Technical Abstract: This study records the fourth consecutive year of high winter losses in managed honey bee (Apis mellifera) colonies in the USA. Over the winter of 2009-2010, US beekeepers responding to this survey lost an average of 42.2% of their colonies, for a total loss of 34.4%. Commercial beekeepers (those operating more than 500 colonies) experienced lower total losses as compared to sideline and backyard beekeepers. Similarly, operations that maintained colonies in more than one state and operations that pollinated almond orchards over the survey period had lower total losses than operations either managing colonies in one state exclusively or those not pollinating almonds. On average beekeepers consider acceptable losses to be 14.5%, and 65% of all responding beekeepers suffered losses in excess of what they considered acceptable. The proportion of operations that experienced losses and reported having no dead bees in their colonies or apiaries was comparable to that reported in the winter of 2008-2009. Manageable conditions, such as starvation and a weak condition in the fall were the leading self-identified causes of mortality as reported by all beekeepers. Commercial beekeepers were, however, less likely to list such manageable causes, instead listing poor queens, mites, and pesticides most frequently as the self-identified causes of mortality in their operations.