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

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2010
Open to Public Inspection
A For the calendar year, or tax year beginning 07-01-2010 and ending 06-30-2011
BCheck if applicable:
CName of organization
TRINITY HEALTH WELFARE BENEFIT TRUST
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
27870 CABOT DRIVE
 
Room/suite
City or town, state or country, and ZIP + 4
NOVI, MI48377
D Employer identification number

20-8151733
E Telephone number

G Gross receipts $ 6,435,736
F Name and address of principal officer:
JEANETTE FRANCK
34605 TWELVE MILE RD
FARMINGTON HILLS,MI483313221
I
Tax-exempt status: ( 9 ) LeftBullet (insert no.) or
J
Website:MediumBullet
N/A
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 2006
M State of legal domicile: MI
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: RETIREE MEDICAL AND RETIREE LIFE INSURANCE COVERAGE
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) .... 3 0
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 0
5 Total number of individuals employed in calendar year 2010 (Part V, line 2a) ... 5 0
6 Total number of volunteers (estimate if necessary) .... 6 0
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b 0
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 0 0
9 Program service revenue (Part VIII, line 2g) ......... 196,775 238,770
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 2,881,907 4,056,393
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 0 0
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 3,078,682 4,295,163
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 0 0
14 Benefits paid to or for members (Part IX, column (A), line 4) .... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 3,873 20,674
16a Professional fundraising fees (Part IX, column (A), line 11e).... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 940,349 2,459,367
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 944,222 2,480,041
19 Revenue less expenses. Subtract line 18 from line 12...... 2,134,460 1,815,122
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............ 45,952,150 54,187,300
21 Total liabilities (Part X, line 26)............ 404,153 129,355
22 Net assets or fund balances. Subtract line 21 from line 20 ..... 45,547,997 54,057,945
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid Preparer's Use Only Preparer's
signatureBig Right Arrow 		Date
right pointing bullet image Preparer’s taxpayer identification number
(see instructions)
Firm’s name (or yours
if self-employed),
address, and ZIP + 4Big Right Arrow




 		EIN right pointing bullet image
Phone no. right pointing bullet image
May the IRS discuss this return with the preparer shown above? (see instructions) .........
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2010)
Form 990 (2010)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III . . . . . . . . . .
1
Briefly describe the organization’s mission: RETIREE MEDICAL AND RETIREE LIFE INSURANCE COVERAGE
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the exempt purpose achievements for each of the organization’s three largest program services by expenses.
Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 2,315,894 including grants of $   ) (Revenue $ 238,770 )
THE TRINITY HEALTH WELFARE BENEFIT TRUST WAS ESTABLISHED MARCH 31, 2006 AND IS A VOLUNTARY EMPLOYEES' BENEFICIARY ASSOCIATION (VEBA). THE PLAN SERVES AS A FUNDING VEHICLE FOR BENEFITS PAYABLE UNDER THE RETIREE MEDICAL AND RETIREE LIFE INSURANCE COMPONENTS OF THE TRINITY HEALTH CORPORATION WELFARE BENEFIT PLAN TO ELIGIBLE RETIREES AND THEIR BENEFICIARIES.PROVISION OF SUCH BENEFITS IS CONSISTENT WITH THE TRUST'S EXEMPT PURPOSE UNDER CODE SECTION 501(C)(9.)
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services. (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet$ 2,315,894
Form 990 (2010)
Form 990 (2010)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule A.....................
1
 
No
2
Is the organization required to complete Schedule B, Schedule of Contributors? ........
2
 
No
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part I..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part II.........................
4
 
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part III........................
5
 
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts where donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete
Schedule D, Part IClick to see attachment.......................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IVClick to see attachment...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in term, permanent,or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
 
No
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
 
No
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, and program service activities outside the United States? If “Yes,” complete Schedule F, Part I.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II..
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III..
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II..........
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
Form 990 (2010)
Form 990 (2010)
Page 4
Part IV
Checklist of Required Schedules (continued)
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H.....
20a
 
No
b
Did the organization attach its audited financial statement to this return? Note: All Form 990 filers that operate one or more hospitals must attach audited financial statements. .....
20b
 
 
21
Did the organization report more than $5,000 of grants and other assistance to governments and organizations in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II..
21
 
No
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III.....
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................
23
 
No
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
 
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I......
25a
 
 
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................
25b
 
 
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II...........................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor, or a grant selection committee member, or to a person related to such an individual? If “Yes,” complete Schedule L, Part III...............
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV .........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV...................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV..
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35
Is any related organization a controlled entity within the meaning of section 512(b)(13)? .....
35
Yes
 
a
Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2...........
36
 
 
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2010)
Form 990 (2010)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V . . . . . . . . . .
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
0
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
 
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
0
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
 
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2010)
Form 990 (2010)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI . . . . . . . . . .
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year ..............
1a
0
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
0
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? ..
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Does the organization have members or stockholders? ................
6
 
No
7a
Does the organization have members, stockholders, or other persons who may elect one or more members of the governing body? .........................
7a
 
No
b
Are any decisions of the governing body subject to approval by members, stockholders, or other persons? ..
7b
 
No
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
 
No
b
Each committee with authority to act on behalf of the governing body? ............
8b
 
No
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Does the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” does the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with those of the organization? ....
10b
 
 
11a
Has the organization provided a copy of this Form 990 to all members of its governing body before filing the form?
11a
 
No
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Does the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Are officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ...........................
12b
 
No
c
Does the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this is done ....................
12c
 
No
13
Does the organization have a written whistleblower policy? ...............
13
Yes
 
14
Does the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
 
No
b
Other officers or key employees of the organization ................
15b
 
No
If "Yes" to line a or b, describe the process in Schedule O. (See instructions.)
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If “Yes,” has the organization adopted a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and taken steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you make these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization makes its governing documents, conflict of interest policy, and financial statements available to the public.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
KIM SAXTON
34605 TWELVE MILE ROAD
FARMINGTON HILLS,MI48331
(248) 489-5004
Form 990 (2010)
Form 990 (2010)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII . . . . . . . . . .
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

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

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

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

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) THE NORTHERN TRUST COMPANY
SOLE TRUSTEE
 1.00   X         0 0 20,674
































Form 990 (2010)
Form 990 (2010)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;


























1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 0 0 20,674
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 in reportable compensation from the organizationMediumBullet0
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
 
No
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization MediumBullet0
Form 990 (2010)
Form 990 (2010)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, gifts, grants and other similar amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d  
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		 
g Noncash contributions included in lines 1a-1f:$  
h Total. Add lines 1a-1f.......MediumBullet  
Program Service Revenue Business Code
2a MEDICARE PART D REIMB. 525,100 131,232 131,232    
b PARTICIPANT CONTRIB. 525,100 107,538 107,538    
c
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 238,770
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 3,439,610     3,439,610
4 Income from investment of tax-exempt bond proceeds..MediumBullet        
5 Royalties............MediumBullet        
(i) Real (ii) Personal
6a Gross Rents    
b Less: rental expenses    
c Rental income or (loss)    
d Net rental income or (loss).......MediumBullet        
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 2,757,356  
b Less: cost or other basis and sales expenses 2,140,573  
c Gain or (loss) 616,783  
d Net gain or (loss)..........MediumBullet 616,783     616,783
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..MediumBullet      
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet        
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet        
Miscellaneous Revenue Business Code
11a            
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ......MediumBullet  
12 Total revenue. See Instructions....MediumBullet 4,295,163 238,770 0 4,056,393
Form 990 (2010)
Form 990 (2010)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the U.S. See Part IV, line 21    
2 Grants and other assistance to individuals in the U.S. See Part IV, line 22    
3 Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 15 and 16    
4 Benefits paid to or for members    
5 Compensation of current officers, directors, trustees, and key employees .... 20,674   20,674  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....        
7 Other salaries and wages        
8 Pension plan contributions (include section 401(k) and section 403(b) employer contributions) ....        
9 Other employee benefits .......        
10 Payroll taxes ...........        
11 Fees for services (non-employees):        
a Management ......        
b Legal .........        
c Accounting ...........        
d Lobbying ...........        
e Professional fundraising. See Part IV, line 17..    
f Investment management fees ......        
g Other ..........        
12 Advertising and promotion ....        
13 Office expenses .......        
14 Information technology ......        
15 Royalties ..        
16 Occupancy ...........        
17 Travel ............        
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ......        
19 Conferences, conventions, and meetings ....        
20 Interest ...........        
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization .....        
23 Insurance .............. 558 558    
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 BENEFIT PAYMNTS-MEDICAL 2,315,336 2,315,336    
b THIRD PARTY ADMINISTRAT 143,473   143,473  
c
d
e
f All other expenses        
25 Total functional expenses. Add lines 1 through 24f 2,480,041 2,315,894 164,147 0
26 Joint costs. Check here MediumBullet if following
SOP 98-2 (ASC 958-720). Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation 		       
Form 990 (2010)
Form 990 (2010)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing ..........   1  
2 Savings and temporary cash investments .......   2  
3 Pledges and grants receivable, net .........   3  
4 Accounts receivable, net ......... 281,703 4 189,338
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 ............ 3,976 9 3,592
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a  
b Less: accumulated depreciation. ..... 10b     10c  
11 Investments—publicly traded securities .......... 44,562,316 11 53,866,866
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 ........... 1,104,155 15 127,504
16 Total assets. Add lines 1 through 15 (must equal line 34)... 45,952,150 16 54,187,300
Liabilities 17 Accounts payable and accrued expenses .   17 1,859
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..... 404,153 25 127,496
26 Total liabilities. Add lines 17 through 25..... 404,153 26 129,355
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets ..... 45,547,997 27 54,057,945
28 Temporarily restricted net assets .....   28  
29 Permanently restricted net assets .....   29  
Organizations that do not follow SFAS 117, check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ..... 45,547,997 33 54,057,945
34 Total liabilities and net assets/fund balances ..... 45,952,150 34 54,187,300
Form 990 (2010)
Form 990 (2010)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI . . . . . . . . . .
1
Total revenue (must equal Part VIII, column (A), line 12) . . .
1
4,295,163
2
Total expenses (must equal Part IX, column (A), line 25) . . . . .
2
2,480,041
3
Revenue less expenses. Subtract line 2 from line 1 . . . .
3
1,815,122
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) . .
4
45,547,997
5
Other changes in net assets or fund balances (explain in Schedule O) . . . .
5
6,694,826
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) . . . . . .
6
54,057,945
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII . . . . . . . . . .
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?..
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O............................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
 
 
Form 990 (2010)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," 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
TRINITY HEALTH WELFARE BENEFIT TRUST
 
Employer identification number

20-8151733
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .......    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) ...    
4 Aggregate value at end of year .......    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds may be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit. ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a–2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06 ........ 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the taxable year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................
9
In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116, not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116, to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 52283D
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIV.
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current Year (b)Prior Year (c)Two Years Back (d)Three Years Back (e)Four Years Back
1a Beginning of year balance ....      
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 ......      
2
Provide the estimated percentage of the year end balance held as:
a
Board designated or quasi-endowment: SchDMd Bullet  
b
Permanent endowment: SchDMd Bullet  
c
Term endowment: SchDMd Bullet  
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
 
(ii) related organizations ........................
3a(ii)
 
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Investments—Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of investment (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................      
b Buildings ................        
c Leasehold improvements ............        
d Equipment ................        
e Other .................        
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........SchDMdBullet 0
Schedule D (Form 990) 2010

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








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








Total. (Column (b) should equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) should equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Amount
Federal Income Taxes  
PENDING INVESTMENT PURCHASES 127,496








Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)Small Bullet 127,496
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1  
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2  
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3  
4 Net unrealized gains (losses) on investments .......................... 4  
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV) ................................. 8  
9 Total adjustments (net). Add lines 4 - 8 ............................. 9  
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10  
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV): ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIV): ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total Revenue. Add lines 3 and 4c. (This should equal Form 990, Part I, line 12.) ...... 5  
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIV): ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIV): ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This should equal Form 990, Part I, line 18.) ...... 5  
Part XIV
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
Schedule D (Form 990) 2010

Additional Data


Software ID:  
Software Version:  




SCHEDULE O
(Form 990 or 990-EZ)

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

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

20-8151733
Identifier Return Reference Explanation
FORM 990, PART VI, SECTION A, LINE 8A   THE SOLE TRUSTEE FOR THE REPORTING ENTITY IS NORTHERN TRUST; THE CONTROL OF THE REPORTING ENTITY RESTS WITH THE TRINITY HEALTH CORPORATION BENEFITS COMMITTEE. THE BENEFITS COMMITTEE CONTEMPORANEUSLY DOCUMENTS ITS MEETINGS.
FORM 990, PART VI, SECTION A, LINE 8B   THE SOLE TRUSTEE FOR THE REPORTING ENTITY IS NORTHERN TRUST; THE CONTROL OF THE REPORTING ENTITY RESTS WITH THE TRINITY HEALTH CORPORATION BENEFITS COMMITTEE. THE BENEFITS COMMITTEE CONTEMPORANEUSLY DOCUMENTS ITS MEETINGS.
FORM 990, PART VI, SECTION B, LINE 11   NO REVIEW WAS OR WILL BE CONDUCTED.
  FORM 990, PART VI, SECTION C, LINE 19 COPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC.
CONTACT ADDRESSES FOR OFFICERS, DIRECTORS, ETC FORM 990, PART VII THE NORTHERN TRUST COMPANY - 50 S. LASALLE STREET, CHICAGO, IL XXX-XX-XXXX.
CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 6,694,826.
  FORM 990, PART XII LINE 2: THE TRINITY HEALTH CORPORATION BENEFITS COMMITTEE ASSUMES THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE TRINITY HEALTH WELFARE BENEFIT TRUST FINANCIAL STATEMENTS. THE FINANCIAL STATEMENTS OF THE TRINITY HEALTH WELFARE BENEFIT TRUST WERE INCLUDED IN THE 6/30/2011 FINANCIAL STATEMENTS OF THE TRINITY HEALTH CORPORATION RETIREE BENEFIT PLAN (GRANDFATHERED) - PLAN 506, WHICH WERE AUDITED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
TRINITY HEALTH WELFARE BENEFIT TRUST
 
Employer identification number

20-8151733
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)
(a)
Name, address, and EIN of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income
(e)
End-of-year assets


 		(f)
Direct controlling
entity

















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


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled organization
Yes No
(1) ADVANTAGE HEALTHSAINT MARY'S MEDICAL GROUP

245 STATE ST SE

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

27870 CABOT DRIVE

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

351 SW 9TH STREET

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

300 NORTH AVENUE

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

300 NORTH AVENUE

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

255 NORTH WELCH AVENUE

PRIMGHAR,IA51245
42-1500277 		ACUTE/AMBULATORY HEALTHCARE SERVICES IA 501(C)(3) 3 MERCY HEALTH SERVICES-IOWA CORP
 
 
No
(7) BAUM HARMON MERCY HOSPITAL & CLINICS FOUNDATION

255 NORTH WELCH AVENUE

PRIMGHAR,IA51245
26-2973307 		SUPPORT THE SERVICES OF RELATED HOSPITAL IA 501(C)(3) 11, TYPE I BAUM HARMON MERCY HOSPITAL
 
 
No
(8) CAPITAL PARK FAMILY HEALTH CENTER INC

6150 EAST BROAD STREET

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

PO BOX 995

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

PO BOX 3998

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

281 ENTERPRISE COURT

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

6150 EAST BROAD STREET

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

250 MERCY DRIVE

DUBUQUE,IA52001
26-2227941 		SUPPORT THE SERVICES OF RELATED HOSPITAL IA 501(C)(3) 11, TYPE I MERCY HEALTH SERVICES-IOWA CORP
 
 
No
(14) DYERSVILLE HEALTH FOUNDATION INC

1111 3RD STREET SW

DYERSVILLE,IA52040
20-5383271 		SUPPORT THE SERVICES OF RELATED HOSPITAL IA 501(C)(3) 11, TYPE I MERCY HEALTH SERVICES-IOWA CORP
 
 
No
(15) HACKLEY HOSPITAL

1700 CLINTON ST PO BOX 3302

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

PO BOX 3302

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

1352 TERRACE ST

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

888 TERRACE ST

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

PO BOX 9184

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

11801 TECH ROAD

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

1500 FOREST GLEN RD

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

27870 CABOT DRIVE

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

351 SW 9TH STREET

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

232 SECOND STREET SE

MASON CITY,IA504016208
42-1173708 		HOSPICE HEALTH CARE SERVICES IA 501(C)(3) 7 MERCY HEALTH SERVICES-IOWA CORP
 
 
No
(25) HOSPICE OF WASHTENAW II

806 AIRPORT BLVD

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

1675 LEAHY STREET

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

24 FRANK LLOYD WRIGHT DR LOBBY J

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

72 S STATE STREET

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

166 EAST GOODALE AVE

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

801 5TH STREET

SIOUX CITY,IA51101
38-3320705 		PROVIDE HOME HEALTH CARE SERVICES IA 501(C)(3) 11, TYPE I MERCY HEALTH SERVICES-IOWA CORP
 
 
No
(31) MCAULEY CLINIC CORPORATION

PO BOX 992

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

281 ENTERPRISE COURT

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

505 HURON AVENUE

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

684 HARVEY STREET

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

1415 LEAHY STREET

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

1000 4TH STREET SW

MASON CITY,IA50401
31-1373080 		HEALTHCARE SERVICES DE 501(C)(3) 3 TRINITY HEALTH-MICHIGAN
 
 
No
(37) MERCY HEALTHCARE FOUNDATION

1410 N 4TH ST

CLINTON,IA52732
42-1316126 		FUNDRAISING AND FINANCIAL ASSISTANCE FOR HOSPITAL CHARITABLE SERVICES IA 501(C)(3) 11, TYPE I MERCY MEDICAL CENTER-CLINTON
 
 
No
(38) MERCY HOSP & HEALTH SERVICES OF DETROITMARSHALL PARK HEALTH SERVICES INC

27870 CABOT DRIVE

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

400 HOBART

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

2601 ELECTRIC AVE

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

1410 NORTH 4TH ST

CLINTON,IA527322940
42-1336618 		TO PROVIDE QUALITY HEALTH CARE DE 501(C)(3) 3 MERCY HEALTH SERVICES-IOWA CORP
 
 
No
(42) MERCY MEDICAL CENTER - SIOUX CITY FOUNDATION

801 5TH STREET

SIOUX CITY,IA51102
14-1880022 		SUPPORT THE SERVICES OF RELATED HOSPITAL IA 501(C)(3) 7 MERCY HEALTH SERVICES-IOWA CORP
 
 
No
(43) MERCY MEDICAL CENTER FOUNDATION - NORTH IOWA

1000 4TH STREET SW

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

1512 12TH AVENUE ROAD

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

7985 MACKINAW TRAIL

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

300 NORTH AVENUE

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

1512 12TH AVENUE ROAD

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

PO BOX 9184

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

1300 VICTORS WAY

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

793 WEST STATE STREET

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

6150 EAST BROAD STREET

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

6150 EAST BROAD STREET

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

6150 EAST BROAD STREET

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

6150 EAST BROAD STREET

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

6150 EAST BROAD STREET

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

6150 EAST BROAD STREET

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

1144 DUBLIN ROAD SUITE B

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

7333 SMITHS MILL RD

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

1820 - 44TH STREET

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

565 W WESTERN AVENUE

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

601 EAST 2ND STREET

OAKLAND,NE68045
20-8072234 		HEALTHCARE SERVICES NE 501(C)(3) 3 MERCY HEALTH SERVICES-IOWA CORP
 
 
No
(62) OAKLAND MERCY HOSPITAL FOUNDATION

601 E 2ND STREET

OAKLAND,NE68045
31-1678345 		SUPPORTS SERVICES OF RELATED HOSPITAL NE 501(C)(3) 11, TYPE III-FI OAKLAND MERCY HOSPITAL
 
 
No
(63) PORT HURON MERCY FAMILY CARE INC

2601 ELECTRIC AVE

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

965 FORK STREET

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

1303 EAST HERNDON AVE

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

1303 EAST HERNDON AVE

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

1055 NORTH CURTIS RD

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

1055 NORTH CURTIS RD

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

1055 N CURTIS ROAD

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

3325 POCAHONTAS ROAD

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

1512 12TH AVENUE ROAD

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

351 SW 9TH STREET

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

1055 NORTH CURTIS RD

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

1915 LAKE AVENUE PO BOX 670

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

PO BOX 1935

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

801 EAST LASALLE AVE

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

1915 LAKE AVENUE

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

PO BOX 9184

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

1430 MONROE NW

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

200 JEFFERSON ST SE

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

27870 CABOT DRIVE

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

44405 WOODWARD AVE

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

500 SOUTH CLEVELAND AVE

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

3325 POCAHONTAS ROAD

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

801 E LASALLE AVE PO BOX 1935

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

4215 EDISON LAKES PARKWAY

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

PO BOX 9184

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

PO BOX 9184

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

27870 CABOT DRIVE

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

27870 CABOT DRIVE

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

27870 CABOT DRIVE

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

27870 CABOT DRIVE

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

17410 COLLEGE PARKWAY

LIVONIA,MI48152
38-2621935 		HOME HEALTH CARE SYSTEM MANAGEMENT SERVICES MI 501(C)(3) 11, TYPE I TRINITY HEALTH CORPORATION
 
 
No
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) ADVANCED IMAGING SERVICES OF BATTLE CREEK

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

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

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

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

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

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

1000 4TH STREET SW
MASON CITY,IA50401
13-4365966 		X-RAY AND MAMMOGRAPHY SERVICES IA N/A
 N/A       No     No 0 %
(8) FRANCES WARDE MEDICAL LABORATORY

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

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

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

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

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

1416 SIXTH STREET SW
MASON CITY,IA50401
42-1328388 		MRI SERVICES IA N/A
 N/A       No     No 0 %
(14) MASON CITY AMBULATORY SURGERY CENTER LLC

990 4TH STREET SW
MASON CITY,IA50401
20-1960348 		SURGERY-SAME DAY IA N/A
 N/A       No     No 0 %
(15) MCE MOB IV LIMITED PARTNERSHIP

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

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

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

1000 4TH STREET SW
MASON CITY,IA50401
13-4237594 		CARDIOVASCULAR SERVICES IA N/A
 N/A       No     No 0 %
(19) MERCY OUTPATIENT SURGERY CENTER LLC

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

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

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

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

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

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

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

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

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

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

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

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

5301 E HURON RIVER DR
ANN ARBOR,MI48106
76-0820959 		RADIOLOGY/IMAGING MI N/A
 N/A       No     No 0 %
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of related organization



 		(b)
Primary activity



 		(c)
Legal domicile
(state or
foreign
country)
 		(d)
Direct controlling
entity


 		(e)
Type of entity
(C corp, S corp,
or trust)

 		(f)
Share of total income



 		(g)
Share of
end-of-year
assets

 		(h)
Percentage
ownership
(1) COMMUNITY HEALTH VENTURES INC
565 W WESTERN AVE
MUSKEGON,MI49440
38-3522260 		SOFTWARE MARKETING MI N/A
 C      
(2) HACKLEY HEALTH MANAGEMENT CENTER
1415 LEAHY ST
MUSKEGON,MI49442
38-2961814 		WEIGHT MANAGEMENT MI N/A
 C      
(3) HACKLEY HEALTH VENTURES INC
1415 LEAHY ST
MUSKEGON,MI49442
38-2589959 		OTHER MEDICAL SERVICES MI N/A
 C      
(4) HACKLEY HEALTHCARE EQUIPMENT
1415 LEAHY ST
MUSKEGON,MI49442
38-2578569 		HOME MEDICAL EQUIPMENT MI N/A
 C      
(5) HACKLEY PROFESSIONAL CENTER
1415 LEAHY ST
MUSKEGON,MI49442
38-3024797 		REAL ESTATE RENTAL MI N/A
 C      
(6) HACKLEY PROFESSIONAL PHARMACY
1415 LEAHY ST
MUSKEGON,MI49442
38-2447870 		PHARMACY MI N/A
 C      
(7) HEF INC
1415 LEAHY ST
MUSKEGON,MI49442
38-3086401 		OFFICE STAFFING MI N/A
 C      
(8) HOLY CROSS PRIVATE HOME SERVICES CORP
11801 TECH ROAD
SILVER SPRING,MD20904
52-1986562 		HOME CARE SERVICES MD N/A
 C      
(9) HPC CO-OWNERS ASSOCIATION
1700 CLINTON
MUSKEGON,MI49442
27-0734448 		CONDOMINIUM ASSOCIATION MI N/A
 C      
(10) HURON ARBOR CORPORATION
5301 EAST HURON RIVER DR PO BOX 992
ANN ARBOR,MI48106
38-2475644 		PROVIDES OFFICE RENTAL SPACE MI N/A
 C      
(11) INTEGRATED HEALTH ASSOCIATES INC
24 FRANK LLOYD WRIGHT DR LOBBY J
ANN ARBOR,MI48106
38-3126920 		MEDICAL MANAGEMENT MI N/A
 C      
(12) IHA AFFILIATION CORPORATION
24 FRANK LLOYD WRIGHT DR LOBBY J
ANN ARBOR,MI48106
38-3188895 		MEDICAL MANAGEMENT MI N/A
 C      
(13) IHA HEALTH SERVICES CORPORATION
24 FRANK LLOYD WRIGHT DR LOBBY J
ANN ARBOR,MI48106
38-3316559 		MEDICAL SERVICES MI N/A
 C      
(14) MARYLAND CARE GROUP INC
11801 TECH ROAD
SILVER SPRING,MD20904
52-1815313 		HEALTHCARE HOLDING MD N/A
 C      
(15) MEDNOW INC
1512 12TH AVENUE ROAD
NAMPA,ID83686
82-0389927 		OUTPATIENT PHARMACY ID N/A
 C      
(16) MERCY COMMUNITY PHYSICIANS
363 FREMONT STREET
BATTLE CREEK,MI49017
26-4252468 		HEALTHCARE SERVICES MI N/A
 C      
(17) MERCY MEDICAL SERVICES
801 5TH STREET
SIOUX CITY,IA51101
42-1283849 		PRIMARY CARE PHYSICIANS IA N/A
 C      
(18) MICHIGAN PHYSICIAN SERVICES
44405 WOODWARD AVENUE H-5
PONTIAC,MI48341
38-3293125 		PHYSICIAN SERVICES MI N/A
 C      
(19) MICHIGAN ATHLETIC CLUB
2500 BURTON
GRAND RAPIDS,MI49546
38-2647304 		ATHLETIC CLUB MI N/A
 C      
(20) MOUNT CARMEL BEHAVIORAL HEALTHCARE SERVICES INC
6150 EAST BROAD STREET
COLUMBUS,OH43213
31-0971510 		BEHAVIORAL HEALTHCARE SERVICES OH N/A
 C      
(21) MOUNT CARMEL HEALTH HORIZONS CORP
6150 EAST BROAD STREET
COLUMBUS,OH43213
31-1177652 		MEDICAL SERVICES/RENT OH N/A
 C      
(22) MOUNT CARMEL HEALTH PROVIDERS INC
6150 EAST BROAD STREET
COLUMBUS,OH43213
31-1382442 		MEDICAL SERVICES OH N/A
 C      
(23) NORTH IOWA MERCY MEDICAL SERVICES INC
1000 4TH ST SW
MASON CITY,IA50401
42-1382308 		MEDICAL SERVICES IA N/A
 C      
(24) PRIMARY CARE NETWORK OF OHIO INC
6150 EAST BROAD STREET
COLUMBUS,OH43213
31-1422486 		HEALTH MANAGEMENT SERVICES OH N/A
 C      
(25) PRIORITY PLUS OF CALIFORNIA
PO BOX 27230
FRESNO,CA93729
77-0395267 		FORMERLY HEALTH MANAGEMENT NOW DISCONTINUED SUBSTANTIALLY ALL OPERATIONS CA N/A
 C      
(26) SAINT ALPHONSUS PHYSICIANS PA
1055 NORTH CURTIS ROAD
BOISE,ID837061370
33-1078261 		PHYSICIANS ID N/A
 C      
(27) SAINT MARY'S HEALTH MANAGEMENT COMPANY
1640 EAST PARIS SE
GRAND RAPIDS,MI49546
38-3450733 		ATHLETIC CLUB MI N/A
 C      
(28) SURGERY CENTER FINANCING CORPORATION
6150 EAST BROAD STREET
COLUMBUS,OH43213
31-1531102 		FINANCE, INSURANCE AND REAL ESTATE OH N/A
 C      
(29) TRINITY HEALTH EMPLOYEE BENEFIT TRUST
27870 CABOT DRIVE
NOVI,MI483772920
38-3410377 		GRANTOR TRUST MI N/A
 T      
(30) VENZKE INSURANCE COMPANY LTD
PO BOX 1051 GRAND CAYMAN
GRAND CAYMAN    
CJ
98-0453602 		PROVISION OF INSURANCE COVERAGE CJ N/A
 C      
(31) WESTSHORE HEALTH NETWORK
1820 44TH STREET
KENTWOOD,MI49508
38-3280200 		PHYSICIAN HOSPITAL ORGANIZATION MI N/A
 C      
(32) WORKPLACE HEALTH OF GRAND HAVEN
1415 LEAHY ST
MUSKEGON,MI49442
38-3112035 		OCCUPATIONAL HEALTH MI N/A
 C      
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III or IV.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
 
No
d Loans or loan guarantees to or for other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Performance of services or membership or fundraising solicitations for other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations by other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Sharing of facilities, equipment, mailing lists, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of paid employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Reimbursement paid to other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
 
No
p Reimbursement paid by other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Other transfer of cash or property to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type(a-r) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1)
(2)
(3)
(4)
(5)
(6)
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Are all
partners
section
501(c)(3)
organizations? 		(e)
Share of
end-of-year
assets 		(f)
Disproprtionate allocations? 		(g)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065) 		(h)
General or
managing
partner?
Yes No Yes No Yes No






























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


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