TY 2010 Form 990

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(C) Position (check all that apply)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) Wellington Jones Jr Chair through Mar 10	2.0	X	X	4,318	0	0
(2) Charles Miller Secretary	2.0	X	X	2,073	0	0
(3) Etta Nevel MD Trustee	2.0	X		1,053	0	0
(4) Robert Yount MD Trustee; Employed Physician	2.0	X		0	25,000	0
(5) Keith Sherry MD Trustee and medical director	20.0	X		176,435	0	18,498
(6) Sandra Brown MD Trustee thru Mar 10	2.0	X		3,011	0	0
(7) Faye Magneson MD Trustee thru August 2010	2.0	X		4,091	0	0
(8) James Schwartz Sr Trustee	2.0	X		0	0	0
(9) Gerard Duprat MD Trustee Apr thru Dec 10	2.0	X		3,990	0	0
(10) Thomas Cassady Jr V.C. thru Mar; Chair thru Dec	2.0	X	X	4,460	0	0
(11) Jesse Hseih MD Trustee	2.0	X		0	0	0
(12) Maurice Hurwich MD Trustee and medical director	4.0	X		32,671	0	0
(13) M Rose Meissner Treas thru 3-10; VC thru 12-10	2.0	X	X	0	0	0
(14) Margaret King Trustee	2.0	X		0	0	0
(15) Thomas Burish PhD Trustee	2.0	X		0	0	0
(16) Thomas Hauch MD Trustee	2.0	X		0	0	0
(17) Maria Slager Trustee	2.0	X		0	0	0

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(C) Position (check all that apply)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) Perry Watson III Treasurer	2.0	X	X			0	0	0
(19) Gayle Rosencrantz Trustee thru Mar 10	2.0	X				0	0	0
(20) Steven Cramer PhD Trustee	2.0	X				3,051	0	0
(21) Melvin Hall Trustee	2.0	X				0	0	0
(22) Delores Wilmoski Trustee; Apr thru Dec 10	2.0	X				0	0	0
(23) Peter Baranay Trustee; Apr thru Dec 10	2.0	X				0	0	0
(24) Carlton Lyons MD Trustee; Apr thru Dec 10	2.0	X				2,797	0	0
(25) Philip Newbold CEO/President	2.0		X			0	1,001,875	229,464
(26) George Soper Asst. Secretary/VP	2.0		X			0	244,651	99,920
(27) Jeffrey Costello Asst. Treasurer/CFO	2.0		X			0	469,348	99,022
(28) Kreg Gruber COO	40.0		X			436,921	0	98,455
(29) Connie M McCahill Chief Nurse Officer / VP	40.0			X		222,879	0	44,036
(30) Cheryl Wibbens - Lesh MD Vice President Medical Staff	40.0				X	368,127	0	38,149
(31) Robert Riley MD Physician	40.0				X	286,762	0	39,014
(32) Scott Thomas MD Medical Director	23.0				X	335,306	0	9,968
(33) Thomas Sutula MD Physician	40.0				X	220,359	0	37,550
(34) Mark Lavallee Physician	40.0				X	222,761	0	37,417

(A) Name and business address	(B) Description of services	(C) Compensation
SOUTH BEND EMERGENCY PHYSICIANS 615 N Michigan SOUTH BEND,IN46601	Physician services	6,320,660
SOUTH BEND MEDICAL FOUNDATION 530 N Lafayette Blvd SOUTH BEND,IN46601	Lab services	6,172,764
CERNER CORPORATION 2800 ROCKCREEK PARKWAY KANSAS CITY,MO64117	IS SFTWR MAINTENANCE	3,177,987
INDIANA BLOOD CENTER 3450 N Meridian Street INDIANAPOLIS,IN46208	Blood Processing Svc	3,086,064
WOODCOX BLDG CONTRACTORS 51175 PRESCOTT AVE SOUTH BEND,IN46637	CONSTRUCTION MANAGER	2,005,882
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 83

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	1,222,556	1,222,556
2	Grants and other assistance to individuals in the U.S. See Part IV, line 22	0
3	Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 15 and 16	0
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	1,058,738	0	1,058,738	0
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	40,200	40,200		0
7	Other salaries and wages	114,072,645	85,616,439	28,456,206	0
8	Pension plan contributions (include section 401(k) and section 403(b) employer contributions) ....	5,636,316	4,230,315	1,406,001	0
9	Other employee benefits .......	19,356,492	14,648,769	4,707,723	0
10	Payroll taxes ...........	8,228,692	6,176,013	2,052,679	0
11	Fees for services (non-employees):
a	Management ......	0			0
b	Legal .........	171,419		171,419	0
c	Accounting ...........	214,598		214,598	0
d	Lobbying ...........	14,727	11,053	3,674	0
e	Professional fundraising. See Part IV, line 17..	0			0
f	Investment management fees ......	1,337,932		1,337,932	0
g	Other ..........	37,559,161	28,189,553	9,369,608	0
12	Advertising and promotion ....	77,348	58,053	19,295	0
13	Office expenses .......	71,927,324	53,983,016	17,944,308	0
14	Information technology ......	24,426	18,333	6,093	0
15	Royalties ..	0			0
16	Occupancy ...........	6,231,210	4,676,811	1,554,399	0
17	Travel ............	783,313	587,913	195,400	0
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0			0
19	Conferences, conventions, and meetings ....	211,634	158,841	52,793	0
20	Interest ...........	2,675,987	2,008,452	667,535	0
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization .....	24,524,075	18,406,450	6,117,625	0
23	Insurance ..............	2,328,440	1,747,602	580,838	0
24	Other expenses. Itemize expenses not covered above. (Expenses grouped together and labeled miscellaneous may not exceed 5% of total expenses shown on line 25 below.)
a	CORPORATE FEE	21,712,987	16,296,599	5,416,388
b	UNCOLLECTIBLE ACCOUNTS	37,433,659	37,433,659
c	DUES & SUBSCRIPTIONS	889,044	666,783	222,261
d	RECRUITMENT	161,813	121,448	40,365
e	WEARING APPAREL	126,081	94,630	31,451
f	All other expenses	2,086,124	1,565,732	520,392
25	Total functional expenses. Add lines 1 through 24f	360,106,941	277,959,220	82,147,721	0
26	Joint costs. Check here if following SOP 98-2 (ASC 958-720). Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation

Part X Balance Sheet
	1	Cashnon-interest-bearing ..........	18,825	1	19,325
2	Savings and temporary cash investments .......	74,667,024	2	50,012,044
3	Pledges and grants receivable, net .........	462,022	3	539,700
4	Accounts receivable, net .........	70,257,527	4	61,880,211
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 .............	68,370	7	12,376
8	Inventories for sale or use ..............	11,710,633	8	13,706,162
9	Prepaid expenses and deferred charges ............	1,104,326	9	1,083,100
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	541,206,724
b	Less: accumulated depreciation. .....	10b	261,294,425	274,080,186	10c	279,912,299
11	Investments—publicly traded securities ..........	103,833,867	11	123,873,292
12	Investments—other securities. See Part IV, line 11 ......	73,770,696	12	99,517,740
13	Investments—program-related. See Part IV, line 11 ..	788,973	13	765,284
14	Intangible assets .........	0	14	1,171,474
15	Other assets. See Part IV, line 11 ...........	11,726,440	15	5,575,399
16	Total assets. Add lines 1 through 15 (must equal line 34)...	622,488,889	16	638,068,406
	17	Accounts payable and accrued expenses .	39,071,682	17	34,064,199
18	Grants payable ..........		18
19	Deferred revenue ..........	153,845	19	14,027
20	Tax-exempt bond liabilities ..........	142,195,035	20	138,791,700
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 ..	0	23	1,780,830
24	Unsecured notes and loans payable to unrelated third parties ....		24
25	Other liabilities. Complete Part X of Schedule D.....	19,933,599	25	45,287,247
26	Total liabilities. Add lines 17 through 25.....	201,354,161	26	219,938,003
		Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....	414,636,025	27	414,391,549
28	Temporarily restricted net assets .....	6,498,703	28	3,738,854
29	Permanently restricted net assets .....		29
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund .....		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances .....	421,134,728	33	418,130,403
34	Total liabilities and net assets/fund balances .....	622,488,889	34	638,068,406

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.

Attach to Form 990 or Form 990-EZ. right arrow

See separate instructions.

OMB No. 1545-0047

2010

Open to Public
Inspection

Name of the organization

MEMORIAL HOSPITAL OF SOUTH BEND INC

Employer identification number

35-0868132

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

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

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

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

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

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

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

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

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

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

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

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

receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of

its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses

acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

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

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

Type I

Type II

Type III - Functionally integrated

Type III - Other

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

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

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

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

Yes

and (iii) below, the governing body of the the supported organization? ................

11g(i)

(ii) a family member of a person described in (i) above? ......................

11g(ii)

(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................

11g(iii)

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

(i) Name of supported organization	(ii) EIN	(iv) Is the organization in col. (i) listed in your governing document?		(v) Did you notify the organization in col. (i) of your support?		(vi) Is the organization in col. (i) organized in the U.S.?		(vii) Amount of support?
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of support?


Total

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2010

Page 2

Part II

Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2006	(b) 2007	(c) 2008	(d) 2009	(e) 2010	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3..
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public Support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year(or fiscal year beginning in)		(a) 2006	(b) 2007	(c) 2008	(d) 2009	(e) 2010	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11	Total support (Add lines 7 through 10).

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

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

Section C. Computation of Public Support Percentage

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

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

16a

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

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

17a

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

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

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

Schedule A (Form 990 or 990-EZ) 2010

Page 3

Part III

Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2006	(b) 2007	(c) 2008	(d) 2009	(e) 2010	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513..
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public Support (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2006	(b) 2007	(c) 2008	(d) 2009	(e) 2010	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13	Total support (Add lines 9, 10c, 11 and 12.).

Section C. Computation of Public Support Percentage

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

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

Section D. Computation of Investment Income Percentage

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

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

19a

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

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

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

Schedule A (Form 990 or 990-EZ) 2010

Page 4

Part IV

Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Explanation

Schedule A (Form 990 or 990-EZ) 2010

Additional Data

Software ID:
Software Version:

- TIN:

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

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

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

OMB No. 1545-0047

2010

Name of organization

MEMORIAL HOSPITAL OF SOUTH BEND INC

Employer identification number

35-0868132

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

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

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

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

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

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

Special Rules

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

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

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

Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990, or check the box in the heading of its
Form 990-EZ, or on line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2010)

Name of organization MEMORIAL HOSPITAL OF SOUTH BEND INC
Schedule B (Form 990, 990-EZ, or 990-PF) (2010) Page 1 of 1 of Part I
Part I	Contributors (see Instructions)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
RESTRICTED	RESTRICTED RESTRICTED RESTRICTED RESTRICTED, RESTRICTED RESTRICTED	$RESTRICTED	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Name of organization MEMORIAL HOSPITAL OF SOUTH BEND INC
Schedule B (Form 990, 990-EZ, or 990-PF) (2010) Page 1 of 1 of Part II
Part II	Noncash Property (see Instructions)
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Page 1 of 1 of Part III

Name of organization
MEMORIAL HOSPITAL OF SOUTH BEND INC

Employer identification number

35-0868132

Part III

Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
aggregating more than $1,000 for the year. (Complete columns (a) through (e) and the following line entry.)
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below.
SchCMd Bullet

Attach to Form 990 or Form 990-EZ. SchCMd Bullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public
Inspection

If the organization answered “Yes,” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes,” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes,” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35a (Proxy Tax), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

MEMORIAL HOSPITAL OF SOUTH BEND INC

Employer identification number

35-0868132

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization's direct and indirect political campaign activities on behalf of or in opposition to candidates for public office in Part IV.

Political expenditures .................................... SchCMd Bullet

Volunteer hours ........................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ......... SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ...... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............

Yes No

Was a correction made? .........................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c) except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt funtion activities .................................... SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b.. SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ..........................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2010

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check if the filing organization belongs to an affiliated group.
B Check if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated Group Totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......
b	Total lobbying expenditures to influence a legislative body (direct lobbying) .......
c	Total lobbying expenditures (add lines 1a and 1b) ...................
d	Other exempt purpose expenditures ........................
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ......................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) Total

2a	Lobbying non-taxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots non-taxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2010

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? .........................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....

Media advertisements? ....................................

Mailings to members, legislators, or the public? .........................

Publications, or published or broadcast statements? .......................

Grants to other organizations for lobbying purposes? .......................

Direct contact with legislators, their staffs, government officials, or a legislative body? ........

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......

Yes

14,727

Other activities? If "Yes," describe in Part IV ..........................

Total. lines 1c through 1i ...................................

14,727

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 .................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ................

Did the organization agree to carryover lobbying and political expenditures from the prior year? ..........

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) if BOTH Part III-A, lines 1 and 2 are answered “No” OR if Part III-A, line 3 is answered “Yes”.

Dues, assessments and similar amounts from members .....................

Section 162(e) non-deductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).

Current year .........................................

Carryover from last year ....................................

Total ...........................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................

Taxable amount of lobbying and political expenditures (see instructions) ..............

Part IV

Supplemental Information

Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; and Part ll-B, line 1i.
Also, complete this part for any additional information.

Identifier	Return Reference	Explanation
Lobbying Detail	Schedule C, Part IV	Memorial Hospital paid dues to the following organizations for which the percentage listed was attributable to lobbying: AASM (American Academy of Sleep Medicine) - 1% AORN (Association of periOperative Registered Nurses) - flat amount $26.94 AOTA (American Occupational Therapy Association) - 13% ASET, Inc (American Society of Electroneurodiagnostic Technologists) - flat amount $25 Dietary Managers Association, Inc. - 2% Indiana Chamber of Commerce - 18% Indiana Hospital Association - 5.45% ISMA (Indiana State Medical Association) - 26% Society of Nuclear Medicine, Inc - 2% AAFP (American Academy of Family Physicians) - 20% Chamber of Commerce of St. Joseph County - 5%

Schedule C (Form 990 or 990EZ) 2010

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11, or 12.
SchDMd Bullet

Attach to Form 990. SchDMd Bullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

MEMORIAL HOSPITAL OF SOUTH BEND INC

Employer identification number

35-0868132

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .......
2	Aggregate contributions to (during year) ...
3	Aggregate grants from (during year) ...
4	Aggregate value at end of year .......

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds may be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit. ...................................

Yes No

Part II

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

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

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

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a–2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06 ........	2d

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

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

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

Yes No

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

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

Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................

Yes No

In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116, not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116, to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:

(i)

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

(ii)

Assets included in Form 990, Part X .............................. SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 relating to these items:

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

Assets included in Form 990, Part X ............................... SchDMd Bullet

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

Cat. No. 52283D

Schedule D (Form 990) 2010

Page 2

Part III

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

Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

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

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

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

Yes No

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


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

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

Yes No

If “Yes,” explain the arrangement in Part XIV.

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current Year	(b)Prior Year	(c)Two Years Back	(d)Three Years Back	(e)Four Years Back
1a	Beginning of year balance ....
b	Contributions ........
c	Investment earnings or losses ...
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........
f	Administrative expenses ....
g	End of year balance ......

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

Board designated or quasi-endowment: SchDMd Bullet

Permanent endowment: SchDMd Bullet

Term endowment: SchDMd Bullet

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

Yes

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

3a(i)

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

3a(ii)

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

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

Part VI

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

Description of investment		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	18,964,553		18,964,553
b	Buildings ................	304,348,743	97,503,997	206,844,746
c	Leasehold improvements ............	722,092	698,406	23,686
d	Equipment ................	202,153,138	160,464,371	41,688,767
e	Other .................	15,018,198	2,627,651	12,390,547
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........				279,912,299

Schedule D (Form 990) 2010

Page 3

Part VII

InvestmentsOther Securities. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)		(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
(3)Other (A) BOND RESERVE FUND		53,000
(B) ALTERNATIVE INVESTMENTS		99,464,740







Total. (Column (b) should equal Form 990, Part X, col.(B) line 12.)		99,517,740

Part VIII

InvestmentsProgram Related. See Form 990, Part X, line 13.

(a) Description of investment type		(b) Book value	(c) Method of valuation: Cost or end-of-year market value









Total. (Column (b) should equal Form 990, Part X, col.(B) line 13.)

Part IX

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

(a) Description				(b) Book value









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

Part X

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

1.(a) Description of Liability		(b) Amount
Federal Income Taxes		0
ASSET RETIREMENT OBLIGATION		4,137,590
INTEREST RATE SWAP		36,316,078
CAPITAL LEASE PAYABLE		1,707,226
BOND ARBITRAGE REBATE PAYABLE		3,126,353





Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)		45,287,247
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).

Schedule D (Form 990) 2010

Page 4

Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1	Total revenue (Form 990, Part VIII, column (A), line 12) ....................	1	395,009,854
2	Total expenses (Form 990, Part IX, column (A), line 25) .....................	2	360,106,941
3	Excess or (deficit) for the year. Subtract line 2 from line 1 .............	3	34,902,913
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	-37,917,238
9	Total adjustments (net). Add lines 4 - 8 .............................	9	-37,917,238
10	Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 .........	10	-3,014,325

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	378,814,938
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a	13,417,708
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIV): ............	2d	-27,657,429
e	Add lines 2a through 2d .....................			2e	-14,239,721
3	Subtract line 2e from line 1.....................			3	393,054,659
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	1,955,195
c	Add lines 4a and 4b.......................			4c	1,955,195
5	Total Revenue. Add lines 3 and 4c. (This should equal Form 990, Part I, line 12.) ......			5	395,009,854

Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1	Total expenses and losses per audited financial statements .............			1	360,111,101
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	4,160
e	Add lines 2a through 2d......................			2e	4,160
3	Subtract line 2e from line 1.....................			3	360,106,941
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	360,106,941

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
Change in Net Assets	Part XI Reconciliaton of Change in Net Assets from 990 to Audited Fin Stmt	Unrealized Loss on Swap Transactions (27,671,589) Transfers to Affiliates (21,016,908) Change in Interest in Recipient Org (2,759,849) Unrealized Gain on Investments 13,417,708 Capital Contributions 113,400 Total (37,917,238)
Reconciliation of Revenue	Part XII Reconciliation of Revenue per Audited Fin Stmt w Revenue per 990	Line 2d Other South Bend Chocolate Cafe Expense 15,164 Unrealized Loss on Swap Transaction (27,671,589) Expense Posted to Revenue (1,004) TOTAL (27,657,429) Line 4b Other Net Assets Released 1,955,195
Reconciliation of Expenses	Part XIII Reconciliation of Expenses per Audited Fin Stmt w Exp per 990	Line 2d South Bend Chocolate Cafe 15,164 Ambulance donation (10,000) Expense classified as revenue 1,004) TOTAL 4,160

Schedule D (Form 990) 2010

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE F
(Form 990)

Department of the Treasury
Internal Revenue Service

Statement of Activities Outside the United States

Complete if the organization answered "Yes" to Form 990,
Part IV, line 14b, 15, or 16.
Right pointing arrow large image

Attach to Form 990. Right pointing arrow large image

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization
MEMORIAL HOSPITAL OF SOUTH BEND INC

Employer identification number

35-0868132

Part I

General Information on Activities Outside the United States. Complete if the organization answered
“Yes” to Form 990, Part IV, line 14b.

For grantmakers. Does the organization maintain records to substantiate the amount of the grants or

assistance, the grantees' eligibility for the grants or assistance, and the selection criteria used to award

the grants or assistance? ...................................

Yes

For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of grant funds outside the
United States.

Activites per Region. (Use Part V if additional space is needed.)

(a) Region		(d) Activities conducted in region (by type) (e.g., fundraising, program services, investments, grants to recipients located in the region)	(f) Total expenditures for region/investments in region
	Central America and the Caribbean	Investments	81,581,380
















3a	Sub-total .....		81,581,380
b	Total from continuation sheets to Part I ...
c	Totals (add lines 3a and 3b)		81,581,380

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2010

Schedule F (Form 990) 2010

Page 2

Part II

Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" to Form 990,

Part IV, line 15, for any recipient who received more than $5,000. Check this box if no one recipient received more than $5,000 ........ MediumBullet

Use Part V if additional space is needed.

1 (a) Name of organization		(b) IRS code section and EIN (if applicable)	(c) Region	(d) Purpose of grant	(e) Amount of cash grant	(f) Manner of cash disbursement	(g) Amount of of non-cash assistance	(h) Description of non-cash assistance	(i) Method of valuation (book, FMV, appraisal, other)

Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter ..... MediumBullet

Enter total number of other organizations or entities ........................ MediumBullet

Schedule F (Form 990) 2010

Schedule F (Form 990) 2010Page 3

Part III

Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 16.

Use Part V if additional space is needed.

(a) Type of grant or assistance		(b) Region	(c) Number of recipients	(d) Amount of cash grant	(e) Manner of cash disbursement	(f) Amount of non-cash assistance	(g) Description of non-cash assistance	(h) Method of valuation (book, FMV, appraisal, other)

Schedule F (Form 990) 2010

Page 4

Part IV

Foreign Forms

Schedule F (Form 990) 2010

Page 5

Part V

Supplemental Information
Complete this part to provide the information (see instructions) required in Part I, line 2, and any additional information.

Identifier	ReturnReference	Explanation

Schedule F (Form 990) 2010

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

MEMORIAL HOSPITAL OF SOUTH BEND INC

Employer identification number

35-0868132

Part I

Charity Care and Certain Other Community Benefits at Cost

Yes

Does the organization have a charity care policy? If "No," skip to question 6a...........

Yes

If "Yes," is it a written policy? .......................

Yes

If the organization has multiple hospitals, indicate which of the following best describes application of the charity care policy to the various hospitals.

Applied uniformly to all hospitals Applied uniformly to most hospitals Generally tailored to individual hospitals

Answer the following based on the charity care eligibility criteria that applies to the largest number of the organization's patients.

Does the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care to low

income individuals? If "Yes," indicate which of the following is the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other

Does the organization use FPG to determine eligibility for providing discounted care to low income individuals? If

"Yes," indicate which of the following is the family income limit for eligibility for discounted care: .....

Yes

200% 250% 300% 350% 400% Other

If the organization does not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization uses an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.

Does the organization's policy provide free or discounted care to the "medically indigent"? ......

Yes

Does the organization budget amounts for free or discounted care provided under its charity care policy? ...

Yes

If "Yes," did the organization's charity care expenses exceed the budgeted amount?.........

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discounted
care to a patient who was eligibile for free or discounted care?...............

Does the organization prepare an annual community benefit report?.............

Yes

If "Yes," does the organization make it available to the public? ..............

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Charity Care and Certain Other Community Benefits at Cost

	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a Charity care at cost (from Worksheets 1 and 2) ..	6,812,762		6,812,762	2.110 %
b Unreimbursed Medicaid (from Worksheet 3, column a) .	50,709,192	19,718,568	30,990,624	9.600 %
c Unreimbursed costs—other means-tested government programs (from Worksheet 3, column b) ....
dTotal Charity Care and Means-Tested Government Programs .....	57,521,954	19,718,568	37,803,386	11.710 %
Other Benefits e Community health improvement services and community benefit operations (from (Worksheet 4) ....	3,998,651	712,373	3,286,278	1.020 %
f Health professions education (from Worksheet 5) ..	6,051,113	2,405,868	3,645,245	1.130 %
g Subsidized health services (from Worksheet 6) ..
h Research (from Worksheet 7)	820,036	697,447	122,589	0.040 %
i Cash and in-kind contributions to community groups (from Worksheet 8) ..	1,098,235	225,085	873,150	0.270 %
jTotal Other Benefits ...	11,968,035	4,040,773	7,927,262	2.460 %
kTotal. Add lines 7d and 7j. ..	69,489,989	23,759,341	45,730,648	14.170 %

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2010

Schedule H (Form 990) 2010

Page 2

Part II

Community Building Activities Complete this table if the organization conducted any community building activities.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Does the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Enter the amount of the organization's bad debt expense (at cost).....

14,791,196

Enter the estimated amount of the organization's bad debt expense (at cost) attributable to patients eligible under the organization's charity care policy ..

7,395,598

Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

74,496,965

Enter Medicare allowable costs of care relating to payments on line 5.....

90,796,161

Subtract line 6 from line 5. This is the surplus or (shortfall)........

-16,299,196

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.
Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.
Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Does the organization have a written debt collection policy? ...............

Yes

If "Yes," does the organization's collection policy contain provisions on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance? Describe in Part VI......

Yes

Part IV

Management Companies and Joint Ventures

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership%	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2010

Page 3

Part VFacility Information

Section A. Hospital Facilities (list in order of size, measured by total revenue per facility, from largest to smallest) How many hospital facilities did the organization operate during the tax year?1 Name and address		Other (Describe)
1	Memorial Hospital of South Bend 615 N Michigan Street South Bend,IN46601	X	X	X	X	X	X

Schedule H (Form 990) 2010

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)

Name of Hospital Facility:Memorial Hospital of South Bend

Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

				Yes	No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1	During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. .....................		1
	If “Yes,” indicate what the Needs Assessment describes (check all that apply):
	a	A definition of the community served by the hospital facility
	b	Demographics of the community
	c	Existing health care facilities and resources within the community that are available to respond to the health needs of the community
	d	How data was obtained
	e	The health needs of the community
	f	Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
	g	The process for identifying and prioritizing community health needs and services to meet those needs
	h	The process for consulting with persons representing the community’s interests
	i	Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
	j	Other (describe in Part VI)
2	Indicate the tax year the hospital facility last conducted a Needs Assessment: 20
3	In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted.		3
4	Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................		4
5	Did the hospital facility make its Needs Assessment widely available to the public? ...........		5
	If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
	a	Hospital facility’s website
	b	Available upon request from the hospital facility
	c	Other (describe in Part VI)
6	If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
	a	Adoption of an implementation strategy to address the health needs of the hospital facility’s community
	b	Execution of the implementation strategy
	c	Development of a community benefit plan for the facility
	d	Participation in community-wide community benefit plan
	e	Inclusion of a community benefit section in operational plans
	f	Adoption of a budget for provision of services that address the needs identified in the CHNA
	g	Prioritization of health needs in the community
	h	Prioritization of services that the hospital facility will undertake to meet health needs in its community
	i	Other (describe in Part VI)
7	Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs.		7
Financial Assistance Policy
	Did the hospital facility have in place during the tax year a written financial assistance policy that:
8	Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?		8
9	Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?..		9
	If “Yes,” indicate the FPG family income limit for eligibility for free care: %

Schedule H (Form 990) 2010

Page 5

Part VFacility Information (continued)

				Yes	No
10	Used FPG to determine eligibility for providing discounted care to low income individuals?.........		10
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: %
11	Explained the basis for calculating amounts charged to patients?.................		11
	If “Yes,” indicate the factors used in determining such amounts (check all that apply):
	a	Income level
	b	Asset level
	c	Medical indigency
	d	Insurance status
	e	Uninsured discount
	f	Medicaid/Medicare
	g	State regulation
	h	Other (describe in Part VI)
12	Explained the method for applying for financial assistance?...................		12
13	Included measures to publicize the policy within the community served by the hospital facility?.......		13
	If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
	a	The policy was posted at all times on the hospital facility’s web site
	b	The policy was attached to all billing invoices
	c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
	d	The policy was posted in the hospital facility’s admissions offices
	e	The policy was provided, in writing, to patients upon admission to the hospital facility
	f	The policy was available upon request
	g	Other (describe in Part VI)
Billing and Collections
14	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........		14
15	Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments or arrests
	e	Other (describe in Part VI)
16	Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?...................................		16
	If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments
	e	Other (describe in Part VI)
17	Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
	a	Notified patients of the financial assistance policy upon admission
	b	Notified patients of the financial assistance policy prior to discharge
	c	Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
	d	Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
	e	Other (describe in Part VI)

Schedule H (Form 990) 2010

Page 6

Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
				Yes	No
18	Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..........		18
	If “No,” indicate the reasons why (check all that apply):
	a	The hospital facility did not provide care for any emergency medical conditions
	b	The hospital facility did not have a policy relating to emergency medical care
	c	The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
	d	Other (describe in Part VI)
Charges for Medical Care
19	Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
	a	The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
	b	The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
	c	The hospital facility used the Medicare rate for those services
	d	Other (describe in Part VI)
20	Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?.........		20
	If “Yes,” explain in Part VI.
21	Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?...................................		21
	If “Yes,” explain in Part VI.

Schedule H (Form 990) 2010

Page 7

Part VFacility Information (continued)

Section C. Other Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, measured by total revenue per facility, from largest to smallest) How many non-hospital facilities did the organization operate during the tax year?6
Name and address		Type of Facility (Describe)
1	MEMORIAL SLEEP DISORDER CENTER 53990 CARMICHAEL DRIVE SOUTH BEND,IN46601	OUTPATIENT CLINIC PROVIDING SLEEP RELATED DIAGNOSIS AND TREATMENT
2	MEMORIAL SLEEP DISORDER CENTER 53990 CARMICHAEL DRIVE SOUTH BEND,IN46601	OUTPATIENT CLINIC PROVIDING SLEEP RELATED DIAGNOSIS AND TREATMENT
3	MEMORIAL SLEEP DISORDER CENTER 53990 CARMICHAEL DRIVE SOUTH BEND,IN46601	OUTPATIENT CLINIC PROVIDING SLEEP RELATED DIAGNOSIS AND TREATMENT
4	MEMORIAL SLEEP DISORDER CENTER 53990 CARMICHAEL DRIVE SOUTH BEND,IN46601	OUTPATIENT CLINIC PROVIDING SLEEP RELATED DIAGNOSIS AND TREATMENT
5	MEMORIAL SLEEP DISORDER CENTER 53990 CARMICHAEL DRIVE SOUTH BEND,IN46601	OUTPATIENT CLINIC PROVIDING SLEEP RELATED DIAGNOSIS AND TREATMENT
6	MEMORIAL SLEEP DISORDER CENTER 53990 CARMICHAEL DRIVE SOUTH BEND,IN46601	OUTPATIENT CLINIC PROVIDING SLEEP RELATED DIAGNOSIS AND TREATMENT
7
8
9
10

Schedule H (Form 990) 2010

Page 8

Part VI

Supplemental Information

Complete this part to provide the following information.

1	Required descriptions. Provide the description required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 2, 4c, 6i, 7, 11i, 13i, 17l, 18l, 19e, 21d, 25, and 26.
2	Community health needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any community health needs assessments reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Identifier	ReturnReference	Explanation
Part I, Line 3c		Not applicable
Part I, Line 6a		The Community Benefit Fund is the System's mechanism for re-investing funds to improve the health status of communities it serves. The System, which includes Memorial Hospital of South Bend Inc., tithes 10% of the previous year's bottom line and transfers it to the Community Benefit Fund for investment in the community. This investment is in addition to the Hospital's charity care and prevention, and education activities supported through its operating budget. The Community Health Enhancement Committee of the Board began the fund in 1993 and makes ongoing policy and oversees the administration of the fund and determines specific investment allocations. Volunteers and staff are committed to prudently investing these resources in an accountable manner. As a community not-for-profit organization, we take seriously our responsibility to invest our resources and energies into understanding and meeting the divergent health care needs of all, and ensure that everyone, regardless of their ability to pay, receives the care they need. Memorial has long been recognized for the collaboration efforts which engage individuals and organizations with diverse socio-economic religious, ethnic, race, age, and gender identity characteristics. Our team of passionate and dedicated health care professionals, along with many partners throughout the Northern Indiana and Southern Michigan (Michiana) region, helped us contribute significantly to the health and well-being of our community. In 2010, we provided charity care to 7,139 individuals. Further, Memorial plays a key role in serving the community as a whole. However, the above is only part of Memorial's community service and investment of the benefit's story. This report paints a picture, of how we touch and improve the health and the quality of lives throughout Michiana. It is a testimony to the commitment and leadership of our medical staff, volunteer board of trustees, employees, auxiliary volunteers, and community partners, whose dedication to serve, touch many lives and make our community a better place to live, work, and play.
Part I, Line 7, Column F		Bad Debt Expense removed from Total Expenses $37,433,659
Part I, Line 7g		Not applicable
Costing Methodology	Part I, Line 7	Donations - the actual cost of the donation or departmental net contribution, whichever is appropriate, from General Ledger records and reports are included In-Kind/Volunteer Services - When a specific person is listed as the event volunteer, the YTD hourly wage is pulled from the labor distribution report for 12/31, multiplied by the number of hours at the event or events. When a specific job class is listed (i.e. "peds rehab"), the average hourly wage is computed for all employees in that job class and department and used in the same manner. Benefits are added to each at a ratio of benefit dollars to total salaries, multiplied by total salaries calculated for the event.
Part III, Line 4		The Corporation evaluates the collectability of its accounts receivable based on the length of time the receivable is outstanding, payor class, and the anticipated future uncollectible amounts based on historical experience. Accounts receivable are charged to the allowance for doubtful accounts when they are deemed uncollectible. Costing methodology is the same as tax form 990, schedule H, worksheet 2 methodology. Patient care cost adjusted by non-patient activity, expenses, and patient care charges.
Rationale for inclusion of the Medicare shortfall as a Community Benefit	Part III, Line 8	Participation in the governmental Medicare program does not provide the opportunity for a hospital to negotiate a reimbursement rate or structure that would allow the hospital to cover the cost of the medical service rendered to the program participant, as would be the case in contractual negotiations with commercial insurance companies. Nor is the hospital allowed to provide only the services for which reimbursement covers the direct cost of care. This produces the same shortfall outcome as does the participation in the Medicaid program. The Medicaid program is recognized as a community benefit on Schedule H and on community benefit reports for most states. The quality and cost of the patient care is the same regardless of payor source. Hence the acceptance of Medicare reimbursement represents a reduction or relief of the government burden to pay the full cost of care provided.
Financial Assistance Policy	Part III, Line 9b	The collection policy and procedures are as follows related to patients who are known to qualify for charity care or financial assistance: To ensure the Hospital fulfills its mission and commitment to the poor, the Hospital shall annually plan for and provide free health care and health-related services to the poor and qualified uninsured/underinsured. A patient is considered for Financial Assistance if all other State and Federal assistance opportunities have been exhausted. The Federal Income and Poverty Guidelines will serve as a guide in determining those patients that may qualify for Financial Assistance. All patients shall be treated consistently in the approval process including Medicare and non Medicare patients. PURPOSE: To provide financial assistance to those patients who cannot afford to pay and to provide discounted care to uninsured patients receiving healthcare services from Memorial Hospital of South Bend. PROCEDURE: 1.Memorial Hospital will assist patients in making a determination regarding whether or not the patient may be able to qualify for some form of entitlement through a Federal or State Government program and complete the appropriate applications for assistance. It is required that the patient will assist in the determination and application process. If the patient does not qualify for any Federal or State Assistance, we will start the Financial Assistance Approval process. 2.Identify patients potentially eligible for Financial Assistance through the pre-registration, admission, eligibility process, or through self pay account review and collection activities. 3.Provide to the patient a Financial Evaluation form. 4.Obtain or receive a signed, completed Financial Evaluation Form from the patient. 5.Determine eligibility by obtaining the following information from the patient: a)Gross income and most recent W-2 b)Prior years tax return (including all schedules) c)Last 3 pay stubs (if unemployed, Work One statement of earnings) d)Employment status and future earnings capacity e)Family size f)Medical expenses including drugs and medical supplies g)Last three bank statements If the patient does not have a prior year tax return, we will make our determination based on current income. A credit report may be run to substantiate documentation. There may be circumstances where a patient may not be able to provide all the above documentation needed to approve financial assistance. It will be up to the discretion of the Department Director and/or the CFO to grant approval in this circumstance. 6.Determine the amount of Financial Assistance by utilizing the Federal Poverty guidelines as a basis for qualification levels. Gross Annual income plus cash assets are used as the basis for income calculations. Financial Assistance will be granted for those patients who are homeless. If a patient is deceased and has no estate, we will grant charity on any outstanding self pay account balances. Documentation that an estate has not been filed will be attached to the Financial Assistance approval form. Note: Approval may be made based on Medical indigence. ie: Patients who have excessive pharmacy, oxygen, or ongoing medical expense. This amount would be deducted from their gross income. Financial Assistance will not be granted for non-medically necessary services. 7.Complete the Financial Assistance Approval form and forward to the Collection Coordinator. 8.The Collection Coordinator will review the Financial Assistance application to ensure that it is complete. The Coordinator will approve or deny the application before sending it to the Patient Account Manager for approval. Depending on the dollar amount of the financial assistance write off, approval signatures are required. The approval guidelines are as follows: $1.00 to $2,500.00 Collection Coordinator $2,501.00 to $10,000.00 Patient Account Service Manager $10,001.00 to $25,000.00 Director, Patient Account Services $25,001.00 and above Vice President, CFO 9. After all the appropriate signatures have been obtained, the Financial Assistance write off along with the corresponding documentation will be forwarded to Cash Application for write off. 10.Send determination letter to notify patient of the approval for Financial Assistance. 11.Financial Assistance approvals will apply retroactively to all open accounts with existing balances (including accounts in collections) and will be active for 6 months following the date of approval. 12.The document will be placed in the Financial Assistance file drawer under the date the write off was posted. UNINSURED SELF PAY DISCOUNTS For those patients who have no insurance and do not meet the above financial assistance guidelines, Memorial Hospital will provide an uninsured discount based on the following tiered structure: 30% discount if account is paid within 30 days from date of service 20% discount if account is paid within 90 days from date of service 10% discount if patient chooses to participate in the CarePayment financing Any exceptions must be approved by the Department Manager or Director.
Needs Assessment	Part VI, Line 2	At Memorial Hospital and Health System, our goal is to strengthen the health and well-being of our individual patients and neighbors, as well as the broader community. Grant dollars totaling $2,174,024 were obtained and blended with Memorial tithing dollars to deliver services and programs that impacted the physical health, mental health and quality of life of tens of thousands of individuals and families. Memorial invested $2,737,938 of tithing funds in community benefit, which in a time of economic upheaval is more important to building the vitality of our community than ever before. The services we provide are essential to not only the community's overall health, but also to the quality of life of every resident. This belief is supported in our culture; our volunteer board of trustees, physicians, nurses, patient care and support staff, and auxiliary volunteers take pride in the community outreach we do in the neighborhoods. It takes a whole system working together and committed to serving the inhabitants of our community. Our community is becoming increasingly diverse. The health risks associated with chronic diseases like diabetes, hypertension, and obesity, are particularly high among our growing, and often medically underserved, Hispanic and African-American populations. We reach out to these groups through churches, local community organizations, and grassroots efforts. Our goal is to help all residents access the care they need; to help them learn to manage their conditions and live healthier lives. In the past year, we collaborated with a number of organizations to gather information about the needs and strengths of our community residents. This information helps us to collaboratively determine our short- and long-term priorities as well as strategies for improving the overall community. Community Plunges provide opportunities for community and hospital leadership to spend time in the neighborhoods meeting with grassroots leaders and neighbors. Getting acquainted with the reality that many of us never see, and do not understand. Community Plunges have become a mainstay of Memorial's research into health and social ills as well as assets and strengths that influence and shape our community. (Plunges are offered annually, beginning in 1988 through 2010.) A committee of the Board of Trustees provides input and oversight into the decision-making of partnership opportunities, addressing the needs, building on the strengths of the community, and setting priorities for resource allocation. The Board Committee is composed of community members who serve on the four System-wide Boards of Directors. In addition, the division of Community Health Enhancement staff and employees of the Hospital and System are seated on most of the social service and health agencies boards and task forces in the community. This involvement provides a vehicle for ongoing communication, which flows continuously between the hospital and the community. The St. Joseph County Health Department Board is chaired by Memorial's Chief Nursing Officer. The CNO also has taken the lead in emergency preparation for the entire county. The greatest health and quality of life needs identified by the community include: - Access to primary and specialty care for the uninsured - Minorities disparities and access to prevention and disease management - Teen pregnancy and minority infant mortality In the coming year, the Hospital will be participating with the Health Department to develop the St. Joseph County Local Public Health System Performance Assessment as part of the State Department of Health's Indiana Public Health System Quality Improvement Program. Once this infrastructure is built through the identification and partnership of key stakeholders, the next activity will be the design and execution of the Community Health Needs Assessment. The projected timeline continues into the spring of 2012 through the strategic identification and planning stage to the implementation of activities to support the objectives based upon the priorities evidenced by the data.
Patient Education and Eligibility for assistance	Part VI, Line 3	When uninsured patients present to our hospital, they are offered the opportunity to meet with our eligibility specialists. Our eligibility specialists discuss the potential eligibility of the patient for multiple assistance programs, including our own internal financial assistance program. Our statements also include a notice that financial assistance is available to patients, and they can contact our customer service group for guidelines.
Community Information	Part VI, Line 4	Hoosier Healthwise (HHW), Children of Special Health Care Services, and Healthy Indiana Plan (HIP), are programs provided through the State of Indiana, to provide health care for children, and adults ages ranging from birth to 64 years of age, as well as children with special health care needs and developmental delays. The Community Health Enhancement team provides education, resources and assistance for community-based enrollment for individuals and families in our community for these programs. Spanish-speaking team members assist with enrollment at all community sites. In 2010, the Community Health Enhancement team facilitated needed coverage being obtained for over 700 individuals in our community. Community Information (geography and demographics) Established in 1830, St. Joseph County, Indiana has become the fourth largest county in the state of Indiana. The county spans 467 square miles, which includes a comfortable mix of rural cultural heritage and urban amenities. St. Joseph County is also the regional center for higher education. The County is home to more than eight colleges and universities including but not limited to Notre Dame University, Indiana University, Purdue Ext., Bethel University and St. Mary's College. The heart of the Health System is located within a mile of the University of Notre Dame, 10 miles south of the Michigan state line, and 40 miles east of Lake Michigan. Through the years, the environment of South Bend, the largest city in St. Joseph County, has changed from a focus on manufacturing (Studebaker and Uniroyal) to one of service industry. In fact, among the ten largest employers in the county, just two represent manufacturing. The University of Notre Dame is the largest employer, followed by Memorial Health System, the South Bend Community School Corporation, AM General, and St. Joseph Regional Medical Center. St. Joseph County, the five contiguous counties comprising its secondary service area and 12 counties in its tertiary service area are characterized by a mix of small to mid-size metropolitan areas and rural communities. Population mix is diverse and includes large numbers of first-generation European immigrants, African Americans, Asians, Hispanics, and Amish. The population for St. Joseph County in 2010 was 268,299 individuals. The race in the County is 80% Caucasians, 11.8% African America, and Hispanics represent 6.6, with 1.6 listed as Other. As expected, with an area saturated with post-secondary education, the county has higher than would be projected educational level. Thirty-three percent of the population is high school graduates, 19.4% have some college, 23.3% have graduated from college, and 10.3% have completed post graduate classes. The average household income was $61,271. Of the primary and secondary Memorial service area, St. Joseph County is the largest, with a population just over 274,372 followed by Elkhart County with just over 197,098. Elkhart County continues to have an industrial focus as a major center of the automotive, recreational vehicle, manufactured housing and musical instrument industries. Additional secondary service area counties and their populations include Berrien (MI) 174,642, LaPorte (IN) 109,124; Cass (MI) 43,701 and Marshall (IN) 50,099. Our service area includes patients from St. Joseph and surrounding counties in Indiana and Michigan; a pediatric emergency transport program serving 18 counties; and our MedFlight helicopter that covers communities within a 150-mile radius. We have the region's only Level 3 Newborn Intensive Care Unit, the only Pediatric Intensive Care Unit and the only Pediatric Hematology/Oncology program in the area. Memorial is also the only hospital in the region with Pediatric Hospitalist and Child Life programs. Memorial is not only recognized nationally as a leader in providing high quality care, but also as a leader in innovation, offering new approaches to patient satisfaction and customer service that set us apart from other health care providers. As the region's only designated children's hospital, Memorial Children's Hospital welcomes and treats children with a wide variety of medical and surgical diagnoses from more than 20 referral hospitals throughout Southwestern Michigan and Northern Indiana. Our world-class team includes pediatric hospitalists and intensivists, registered nurses, child life specialists, pediatric diabetic educators, pediatric dietitians, social workers, neonatologists, pediatric oncologists, respiratory therapists, clinical nurse specialists, pastoral care, and pediatric specialists in physical therapy, pulmonary medicine and infectious disease. Memorial Hospital and Health System also serves the community with Memorial Neighborhood Health Center - Southeast Clinic, and the Central Neighborhood Clinic at the Center for the Homeless. These two clinics offer primary health care services including all basic services as well as family planning and reproductive health, low-risk obstetrics, and colonoscopy services. Services are available to anyone, and our fees are within the customary range for your community. We accept Medicaid, Medicare and private insurance, and offer a sliding fee scale based on income guidelines for uninsured. We also participate in Hoosier Healthwise, the CHIP program that provides healthcare for Indiana children, pregnant women and low-income families. Other hospitals in our region include: St. Joseph Regional Medical Center, Elkhart General Hospital, Goshen Hospital and Lakeland Health Care. Education and Research for a Healthy Future We consider education and research to be part of our mission. Each is vital to preparing the next generation of health care professionals to meet future health care demands. As our country ages, we will need more caregivers than ever before; at the same time, there is a shortage of new graduates in key clinical and technical positions. To ensure that we have the quality workforce we need to care for our patients in the future, we are committed to the education of current and future caregivers, and have partnered with local high schools, colleges, universities and Indiana University Medical School at Notre Dame. Preparing for tomorrow's health care needs also requires a commitment to researching new and innovative treatments that battle tomorrow's health care challenges. Clinical research is a part of programming across the Health System. Memorial Medical Group participates in a significant number of pharmaceutical trials annually; physicians in the Hospital participate in various research projects that are national in scope and are evaluated by FDA guidelines by Memorial's Institutional Review Board. Memorial is also a member of an Oncology Consortium which does cancer-related research with grants funding in excess of $853,600. Our medical staff is working to find tomorrow's treatments and cures today. Research also evolves from the nursing, pre-medical and social service disciplines at the local post-secondary education institutions. The University of Notre Dame is a close partner in community-based research, which includes evaluating education curricula, intervention modalities, and quantitative analysis as well as qualitative research methods. Together, we offer a comprehensive learning experience for medical students, enabling interns, residents, and fellows to utilize our state-of-the-art training facilities and integrate advanced technology learned in the classroom directly with patient care. Together, we further the evidence of community-based research in addition to clinical research, particularly in the intersection of neuroscience and medical interventions, such as the impact of chemotherapy on the memory and cognitive functioning of breast cancer victims.
Community Building Activities	Part VI, Line 5	All information included in Part I, see 'Other Information Required'.
Part VI, Line 6		Community plunges were developed at Memorial 23 years ago. The first was the Aging Plunge, which looked at the plight of an aging society, living independently as long as possible, often isolated, suffering from depression, had little opportunities for socialization, and was mismanaging their health with polypharmacy resulting in counter indications, and dangerous interactions, from seeing different physicians to treat many different diseases and ailments. Board members, staff, and community leaders spend a few hours together delving into the problems confronting our society; personally interacting with an Alzheimer's victim, a gang member, a cocaine addict, a child in the midst of family and neighborhood, a mother whose two-year-old had suffered a Sickle Cell stroke, homeless children with developmental delays, bright children of immigrants without citizenship and in dead-in jobs, rural communities without sufficient access to medical care, pregnant teens, and high school drop-outs. In 2010, Memorial invested $26,087 in acquainting Community Leaders with the needs in the community through their participation in plunges. Over the past two decades, these forays into the community have educated us about the reality of poverty, of being uninsured, pregnant with the tenth child, with only two living babies, both with severe disabilities. The stories often move us to tears, which makes the learning even more poignant and the reality more urgent. Two plunges that have influenced outreach programming have been (a) "Enough is Enough: Violence as a Public Health Mandate," and (b) "High School Drop Out" which incorporated a number of opportunities for youth who had dropped out to tell their stories about the bearing it has had on their life and economic health. Included in the plunge was "The Pact" - shared by three doctors who grew up in public housing in Newark; had brushes with the law, and succeeded in their middle-school pact to become doctors. The teens from Washington High School, who spent time with The Three Doctors, developed an anti-violence mime which was produced along with a discussion guide by the group. The students then formed and named their team 212-degrees. This skit and the 212-degree teens were instrumental in participating in the Civic League's competition which resulted in South Bend being named one of the top ten cities in the nation. Quality of Life Programs Memorial's Community Health Enhancement team innovatively served Michiana with a wide range of effective, evidence-based and fiscally-responsible programs and initiatives in 2010. Community Health Enhancement's programs reached across the life span, ensuring healthy pregnancies, productive senior years, and proactive disease management now and wise investment in our community's future. Pre-Natal Programs Community Health Enhancement's team provided a variety of programs for expectant mothers with two common goals - helping the women stay healthy, and helping their babies be born healthy - and one common denominator: caring staff skillful at building trusting relationships. Specific 2010 highlights include: Keeping pregnant women alcohol free throughout pregnancy through Foundations for Alcohol Cessation, Education, and Support. Educators teach expectant women about alcohol's harmful effects on fetal brain development and screen for alcohol use during pregnancy. 22% of women screened in 2010 received an intervention, and 98% who were followed remained alcohol-free throughout their pregnancy. Numbers Served: 3,271 The establishment of Black American Mothers Breastfeeding Awareness Initiative, a local initiative to increase awareness of the benefits of breastfeeding throughout the African American Community. This group is also studying reasons African American women are less inclined to breastfeed than their white and Latina peers. Bedtime Basics for Baby: This First Candle program educates families about safe infant sleep practices and provides free pack and play cribs. Numbers Served: 180 Pre-natal Care Coordination educators work with clients to reduce barriers to receiving prenatal care and connect them with resources such as breastfeeding classes, medical and mental health care providers and insurance programs, programs teaching parenting and childcare skills, immunization resources, and the BABE store. 275 Pregnant women were served, Almost daily science and medicine are making groundbreaking discoveries that will forever change how we: -focus on building a strong brain foundation during the critical early childhood development years, -help teens navigate new brain impulses toward risky behaviors on their way to learning reasoning and judgment, -understand and use our own brain to find efficiency, focus, and calm in this overwhelming world of many distractions and obligations, -best assure a vibrant mind and working memory able to be resilient against Alzheimer's and dementia. In 2010, BrainWorks continued innovating at the intersection of lifestyle, science and medicine offering actionable step to bring the insights of neuroscience into daily life to a total of over 4600 attendees. Feedback from programs confirmed the relevance of this information with 88% of individuals stating that some or all the information they learned was new to them, and that they intended to make changes in their life because of it. BrainWorks chartered new territory in an early childhood development plunge by bringing together the views from academic research, pediatrics and NICU care, school psychology, and parenting for an art based learning journey about best practices in early childhood brain health and development. In follow-up to this, BrainWorks awarded mini-grants of up to $5,000 to each of five local non-profits so they could add brain-based childhood development programming to their services to children between the ages of 0 - 4, or to create additional capacity in well orchestrated existing programs that support healthy brain development. This nicely supplemented the success BrainWorks achieved in influencing mother/child play practices through the redesign of play spaces, the most recent of which was implemented at the YWCA in conjunction with and with support from the Junior League of South Bend's Done in a Day projects. In the business community, BrainWorks provided 65 brain health based programs to 1775 individuals ranging from a full-day conference to the Mendoza School of Business team to break out sessions for the St. Joseph County Public Libraries professional development day to being part of courses offered at IUSB, Holy Cross College, and the University of Notre Dame. BrainWorks continue to partner with others for the purpose of contributing to research that results in useable information to our community. In conjunction with Indiana University South Bend and Memorial Sleep Lab, BrainWorks kicked off a research project exploring the impact of sleep variability on cognitive processes in two differently aged populations. Running concurrently with this, and staged to begin in spring of 2011, a second research project assessing a non-medical protocol to improve the side effects of Community Health Enhancement commonly called chemobrain will begin. And lastly, BrainWorks was proud to be able to continue the over a decade long tradition of bringing national experts in to speak to the community. Dr. Bruce Perry, national expert in brain-based remediation for children of trauma presented to service providers, physicians, and the general public. And through the generous support of the Butler-Oare Foundation, Dr. James Rippe, national lifestyle medicine expert provided an educational program for the physicians of our community and a complementary evening program to the public on improving mind and body health through lifestyle changes. Health Education and Outreach for At-Risk, Underserved Populations The Health System's innovative community outreach has received national recognition for models of involvement as well as state and federal grants to assist in the support of some of these programs. African American Women in Touch, provides breast care information, education, and screenings. Forty women were referred to the free community-based gestational diabetes program (Bebes Dulces sin Azucar: Sweet Babies without Sugar); there were no babies born over ten pounds, overall birth outcomes were positive, and mothers returned to normal glucose readings six-weeks post-partum. Memorial was in collaboration with the Health Department to address the potential influenza pandemic; as well as preparing the community for a national and/or regional disaster. Additional Spanish-speaking education and screens for cancer included breast screens for Latino women, and Latino men were screened for prostate cancer. A program for African American men had been introduced at a local barbershop, to increase awareness and encourage men to make behavioral changes to monitor their blood pressur
Affiliated Health Care System Roles		See 'Other Information Required'.
Financial Assistance		Patients are notified on their statements that financial assistance is available.
Charges for Medical Care		Uninsured patient accounts do not have discounts posted automatically.
STATE FILING OF COMMUNITY BENEFIT REPORT	990 SCHEDULE H, PART VI	IN,

Schedule H (Form 990) 2010

Additional Data

Software ID:
Software Version:

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990

OMB No. 1545-0047

2010

Open to Public
Inspection

Name of the organization
MEMORIAL HOSPITAL OF SOUTH BEND INC

Employer identification number
35-0868132

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet

(a) Name and address of organization or government	(b) EIN	(c) IRC Code section if applicable	(d) Amount of cash grant	(e) Amount of non-cash assistance	(h) Purpose of grant or assistance
(1) BIKE MICHIANA COALITION INC66841 WALNUT RD WALKERTON,IN46574	26-3357356	501(c)(3)	7,100		DONATION
(2) NORTHERN INDIANA HISTORICAL SOCIETY INC808 W WASHINGTON SOUTH BEND,IN46601	35-1124156	501(C)(3)	10,600		GOLD SPONSORSHIP
(3) COMMUNITY COORDINATED CHILD CARE OF ST JOSEPH CNTY401 E COLFAX AVE SUITE 210 SOUTH BEND,IN46617	35-1389028	501(C)(3)	76,721		SPONSORSHIP
(4) COMMUNITY FOUNDATION OF ST JOSEPH COUNTYPO BOX 837 SOUTH BEND,IN46624	23-7365930	501(C)(3)	10,000		SPONSORSHIP AFRICAN AMERICAN COMM
(5) EL CAMPITO INC1024 THOMAS ST SOUTH BEND,IN46601	35-1438892	501(C)(3)	8,160		CHE MINI GRANT
(6) FAMILY & CHILDREN'S CENTER CDS1411 LINCOLNWAY WEST MISHAWAKA,IN46544	35-1404782	501(C)(3)	57,000		CHAG 2010
(7) GRACE COMMUNITY CENTER INCPO BOX 1671 SOUTH BEND,IN46634	35-1900380	501(C)(3)	25,000		VOYAGES 2010
(8) HABITAT FOR HUMANITY INTERNATIONAL INC402 E SOUTH ST SOUTH BEND,IN46601	31-1196894	501(C)(3)	10,000		WOMEN BUILD 2010
(9) HISPANIC LEADERSHIP COALITION INCPO BOX 3744 SOUTH BEND,IN46619	35-2151895	501(c)(3)	5,250		SPONSORSHIP
(10) RESCUE INCPO BOX 4488 SOUTH BEND,IN46634	35-1038532	501(C)(3)	75,000		2010 HOPE FOR KIDS
(11) INNOVATION PART AT NOTRE DAME INC1400 E ANGELA BLVD SOUTH BEND,IN46634	94-3445005	501(C)(3)	10,000		CONTRIBUTION
(12) MEDICAL EDUCATION FOUNDATION INCPO BOX 1132 SOUTH BEND,IN46634	35-1291588	501(C)(3)	15,000		MED BALL BENEFACTOR
(13) NEAR NORTHWEST NEIGHBORHOODPO BOX 1132 SOUTH BEND,IN46624	23-7414729	501(C)(3)	35,000		CONTRIBUTION
(14) NORTHEAST NEIGHBORHOOD REVITALIZATION ORGANIZATION803 LINCOLNWAY WEST SOUTH BEND,IN46616	35-2118149	501(C)(3)	50,000		CONTRIBUTION
(15) O'HANA HERITAGE FOUNDATION INCPO BOX 186 SOUTH BEND,IN46624	37-1523448	501(C)(3)	80,000		CONTRIBUTION
(16) PENN-HARRIS-MADISON EDUC FOUNDATION INC55900 BITTERSWEET RD MISHAWAKA,IN46545	35-1996785	501(C)(3)	7,000		RUNNING FOR EDUCATION
(17) PROJECT FUTURE CHARITABLE FUND401 E COLFAX SOUTH BEND,IN46617	31-1033632	501(C)(3)	120,000		CONTRIBUTION
(18) SALVATION ARMY540 S CARROLL ST SOUTH BEND,IN46601	36-2167910	501(c)(3)	50,000		CONTRIBUTION
(19) SJC BRIDGES OUT OF POVERTY INC117 N LAFAYETTE BLVD SOUTH BEND,IN46601	26-3195466	501(C)(3)	73,160		CONTRIBUTION
(20) SOUTH BEND HERITAGE FOUNDATION INC803 LINCOLNWAY WEST SOUTH BEND,IN46601	23-7394320	501(C)(3)	72,500		CONTRIBUTION
(21) SOUTH BEND SYMPHONY127 N MICHIGAN ST SOUTH BEND,IN46601	35-6042189	501(C)(3)	10,000		STRYCKER MUSIC
(22) THE NATIONAL FOOTBALL FOUNDATION & COLLEGE HALL OF1105 CLERMONTH DR SOUTH BEND,IN46617	35-1436531	501(C)(3)	5,250		2010 ENSHRINEMENT
(23) UNIVERSITY OF NOTRE DAME DU LAC731 GRACE HALL NOTRE DAME,IN46556	35-0868188	501(C)(3)	115,545		CONTRIBUTION
(24) MICHIANA PUBLIC BROADCASTING CORPORATION300 W JEFFERSON SOUTH BEND,IN46601	35-1155594	501(C)(3)	105,430		SPONSORSHIP
(25) STUDEBAKER NATIONAL MUSEUM INC201 S CHAPIN STREET SOUTH BEND,IN46601	35-1555535	501(C)(3)	20,000		CONTRIBUTION
(26) SAINT JOSEPH COUNTY POLICE DEPARTMENT401 SOUTH SAMPLE STREET SOUTH BEND,IN46601	35-6000194			10,000	AMBULANCE

Enter total number of section 501(c)(3) and government organizations ......................... Bullet Image

Enter total number of other organizations ................................ . Bullet Image

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

Cat. No. 50055P

Schedule I (Form 990) 2010

Page 2

Part III

Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.

(a)Type of grant or assistance	(b)Number of recipients	(c)Amount of cash grant	(d)Amount of non-cash assistance	(e)Method of valuation (book, FMV, appraisal, other)	(f)Description of non-cash assistance

Part IV

Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.

Identifier	Return Reference	Explanation
GRANT MONITORING PROCEDURES	SCHEDULE I, PART IV	Part of the Organization's mission is to improve the health of our community. In order to fulfill this goal, our Administrators have the ability to make donations to Organizations that improve the health and well being of our community.

Schedule I (Form 990) 2010

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet

Attach to Form 990. SchJMediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

MEMORIAL HOSPITAL OF SOUTH BEND INC

Employer identification number

35-0868132

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement orprovision of all the expenses described above? If "No," complete Part III to explain....

Yes

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....

Yes

Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ...............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? ........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ...........................

Yes

Any related organization? .........................

Yes

If "Yes," to line 6a or 6b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regs. section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

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

Cat. No. 50053T

Schedule J (Form 990) 2010

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use Schedule J-1 if additional space needed.

For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) must equal the applicable column (D) or column (E) amounts on Form 990, Part VII, line 1a.

(A) Name		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported in prior Form 990 or Form 990-EZ
(A) Name		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
(1) Philip Newbold	(i) (ii)	0 556,903	0 304,355	0 140,617	0 210,175	0 19,289	0 1,231,339	0 140,555
(2) George Soper	(i) (ii)	0 178,933	0 44,616	0 21,102	0 78,746	0 21,174	0 344,571	0 0
(3) Jeffrey Costello	(i) (ii)	0 273,186	0 106,000	0 90,162	0 84,363	0 14,659	0 568,370	0 0
(4) Keith Sherry MD	(i) (ii)	176,435 0	0 0	0 0	6,281 0	12,217 0	194,933 0	0 0
(5) Kreg Gruber	(i) (ii)	298,224 0	119,480 0	19,217 0	72,250 0	26,205 0	535,376 0	0 0
(6) Cheryl Wibbens - Lesh MD	(i) (ii)	296,356 0	70,042 0	1,729 0	19,671 0	18,478 0	406,276 0	0 0
(7) Connie M McCahill	(i) (ii)	169,043 0	42,073 0	11,763 0	29,814 0	14,222 0	266,915 0	0 0
(8) Robert Riley MD	(i) (ii)	282,033 0	0 0	4,729 0	27,587 0	11,427 0	325,776 0	0 0
(9) Scott Thomas MD	(i) (ii)	335,014 0	0 0	292 0	9,968 0	0 0	345,274 0	0 0
(10) Thomas Sutula MD	(i) (ii)	214,878 0	0 0	5,481 0	20,247 0	17,303 0	257,909 0	0 0
(11) Mark Lavallee	(i) (ii)	197,208 0	20,892 0	4,661 0	18,709 0	18,708 0	260,178 0	0 0

Schedule J (Form 990) 2010

Page 3

Part III

Supplemental Information

Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.

Identifier	Return Reference	Explanation
Health Club and Spousal Travel	Schedule J, Part I, Line 1A	Memorial Hospital reimburses trustees for the tax effect of the 1099 reportable benefits for health club membership with Memorial's Health and Lifestyle Center and spousal travel. This reporting impacts 11 current Board Members. Memorial Hospital also reimburses for direct expenses related to any travel on Memorial's behalf. Social club membership included in taxable compensation - 2 employees (Jeff Costello and Kreg Gruber) Spousal travel included in taxable compensation - 1 employee (Philip Newbold) CHARTER TRAVEL FOR INVESTMENT COMMITTEE MEMBERS TO TRAVEL TO INVESTMENT ADVISOR, LOCATED IN MINNEAPOLIS. CHARTER TRAVEL ALLOWED THE ORGINIZATION TO REDUCE THE OVERALL COST OF TRAVEL, BY ELIMINATING THE NEED FOR OVER NIGHT ACCOMIDATIONS. THE CHARTER TRAVEL ALSO REDUCED THE TIME UNPAID BOARD MEMBERS HAD TO COMMIT. (1 INDIVIDUAL LISTED ON PART VII, SECTION LINE 1A - JEFFREY COSTELLO)
Supplemental Non-Qualified Retirement Plan	Schedule J, Part I, Line 4B	Related Organization (Memorial Health System, Inc.) 2010 Earned Vested 457(f) Phillip Newbold $108,930 Jeffrey Costello $ 66,001 Memorial Health System provides a non-qualified Supplemental Executive Retirement Program (SERP) to certain executives. The plan provides for an added retirement benefit over the qualified retirement program. Qualified individuals are eligible to receive a benefit, in the form of an after tax lump sum which is the actuarial equivalent of an annuity equal to 65% of the average of their last five years of preretirement earnings, or 70% with more than 25 years of service, with offsets for the value of social security and qualified retirement plan benefits. Participants vest into the SERP after five years of service. The increase in value of the benefit each year is included in the taxable compensation of vested SERP participants. Such amounts are included in Part II Column (b) (iii). The annual value of the benefit is converted to a lump sum and paid to the participant after fulfilling the terms of their non-compete agreement.
Compensation Contingent on Net Earnings	Schedule J, Part I, Line 6A & 6B	The related organization has 2 incentive plans (employee and management) which have a net operating income to budget measurement for the payout threshold. The employee plan shares the excess over budgeted net operating income with the non-management employees for Memorial Health System, Inc and the affiliated entities which includes Memorial Hospital of South Bend, Inc. The employee incentive pool has a maximum cap of $2,500,000. The management incentive plan pays a sliding percentage of base compensation if the net operating income is equal to or greater than 80% of the budgeted net operating income. The sliding scale caps when operating income reaches 120% of the budgeted operating income.

Schedule J (Form 990) 2010

Additional Data

Software ID:
Software Version:

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Schedule O (Form 990).
SchKMediumBullet

Attach to Form 990. SchKMediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public
Inspection

Name of the organization
MEMORIAL HOSPITAL OF SOUTH BEND INC

Employer identification number
35-0868132

Part I

Bond Issues

(a) Issuer Name		(b) Issuer EIN	(c) CUSIP #	(d) Date Issued	(e) Issue Price	(f) Description of Purpose	(g) Defeased		(h) On Behalf of Issuer		(i) Pool financing
(a) Issuer Name		(b) Issuer EIN	(c) CUSIP #	(d) Date Issued	(e) Issue Price	(f) Description of Purpose	Yes	No	Yes	No	Yes	No
A	HOSPITAL AUTHORITY OF ST JOSEPH COUNTY	35-6311914	79061BCQ6	05-01-2007	80,000,000	SEE SCHEDULE O FOR DESCRIPTION		X		X		X
B	HOSPITAL AUTHORITY OF ST JOSEPH COUNTY	35-6311914	79061BCW3	03-16-2006	38,580,000	SEE SCHEDULE O FOR DESCRIPTION		X		X		X
C	HOSPITAL AUTHORITY OF ST JOSEPH COUNTY	35-6311914	79061BCX1	08-28-2008	39,915,000	SEE SCHEDULE O FOR DESCRIPTION		X		X		X
D	HOSPITAL AUTHORITY OF ST JOSEPH COUNTY	35-6311914	000000000	07-01-2008	2,147,750	SEE SCHEDULE O FOR DESCRIPTION		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired. . . . .
2 Amount of bonds defeased . . . .
3 Total proceeds of issue . . . .	84,814,783		38,580,000		39,915,000		2,147,750
4 Gross proceeds in reserve funds . .
5 Capitalized interest from proceeds.
6 Proceeds in refunding escrow. . . . .	38,580,000		38,580,000		39,337,496
7 Issuance costs from proceeds . . .	762,312		1,243,764		577,204
8 Credit enhancement from proceeds.
9 Working capital expenditures from proceeds . .
10 Capital expenditures from proceeds . .	79,201,600						2,147,750
11 Other spent proceeds . .	4,850,871
12 Other unspent proceeds. . .
13 Year of substantial completion . . .	2009		2000		2003		2008
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue?		X	X				X
15 Were the bonds issued as part of an advance refunding issue?		X		X		X		X
16 Has the final allocation of proceeds been made? . .	X		X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? .	X		X		X		X

Part III

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . .		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . .		X		X		X

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

Cat. No. 50193E

Schedule K (Form 990) 2010

Page 2

Part III

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use?	X		X		X
b Are there any research agreements that may result in private business use of bond-financed property? . .		X		X		X
c Does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts or research agreements relating to the financed property? .	X		X		X
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . . . . . . . . . . . .	0 %		0 %		0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .	0 %		0 %		0 %
6 Total of lines 4 and 5 . . .. . . . . .	0 %		0 %		0 %
7 Has the organization adopted management practices and procedures to ensure the post-issuance compliance of its tax-exempt bond liabilities?	X		X		X

Part IV

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . .		X		X				X
2 Is the bond issue a variable rate issue?	X		X					X
3a Has the organization or the governmental issuer entered into a hedge with respect to the bond issue?		X	X		X			X
b Name of provider .	CITIGROUP FINANCIAL		CITIGROUP FINANCIAL		CITIGROUP FINANCIAL
c Term of hedge . .
d Was the hedge superintegrated? .		X		X		X		X
e Was a hedge terminated? .		X		X		X		X
4a Were gross proceeds invested in a GIC? .	X			X		X		X
b Name of provider .	HYPO PUBLIC FINANCE
c Term of GIC . .	3.91
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? .		X
5 Were any gross proceeds invested beyond an available temporary period? .		X		X		X		X
6 Did the bond issue qualify for an exception to rebate? . . .		X	X		X			X

Schedule K (Form 990) 2010

Page 3

Part V

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule K (see instructions).

Identifier	Return Reference	Explanation

Schedule K (Form 990) 2010

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ. MediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

MEMORIAL HOSPITAL OF SOUTH BEND INC

Employer identification number

35-0868132

Part I

Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

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

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

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.

(a) Name of interested person and purpose	(b) Loan to or from the organization?		(c)Original principal amount	(d)Balance due	(e) In default?		(f) Approved by board or committee?		(g)Written agreement?
(a) Name of interested person and purpose	To	From	(c)Original principal amount	(d)Balance due	Yes	No	Yes	No	Yes	No






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

Part III

Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b)Relationship between interested person and the organization	(c)Amount of grant or type of assistance

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

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2010

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) Geralrd Duprat MD	Trustee	2,151,838	Purchase of JV ownership		No
(2) Sandra Brown MD	Trustee	349,517	Bldg rental, Proctor Services		No
(3) Carlton Lyons MD	Trustee	349,517	Bldg rental, Proctor Services		No
(4) Candace Hurwich	See Part V	40,200	See Part V		No
(5) Robert Yount MD	Trustee	604,688	Trauma Call Services		No
(6) Jesse Hseih MD	Trustee	258,920	Trauma Call Services		No
(7) Keith Sherry MD	Trustee	6,320,660	Professional ER Phys. Services		No

Part V

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule L (see instructions).

Identifier	Return Reference	Explanation
Business Transactions Involving Interested Persons	Schedule L, Part IV	Candace Hurwich, wife of Maurice Hurwich, MD (Trustee and Medical Director) was compensated for services as a Staff RN on the Emergency Response Team.

Schedule L (Form 990 or 990-EZ) 2010

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.

OMB No. 1545-0047

2010

Open to Public
Inspection

Name of the organization

MEMORIAL HOSPITAL OF SOUTH BEND INC

Employer identification number

35-0868132

Identifier	Return Reference	Explanation
VOLUNTEERS	Form 990, Part I, Line 6	Memorial Hospital of South Bend has a department called Ambassador and Customer Services. It is the responsibilty of this department to recruit, orient, process and place new ambassadors in approximately 30 service areas of the hospital. It is also the responsibility of the department to follow up, schedule and recognize ambassadors. Some of the areas of service include Major Surgery Waiting Room, Escort Service, Flower Delivery, Mail Delivery, Living History Program, Emergency Department Volunteers and Cookie Bakers. In 2010, Memorial had 547 volunteers in this program who served 38,567.5 hours.
Other Program Services	Form 990, Part III, Line 4d	Memorial Health System, Inc. (the "Corporation") was established as the parent corporation of Memorial Hospital of South Bend, Inc. (the "Hospital") in 1981 to develop a full spectrum of health-related services for North Central Indiana and Southwestern Michigan. The Corporation is community-owned and not-for-profit. Along with its subsidiaries, the Corporation serves the greater community throughout the continuum of care from health promotion and sickness prevention to diagnosis, inpatient, outpatient and home health services. It controls the Hospital, Memorial Health Foundation, the Hospital's philanthropic arm, and Memorial Home Care, Inc., collectively referred to as the "System". The Hospital with 526 licensed adult beds and 80 bassinets, a staff of approx. 2,693, a medical staff of more than 605, and a volunteer Auxiliary of 594, is the largest hospital in the primary and secondary service areas. The Corporation owns and operates the acute care Hospital facility and Family Practice Residency Program. The Hospital's purpose is to provide hospital care and enhance wellness for the community. The Hospital has its own Board of Trustees (the "Hospital Board") elected by the persons serving on the Board of Directors of the Corporation. The Hospital Board has responsibility for the operation of the Hospital as defined in its bylaws. Memorial Hospital of South Bend is the largest and most comprehensive tertiary care medical center in Northern Indiana. Services are delivered through service divisions and professional ancillary services: Adult Patient Services, Cardiovascular & Critical Care Services, Women's and Children's Services, Surgical Services, Oncology Services and Professional Services. Key utilization Statistics for the Hospital for 2010 include: Admissions 18,824 Total Patient Days 77,727 Births 2,614 Inpatient Surgical Procedures 4,357 Outpatient Surgical Procedures 7,825 Emergency Department visits 52,349 Creating community health is at the core of Memorial Hospital of South Bend, Inc's mission. Promotion of community health is the right thing to do and a key to long term cost effectiveness. In addition, improving the health status of a community is as much a social, economic and environmental issue, as it is a medical one. Consequently, the System takes a broad approach to creating community health. This approach has included ongoing education of board members, staff and local leaders through community plunges (experiential activities to involve the community residents with a neighborhood-based agency), Community Foundation support, ongoing allocation of tithing resources, a clear statement of vision and goals, a commitment to continuous quality improvement and promotion of volunteer involvement and community partnerships. In the early 1990s, the System made a dramatic shift from a disease-focused medical model to a prevention-focused model. Its vision is to continue the journey to be among the nation's healthiest communities. Memorial's health enhancement plan focuses on five priorities: schools, neighborhoods, congregations, seniors and mother/child concerns. Its methods include building partnerships, investing dollars, listening and communicating, nurturing leadership, and continuous evaluation backed by sound outcome and impact measurement. The Community Benefit Fund is the System's mechanism for re-investing funds to improve the health status of communities it serves. The System, which includes Memorial Hospital of South Bend Inc, tithes 10% of the previous year's excess operating revenue and transfers it to the Community Benefit Fund. This investment is in addition to the Hospital's charity care and prevention and education activities supported through its operating budget. The Community Health Enhancement Committee of the Board began the fund in 1993 and makes ongoing policy and oversees the administration of the fund and determines specific investment allocations. Volunteers and staff are committed to prudently investing these resources in an accountable manner. BrainWorks at Memorial Hospital is housed within the Leighton Center, located on the Hospital campus. The programs sponsored at the Leighton Center promote a holistic understanding and approach to brain health across the lifespan, emphasizing the importance of a healthy brain to enhance the quality of life at every age. Education and physical movement are important aspects of aging well for all of us. Programming at the Leighton Center supports a platform to expand the knowledge of brain health. While the focus continues to be on holistic health, brain health as a key component to well-being which can contribute to the prevention of neurodegenerative disorders, improve rehabilitation and recovery from trauma, and enhance productivity and capabilities to be realized in the later years. As a part of senior programming, Memorial's Sage-ing Center contributes to spiritually Eldering and socially responsible aging. The System's innovative community outreach has received national recognition for models of involvement as well as state and federal grants to assist in the support of some of these programs. Programs include: African American Women in Touch - breast care education and screening programs, the PEDS developmental delay screening program for infants 0 to 3 years of age which is offered at the St. Joseph County WIC clinics, the YWCA, and the Center for the Homeless, and health education and outreach into the Latino community, including an innovative diabetes education and case management program that has had significant results. More than 220 Type II diabetics have participated in the program with no hospitalizations in 2010. The program expanded to include African Americans and Caucasians as well. The newest addition has two Zumba exercise classes, which have approximately 50 individuals of all ages participating in each session. Nearly 40 women were referred to the gestational diabetes program; of the deliveries, there were a few minor complications, however the overall birth outcomes were positive, and mothers returned to normal glucose readings six-weeks post-partum. Two programs which received federal grants to be initiated in St. Joseph County were the Fetal Alcohol screening and education program for pregnant women, and the HUD affiliated program working with Healthy Homes. Other noteworthy programs include the free Children's Health Clinic providing school physicals and early detection of health problems at Memorial's Southeast Neighborhood Clinic's event for approximately 150 children. 6,207 South Bend youths, in school year 2010-2011, participated in the evidenced-based program, "Draw the Line, Respect the Line" targeting middle school aged students on making and practicing good choices. The "Healthy Babies Program" focused on proper prenatal care and reducing infant mortality. A program for African American men was held at three local barbershops during one weekend, to increase awareness and encourage men to make behavioral changes to monitor their blood pressure and take steps to control high blood pressure received additional support. In 2010, 98 men participated in the program. The Sickle Cell Initiative serves Northwest Indiana with screening, education, and counseling. In 2010, new initiatives included high school athlete screening, regular educational newsletters, and public service announcements. The total number served in 2010 was 5,233 individuals. The "Domestic Violence Ends ("DOVE") project, and the Health Professionals, a free service for residents needing physician referral or health information have proven their value to the community, while the partnership with South Bend Community School's magnet schools finds Memorial's evolving role in building a high school program intended to prepare students for future careers in health care and scientific research. Summer programs were offered to Latino students at La Casa de Amistad, Martin Luther King Center, and with the South Bend Community School Corporation's Bilingual Education department. As a supporter of the St. Joseph County Volunteer Provider Network providing care for the uninsured adults in our community, with over 363 physicians, diagnostic service providers, and two hospitals, VPN contributed over 7 million dollars worth of care in 2010. A demonstration project in partnership with South Bend Heritage Foundation provides health and social service case management to 60 low-income elderly living independently in the converted Robertson's Department Store. The results of the intervention have shown a decrease in depression and increases in 8 indices of health in those elderly participating in the program. This project received funding from a local foundation to expand to seniors living in public housing.
Members of the Organization	Form 990, Part VI, Section A, Line 6	Membership in Memorial Hospital of South Bend shall be divided into two classes: Corporate and Personal. The Corporate Member shall be Memorial Health System, Inc. The Personal Members shall be the directors of Memorial Hospital of South Bend.
Election of Board Members	Form 990, Part VI, Section A Line 7A	The Corporate Member shall appoint the Board of Directors of Memorial Hospital of South Bend and shall have such powers of advance approval regarding corporate actions as are delineated in the By-Laws of Memorial Hospital of South Bend.
Decisions of The Board of Directors	Form 990, Part VI, Section A, Line 7B	Decisions of the Board of Directors must be approved by the Corporate Member.
FORM 990, PART VI, SECTION B		THE ORGINIZATION HAS WRITTEN POLICIES AND PROCEDURES THAT COVER NUMEROUS TOPICS. THESE POLICIES AND PROCEDURES WERE NOT APPROVED BY THE GOVERNING BOARD IN THE CURRENT TAX YEAR, BUT WILL BE REVIEWED AND APPROVED BY THE GOVERNING BOARD IN FUTURE YEARS. A FEW OF THE TOPICS COVERED BY THE CURRENT POLICIES AND PROCEDURES OF THE ORGINIZATION ARE: - LOCAL CHAPTERS, BRANCHES AND AFFILIATES - CONFLICT OF INTEREST - WHISTLEBLOWER - DOCUMENT RETENTION AND DESTRUCTION - JOINT VENTURES
Review Process	Form 990, Part VI, Section B, Line 11B	The organization incorporates numerous parties in the production and review of the Form 990 and associated schedules. Senior accounting staff and management complete the Form 990 and schedules. The forms and schedules are reviewed by the Accounting Manager, Controller and CFO. Subsequent to those steps, the organization engaged Ernst & Young to review the completed Form 990 and appropriate schedules. Prior to filing the return, the compensation committee of the organization and the CEO conduct a general overview of the form 990, including applicable compensation schedules. In addition, the Board of Directors and the Audit Committee will receive a copy of the 990 prior to filing.
Conflict of Interest Policy	Form 990, Part VI, Section B, Line 12	There are three separate forms that are sent out through the Internal Audit Department to Key Employees or Board Members regarding Conflict of Interest. They are as follows 1. The first is a Conflict of Interest Statement that is sent to Senior level Administration, Management, and select staff such as Purchasing Department employees. The purpose of the Statement is to require these Employees to disclose any potential conflict of interests they may have. The Statements are sent in January of each year and we pursue the replies to get a 100% response rate. In the current year we sent out over 250 Statements and did achieve a 100% response rate. Each response is reviewed by the Director of Internal Audit and the results are reported to the CEO of Memorial as well as the Audit Committee of the Board of Directors. 2. The second Statement is the Board Duality of Interest Statement that is sent to current Board Members, former Board Members from the last five years, the five highest compensated employees from the previous year, employees that are on the Grant and Scholarship Committees, and Other key Employees. The Duality of Interest Statements was sent out in May, 2010. The replies are reviewed by the Director of Internal Audit who summarizes the results which are reviewed by an independent party. The results are reported to the CEO of Memorial and the Audit Committee of the Board of Directors. 3. The third Statement is entitled "Code of Ethics for Senior Financial Officers". The Statement requires an acknowledgment form to be signed by Memorial's Key Financial Employees that Memorial's financial information is to the best of their knowledge true and accurate. This Statement was sent out in early January, 2010 and the signed acknowledgements are kept by the Director of Internal Audit. In 2010, fourteen designated employees were requested to sign the form and we had a 100% compliance rate. Any potential Conflicts of Interest are reviewed by independent parties both internal and external to the organization, and if necessary, corrective action would be taken to resolve a true Conflict. The individual with the potential conflict of interest is excluded from all review proceedings.
Process For Determining Compensation	Form 990, Part VI, Section B, Line 15	An extensive examination is conducted using comparable market data and it is then reviewed by an independent consultant hired by, and reporting to, the Board of Directors. Recommendations are presented to the Compensation Committee of the Memorial Health System Inc Board for deliberation and final decision. Deliberation and final decision are performed by the independent members of the Board.
Public Availability for Documents	Form 990, Part VI, Section C, Line 19	The governing documents and conflict of interest policy are not made available to the public. The financial statements are distributed quarterly to the Electronic Municipal Market Access (EMMA) website as part of the continuing disclosures for the Memorial Health System, Inc. bonds.
Other Changes in Net Assets of Fund Balances	Part XI, Line 5	Unrealized Loss on Swap Transactions (27,671,589) Transfers to Affiliates (21,016,908) Change in Interest in Recipient Org (2,759,849) Unrealized Gain on Investments 13,417,708 Capital Contributions 113,400 Ambulance donation 10,000 Total (37,907,238)
Bond Purpoase Descr for Schedule K	Schedule K, Part I, Column F	Line A(f) - The Hospital Authority of St. Joseph County Health System Revenue Bonds, Series 2007 (Memorial Health System) were issued for the purpose, together with other available funds, of financing the costs of health care capital improvements. Line B(f) - The Hospital Authority of St. Joseph County Health System Revenue Bonds, Series 2006 (Memorial Health Care Network), were issued for the purpose, together with other available funds, of refunding all or a portion of the Organization's Series 2000 Bonds which were originally issued on 12/01/2000. The Series 2006 Bonds were exchanged for the Hospital Authority of St. Joseph County Health System Revenue Bonds, Series 2008A (Memorial Health System) on August 28, 2008. Based on the advice of bond counsel, the Organization is treating the Series 2008A Bonds as the same issue as the Series 2006 Bonds for federal income tax purposes. Further information regarding the Series 2008A Bonds is set forth in the table below. Line C(f) - The Hospital Authority of St. Joseph County Health System Revenue Refunding Bonds, Series 2008B Memorial Health System) were issued for the purpose, together with other available funds, of refunding the then-outstanding Hospital Authority of St. Joseph County Health System Revenue Bonds, Series 2003 (Memorial Health System), on a current basis. Line D(f) - The Lease Obligations under a Lease Purchase Agreement dated July 1, 2008 were issued for the purpose of financing certain equipment used for health care purposes.
Private Business Use for Schedule K	Schedule K, Part III, Line 5	In August 2008, the Hospital Authority of St. Joseph County, on behalf of the Corporation, issued revenue refunding bonds in the principal amount of $39,915,000 to refund Series 2003 Bonds. The Series 2003 Bonds were used to finance various capital projects including the Heart and Vascular Center. As part of the planning for the Series 2003 Bonds, the Memorial Hospital management team planned for private use of the first floor of the Heart and Vascular Center. After planning for the private use of the first floor the Memorial management team consulted bond counsel at that time. Bond counsel advised that the first floor should be funded through equity. Memorial Hospital followed bond counsels recommendations and the Heart and Vascular Center first floor was entirely funded by equity. Memorial Hospital had used approximately $22,100,000 in equity in relation to the projects funded with Series 2003 bond draws.
Arbitrage for Schedule K	Schedule K, Part IV	Part IV is not completed for the Series 2008A Bonds because such bonds indirectly refunded new money bonds issued in 2000.
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:Robert Yount MD TITLE:Trustee; Employed Physician HOURS:40
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:Philip Newbold TITLE:CEO/President HOURS:40
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:George Soper TITLE:Asst. Secretary/VP HOURS:40
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:Jeffrey Costello TITLE:Asst. Treasurer/CFO HOURS:40

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2010

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

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

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

MEMORIAL HOSPITAL OF SOUTH BEND INC

Employer identification number

35-0868132

Part I

Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)

(a) Name, address, and EIN of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled organization
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1) Memorial Health System Inc 615 N Michigan Street South Bend,IN46601 35-1536132	Corp Svc/Clin	IN	501c(3)	9	NA
(2) Memorial Health Foundation Inc 615 N Michigan Street South Bend,IN46601 35-1536129	Financial Sup	IN	501c(3)	9	MHS

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

Cat. No. 50135Y

Schedule R (Form 990) 2010

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

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)
(1) Memorial Home Care Inc 615 N Michigan Street South Bend,IN46601 35-1901068	Home Medical	IN	NA	C

Schedule R (Form 990) 2010

Page 3

Part V

Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)

Note. Complete line 1 if any entity is listed in Parts II, III or IV.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

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

Yes

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

Yes

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

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

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

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

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

Yes

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

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

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of other organization	(b) Transaction type(a-r)	(c) Amount involved
(1) Memorial Health Foundation Inc	C	175,884
(2) Memorial Health Foundation Inc	H	163,004
(3) Memorial Health Foundation Inc	L	3,450,860
(4) Memorial Health Foundation Inc	O	77,061
(5) Memorial Health Foundation Inc	Q	82,427
(6) Memorial Home Care Inc	L	717,407
(7) Memorial Home Care Inc	R	642,419

Schedule R (Form 990) 2010

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Are all partners section 501(c)(3) organizations?		(e) Share of end-of-year assets	(f) Disproprtionate allocations?		(g) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(h) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(e) Share of end-of-year assets	Yes	No	(g) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2010

Page 5

Part VII

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule R (see instructions).

Identifier	Return Reference	Explanation

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: MEMORIAL IS COMMITTED TO IMPROVING THE QUALITY OF LIFE OF THE PEOPLE IN OUR COMMUNITY.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ....	3	21
4	Number of independent voting members of the governing body (Part VI, line 1b) ....	4	14
5	Total number of individuals employed in calendar year 2010 (Part V, line 2a) ...	5	3,036
6	Total number of volunteers (estimate if necessary) ....	6	547
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ..	7a	38,888
b	Net unrelated business taxable income from Form 990-T, line 34 ..	7b	13,534

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	3,220,079	5,006,001
9	Program service revenue (Part VIII, line 2g) .........	394,957,158	372,173,020
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	-777,596	4,909,387
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	21,237,837	12,921,446
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	418,637,478	395,009,854
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	1,222,556
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)	147,694,088	148,393,083
16a	Professional fundraising fees (Part IX, column (A), line 11e)....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f)....	203,891,263	210,491,302
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	351,585,351	360,106,941
19	Revenue less expenses. Subtract line 18 from line 12......	67,052,127	34,902,913
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16)............	622,488,889	638,068,406
21	Total liabilities (Part X, line 26)............	201,354,161	219,938,003
22	Net assets or fund balances. Subtract line 21 from line 20 .....	421,134,728	418,130,403

Sign Here

	Signature of officer	Date

	Type or print name and title.

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


4a	(Code: ) (Expenses $ 65,561,780 including grants of $ ) (Revenue $ 157,865,066 )
	Ancillary Services offers the following services for patients and facilities: - Imaging Services - Outpatient Physical, Occupational and Speech Therapy - Infusion Treatments - Radiation Oncology Therapy - Cancer Research - Cardiac Cath Lab - Sleep Lab - Interventional Radiology - Environmental Services - Nutritional Services - Pharmacy Services - Laboratory 2010 Statistics for this service unit include: - 453,328 Inpatient procedures - 292,525 Outpatient procedures - 1,359 Inpatient Caths - 1,519 Outpatient Caths - 295,014 Outpatient visits - 655,868 Meals

4b	(Code: ) (Expenses $ 56,838,457 including grants of $ ) (Revenue $ 91,592,813 )
	Patient Care Unit Services provides a wide variety of hospital services including: - Inpatient rehabilitation CARF accredited - Medical - Post surgical - Orthopedic - Oncology - Intensive and intermediate - Heart and Vascular - Mother and Child - Special Care Obstetrics - Neonatal Intensive Care Level III - Emergency - Trauma Level II - Pediatrics - Pediatric Intensive Care - Pediatric Hematology Oncology - Medical Flight program - Pediatric Intensive Care Transports 2010 Statistics for this service unit include: - 84,088 Patient Days - 16,911 Inpatient ER visits - 96,481 Outpatient ER visits - 2,837 Births - 6,586 Observation stays - 235 Medical flights - 840 Full time equivalent employees

4c	(Code: ) (Expenses $ 45,258,500 including grants of $ ) (Revenue $ 99,397,638 )
	Surgical Services provides the following services: - General Surgery - Vascular Surgery - Cardiac Surgery - Orthopedic Surgery - Gynecological Surgery - Trauma Surgery - GI Labs - Pulmonary Services - Pain Center - DaVinci Robotic Surgery 2010 Statistics for this service unit include: - 8,085 Inpatient procedures - 366 Open Heart procedures - 18,363 Outpatient procedures

4d	Other program services. (Describe in Schedule O.)
	(Expenses $ 110,300,483 including grants of $ 1,222,556 ) (Revenue $ 27,714,847 )
4e	Total program service expenses$ 277,959,220

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	2,331,065	1,740,874	751,493

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512, 513, or 514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d		3,450,860
e	Government grants (contributions)1e		1,555,141

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.......			5,006,001
			Business Code
2a	NET PATIENT REVENUE		621,110	370,805,467	370,805,467
b	RENTAL REVENUE		532,000	1,173,329	1,173,329
c	MEDICAL EDUCATION		611,710	77,469	77,469
d	CASH DISCOUNTS		561,499	34,272	34,272
e	AMBULANCE SUPPLY		621,910	82,483	82,483
f	All other program service revenue .
g	Total. Add lines 2a–2f........			372,173,020
3	Investment income (including dividends, interest
	and other similar amounts).....			3,296,799			3,296,799
4	Income from investment of tax-exempt bond proceeds..			91,693			91,693
5	Royalties............			0			0
		(i) Real	(ii) Personal
6a	Gross Rents	62,798
b	Less: rental expenses	15,164
c	Rental income or (loss)	47,634
d	Net rental income or (loss).......			47,634			47,634
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	26,316,575	4,500
b	Less: cost or other basis and sales expenses	24,797,573	2,607
c	Gain or (loss)	1,519,002	1,893
d	Net gain or (loss)..........			1,520,895			1,520,895
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...			0
10a	Gross sales of inventory, less returns and allowances .
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..			0
Miscellaneous Revenue			Business Code
11a	GAIN ON SWAP TERMINATION		561,499	5,270,917			5,270,917
b	ATHLETIC CLUB		713,940	1,661,156			1,661,156
c	MRI (JOINT VENTURE) INCOME		561,499	1,326,311	1,326,311
d	All other revenue ....			4,615,428	3,071,033	38,888	1,505,507
e	Total. Add lines 11a–11d ......			12,873,812
12	Total revenue. See Instructions....			395,009,854	376,570,364	38,888	13,394,601


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing ..........			18,825	1	19,325
2	Savings and temporary cash investments .......			74,667,024	2	50,012,044
3	Pledges and grants receivable, net .........			462,022	3	539,700
4	Accounts receivable, net .........			70,257,527	4	61,880,211
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 .............			68,370	7	12,376
8	Inventories for sale or use ..............			11,710,633	8	13,706,162
9	Prepaid expenses and deferred charges ............			1,104,326	9	1,083,100
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	541,206,724
b	Less: accumulated depreciation. .....	10b	261,294,425	274,080,186	10c	279,912,299
11	Investments—publicly traded securities ..........			103,833,867	11	123,873,292
12	Investments—other securities. See Part IV, line 11 ......			73,770,696	12	99,517,740
13	Investments—program-related. See Part IV, line 11 ..			788,973	13	765,284
14	Intangible assets .........			0	14	1,171,474
15	Other assets. See Part IV, line 11 ...........			11,726,440	15	5,575,399
16	Total assets. Add lines 1 through 15 (must equal line 34)...			622,488,889	16	638,068,406
17	Accounts payable and accrued expenses .			39,071,682	17	34,064,199
18	Grants payable ..........				18
19	Deferred revenue ..........			153,845	19	14,027
20	Tax-exempt bond liabilities ..........			142,195,035	20	138,791,700
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 ..			0	23	1,780,830
24	Unsecured notes and loans payable to unrelated third parties ....				24
25	Other liabilities. Complete Part X of Schedule D.....			19,933,599	25	45,287,247
26	Total liabilities. Add lines 17 through 25.....			201,354,161	26	219,938,003
	Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....			414,636,025	27	414,391,549
28	Temporarily restricted net assets .....			6,498,703	28	3,738,854
29	Permanently restricted net assets .....				29
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances .....			421,134,728	33	418,130,403
34	Total liabilities and net assets/fund balances .....			622,488,889	34	638,068,406

1	Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 926 (see instructions for Form 926).................	Yes	No
2	Did the organization have an interest in a foreign trust during the tax year? If " Yes," the organization may be required to file Form 3520 and/or Form 3520-A. (see instructions for Forms 3520 and 3520-A)..........	Yes	No
3	Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with respect to Certain Foreign Corporations. (see instructions for Form 5471)..............................	Yes	No
4	Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If "Yes," the organization may be required to file Form 8621, Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see instructions for Form 8621)	Yes	No
5	Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with respect to Certain Foreign Partnerships. (see instructions for Form 8865)....................................	Yes	No
6	Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to file Form 5713, International Boycott Report (see instructions for Form 5713)................................................	Yes	No