2011-05-11T14:46:16-05:00 2010-06-30 Baker Tilly Virchow Krause LLP 500 Midland Court PO Box 8130 Janesville WI 535478130 990 2009-07-01 391679859 MERCY ALLIANCE INC MERC 6087566000 PO BOX 5003 - 1000 MINERAL POINT JANESVILLE WI 535475003 Javon Bea 6087566000 2011-05-06 1 William T Murphy CPA 6087525835 2011-05-06 X 2009 2016-02-24 21:20:13Z JAVON BEA PO BOX 5003 - 1000 MINERAL POINT JANESVILLE WI 535475003 90042788 0 X N/A X 1992 WI MERCY ALLIANCE, INC. IS ORGANIZED AND OPERATED EXCLUSIVELY FOR CHARITABLE, EDUCATIONAL, AND SCIENTIFIC PURPOSES, SPECIFICALLY TO MEET THE COMMUNITY'S NEEDS FOR HOSPITAL AND MEDICAL SERVICES FOR THE CARE AND TREATMENT OF SICK OR INJURED PERSONS, TO PROMOTE WELLNESS IN THE COMMUNITY, AND ENGAGE IN MEDICAL AND SCIENTIFIC RESEARCH, DEVELOPMENT, AND EDUCATIONAL ACTIVITIES IN FURTHERANCE OF ITS OBJECTIVES. 8 6 0 0 0 0 0 0 -9855988 9001394 0 -9855988 9001394 0 0 1985483 2052941 0 0 3923951 3757285 5909434 5810226 -15765422 3191168 275063367 374071195 65125859 147709457 209937508 226361738 MERCY ALLIANCE, INC. IS ORGANIZED AND OPERATED EXCLUSIVELY FOR CHARITABLE, EDUCATIONAL, AND SCIENTIFIC PURPOSES, SPECIFICALLY TO MEET THE COMMUNITY'S NEEDS FOR HOSPITAL AND MEDICAL SERVICES FOR THE CARE AND TREATMENT OF SICK OR INJURED PERSONS, TO PROMOTE WELLNESS IN THE COMMUNITY, AND ENGAGE IN MEDICAL AND SCIENTIFIC RESEARCH, DEVELOPMENT, AND EDUCATIONAL ACTIVITIES IN FURTHERANCE OF ITS OBJECTIVES. 0 0 0 0 0 NONE 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 8 6 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 0 0 0 X JOHN COOK 6087566642 1000 MINERAL POINT Janesville WI 535475003 X Thomas R Pool 1.00 X X 0 0 0 Larry Squire 1.00 X X 0 0 0 Mark L Goelzer MD 1.00 X 0 0 0 Rowland J McClellan 1.00 X 0 0 0 Dave Syverson 1.00 X 0 0 0 Sima Wexler 1.00 X 0 0 0 Douglas Hawthorne 1.00 X 0 0 0 JAVON R BEA 1.00 X X 0 1979023 1660001 John Cook 1.00 X 0 275733 19902 0 2254756 1679903 0 0 1 0 MERCER HUMAN RESOURCE CONSULTING 10 S WACKER DRIVE SUITE 1700 CHICAGO IL 606067500 CONSULTING 162059 Friess Associates LLC PO Box 576 Jackson WY 83001 Investment Management Services 144708 Sidley Austin LLP 1 S Dearborn ChiCAGO IL 60603 ConSULTING 135715 3 5566129 5566129 84476659 81041394 3435265 3435265 3435265 9001394 0 0 9001394 2040811 2040811 12130 12130 14978 14978 35600 35600 344182 344182 2352772 2352772 EXTRAORDINARY LOSS BOND 470037 0 470037 CONSULTING 374553 0 374553 OTHER INVESTMENT EXPENS 121187 0 121187 BOND AMORTIZATION 25802 0 25802 MISCELLANEOUS 18174 0 18174 5810226 0 5810226 0 1510503 632999 315512 199887640 220124719 73665224 152997965 275063367 374071195 12251 61135000 144898974 3978608 2810483 65125859 147709457 X 209937508 226361738 209937508 226361738 275063367 374071195 X 0 1 1 X 0 X X 0 0 0 MERCY HEALTH SYSTEM CORPORATION 390816848 3 1 0 1 0 MERCY ASSISTED CARE INC 391035110 9 1 0 1 0 HARVARD MEMORIAL HOSPITAL INC 311551871 3 1 0 1 0 3 0 0 101041187 C INVESTMENTS IN NOTES, BONDS, & SECURITIES 119083532 F 220124719 ACCRUED INTEREST 163742 UNAMORTIZED BOND FEES 699165 DUE FROM RELATED PARTY 109534537 BOND PROJECT FUNDS 42600521 152997965 INTEREST PAYABLE 177181 INTEREST RATE SWAP 2632696 DUE TO RELATED PARTY 606 2810483 9001394 5810226 3191168 13233062 13233062 16424230 Part XI, Line 8 - Other Adjustments: REVENUES/GAINS IN EXCESS OF EXPENSES - SUBSIDIARIES: 12099040. UNREALIZED LOSS - MERCY ALLIANCE, INC.: 542427. UNREALIZED SWAP VALUATION LOSS: -482030. MERCY ALLIANCE - LESS THAN TEMP - UNREALIZED LOSS - ADJUSTMENT TO PY: 1073625. 0 0 0 0 0 0 0 0 0 JAVON R BEA 0 810298 0 661794 0 506931 0 1619257 0 40744 0 3639024 0 0 John Cook 0 212406 0 56250 0 7077 0 0 0 19902 0 295635 0 0 Illinois Finance Authority 521297563 45200BLQ9 2005-03-16 35000000 Capital expenditures, renovations and construction of hospital in Illinois 0 0 Wisconsin Health and Educational Facilities Authority 391337855 97710BRL8 2009-12-31 65000000 Capital expenditures, renovations and construction 0 0 Wisconsin Health and Educational Facilities Authority 391337855 97710BWD0 2010-06-09 48445000 REFINANCE OF '03/'07 BONDS, Capital expenditure, renovation and construction 1 0 36094389 596776 33088193 2008 0 0 1 1 64747556 42600507 959204 21187845 0 0 0 1 48445000 4855000 43650000 39480 669206 1 0 0 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 1 0 0 0 0 0 1 0 0 0 0 0 0 1 BMO Capital Markets 14.700000000000 0 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 HEALTH SYSTEM CORPORATION 1000 MINERAL POINT JANESVILLE WI 535475003 390816848 MEDICAL HEALTHCARE WI 501(c)(3) 3 MERCY ALLIANCE INC MERCY FOUNDATION INC 1000 MINERAL POINT JANESVILLE WI 535475003 237275336 TO SUPPORT MERCY HEALTH SYSTEM & THE HOUSE OF MERCY WI 501(c)(3) 11A MERCY HEALTH SYSTEM CORPORATION 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 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 1 0 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1