2011-05-11T14:46:42-05:00 2010-06-30 Baker Tilly Virchow Krause LLP 500 Midland Court PO Box 8130 Janesville WI 535478130 990 2009-07-01 237275336 MERCY FOUNDATION INC MERC 6087566000 PO BOX 5003 - 1000 MINERAL POINT JANESVILLE WI 535475003 Javon Bea 6087566000 2011-05-05 1 William T Murphy CPA 6087525835 2011-05-05 X 2009 2016-02-24 21:20:13Z Javon Bea PO BOX 5003 - 1000 MINERAL POINT JANESVILLE WI 535475003 745282 0 X N/A X 1972 WI TO SUPPORT MERCY HEALTH SYSTEM CORP, THE HOUSE OF MERCY & MERCY ASSISTED CARE HOSPICE PROGRAM. 3 2 0 120 0 0 195689 208992 132200 129300 46405 4812 2041 -43423 376335 299681 0 0 50361 39480 0 50360 225824 202769 276185 242249 100150 57432 1168302 1260791 112928 8717 1055374 1252074 TO SUPPORT MERCY HEALTH SYSTEM CORP, THE HOUSE OF MERCY & MERCY ASSISTED CARE HOSPICE PROGRAM. 0 0 147530 0 0 HOUSE OF MERCY, A HOMELESS SHELTER, PROVIDED 7,904 SHELTER NIGHTS. A TOTAL OF 277 INDIVIDUALS (140 ADULTS AND 137 CHILDREN) WERE SERVED. 23556 0 129300 Mercy Foundation provides subsidy funding for the Mercy Health System Residency Program. Use of these donations are for educational necessities outside the normal operating budget of the Mercy Residency Program. Expenses in fiscal year 2010 included paying for a medical mission to Honduras in conjunction with The Shoulder to Shoulder, Inc. Doctor James Horton, and three residents spent two weeks providing preventative care/treatment. Other expenses included stipends paid to physicians for their preceptor time and their time spent coordinating the rotation of their students. 570 0 0 Mercy Foundation provides subsidy funding for the Mercy Assisted Care hospice program. The Hospice Homecare program provided 6,518 visits to patients needing RNs, health aides, therapists, and social workers during the year. Funding from the Foundation, allowed this program to continue to provide hospice care to the community. 4724 0 0 Other Miscellaneous Program Expenses 4724 176380 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 9 0 1 0 0 0 0 0 0 0 0 0 0 3 2 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 1 0 0 0 WI X JOHN COOK 6087566642 1000 MINERAL POINT Janesville WI 535475003 X LARRY E SQUIRE 1.00 X X 0 3934 0 SIMA WEXLER 1.00 X X 0 0 0 RICHARD GRUBER 1.00 X 0 188532 13195 JAVON R BEA 1.00 X X 0 1979023 1660001 BARB BORTNER 1.00 X 0 178564 21245 0 2350053 1694441 0 0 1 0 0 124694 28692 55606 208992 FAMILY PRACTICE RESIDE 900099 129300 129300 129300 26138 26138 285604 306930 -21326 -21326 -21326 95248 124694 138671 -43423 -43423 299681 129300 0 -38611 39480 39480 7200 7200 6870 6870 1123 1123 HOUSE OF MERCY EXP (HOM 147530 147530 0 0 STUDENT ACTIVITY EXPENS 23556 23556 0 0 COMMUNITY DEVELOPMENT F 10514 0 0 10514 DONATION - ALZHEIMERS S 3500 3500 0 0 LICENSES, PERMITS & FEE 2118 2004 114 0 358 -210 202 366 242249 176380 15509 50360 72056 71740 1050658 1187609 45588 1442 1168302 1260791 112928 8717 112928 8717 X 1055374 1252074 1055374 1252074 1168302 1260791 X 0 1 1 X 0 X X 0 0 0 MERCY ASSISTED CARE INC 391035110 9 1 0 1 0 MERCY HEALTH SYSTEM CORPORATION 390816848 3 1 0 1 0 2 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 VARIOUS INVESTMENTS 1187609 F 1187609 DUE TO RELATED PARTY 8717 8717 299681 242249 57432 139268 139268 196700 Part XI, Line 8 - Other Adjustments: UNREALIZED GAIN: 139268. Charity Ball 161907 98690 63217 10000 2999 1746 28166 825 58169 JINGLE MINGLE 49736 26004 23732 7000 2454 0 10432 1000 8293 1 8299 0 8299 0 0 0 0 0 7587 219942 124694 95248 17000 5453 1746 38598 1825 74049 138671 -43423 0 0 0 0 0 0 0 0 0 RICHARD GRUBER 0 139245 0 45883 0 3404 0 0 0 13195 0 201727 0 0 JAVON R BEA 0 810298 0 661794 0 506931 0 1619257 0 40744 0 3639024 0 0 BARB BORTNER 0 130620 0 45554 0 2390 0 0 0 21245 0 199809 0 0 Form 990, Part VI, Section B, line 11 NO REVIEW WAS OR WILL BE CONDUCTED Form 990, Part VI, Section B, line 12c Officers, directors, and key employees are required to report all conflicts of interest. The compliance officer is responsible for investigating all conflicts and reporting to the board. Form 990, Part VI, Section C, line 19 Governing Documents, Conflict of Interest Policy & Financial Statements are available upon request. MERCY ALLIANCE INC 1000 MINERAL POINT JANESVILLE WI 535475003 391679859 MANAGEMENT OF HEALTHCARE ORGANIZATIONS WI 501(C)(3) 11A N/A MERCY HEALTH SYSTEM ASSOCIATION OF VOLUNTEERS 1000 MINERAL POINT JANESVILLE WI 535475003 390912682 TO SUPPORT MERCY HEALTH SYSTEM CORPORATION WI 501(C)(3) 11C MERCY HEALTH SYSTEM CORPORATION MERCY HEALTH SYSTEM CORPORATION 1000 MINERAL POINT JANESVILLE WI 535475003 390816848 MEDICAL HEALTHCARE WI 501(C)(3) 3 MERCY ALLIANCE INC MERCY ASSISTED CARE INC 901 MINERAL POINT JANESVILLE WI 535475003 391035110 HOME HEALTH CARE & SERVICES WI 501(C)(3) 9 MERCY ALLIANCE INC MERCY HARVARD HOSPITAL INC 901 GRANT STREET Harvard IL 60033 311551871 MEDICAL HEALTHCARE IL 501(C)(3) 3 MERCY ALLIANCE INC HARVARD MEMORIAL HOSPITAL FOUNDATION 901 GRANT STREET Harvard IL 60033 364308662 TO SUPPORT MERCY HARVARD HOSPITAL, INC. IL 501(C)(3) 11A MERCY HARVARD HOSPITAL INC MERCY CRYSTAL LAKE HOSPITAL AND MEDICAL CENTER 1000 MINERAL POINT JANESVILLE WI 535475003 201673011 NONE IL 501(C)(3) 3 MERCY ALLIANCE INC JANESVILLE MEDICAL CENTER INC 1000 MINERAL POINT JANESVILLE WI 535475003 391520130 MANAGEMENT ENTITY OF UNION EMPLOYEES WI MERCY HEALTH SYSTEM CORPORATION C 10969 MERCYCARE INSURANCE COMPANY 3430 PALMER DRIVE JANESVILLE WI 53545 391768192 INSURANCE COMPANY WI MERCY HEALTH SYSTEM CORPORATION C -248491 39303114 MERCYCARE HMO INC - CONSOLIDATED WITH MERCYCARE INSURANCE CO 3430 PALMER DRIVE JANESVILLE WI 53545 201482553 INSURANCE COMPANY WI MERCY HEALTH SYSTEM CORPORATION C 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0