Accounts receivable, net .........	533,148	4	497,453
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........		5
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 .............		7
8	Inventories for sale or use ..............		8
9	Prepaid expenses and deferred charges ............		9
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	2,241,026
b	Less: accumulated depreciation. .....	10b	1,745,432	544,475	10c	495,594
11	Investments—publicly traded securities ..........		11
12	Investments—other securities. See Part IV, line 11 ......		12
13	Investments—program-related. See Part IV, line 11 ..		13
14	Intangible assets .........		14
15	Other assets. See Part IV, line 11 ...........		15
16	Total assets. Add lines 1 through 15 (must equal line 34)...	1,380,342	16	1,032,489
	17	Accounts payable and accrued expenses .	55,991	17	23,790
18	Grants payable ..........		18
19	Deferred revenue ..........		19
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.....	48,229	25	550,313
26	Total liabilities. Add lines 17 through 25.....	104,220	26	574,103
		Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....	1,276,122	27	458,386
28	Temporarily restricted net assets .....		28
29	Permanently restricted net assets .....		29
	Organizations that do not follow SFAS 117, check here 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 .....	1,276,122	33	458,386
34	Total liabilities and net assets/fund balances .....	1,380,342	34	1,032,489

- TIN:

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.

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

House of Mercy

Employer identification number

42-1323808

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.)

A church, convention of churches, or association of churches. section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in

section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

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.)

An organization organized and operated exclusively to test for public safety. Seesection 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.

Type I

Type II

Type III - Functionally integrated

Type III - Other

By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).

If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box ..................................................

Since August 17, 2006, has the organization accepted any gift or contribution from any of the
following persons?

(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)

Yes

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)

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(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?
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of support?


Total

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 11285F

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.") ....	2,443,722	2,299,633	1,974,346	5,315,623	2,505,445	14,538,769
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..	2,443,722	2,299,633	1,974,346	5,315,623	2,505,445	14,538,769
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.						14,538,769

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..	2,443,722	2,299,633	1,974,346	5,315,623	2,505,445	14,538,769
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..	24,600	24,600	67,367	73,533	59,053	249,153
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..	0	0	0	169,152	134,826	303,978
11	Total support (Add lines 7 through 10).						15,091,900

Gross receipts from related activities, etc. (See instructions.) ..................

11,390,471

First Five Years If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.......................................... right arrow

Section C. Computation of Public Support Percentage

Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f)) .........

96.335 %

Public Support Percentage for 2009 Schedule A, Part II, line 14 ...............

98.620 %

16a

33 1/3% support test—2010. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ...................... right arrow

33 1/3% support test—2009. If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2010. If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization .................................................. right arrow

10%-facts-and-circumstances test—2009. If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly
supported organization .............................................. right arrow

Private Foundation If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions ................................................... right arrow

Schedule A (Form 990 or 990-EZ) 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.).

Section C. Computation of Public Support Percentage

Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f)) .........

Public support percentage from 2009 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f)) ......

Investment income percentage from 2009 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2010. If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .......... right arrow

33 1/3% support tests—2009. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private Foundation If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions ..... right arrow

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:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

OMB No. 1545-0047

2010

Name of organization

House of Mercy

Employer identification number

42-1323808

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

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

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II.

Special Rules

For a section 501(c)(3) organization filing Form 990 or 990-EZ, that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), and received from any one contributor, during the year, a contribution of the
greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ, that received from any one contributor,
during the year, aggregate contributions of more than $1,000 for use exclusively for religious, charitable,
scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. Complete Parts I, II, and
III.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ, that received from any one contributor,
during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did
not aggregate to more than $1,000. If this box is checked, enter here the total contributions that were received during
the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule
applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more
during the year. ......................... 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)

Name of organization House of Mercy
Schedule B (Form 990, 990-EZ, or 990-PF) (2010) Page 1 of 1 of Part I
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	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Name of organization House of Mercy
Schedule B (Form 990, 990-EZ, or 990-PF) (2010) Page 1 of 1 of Part II
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
House of Mercy

Employer identification number

42-1323808

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

(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

(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

(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

(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:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

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

House of Mercy

Employer identification number

42-1323808

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 .......

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? ............

Yes No

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. ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or pleasure) Preservation of an historically importantly land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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.


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

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the taxable year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year SchDMd Bullet

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)? ....................................

Yes No

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.

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.

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

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:

Revenues included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

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

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

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):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.

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?........

Yes No

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.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIV and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21? .....................

Yes No

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 ....
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 ......

Provide the estimated percentage of the year end balance held as:

Board designated or quasi-endowment: SchDMd Bullet

Permanent endowment: SchDMd Bullet

Term endowment: SchDMd Bullet

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIV the intended uses of the organization's endowment funds.

Part VI

InvestmentsLand, Buildings, and Equipment. See Form 990, Part X, line 10.

Description of investment		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	4,250		4,250
b	Buildings ................	2,001,496	1,549,200	452,297
c	Leasehold improvements ............
d	Equipment ................	235,279	196,232	39,047
e	Other .................		0	0
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........				495,594

Schedule D (Form 990) 2010

Page 3

Part VII

InvestmentsOther 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
Other








Total. (Column (b) should equal Form 990, Part X, col.(B) line 12.)

Part VIII

InvestmentsProgram 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.)

Part IX

Other Assets. See Form 990, Part X, line 15.

(a) Description				(b) Book value









Total. (Column (b) should equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. See Form 990, Part X, line 25.

1.(a) Description of Liability		(b) Amount
Federal Income Taxes		0
ACCRUED EXPENSE		15,793
INTERCOMPANY ACCOUNTS PAYABLE		534,520







Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)		550,313
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

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
Schedule D, Part X, Line 2	FIN 48 (ASC 740) Footnote RE: Uncertain Tax Positions	House of Mercy is included in the consolidated financial statements of Catholic Health Initiatives - Iowa, Corp dba Mercy Medical Center - Des Moines ("CHI-Iowa, Corp.") a related organization. Below is the text of the footnote from those financial statements: "The Corporation and all subsidiaries, except MPA, and DMMC are exempt from federal income taxes under section 501(c)(3) of the code. ASC 740, income taxes, prescribes criteria for the financial statement recognition and measurement of a tax position taken or expected to be taken in a tax return. ASC 740 also provides guidance on derecognition, classification, interest and penalties, accounting in interim periods, disclosure, and transition. Management has determined that there are no material uncertain tax positions that have not been reflected in the consolidated financial statements. The corporation's federal income tax returns are open to examination for the years ended June 30, 2008 through June 30, 2011."

Schedule D (Form 990) 2010

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

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. MediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

House of Mercy

Employer identification number

42-1323808

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?
1(a) Name of disqualified person	(b) Description of transaction	Yes	No

Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image

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?
(a) Name of interested person and purpose	To	From	(c)Original principal amount	(d)Balance due	Yes	No	Yes	No	Yes	No






Total ............... $

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

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?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) Ball Construction Services LLC	Board Member Owns 50%	42,302	Elevator Code Upgrades		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:

- TIN:

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

House of Mercy

Employer identification number

42-1323808

Identifier	Return Reference	Explanation
Form 990, Part III, Line 4a	Statement of Program Service Activities	I. INTRODUCTION: Organization's Mission, Vision, and Tax-Exempt Purpose In 1988, Iowa residents were confronted with data showing a high rate of infant mortality in Des Moines and Polk County. Many causes were cited: substance abuse, physical abuse, homelessness, lack of prenatal care, lack of insurance and all too often, simply a lack of hope. In response to this situation, Mercy Medical Center - Des Moines and the Sisters of Mercy, founded "House of Mercy." Sister Mary Brigid Condon led the charge, modeling it after the first "House of Mercy" founded in Dublin, Ireland by Sister Catherine McCauley, foundress of the Sisters of Mercy. Located on six acres of land in Des Moines' inner city, a federally designated Enterprise Community, House of Mercy's initial focus was on assisting pregnant, parenting, and non-parenting women in developing personal responsibility and independence through counseling, education, and primary medical care in collaboration with other providers. Over the years, House of Mercy's mission and services have expanded to now address the unmet health and human service needs of those in the community (regardless of gender and parenting status) for whom access to services is difficult. Our current vision is to be a preeminent provider of health, wellness, and human services to those for whom access to care/services is difficult. In keeping with this vision House of Mercy is committed to: * Insuring the safety, health, and well being of children. * Building healthy families. * Supporting at-risk individuals in their development of a positive self-regard. * Assisting chemically dependent women in becoming self-sufficient through the enhancement of their educational status and development of the skills necessary to seek and maintain meaningful employment. * Assisting chemically dependent individuals in achieving and maintaining a life of quality recovery. * Promoting community physical and behavioral health through the provision of quality outpatient medical care and behavioral health services. * Providing safe, secure, therapeutically supportive housing services. House of Mercy is included in the Official Catholic Directory as a tax-exempt entity. Its services are provided to the community on a non-discriminatory basis and is governed by a board in which independent persons representative of the community comprise the majority. The house receives funding from government-sponsored health care programs like Medicaid. II. QUALITATIVE DESCRIPTION OF COMMUNITY BENEFIT Supportive Community Living Services Programming Project Together is a chemical dependency treatment program offering High Intensity Residential; Medium Intensity Residential; and Low Intensity Residential levels of care to homeless, chemically dependent, pregnant and/or parenting women who are in need of assistance with recovery, self-sufficiency, parenting, and life skills. House of Mercy subscribes to a philosophy of care that focuses on access, engagement, retention, and outcomes. All participating persons in recovery have access to not only substance abuse services but also co-occurring issues (such as problem gambling, mental health, and physical health concerns) through a recovery-oriented system of care. Participants work with a counselor to develop and implement an individualized treatment plan that collaboratively addresses the issues which brought them to House of Mercy. Programming is holistic in scope, research/best practices-based, gender-specific, and unique in that it allows for mothers to pursue treatment while still residing with their children. Keeping mothers and their children together or reuniting them after a prolonged absence is important to the healing process. Participants (and their children) have access to: individual and group therapy; 12-step meetings; assertiveness/communication education; trauma education and counseling; mental health counseling; life skills education; smoking education and cessation services; primary medical care (including prenatal care); primary pediatric care (including immunizations); child care; therapeutic interventions to address relationship, sexual and physical abuse issues; gender specific services; urinalysis related to substance abuse services; and, parenting education and skill development sessions. When participants have demonstrated progress and stability in the areas of recovery and parenting, they expand their treatment focus to include self-sufficiency programming. This includes, but is not limited to, GED classes and college courses, job skill training sessions, employment search initiatives, money management and debt reparation activities, etc. All programming is respectful of client issues related to diversity including language, culture, religion, ethnicity, and disability. Specialized efforts are directed towards providing services sensitive to the needs of those served (e.g. interpreter services, use of culturally specific media, etc.). During the time period July 2010 through June 2011 80 women and 119 children received residential services resulting in 16,964 bed days of care being provided. Project Together II is a chemical dependency treatment program offering High Intensity Residential; Medium Intensity Residential; and Low Intensity Residential levels of care to women (regardless of housing or parenting status) who are in need of assistance with recovery, self-sufficiency, parenting (in most instances), and life skills. House of Mercy subscribes to a philosophy of care that focuses on access, engagement, retention, and outcomes. All participating persons in recovery have access to not only substance abuse services but also co-occurring issues (such as problem gambling, mental health, and physical health concerns) through a recovery-oriented system of care. Participants work with a counselor to develop and implement an individualized treatment plan that collaboratively addresses the issues which brought them to House of Mercy. Programming is holistic in scope, research/best practices-based, gender-specific, and unique in that it allows for mothers to pursue treatment while still residing with their children. Keeping mothers and their children together or reuniting them after a prolonged absence is important to the healing process. Participants (and their children) have access to: individual and group therapy; 12-step meetings; assertiveness/communication education; trauma education and counseling; mental health counseling; life skills education; smoking education and cessation services; primary medical care (including prenatal care); primary pediatric care (including immunizations); child care; therapeutic interventions to address relationship, sexual and physical abuse issues; gender specific services; urinalysis related to substance abuse services; and, parenting education and skill development sessions. When participants have demonstrated progress and stability in the areas of recovery and parenting, they expand their treatment focus to include self-sufficiency programming. This includes, but is not limited to, GED classes and college courses, job skill training sessions, employment search initiatives, money management and debt reparation activities, etc. All programming is respectful of client issues related to diversity including language, culture, religion, ethnicity, and disability. Specialized efforts are directed towards providing services sensitive to the needs of those served (e.g. interpreter services, use of culturally specific media, etc.). During the time period July 2010 through June 2011 104 women and 101 children received residential services resulting in 14,139 bed days of care being provided.
Form 990, Part III, Line 4a	Continued	Healthy Transitions is a transitional living program designed for homeless women and their children who are in need of assistance with self-sufficiency, parenting, and life skills. Participants work with a Primary Counselor to develop and implement an individualized treatment plan. They are involved in research based/best practices curriculum in the area of parenting (e.g. courses entitled Active Parenting Today, and Make Parenting a Pleasure). They also attend individual and group therapy, assertiveness/communication education, trauma education/counseling, mental health counseling, life skills education, healthy relationship counseling sessions, and self-sufficiency programming (e.g. GED classes and college courses, job skill training sessions, employment search initiatives, money management and debt reparation activities, etc.). Participants acquire skills necessary to become more self-sufficient and decrease the likelihood of again becoming homeless. Clients have the option of staying for as long as two years. All programming is respectful of client issues related to diversity including language, culture, religion, ethnicity, and disability. Specialized efforts are directed towards providing services sensitive to the needs of those served (e.g. interpreter services, use of culturally specific media, etc.). During the time period July 2010 through June 2011 7 women and 7 children received residential services resulting in 1,000 bed days of care being provided. House of Mercy also provided short-term Emergency Shelter for women and their children, in the hopes of admission into one of the adult programs, if deemed appropriate and she meets program guidelines. During the time period July 2010 through June 2011 22 women and 11 children received temporary shelter resulting in 219 bed days of care being provided. In Touch With Teens is a comprehensive group living services program that encompasses a holistic approach. This program is available to adolescent women up to the age of 18 who are pregnant and/or parenting and who present with a behavioral-medical need. Services are available to address a variety of treatment needs including, but not limited to: emotional inadequacy; abuse victimization; delinquency; and, behavioral disorders. House of Mercy subscribes to a philosophy of care that focuses on access, engagement, retention, and outcomes. All participating persons in recovery have access to not only substance abuse services but also co-occurring issues (such as problem gambling, mental health, and physical health concerns) through a recovery-oriented system of care. All pregnant participants are provided prenatal care in order to bring their babies to term in a safe and healthy environment, while at the same time bringing order to their lives. Keeping mothers and their children together is important to the healing process and provides teaching opportunities. Counseling staff work with the women to build upon their existing skills and develop new parenting approaches. The women work with a counselor to develop and implement an individualized treatment plan. Each teen is assigned a counselor who provides one-to-one counseling in addition to group and family counseling. Participants focus on their own lives and can process past events with a supportive adult. Specialty services offered include: anger management; healthy relationships; life skills training; health and wellness activities; substance abuse education and counseling; mental health treatment services; and, education and skill development sessions. Special emphasis is placed on continuing their education with the goal of attaining a high school diploma or its equivalency. Job training assistance is provided when appropriate. All programming is respectful of client issues related to diversity including language, culture, religion, ethnicity, and disability. Specialized efforts are directed towards providing services sensitive to the needs of those served (e.g. interpreter services, use of culturally specific media, etc.). During the time period July 2010 through June 2011; 20 adolescent women and 22 children were provided residential services resulting in 5,641 bed days of care being provided. House of Mercy Permanent Housing offers affordable, safe, clean, and therapeutically supportive long-term housing to successfully recovering women and women with children. The program is designed to assist homeless individuals and families to live as independently as possible in a permanent setting. Supportive services that promote residential stability, increased skill level and/or income, and greater self-determination are either provided on-site or coordinated by staff and provided by other public or private agencies. All program participants are asked to: continue working a positive recovery program including serving as a support to other women in the program; commit to developing a self sufficiency program that has a full-time focus on either education, employment or a combination of the two; further develop critical life skills (e.g., personal finance management) that will enhance their ability to provide for themselves and family; achieve stability with respect to decision making, emotional health circumstances, and relationship choices. All participants are expected to make at least a 7-month minimum length of stay commitment to the program with no maximum length of stay requirement. During the time period March 2010 through February 2011; 13 adult women and 12 children participated in the program. Child Care Programming House of Mercy/John R. Grubb Child Development Center is a licensed and accredited child-care facility that serves the children of House of Mercy's residential, outpatient, and continuing care clients as well as alumnae. The center serves children six weeks old through school age. On average, twenty to thirty percent of the children residing at House of Mercy have been affected by the drug use of their mothers during pregnancy and as a result have special needs. Some of these children are developmentally delayed and suffer from fetal alcohol syndrome. All children at House of Mercy qualify as at-risk children. Child-care is available to all program participants who are working or attending educational activities, counseling sessions or treatment programming. Teachers provide a non-biased, multi-cultural, developmentally appropriate curriculum. Developmental assessments are completed regularly on all of the children to support their individual learning plans. Children are offered experiences designed to promote positive self-concept, social skills, critical thinking/problem solving, language development, physical development, and creative expression. Child Development Center staff also work with the clients to assist them in enhancing their existing skills and developing new, more effective parenting approaches. Parenting education is age specific and complimented by a structured daily "family activity" that focuses on assisting mothers in the development of the skills they require to interact appropriately with their children. On average, 72 children received childcare services per month. Health Care Programming Dental Program is an initiative involving House of Mercy and several area dentists. The program was established to provide dental care to the adult women living at House of Mercy since access to needed dental services was quite problematic for them and often not available. The House of Mercy dental program links local volunteer dentists with House of Mercy clients. The clients are initially screened and then referred to participating dentists to be seen for needed dental services. In addition to providing much needed dental care (often involving complex restorative work), the program reinforces the importance of good oral hygiene in hopes that participants will practice these newly acquired skills on their children thus ensuring they receive the care and preventative interventions they need. During FY 2011; 27 patients received dental care services.
Form 990, Part III, Line 4a	Continued	House of Mercy Medical Clinic provides medical care services to uninsured and underinsured individuals. The clinic's multi-specialty health care team provides services to a diverse group of patients each month. The clinic is open Monday through Friday and accepts appointments from 8:30 a.m. to 4:00 p.m. each day. All clinic services are free of charge. In addition to House of Mercy's employed primary care providers, family practice physicians, pediatricians, and other specialty health care professionals regularly volunteer their time at the clinic. Several specialty medical services are offered on-site including gynecological, pediatric, diabetic, and ophthalmologic care. Their services are complemented by access to specialty and sub-specialty care made possible through Mercy Medical Center - Des Moines. During FY 2011; 3,512 patients received primary care services. Of those individuals, 48 patients received gynecological services; 167 patients received pediatric services; 17 patients received diabetic services; 97 patients participated in the immunization clinic; and 3,050 Spanish interpretations were provided. Community Services Programming Outpatient Counseling Services are available to children, adolescents, and adults and consist of: Level 0.5, Level I, and Level II.1 Substance Abuse Treatment services; Individual, Family, and Group Mental/Behavioral Health services; and, Remedial services. House of Mercy subscribes to a philosophy of care that focuses on access, engagement, retention, and outcomes. All participating persons in recovery have access to not only substance abuse services but also co-occurring issues (such as problem gambling, mental health, and physical health concerns) through a recovery-oriented system of care. Substance Abuse Treatment services are available to: any individual regardless of age or gender who is in need of support to establish and maintain a recovery program. All participants work with a certified addictions counselor to develop and implement an individualized treatment plan. Participants are involved in research based/best practices curriculum in the area of recovery (e.g. education in relapse prevention, early recovery skills, trauma and recovery). They receive individual and group therapy; case management services; and, encouraged to develop a support system within the community utilizing the 12-step program. Clients participating in outpatient programming have access to a flexible menu of services including: individual and group counseling; chemical dependency related educational offerings; trauma education and counseling; therapeutic interventions to address relationship, sexual and physical abuse issues; gender specific services; urinalysis related to substance abuse services; parenting classes, and self-sufficiency activities (e.g., education and employment assistance). Outpatient clients may utilize the House of Mercy/John R. Grubb Child Development Center for child-care during treatment programming. They may also be eligible to receive assistance with transportation. Continuing Care groups are open to anyone who could benefit from having additional therapeutic support in reinforcing a positive recovery outcome. These groups provide a group therapy format that participants can utilize for support as they face the daily challenges of reinforcing recovery, parenting and overall living skills on their own. Group sessions are facilitated by staff that are also available to provide individual therapy, as well as, case management services. Participants are encouraged to commit to their Continuing Care group for at least one year secondary to discharge yet can continue to attend indefinitely. During FY 2011; 1,501 individuals received outpatient or continuing care services one or more times through this program. Mental and Behavioral Health services are provided by masters prepared, licensed therapists and are available to anyone with an identified/diagnosable mental health or behavioral health need. A board certified psychiatrist is available to provide treatment oversight, evaluate medication needs, and provide additional needed mental health supports. House of Mercy mental health treatment services include, but are not limited to, individual, marital, family, and group therapy sessions, as well as, pharmacological interventions. During FY 2011; 215 individuals received outpatient services one or more times through this program. Remedial services are available to children and adults. Remedial services are intended to build skills and help reduce symptoms and behaviors that are associated with a diagnosed psychological disorder. Remedial services are specifically designed to restore mental health functioning that the individual lost or never achieved because of interference in the normal maturational and learning process due to individual or parental dysfunction. Individuals receiving remedial services begin with a behavioral health assessment, which will determine a diagnosis and recommendation for service. A treatment plan is then established, where goals and objectives are specifically listed and outlined. Individual Interventions are provided through a predictable schedule of formal sessions that are directed at the cognitive and emotional dynamics that influence behavior. Family Interventions enhance the family's ability to effectively interact with the child and support the child's functioning. Crisis Interventions are unscheduled intensive interventions for the purpose of restoring adequate child or family functioning. Diocesan Schools Program is a collaborative partnership between House of Mercy and the Diocese of Des Moines where House of Mercy provides assessment and counseling services to the students of the Des Moines area Diocesan schools. House of Mercy's licensed therapists provide comprehensive substance abuse and mental health evaluations, develop related treatment plans, and provide therapy services when and where needed. House of Mercy personnel also provide case management assistance and initiate treatment referrals when appropriate. Homeless Outreach Program is a collaborative partnership between House of Mercy and Primary Health Care Inc., in which House of Mercy personnel provide the community's homeless population with a range of substance abuse related services including assessment, information and referral, crisis intervention, brief counseling, individual and group counseling, case management, and financial/resource management assistance. Services are provided at a variety of locations including area homeless shelters, halfway houses, and outdoor sites where homeless individuals congregate. All House of Mercy services and interventions are initiated with the purpose of assisting clients in moving towards self-sufficiency via treatment, transitional housing and/or permanent housing. During FY 2011; 696 men and women received services/counseling through this program. Student Internships and Educational Programming are provided by House of Mercy for students from a variety of disciplines as part of its mission and purpose. Students are provided diverse "real life" experiences as they work on their degrees, from associate of arts to graduate level. A variety of human service and health care related professionals participate in programming at House of Mercy in order to gain valuable experience in real life work situations. Human services related learning experiences are available in such professional degree areas as social work, addictions, vocational rehabilitation, human services, marriage/family counseling, children and family services, child development, etc. Medical education related opportunities are available in such professional degree areas as nursing, pharmacy, emergency responder, and a variety of provider disciplines. House of Mercy personnel are also available to provide educational programs on topics related to the various programs and services offered at House of Mercy. Staff frequently guest lecture at area schools, colleges and universities as a part of the facility's commitment to community education and outreach.
Form 990, Part VI, Line 2	Board Members with Family Relationships	Rick and Nancy Ball are Board Members reporting a family relationship.
Form 990, Part VI, Line 6	The Organization's Corporate Members/ Stockholders	The organization's sole corporate member is Catholic Health Initiatives - Iowa, Corp. dba Mercy Hospital Medical Center - Des Moines, (CHI-Iowa Corp), an Iowa Non-Profit Corporation.
Form 990, Part VI, Line 7a	Members/Stockholders Electing Governing Body	Pursuant to the organization's bylaws, all members of the board of directors are appointed by CHI-Iowa Corp, the sole corporate member.
Form 990, Part VI, Line 7b	Approval of Governing Body Decisions by Members/Stockholders	HOUSE OF MERCY'S corporate member is Catholic Health Initiatives-Iowa, Corp. dba Mercy Medical Center-Des moines ("CHI-Iowa Corp"). Pursuant to Article IX of the organization's bylaws, both CHI-Iowa Corp and Catholic Health Initiatives ("CHI") (CHI-Iowa Corp's sole corporate member) have reserved powers as outlined in the CHI governance matrix. Pursuant to the governance matrix, the following rights are held by the CHI-Iowa Corp's board: * Approve members of the HOUSE OF MERCY board * Approve removal of a member of the governing body of HOUSE OF MERCY * Adoption of long range and strategic plans for HOUSE OF MERCY * Substantial change in the mission or philosophy of HOUSE OF MERCY * Amendment of the corporate documents of HOUSE OF MERCY * Approval of issuance of debt by HOUSE OF MERCY * Approval of participation of HOUSE OF MERCY in a joint venture * Approval of a merger involving HOUSE OF MERCY * Approval of the sale of all or substantially all of the assets of HOUSE OF MERCY, to require the transfer of assets by HOUSE OF MERCY to CHI to accomplish CHI's goals and objectives, and to satisfy CHI debts. * To the extent permitted by law, CHI shall possess the same rights and powers as are reserved to CHI-Iowa Corp, pursuant to Article VII of the organization's articles of incorporation. Pursuant to Article VII of HOUSE OF MERCY's articles of incorporation, CHI-Iowa Corp or CHI may, in exercise of their approval powers, grant or withhold approval in whole or in part, or may, in its complete discretion, after consultation with the board and its President and CEO of the organization, recommend such other or different actions as it deems appropriate.
Form 990, Part VI, Line 11b	Process the Organization Uses to Review Form 990	The organization's accounting personnel work with CHI's tax department personnel to prepare the form 990. When available, the CFO reviews the return and any necessary revisions are included in the final version which is approved for filing with the IRS. Subsequent to review by the chief financial officer, the tax department files the return with the appropriate federal and state agencies, making any non-substantive changes necessary to effect e-filing. Subsequent to e-filing, the final e-filed form 990 is presented to the board at a regularly scheduled board meeting.
Form 990, Part VI, Line 12c	Procedures for Monitoring and Enforcing the COI Policy	All board members are required to complete an annual conflict of interest disclosure statement. In addition, any board member with a conflict is required to declare the conflict before the beginning of each board or committee meeting. The entire board or committee determines whether the affected board member should be excluded from the meeting due to the disclosed conflict.
Form 990, Part VI, Line 15a&b	Process for Determining Compensation - Officers/Key Employees	During the tax year ended 6/30/11, no officers, directors or trustees received compensation from the organization. Any executive compensation paid to officers, directors or trustees by related organizations was set by the related organization's compensation committee utilizing both an independent consultant and comparability studies to determine compensation. Therefore, these questions are more appropriately answered as N/A.
Form 990, Part VI, Line 19	Public Inspection of Documents	THE ORGANIZATION'S FINANCIAL STATEMENTS ARE INCLUDED IN CATHOLIC HEALTH INITIATIVES' CONSOLIDATED AUDITED FINANCIAL STATEMENTS THAT ARE AVAILABLE AT WWW.CATHOLICHEALTHINIT.ORG OR AT WWW.DACBOND.COM. THE ORGANIZATION'S GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST FROM THE ADMINISTRATION DEPARTMENT, AND ON THE IOWA SECRETARY OF STATE'S WEBSITE. THE ORGANIZATION'S CONFLICT OF INTEREST POLICY IS NOT PUBLICLY AVAILABLE.
Form 990, Part VII	Estimate of Hours Devoted to Related Organizations	COMPENSATION REPORTED ON FORM 990, PART VII WAS PAID TO THESE INDIVIDUALS BY RELATED ORGANIZATIONS IN EXCHANGE FOR THE FULFILLMENT OF THEIR DUTIES AS FULL-TIME, 40 HOUR-PER-WEEK EMPLOYEES.

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:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

House of Mercy

Employer identification number

42-1323808

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
(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	Yes	No
(1) Catholic Health Initiatives 198 Inverness Drive West Englewood,CO80112 47-0617373	Healthcare	CO	501(c)(3)	9	CHI
(2) Bornemann Healthcare Corporation 2500 Bernville Road PO Box 316 Reading,PA19603 23-2187242	Healthcare	PA	501(c)(3)	11a	CHI
(3) CHI Institute For Research and Innovatio 198 Inverness Drive West Englewood,CO80112 27-1050565	Healthcare	CO	501(c)(3)	11a	CHI
(4) CHI National Foundation 198 Inverness Drive West Englewood,CO80112 27-0930004	Fundraising	CO	501(c)(3)	11a	CHI
(5) CHI National Services 198 Inverness Drive West Englewood,CO80112 45-2532084	Healthcare	CO	501(c)(3)	9	CHI
(6) CHI National Home Care 198 Inverness Drive West Englewood,CO80112 45-1261716	Healthcare	CO	501(c)(3)	11a	CHI
(7) Global Health Initiatives 198 Inverness Drive West Englewood,CO80112 20-1536108	Ministries	CO	501(c)(3)	11a	CHI
(8) St Joseph Physician Enterprises 7601 Osler Drive Towson,MD21204 52-1311775	Physicians	MD	501(c)(3)	11a	CHI
(9) St Vincent Infirmary Medical Center 2 St Vincent Circle Little Rock,AR72205 71-0236917	Healthcare	AR	501(c)(3)	3	CHI
(10) St Anthony's Hospital Association 4 Hospital Drive Morrilton,AR72110 71-0245507	Healthcare	AR	501(c)(3)	3	SVIMC
(11) St Vincent Foundation Two St Vincent Circle Little Rock,AR72205 51-0169537	Fundraising	AR	501(c)(3)	11a	SVIMC
(12) St Vincent Medical Group 2 St Vincent Circle Little Rock,AR72205 71-0830696	Healthcare	AR	501(c)(3)	9	SVIMC
(13) CHI Colorado 188 Inverness Drive West Englewood,CO80112 84-0405257	Healthcare	CO	501(c)(3)	3	CHI
(14) Mercy Regional Medical Center of Durango 1010 Three Springs Blvd Durango,CO81301 84-0405515	Healthcare	CO	501(c)(3)	3	CHI
(15) Catholic Health Initiatives Colorado Fou 961 East Colorado Avenue Colorado Springs,CO80903 84-0902211	Fundraising	CO	501(c)(3)	7	CHI Colorado
(16) Health SET 4200 West Conejos Place 436 Denver,CO80204 84-1102943	Low Inc.Care	CO	501(c)(3)	7	CHI Colorado
(17) Pueblo Stepup 1925 East Orman Avenue Suite G52 Pueblo,CO81004 84-1234295	Community	CO	501(c)(3)	7	CHI
(18) SET of Colorado Springs Inc 825 E Pikes Peak Avenue Bldg 29 Colorado Springs,CO80903 84-1183335	LTerm Care	CO	501(c)(3)	7	CHI Colorado
(19) Total Healthcare PO Box 7021 Colorado Springs,CO80933 84-0927232	Healthcare	CO	501(c)(3)	3	CHI Colorado
(20) CHI-Iowa Corp 1111 6th Avenue Des Moines,IA50314 42-0680448	Healthcare	IA	501(c)(3)	3	MHN
(21) Bishop Drumm Retirement Center 1111 6th Avenue Des Moines,IA50314 42-0725196	LTerm Care	IA	501(c)(3)	9	CHI-IA Corp
(22) House of Mercy 1111 6th Avenue Des Moines,IA50314 42-1323808	Shelter	IA	501(c)(3)	7	CHI-IA Corp
(23) Mercy Clinics Inc 1111 6th Avenue Des Moines,IA50314 42-1193699	Physician	IA	501(c)(3)	9	CHI-IA Corp
(24) Mercy College of Health Sciences 1111 6th Avenue Des Moines,IA50314 42-1511682	Education	IA	501(c)(3)	2	CHI-IA Corp
(25) Mercy Foundation of Des Moines IA 1111 6th Avenue Des Moines,IA50314 23-7358794	Fundraising	IA	501(c)(3)	7	CHI-IA Corp
(26) Mercy Auxiliary of Central Iowa 1111 6th Avenue Des Moines,IA50314 42-6076069	Auxiliary	IA	501(c)(3)	11a	CHI-IA Corp
(27) Mercy Professional Practice Associates 1111 6th Avenue Des Moines,IA50314 42-1470935	Physician	IA	501(c)(3)	9	CHI-IA Corp
(28) Mercy Medical Center - Centerville FKA 1 St Josephs Drive Centerville,IA52544 42-0680308	Healthcare	IA	501(c)(3)	3	CHI-IA Corp
(29) St Rose Ambulatory and Surgery Center F 3515 Broadway Great Bend,KS67530 48-0543724	Surgery Cntr	KS	501(c)(3)	3	CHI
(30) St Catherine Hospital 401 East Spruce Street Garden City,KS67846 48-0543721	Healthcare	KS	501(c)(3)	3	CHI
(31) St Catherine Hospital Development Found 401 East Spruce Street Garden City,KS67846 20-0598702	Fundraising	KS	501(c)(3)	11a	SCH
(32) CHI Kentucky Inc 3900 Olympic Blvd Suite 400 Erlanger,KY41018 20-2741651	Healthcare	KY	501(c)(3)	11a	CHI
(33) Saint Joseph Health System Inc 150 N Eagle Creek Dr Lexington,KY40509 61-1334601	Healthcare	KY	501(c)(3)	3	CHI
(34) Continuing Care Hospital 150 North Eagle Creek Drive Lexington,KY40509 61-1400619	LTACH	KY	501(c)(3)	3	SJHS
(35) Flaget Healthcare DBA Flaget Memorial 4305 New Shepherdsville Road Bardstown,KY40004 61-1345363	Healthcare	KY	501(c)(3)	3	CHI
(36) Flaget Memorial Hospital Foundation Inc 4305 New Shepherdsville Road Bardstown,KY40004 56-2351341	Fundraising	KY	501(c)(3)	11a	FH
(37) Saint Joseph London Foundation Inc 310 East Ninth Street London,KY40741 26-0438748	Fundraising	KY	501(c)(3)	11a	SJHS
(38) Saint Joseph Berea Hospital Foundation 305 Estill Street Berea,KY40403 26-0152877	Fundraising	KY	501(c)(3)	7	SJHS
(39) St Joseph Hospital Foundation Inc 305 Estill Street Lexington,KY40504 61-1159649	Fundraising	KY	501(c)(3)	11a	SJHS
(40) Saint Joseph Medical Foundation Inc One St Joseph Drive Lexington,KY40504 31-1539059	Phy Practices	KY	501(c)(3)	3	SJHS
(41) Saint Joseph Mount Sterling Foundation 50 Sterling Avenue Mount Sterling,KY40353 27-2884584	Fundraising	KY	501(c)(3)	7	SJHS
(42) St Joseph Medical Center Inc 7601 Osler Drive Towson,MD21204 52-0591461	Healthcare	MD	501(c)(3)	3	CHI
(43) St Joseph Medical Center Foundation In 7601 Osler Drive Towson,MD21204 52-1681044	Fundraising	MD	501(c)(3)	7	SJMC
(44) Alverna Apartments 300 SE 8th Avenue Little Falls,MN56345 41-1351177	Lterm Care	MN	501(c)(3)	9	CHI
(45) Lakewood Health Center 600 Main Avenue South Baudette,MN56623 41-0758434	LTerm Care	MN	501(c)(3)	3	CHI
(46) St Francis Home 2400 St Francis Drive Breckenridge,MN56520 41-0729978	LTerm Care	MN	501(c)(3)	9	CHI
(47) Appletree Court 601 Oak Street Breckenridge,MN56520 41-1850500	Senior Homes	MN	501(c)(3)	9	SFH
(48) St Francis Medical Center 2400 St Francis Drive Breckenridge,MN56520 41-0695598	Healthcare	MN	501(c)(3)	3	CHI
(49) Healthcare and Wellness Foundation 2400 St Francis Drive Breckenridge,MN56520 76-0761782	Fundraising	MN	501(c)(3)	11a	SFMC
(50) St Joseph's Area Health Services 600 Pleasant Avenue Park Rapids,MN56470 41-0695603	Healthcare	MN	501(c)(3)	3	CHI
(51) Unity Family Healthcare 815 2nd Street SE Little Falls,MN56345 41-0721642	Healthcare	MN	501(c)(3)	3	CHI
(52) St John's Regional Medical Center 2727 McClelland Blvd Joplin,MO64804 44-0545809	Healthcare	MO	501(c)(3)	3	CHI
(53) Mercy Lifecare Systems 2727 McClelland Blvd Joplin,MO64804 43-1305163	Property Mgmt	MO	501(c)(3)	11a	SJRMC
(54) MNMCH Inc 220 North Pennsylvania Columbus,KS66725 48-1216238	Healthcare	KS	501(c)(3)	3	SJRMC
(55) St John's Medical Group 2727 McClelland Blvd Joplin,MO64804 43-1882377	Phys Practice	MO	501(c)(3)	9	SJRMC
(56) St John's Mercy Regional Foundation 2727 McClelland Blvd Joplin,MO64804 43-1308084	Fundraising	MO	501(c)(3)	7	SJRMC
(57) Alegent Health - Bergan Mercy Health Sys 7500 Mercy Road Omaha,NE68124 47-0484764	Healthcare	NE	501(c)(3)	3	CHI
(58) Alegent Health - Mercy Hospital Corning PO Box 368 Corning,IA50841 42-0782518	Healthcare	IA	501(c)(3)	3	AHBMHS
(59) Mercy Health Care Foundation PO Box 368 Corning,IA50841 42-1461064	Fundraising	NE	501(c)(3)	11a	AHMH
(60) Mercy Hospital Foundation Council Bluff 800 Mercy Drive Council Bluffs,IA51503 42-1178204	Fundraising	IA	501(c)(3)	11a	AHBMHS
(61) CHI Nebraska 555 South 70th Street Lincoln,NE68510 36-3233121	Healthcare	NE	501(c)(3)	11a	CHI
(62) The Physician Network 8055 O Street Suite 300 Lincoln,NE68510 47-0780857	Phys Practice	NE	501(c)(3)	11a	CHI Nebraska
(63) Good Samaritan Hospital PO Box 1990 Kearney,NE68848 47-0379755	HealthCare	NE	501(c)(3)	3	CHI Nebraska
(64) Good Samaritan Hospital Foundation PO Box 1810 Kearney,NE68848 47-0659443	Fundraising	NE	501(c)(3)	7	GSH
(65) Catholic Health Care Federation 198 Inverness Drive West Englewood,CO80112 20-8473567	Jurdic Person	CO	501(c)(3)	11a	CHI
(66) Saint Elizabeth Regional Medical Center 555 South 70th Street Lincoln,NE68510 47-0379836	Healthcare	NE	501(c)(3)	3	CHI Nebraska
(67) Saint Elizabeth Foundation 555 South 70th Street Lincoln,NE68510 47-0625523	Fundraising	NE	501(c)(3)	7	SERMC
(68) Saint Elizabeth Health Services 555 South 70th Street Lincoln,NE68510 36-3233120	Healthcare	NE	501(c)(3)	3	SERMC
(69) Saint Francis Medical Center PO Box 9804 Grand Island,NE68802 47-0376601	HealthCare	NE	501(c)(3)	3	CHI Nebraska
(70) Saint Francis Medical Center Foundation PO Box 9804 Grand Island,NE68802 47-0630267	Fundraising	NE	501(c)(3)	7	SFMC
(71) St Mary's Hospital 1314 3rd Avenue Nebraska City,NE68410 47-0443636	Healthcare	NE	501(c)(3)	3	CHI Nebraska
(72) St Mary's Hospital Foundation 1314 3rd Avenue Nebraska City,NE68410 47-0707604	Fundraising	NE	501(c)(3)	7	SMH
(73) Saint Clare's Health Services Inc 25 Pocono Road Denville,NJ07834 22-3639733	Management	NJ	501(c)(3)	7	CHI
(74) Saint Clare's Community Care 66 Ford Road Denville,NJ07834 22-2876836	Healthcare	NJ	501(c)(3)	11b	SCHS
(75) Saint Clare's Foundation Inc 66 Ford Road Denville,NJ07834 22-2502997	Fundraising	NJ	501(c)(3)	7	SCHS
(76) Saint Clare's Hospital 66 Ford Road Denville,NJ07834 22-3319886	Healthcare	NJ	501(c)(3)	3	CHI
(77) St Francis Life Care Corporation 19 Pocono Road Denville,NJ07834 22-2536017	Elderly Care	NJ	501(c)(3)	9	SCHS
(78) Visiting Nurse Association of Saint Clar 191 Woodport Road Sparta,NJ07871 22-1768334	Home Health	NJ	501(c)(3)	9	SCHS
(79) St Joseph Community Health Services 300 Central Ave SW Suite 3000W Albuquerque,NM87102 71-0897107	Community	NM	501(c)(3)	11a	CHI
(80) CHI Health Connect at Home - Fargo 4816 Amber Valley Parkway Fargo,ND58104 27-1966847	Healthcare	ND	501(c)(3)	3	CHI
(81) Carrington Health Center 800 North 4th Street Carrington,ND58421 45-0227311	Healthcare	ND	501(c)(3)	3	CHI
(82) Lisbon Area Health Services 905 Main Street Lisbon,ND58054 82-0558836	Healthcare	ND	501(c)(3)	3	CHI
(83) Mercy Hospital of Devils Lake 1031 East Seventh Street Devils Lake,ND58301 45-0227012	Healthcare	ND	501(c)(3)	3	CHI
(84) The Mercy Hospital of Devils Lake Fdn 1031 East Seventh Street Devils Lake,ND58301 35-2367360	Fundraising	ND	501(c)(3)	11a	MHDL
(85) Mercy Hospital of Valley City 570 Chautauqua Boulevard Valley City,ND58072 45-0226553	Healthcare	ND	501(c)(3)	3	CHI
(86) Mercy Medical Center 1301 15th Avenue West Williston,ND58801 45-0231183	Healthcare	ND	501(c)(3)	3	CHI
(87) Mercy Medical Foundation 1301 15th Avenue West Williston,ND58801 45-0381803	Fundraising	ND	501(c)(3)	11a	MMC
(88) Oakes Community Hospital 314 South 8th Street Oakes,ND58474 45-0231675	Healthcare	ND	501(c)(3)	3	CHI
(89) Oakes Community Hospital Foundation 314 South 8th Street Oakes,ND58474 71-0966606	Fundraising	ND	501(c)(3)	11a	OCH
(90) St Joseph's Hospital and Health Center 30 West 7th Street Dickinson,ND58601 45-0226429	Healthcare	ND	501(c)(3)	3	CHI
(91) Saint Joseph's Hospital Foundation 30 West 7th Street Dickinson,ND58601 36-3418207	Fundraising	ND	501(c)(3)	11a	SJHHC
(92) Villa Nazareth Inc 801 Page Drive Fargo,ND58103 45-0226714	LT Care	ND	501(c)(3)	9	CHI
(93) Samaritan Health Partners 2222 Philadelphia Drive Dayton,OH45406 31-1107411	Healthcare	OH	501(c)(3)	11a	CHI
(94) Samaritan Behavioral Health 601 S Edwin C Moses Blvd Dayton,OH45408 02-0633634	Healthcare	OH	501(c)(3)	3	SHP
(95) Samaritan Health Foundation 2222 Philadelphia Drive Dayton,OH45406 23-7296923	Fundraising	OH	501(c)(3)	7	SHP
(96) The Good Samaritan Hospital of Cincinnat 619 Oak Street Accounting-3 West Cincinnati,OH45206 31-0537486	Healthcare	OH	501(c)(3)	3	TRI-HEALTH
(97) The Community Limited Care Dialysis Cent 619 Oak Street Accounting-3 West Cincinnati,OH45206 23-7419853	Dialysis	OH	501(c)(2)	none	GSH
(98) Good Samaritan College of Nursing & Heal 375 Dixmyth Ave Cincinnati,OH45220 31-1778403	Education	KY	501(c)(3)	2	GHS
(99) Good Samaritan Foundation of Cincinnati 619 Oak Street Accounting-3 West Cincinnati,OH45206 31-1206047	Fundraising	OH	501(c)(3)	11a	GSH
(100) Hospital Association for St Joseph Hosp 7601 Osler Drive Towson,MD21204 52-6050777	Healthcare	MD	501(c)(3)	9	SJMC
(101) Mercy Medical Center 2700 Stewart Parkway Roseburg,OR97470 93-0386868	Healthcare	OR	501(c)(3)	3	CHI
(102) Centennial Medical Group Inc 2700 Stewart Parkway Roseburg,OR97470 90-0433062	Physicians	OR	501(c)(3)	9	MMC
(103) Linus Oakes Inc 2700 Stewart Parkway Roseburg,OR97470 93-0821381	Senior Living	OR	501(c)(3)	9	MMC
(104) Mercy Foundation Inc 2700 Stewart Parkway Roseburg,OR97470 93-6088946	Fundraising	OR	501(c)(3)	7	MMC
(105) Mt St Joseph Inc 3060 SE Stark Street Portland,OR97214 93-0386870	Nursing Care	OR	501(c)(3)	9	CHI
(106) St Anthony Hospital 1601 SE Court Avenue Pendleton,OR97801 93-0391614	Healthcare	OR	501(c)(3)	3	CHI
(107) St Anthony Hospital Foundation 1601 SE Court Avenue Pendleton,OR97801 93-0992727	Fundraising	OR	501(c)(3)	11a	SA Hospital
(108) St Dominic at Ontario 351 SW 9th Street Ontario,OR97914 93-0433692	Healthcare	OR	501(c)(3)	3	CHI
(109) St Francis of Baker City 3325 Pocahontas Road Baker City,OR97814 93-0412495	Healthcare	OR	501(c)(3)	3	CHI
(110) St Joseph Health Ministries 1929 Lincoln Hwy E Ste 150 Lancaster,PA17602 23-2342997	Health	PA	501(c)(3)	11a	CHI
(111) St Joseph Health Ministries Foundation 1929 Lincoln Hwy E Ste 150 Lancaster,PA17602 23-2605579	Fundraising	PA	501(c)(3)	11a	SJHM
(112) St Joseph Health Services Inc 1929 Lincoln Hwy E Ste 150 Lancaster,PA17602 20-1425375	Dental care	PA	501(c)(3)	11a	SJHM
(113) St Joseph Regional Health Network 2500 Bernville Road PO Box 316 Reading,PA19603 23-1352211	Healthcare	PA	501(c)(3)	3	CHI
(114) St Joseph Medical Group 2500 Bernville Road PO Box 316 Reading,PA19603 20-8544021	Healthcare	PA	501(c)(3)	9	BHC
(115) St Joseph Medical Center Foundation 2500 Bernville Road PO Box 316 Reading,PA19603 23-2649362	Fundraising	PA	501(c)(3)	11a	SJRHN
(116) St Mary's Healthcare Center 801 East Sioux Avenue Pierre,SD57501 46-0230199	Healthcare	SD	501(c)(3)	3	CHI
(117) Gettysburg Medical Center 606 East Garfield Avenue Gettysburg,SD57442 46-0234354	Healthcare	SD	501(c)(3)	3	SMHC
(118) Memorial Health Care System Inc 2525 De Sales Avenue Chattanooga,TN37404 62-0532345	Healthcare	TN	501(c)(3)	3	CHI
(119) Memorial Health Care System Foundation 2525 De Sales Avenue Chattanooga,TN37404 62-1839548	Fundraising	TN	501(c)(3)	7	MHCS
(120) Memorial Health Partners Foundation Inc 6028 Shallowford Road Chattanooga,TN37421 03-0417049	Healthcare	TN	501(c)(3)	9	MHCS
(121) Franciscan Health System FKA Franciscan 1717 South J Street Tacoma,WA98405 91-0564491	Healthcare	WA	501(c)(3)	3	CHI
(122) Enumclaw Regional Hospital Association 1450 Battersby Avenue Enumclaw,WA98022 91-0715805	Healthcare	WA	501(c)(3)	3	FHS
(123) Franciscan Foundation 1717 South J Street Tacoma,WA98405 91-1145592	Fundraising	WA	501(c)(3)	9	FHS
(124) Franciscan Medical Group 1708 South Yakima Avenue Tacoma,WA98405 91-1939739	Healthcare	WA	501(c)(3)	9	FHS
(125) Franciscan Villa of South Milwaukee Inc 3601 South Chicago Avenue South Milwaukee,WI53172 39-1093829	Healthcare	WI	501(c)(3)	9	CHI

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

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 VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) CHI Operating Investment Program LP 198 Inverness Drive West Englewood,CO80112 47-0727942	Investments	CO	CHI	Investment	139,679,805	2,069,974,790		No	371,292	Yes		100.000 %
(2) North River Surgery Center LLC 2209 Wildwood Avenue Sherwood,AR72120 71-0799771	Ambul Surg Ctr	AR	SVIMC	Related	198,313	1,758,688		No			No	57.450 %
(3) Audubon Land Company LLC 5390 N Academy Blvd Suite 300 Colorado Springs,CO80918 84-1513085	Real Estate	CO	THC	Related	-157,673	14,390,550		No			No	50.100 %
(4) OrthoColorado LLC 11650 West 2nd Place Lakewood,CO80255 37-1577105	Ortho Hospital	CO	THC	Related	-3,249,314	10,905,384		No			No	60.000 %
(5) Penrad Imaging 1390 Kelly Johnson Blvd Colorado Springs,CO80920 84-1072619	Medical Imaging	CO	THC	Related	1,857,228	5,457,224		No			No	70.000 %
(6) St Anthony Regional Mtn Cancer Center 4231 W 16th Avenue Denver,CO80112 37-1568013	Cancer Center	CO	THC	Related	-290,552			No			No	51.000 %
(7) St Francis Land Company 5390 N Academy Blvd Suite 300 Colorado Springs,CO80918 26-3134100	Real Estate	CO	THC	Related	-180,979	14,886,022		No			No	51.000 %
(8) Bluegrass Regional Imaging Center 1218 South Broadway Suite 310 Lexington,KY40504 61-1386736	Diagnostic	KY	SJ HospitalLex	Related				No			No	65.000 %
(9) St Joseph-PAML LLC 424 Lewis Hargett Circle Ste 160 Lexington,KY40503 45-2116736	Mgmt Svcs	KY	SJHS	Related				No		Yes		62.500 %
(10) Saint Joseph SCA Holdings LLC 424 Lewis Hargett Circle Ste 160 Lexington,KY40503 45-3801157	OP Surgery	DE	SJHS	Related				No		Yes		51.000 %
(11) Surgery Center of Lexington LLC 1451 Harrodsburg Road Lexington,KY40504 62-1179539	Surgery Center	DE	SJHS	Related	808,840	4,236,901		No		Yes		51.000 %
(12) Ruxton Surgicenter LLC 8322 Bellona Avenue Suite 201 Baltimore,MD21204 52-2095835	Surgery Center	MD	SJMC	Related				No		Yes		51.000 %
(13) Avantas LLC 1207 South 13 Street Omaha,NE68108 39-2045003	Healthcare	NE	AHMH	Unrelated				No			No	95.000 %
(14) Healthcare Support Services LLC PO Box 9804 Grand Island,NE68802 72-1546196	Laundry	NE	CHI	Related	196,124	3,913,481		No	-58,436		No	100.000 %
(15) Central Nebraska Home Care Services PO Box 1146-4510 Second Avenue Kearney,NE68848 47-0692112	Healthcare Srvc	NE	HSEINC	Related	-99,941	1,021,498		No	-48,712	Yes		100.000 %
(16) Superior Medical Imaging LLC 5000 North 26th Street Lincoln,NE68521 26-2884555	OP Diagnostics	NE	SERMC	Related				No			No	51.000 %
(17) Central Nebraska Rehab Services 3004 W Faidley Ave Grand Island,NE68802 81-0653461	Physical Therapy	NE	CHI	Related	1,857,991	2,262,775		No			No	51.000 %
(18) St Francis Medical Center Associates 1717 South J Street Tacoma,WA98405 91-1352698	Med. Office	WA	FHS	Related	116,948	1,652,280		No			No	54.210 %
(19) Peninsula Radiation Oncology 314 Martin Luther King Jr Way 11 Tacoma,WA98405 87-0808610	Healthcare Srvc	WA	FHS	Related	131,195	3,052,504		No			No	60.000 %
(20) Berywood Office Properties LLC 400 Berywood Trail Cleveland,TN37312 62-1875199	Phys Office	TN	MHCS	Related				No		Yes		63.000 %

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) Alternative Insurance Management Service 3900 Olympic Boulevard Suite 400 Erlanger,KY41018 84-1112049	Management Servic	CO	CHI	C Corp		3,267,441	100.000 %
(2) Captive Management Initiatives 98-0663022	Captive Managemen	CJ	CHI	C Corp			100.000 %
(3) Center for Translational Research 198 Inverness Drive West Englewood,CO80112 27-2269511	Healthcare	CO	CHI	C Corp	-2,247,962	1,668,589	100.000 %
(4) First Initiatives Insurance Ltd 98-0203038	Insurance	CJ	CHI	C Corp			100.000 %
(5) Franciscan Services Inc 198 Inverness Drive West Englewood,CO80112 23-2487967	Healthcare	CO	CHI	C Corp	-507,578	11,914,284	100.000 %
(6) SJH Services Corporation 198 Inverness Drive West Englewood,CO80112 23-2307408	Healthcare	CO	FSI	C Corp	-518,360	3,180,100	100.000 %
(7) St Joseph Development Company Inc 1717 South J Street Tacoma,WA98405 91-1480569	Rental	WA	FSI	C Corp	-36,395	12,168,022	100.000 %
(8) Towson Management Inc 7601 Osler Drive Towson,MD21204 52-1710750	Management Servic	MD	FSI	C Corp	-469,016	498,393	100.000 %
(9) Nazareth Assurance Company 76 St Paul Street Suite 500 Burlington,VT05401 03-0304831	Insurance	VT	CHI	C Corp	-379	123,535	100.000 %
(10) St Vincent Community Health Services In Two St Vincent Circle Little Rock,AR72205 71-0710785	Healthcare	AR	SVIMC	C Corp	2,309,129	14,049,375	100.000 %
(11) Comcare Services 4231 W 16th Avenue Denver,CO80204 84-0904813	Inactive	CO	CHIC	C Corp			100.000 %
(12) Des Moines Medical Center Inc 1111 6th Avenue Des Moines,IA50314 42-0837382	Real Estate	IA	CHI-IA Corp	C Corp		1,253,452	92.980 %
(13) Mercy Park Apartments Ltd 1111 6th Avenue Des Moines,IA50314 42-1202422	Housing	IA	CHI-IA Corp	C Corp	264,489	1,796,053	100.000 %
(14) Central Kansas Health Services Associati 3515 Broadway Great Bend,KS67530 48-1042853	MEDICAL EQUIPMENT	KS	CKMC	C Corp			100.000 %
(15) SJL Physician Management Services Inc 424 Lewis Hargett Cr 160 Lexington,KY40503 27-0164198	Management	KY	SJHS	C Corp			100.000 %
(16) St Joseph Office Park Association 1401 HarrodsBurg Road Bldg B70 Lexington,KY40504 61-1079899	Management	KY	SJHS	C Corp	16,644	882,139	85.000 %
(17) Mercy Health Services Corporation 2727 McClelland Blvd Joplin,MO64804 43-1457881	DME	MO	St John's RMC	C Corp	-1,533,371	1,369,083	100.000 %
(18) Good Samaritan Outreach Services PO BOX 1990 Kearney,NE68848 47-0659440	MEDICAL CLINIC	NE	CHI Nebraska	C Corp	-2,921,063	355,110	100.000 %
(19) Health Systems Enterprises Inc PO BOX 1990 Kearney,NE68848 47-0664558	MANAGEMENT	NE	GSH	C Corp	25,289	1,443,049	100.000 %
(20) Saint Clare's Primary Care Inc 66 Ford Road Denville,NJ07834 22-2441202	Billing Services	NJ	SCCC	C Corp	-342,970	2,177,166	100.000 %
(21) MedQuest 1301 15th Avenue West Williston,ND58801 45-0392137	Sale of DME	ND	MHof Williston	C Corp	9,852	962,554	100.000 %
(22) Consolidated Health Services 1700 Edison Drive Milford,OH45150 31-1378212	Home Health	OH	CHI	C Corp		11,595,125	100.000 %
(23) American Nursing Care 1700 Edison Drive Milford,OH45150 31-1085414	Home Health	OH	CHS	C Corp	1,778,617	44,470,358	100.000 %
(24) Amerimed Inc 1700 Edison Drive Milford,OH45150 31-1158699	Home Health	OH	ANC	C Corp	2,395,230	11,869,657	100.000 %
(25) Patient Transport Services Inc 1700 Edison Drive Milford,OH45150 31-1100798	Home Health	OH	ANC	C Corp	662,425	5,325,941	100.000 %
(26) Samaritan Family Care Inc 40 W Fourth St 1700 Dayton,OH45402 31-1299450	Healthcare	OH	SHP	C Corp			100.000 %
(27) Mercy Services Corp 2700 Stewart Parkway Roseburg,OR97470 93-0824308	Retail Sales	OR	MMC	C Corp	-690,267	954,798	100.000 %
(28) St Anthony Development Company 1415 Southgate Pendleton,OR97801 93-1216943	Athletic Club	OR	St Anthony H	C Corp	53,891	3,007,554	100.000 %
(29) CGH Realty Company Inc 215 N 12th St Reading,PA19603 23-2326801	Real Estate	PA	SJHM	C Corp	1,007	42,415	100.000 %
(30) Caduceus Medical Associates Inc 6028 Shallowford Road Suite D Chattanooga,TN37422 62-1570736	Healthcare	TN	MHCS	C Corp		1,008	100.000 %
(31) Mountain Management Services Inc 6028D Shallowford Road Chattanooga,TN37422 62-1570739	mgmt svc org	TN	MHCS	C Corp	-386,020	4,667,998	100.000 %
(32) Physician Health System Network 1149 Market St Tacoma,WA98402 91-1746721	Health Org.	WA	FHS	C Corp			100.000 %
(33) Healthcare Mgmt Services Org Inc 1149 Market St Tacoma,WA98402 91-1865474	Health Org.	WA	FHS	C Corp			100.000 %
(34) Harold W Rase 1995 Charitable Unittrust 30 West 7th Street Dickinson,ND58601 45-6090420	Investments	ND	SJHHC	Trust	1,240	21,533	100.000 %
(35) Harold W Rase 1996 Charitable Unittrust 30 West 7th Street Dickinson,ND58601 20-6037112	Investments	ND	SJHHC	Trust	900	15,495	100.000 %
(36) Harold W Rase 1997 Charitable Unittrust 30 West 7th Street Dickinson,ND58601 20-6037104	Investments	ND	SJHHC	Trust	1,025	20,261	100.000 %
(37) Harold W Rase 1999 Charitable Unittrust 30 West 7th Street Dickinson,ND58601 20-6037099	Investments	ND	SJHHC	Trust	1,313	25,027	100.000 %
(38) James & Henrietta Nistler Unitrust 30 West 7th Street Dickinson,ND58601 20-6021899	Investments	ND	SJHHC	Trust	-16,708	41,455	100.000 %
(39) Joseph A Schuster Annuity Trust #1 400 Univerity Avenue Des Moines,IA50314 42-1195122	Investments	IA	MFDM	Trust	18,924	441,488	100.000 %
(40) Ray & Shirley David 1999 Unitrust 30 West 7th Street Dickinson,ND58601 20-6037077	Investments	ND	SJHHC	Trust	1,250	24,194	100.000 %
(41) Tom Deyle Charitable Remainder Unitrust PO Box 1810 Kearney,NE68848 47-6192393	Investments	NE	GSHF	Trust	4,884	166,321	100.000 %
(42) David Deyle Charitable Remainder Unitrus PO Box 1810 Kearney,NE68848 47-6192395	Investments	NE	GSHF	Trust	4,880	166,425	100.000 %
(43) Jeanne Deyle Charitable Remainder Unitru PO Box 1810 Kearney,NE68848 47-6192398	Investments	NE	GSHF	Trust	4,880	166,320	100.000 %
(44) Lodesca Miller Charitable Remainder Unit PO Box 1810 Kearney,NE68848 47-6186933	Investments	NE	GSHF	Trust	3,387	86,367	100.000 %
(45) Robert & Wanda Charitable Remainder Unit PO Box 1810 Kearney,NE68848 26-6191916	Investments	NE	GSHF	Trust	13,030	537,775	100.000 %

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

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 . . . . . . . . . . . . . . . . . . . . . . .

b Gift, grant, or capital contribution to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c Gift, grant, or capital contribution from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

d Loans or loan guarantees to or for other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Sale of assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Purchase of assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Exchange of assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Lease of facilities, equipment, or other assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

j Lease of facilities, equipment, or other assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

k Performance of services or membership or fundraising solicitations for other organization(s) . . . . . . . . . . . . . . . . . . . . . .

l Performance of services or membership or fundraising solicitations by other organization(s) . . . . . . . . . . . . . . . . . . . . . .

m Sharing of facilities, equipment, mailing lists, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

n Sharing of paid employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

o Reimbursement paid to other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

p Reimbursement paid by other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

q Other transfer of cash or property to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

r Other transfer of cash or property from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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
(1) Catholic Health Initiatives - Iowa Corp	c	600,000
(2) Mercy Foundation	c	1,122,209
(3) Catholic Health Initiatives - Iowa Corp	j	82,884
(4) Catholic Health Initiatives - Iowa Corp	n	3,806,527
(5)
(6)

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 VUBI amount in box 20 of Schedule K-1 (Form 1065)	(h) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(e) Share of end-of-year assets	Yes	No	(g) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

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

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: Dedicated to assisting pregnant, parenting and non-parenting women in developing responsibility and independence through counseling, education and medical care in collaboration with providers.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ....	3	14
4	Number of independent voting members of the governing body (Part VI, line 1b) ....	4	14
5	Total number of individuals employed in calendar year 2010 (Part V, line 2a) ...	5	0
6	Total number of volunteers (estimate if necessary) ....	6	19
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

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	5,315,623	2,505,445
9	Program service revenue (Part VIII, line 2g) .........	2,178,005	2,135,409
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	0	0
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	218,085	169,289
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	7,711,713	4,810,143
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
14	Benefits paid to or for members (Part IX, column (A), line 4) ....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	0	0
16a	Professional fundraising fees (Part IX, column (A), line 11e)....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f)....	5,591,101	5,627,879
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	5,591,101	5,627,879
19	Revenue less expenses. Subtract line 18 from line 12......	2,120,612	-817,736
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16)............	1,380,342	1,032,489
21	Total liabilities (Part X, line 26)............	104,220	574,103
22	Net assets or fund balances. Subtract line 21 from line 20 .....	1,276,122	458,386

Sign Here

	Signature of officer	Date

	Type or print name and title.

Paid Preparer's Use Only	Preparer's signature	Date	Check if self- employed	Preparer’s taxpayer identification number (see instructions)
	Firm’s name (or yours if self-employed), address, and ZIP + 4			EIN
				Phone no.


4a	(Code: ) (Expenses $ 5,261,655 including grants of $ ) (Revenue $ 2,135,409 )
	SEE Schedule O

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services. (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses$ 5,261,655

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(C) Position (check all that apply)		(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(1) ASHLEY Shafer DIRECTOR	1.0	X
(2) MIKE CROWLEY DIRECTOR	1.0	X
(3) RICK BALL DIRECTOR	1.0	X
(4) NANCY BALL DIRECTOR	1.0	X
(5) JEANETTE BONNEY DIRECTOR	1.0	X
(6) PAUL DREY CHAIRMAN	1.0	X	X
(7) MICHAEL DEE DIRECTOR	1.0	X
(8) EMILY ECKMAN DIRECTOR	1.0	X
(9) ROGER GREFE DIRECTOR	1.0	X
(10) BARBARA HODNE DO VICE CHAIRMAN	1.0	X	X
(11) LIZ MYERS DIRECTOR	1.0	X
(12) BRADLEY REIMAN DIRECTOR	1.0	X
(13) Heather Campbell DIRECTOR	1.0	X
(14) Don Scandrett DIRECTOR	1.0	X
(15) TODD BEVERIDGE TREASURER/SECRETARY	40.0		X	118,916	23,280

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	118,916	23,280

(A) Name and business address	(B) Description of services	(C) Compensation
Securitas Security Service 12672 Collection Drive Chicago,IL60693	Security Services	144,318




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 1

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512, 513, or 514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d		1,774,126
e	Government grants (contributions)1e		698,179

f	All other contributions, gifts, grants, and similar amounts not included above1f		33,140
g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			2,505,445
			Business Code
2a	Program Service Revenue		900,099	2,135,409	2,135,409
b
c
d
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			2,135,409
3	Investment income (including dividends, interest
	and other similar amounts).....			0
4	Income from investment of tax-exempt bond proceeds..			0
5	Royalties............			0
		(i) Real	(ii) Personal
6a	Gross Rents	59,053
b	Less: rental expenses	24,590
c	Rental income or (loss)	34,463
d	Net rental income or (loss).......			34,463			34,463
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory
b	Less: cost or other basis and sales expenses
c	Gain or (loss)
d	Net gain or (loss)..........			0
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..			0
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...			0
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..			0
Miscellaneous Revenue			Business Code
11a	Laboratory Services		621,500	80,816			80,816
b	Cafeteria		722,100	54,010			54,010
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			134,826
12	Total revenue. See Instructions....			4,810,143	2,135,409	0	169,289


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing ..........			3,000	1	3,000
2	Savings and temporary cash investments .......			299,719	2	36,442
3	Pledges and grants receivable, net .........				3
4	Accounts receivable, net .........			533,148	4	497,453
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........				5
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 .............				7
8	Inventories for sale or use ..............				8
9	Prepaid expenses and deferred charges ............				9
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	2,241,026
b	Less: accumulated depreciation. .....	10b	1,745,432	544,475	10c	495,594
11	Investments—publicly traded securities ..........				11
12	Investments—other securities. See Part IV, line 11 ......				12
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets .........				14
15	Other assets. See Part IV, line 11 ...........				15
16	Total assets. Add lines 1 through 15 (must equal line 34)...			1,380,342	16	1,032,489
17	Accounts payable and accrued expenses .			55,991	17	23,790
18	Grants payable ..........				18
19	Deferred revenue ..........				19
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.....			48,229	25	550,313
26	Total liabilities. Add lines 17 through 25.....			104,220	26	574,103
	Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....			1,276,122	27	458,386
28	Temporarily restricted net assets .....				28
29	Permanently restricted net assets .....				29
	Organizations that do not follow SFAS 117, check here 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 .....			1,276,122	33	458,386
34	Total liabilities and net assets/fund balances .....			1,380,342	34	1,032,489