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

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2010
Open to Public Inspection
A For the calendar year, or tax year beginning 07-01-2010 and ending 06-30-2011
BCheck if applicable:
CName of organization
Holy Cross Hospital Inc
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
2202 N Forbes Blvd
 
Room/suite
City or town, state or country, and ZIP + 4
Tucson, AZ857451412
D Employer identification number

86-0575938
E Telephone number

G Gross receipts $ 25,130,847
F Name and address of principal officer:
Debra Knapheide
2202 N Forbes Blvd
Tucson,AZ857451412
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.carondelet.org
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet0928
K Form of organization:
 
L Year of formation: 1987
M State of legal domicile: AZ
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: Providing various types of advanced medical/surgical services to our patients.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) .... 3 10
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 9
5 Total number of individuals employed in calendar year 2010 (Part V, line 2a) ... 5 270
6 Total number of volunteers (estimate if necessary) .... 6 10
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 304,012
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b 0
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 119,312 189,747
9 Program service revenue (Part VIII, line 2g) ......... 23,129,629 23,975,118
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 0 262,148
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 1,681,939 665,797
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 24,930,880 25,092,810
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 0 0
14 Benefits paid to or for members (Part IX, column (A), line 4) .... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 12,250,849 12,309,577
16a Professional fundraising fees (Part IX, column (A), line 11e).... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet3,216    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 17,394,124 15,663,621
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 29,644,973 27,973,198
19 Revenue less expenses. Subtract line 18 from line 12...... -4,714,093 -2,880,388
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............ 9,470,609 9,883,434
21 Total liabilities (Part X, line 26)............ 5,481,833 8,830,791
22 Net assets or fund balances. Subtract line 21 from line 20 ..... 3,988,776 1,052,643
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid Preparer's Use Only Preparer's
signatureBig Right Arrow 		Date
right pointing bullet image Preparer’s taxpayer identification number
(see instructions)
Firm’s name (or yours
if self-employed),
address, and ZIP + 4Big Right Arrow




 		EIN right pointing bullet image
Phone no. right pointing bullet image
May the IRS discuss this return with the preparer shown above? (see instructions) .........
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2010)
Form 990 (2010)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III . . . . . . . . . .
1
Briefly describe the organization’s mission: Provide for the healthcare needs of the community; to embrace the person in mind, body and spirit; and to serve all people with dignity.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the exempt purpose achievements for each of the organization’s three largest program services by expenses.
Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 19,282,720 including grants of $   ) (Revenue $ 24,032,028 )
Holy Cross Hospital is a 72-bed facility that provides general medical/surgical services, 24-hour emergency care, rehabilitation, mammography, ultrasound, chemotherapy, hospice, home health, and long-term care. We also offer advanced technology such as renal dialysis, teleradiology, and lithotripsy programs. Holy Cross Hospital's community benefit information is included in the community benefit report for Carondelet Health Network.
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services. (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet$ 19,282,720
Form 990 (2010)
Form 990 (2010)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment........
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part IIClick to see attachment.........................
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part III........................
5
 
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts where donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete
Schedule D, Part IClick to see attachment.......................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IVClick to see attachment...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in term, permanent,or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
 
No
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, and program service activities outside the United States? If “Yes,” complete Schedule F, Part I.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II..
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III..
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II..........
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
Form 990 (2010)
Form 990 (2010)
Page 4
Part IV
Checklist of Required Schedules (continued)
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H..... Click to see attachment
20a
Yes
 
b
Did the organization attach its audited financial statement to this return? Note: All Form 990 filers that operate one or more hospitals must attach audited financial statements. ..... Click to see attachment
20b
Yes
 
21
Did the organization report more than $5,000 of grants and other assistance to governments and organizations in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II..
21
 
No
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III.....
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
 
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I...... Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................ Click to see attachment
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II........................... Click to see attachment
26
Yes
 
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor, or a grant selection committee member, or to a person related to such an individual? If “Yes,” complete Schedule L, Part III............... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ......................... Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV................... Click to see attachment
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV.. Click to see attachment
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35
Is any related organization a controlled entity within the meaning of section 512(b)(13)? .....
35
Yes
 
a
Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2........... Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2010)
Form 990 (2010)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V . . . . . . . . . .
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
0
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
 
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
270
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2010)
Form 990 (2010)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI . . . . . . . . . .
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year ..............
1a
10
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
9
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? ..
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Does the organization have members or stockholders? ................
6
Yes
 
7a
Does the organization have members, stockholders, or other persons who may elect one or more members of the governing body? .........................
7a
Yes
 
b
Are any decisions of the governing body subject to approval by members, stockholders, or other persons? ..
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Does the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” does the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with those of the organization? ....
10b
 
 
11a
Has the organization provided a copy of this Form 990 to all members of its governing body before filing the form?
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Does the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Are officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ...........................
12b
Yes
 
c
Does the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this is done ....................
12c
Yes
 
13
Does the organization have a written whistleblower policy? ...............
13
Yes
 
14
Does the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line a or b, describe the process in Schedule O. (See instructions.)
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If “Yes,” has the organization adopted a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and taken steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
AZ
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you make these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization makes its governing documents, conflict of interest policy, and financial statements available to the public.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
ReShelle Enoch
2202 N Forbes Blvd
Tucson,AZ857451412
(520) 872-7520
Form 990 (2010)
Form 990 (2010)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII . . . . . . . . . .
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

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

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

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

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) Eladio Pereira MD
Chairman
 .50 X   X       0 0 0
(2) Mark Valenzuela
Vice Chairman
 .50 X   X       0 0 0
(3) Leonard Lizardi
Secretary/Treasurer
 .50 X   X       0 0 0
(4) Jose Duran MD
Director
 .50 X           0 0 0
(5) Jorge Mera MD
Director
 .50 X           0 0 0
(6) Anita Moreno
Director
 .50 X           0 0 0
(7) Sr Irma Odabashian
Director
 .50 X           0 0 5,498
(8) James Ross
Director
 .50 X           0 0 0
(9) William Stout
Director
 .50 X           0 0 0
(10) Ruth Brinkley Sch O
CEO-CHN
 40.00 X   X       0 1,329,431 30,355
(11) Odette Bolano Sch O
COO-CHN
 40.00     X       0 455,122 50,383
(12) Wanona Fritz Sch O
CEO-CSM/HCH
 40.00     X       0 435,187 38,372
(13) Deb Mohesky
CFO-CHN (start 1/11)
 40.00     X       0 0 0
(14) Debra Knapheide
CNO/COO-HCH
 40.00     X       100,945 0 8,303
(15) Neil Carolan Sch O
VP Phys. Development
 40.00       X     0 218,131 38,951
(16) Roy Farrell
CMO-HCH
 40.00       X     184,535 0 11,533
(17) Anthony Fonze Sch O
VP CIO
 40.00       X     0 274,481 28,915
Form 990 (2010)
Form 990 (2010)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) Daisy Jenkins Sch O
Sr. VP Human Resources
 40.00       X     0 291,966 21,573
(19) Jude Magers Sch O
VP Mission Integration
 40.00       X     0 187,271 30,565
(20) Patricia Martinez Sch O
VP Chief Quality Off.
 40.00       X     0 266,859 16,541
(21) Tracy Prigmore Sch O
VP Strategic Planning (end 10/10)
 40.00       X     0 312,174 11,611
(22) Irma Ramirez Sch O
VP Comm/Govt. Relations
 40.00       X     0 217,287 29,391
(23) Judy Tatman Sch O
VP Clinical Excellence
 40.00       X     0 320,193 21,173
(24) Linda Werbylo Sch O
VP Ops & Integrity
 40.00       X     0 242,229 47,377
(25) Donna Zazworsky Sch O
VP Community Health
 40.00       X     0 166,540 12,726
(26) Mary Abraham
RN
 40.00         X   102,666 0 19,068
(27) Stephen Henefield
CRNA
 40.00         X   190,208 0 17,988
(28) Jacinto Orozco
General Surgeon
 40.00         X   228,486 0 5,718
(29) Dina Rojas-Sanchez
Planning & Comm Director
 40.00         X   100,798 0 18,952
(30) Celia Torres
Director Pharmacy
 40.00         X   122,889 0 18,075
(31) Wesley Colvin
Former COO-CHN (end 7/09)
 0.00           X 0 415,301 3,474
(32) Richard Polheber
Former CEO-HCH (end 8/09)
 0.00           X 0 148,243 3,021
(33) Andrew Guarni
Former CFO-CHN (end 1/10)
 0.00           X 0 189,861 2,236
(34) Thomas Murphy
Former CLO-CHN (end 1/09)
 0.00           X 0 139,955 0
(35) Marlene Wade
Former CNO-HCH (end 8/09)
 0.00           X 197,175 0 36,114
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 1,227,702 5,610,231 527,913
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 in reportable compensation from the organizationMediumBullet9
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
Crothall Healthcare
13028 Collections Center Dr
Chicago,IL60693 		Housekeeping 755,320
Morrisons Management Specialists
5801 Peachtree Dunwoody Rd
Atlanta,GA30342 		Nutritional Services 638,795
TriMedx LLC
PO Box 636129
Cincinnati,OH452636129 		Equipment Maintenance 466,637
Quantum Plus Inc
PO Box 634850
Cincinnati,OH452634850 		Emergency Room Physicians 377,068
Alliance Imaging Inc
File 55826
Los Angeles,CA900745826 		Physician Services 241,233
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization MediumBullet7
Form 990 (2010)
Form 990 (2010)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, gifts, grants and other similar amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 175,997
e Government grants (contributions)1e 13,750
f All other contributions, gifts, grants, and
similar amounts not included above1f 		 
g Noncash contributions included in lines 1a-1f:$  
h Total. Add lines 1a-1f.......MediumBullet 189,747
Program Service Revenue Business Code
2a Patient Service Rev 621,400 23,975,118 23,975,118    
b
c
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 23,975,118
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 123,608     123,608
4 Income from investment of tax-exempt bond proceeds..MediumBullet        
5 Royalties............MediumBullet        
(i) Real (ii) Personal
6a Gross Rents 161,505  
b Less: rental expenses 5,336  
c Rental income or (loss) 156,169  
d Net rental income or (loss).......MediumBullet 156,169     156,169
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory   171,241
b Less: cost or other basis and sales expenses   32,701
c Gain or (loss)   138,540
d Net gain or (loss)..........MediumBullet 138,540     138,540
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet      
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet        
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet        
Miscellaneous Revenue Business Code
11a Reference Lab 621,500 304,012   304,012  
b Cafeteria Revenue 722,210 148,706     148,706
c Unclaimed Property Rev 900,099 49,387 49,387    
d All other revenue .... 7,523 7,523    
e Total. Add lines 11a–11d ......MediumBullet 509,628
12 Total revenue. See Instructions....MediumBullet 25,092,810 24,032,028 304,012 567,023
Form 990 (2010)
Form 990 (2010)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the U.S. See Part IV, line 21    
2 Grants and other assistance to individuals in the U.S. See Part IV, line 22    
3 Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 15 and 16    
4 Benefits paid to or for members    
5 Compensation of current officers, directors, trustees, and key employees .... 310,488 310,488    
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....        
7 Other salaries and wages 9,794,025 7,529,925 2,264,100  
8 Pension plan contributions (include section 401(k) and section 403(b) employer contributions) .... 252,917 191,939 60,978  
9 Other employee benefits ....... 1,207,867 916,650 291,217  
10 Payroll taxes ........... 744,280 564,834 179,446  
11 Fees for services (non-employees):        
a Management ...... 8,224   8,224  
b Legal .........        
c Accounting ...........        
d Lobbying ........... 17,830   17,830  
e Professional fundraising. See Part IV, line 17..    
f Investment management fees ......        
g Other .......... 3,957,593 1,597,282 2,360,311  
12 Advertising and promotion .... 13,945   13,945  
13 Office expenses ....... 355,975 222,708 133,267  
14 Information technology ...... 35,542 33,839 1,703  
15 Royalties ..        
16 Occupancy ........... 307,104 147,410 159,694  
17 Travel ............ 60,441 33,092 27,349  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ......        
19 Conferences, conventions, and meetings ....        
20 Interest ........... 171,111 82,133 88,978  
21 Payments to affiliates ....... 368,439   368,439  
22 Depreciation, depletion, and amortization ..... 713,508 342,484 371,024  
23 Insurance .............. 347,071 336,954 10,117  
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 Shared Services 4,744,340 2,968,812 1,772,312 3,216
b Bad Debt 2,352,351 2,352,351 0 0
c Supplies 1,554,454 1,467,590 86,864 0
d Food Service Expense 291,798 36,331 255,467  
e Repairs and Maintenance 247,313 118,710 128,603 0
f All other expenses 116,582 29,188 87,394  
25 Total functional expenses. Add lines 1 through 24f 27,973,198 19,282,720 8,687,262 3,216
26 Joint costs. Check here MediumBullet if following
SOP 98-2 (ASC 958-720). Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation 		       
Form 990 (2010)
Form 990 (2010)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing ..........   1  
2 Savings and temporary cash investments ....... 6,922 2 2,362
3 Pledges and grants receivable, net .........   3  
4 Accounts receivable, net ......... 2,452,891 4 3,107,513
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..........   5 78,263
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 92,740
7 Notes and loans receivable, net ............. 210,080 7  
8 Inventories for sale or use .............. 316,474 8 364,322
9 Prepaid expenses and deferred charges ............ 36,878 9 42,671
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 11,685,270
b Less: accumulated depreciation. ..... 10b 5,992,588 5,949,790 10c 5,692,682
11 Investments—publicly traded securities ..........   11  
12 Investments—other securities. See Part IV, line 11 ......   12  
13 Investments—program-related. See Part IV, line 11 ..   13  
14 Intangible assets .........   14  
15 Other assets. See Part IV, line 11 ........... 497,574 15 502,881
16 Total assets. Add lines 1 through 15 (must equal line 34)... 9,470,609 16 9,883,434
Liabilities 17 Accounts payable and accrued expenses . 1,286,271 17 1,006,452
18 Grants payable ..........   18  
19 Deferred revenue ..........   19  
20 Tax-exempt bond liabilities ..........   20  
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22  
23 Secured mortgages and notes payable to unrelated third parties ..   23  
24 Unsecured notes and loans payable to unrelated third parties ....   24  
25 Other liabilities. Complete Part X of Schedule D..... 4,195,562 25 7,824,339
26 Total liabilities. Add lines 17 through 25..... 5,481,833 26 8,830,791
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets ..... 3,954,316 27 1,034,591
28 Temporarily restricted net assets ..... 34,460 28 18,052
29 Permanently restricted net assets .....   29  
Organizations that do not follow SFAS 117, check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ..... 3,988,776 33 1,052,643
34 Total liabilities and net assets/fund balances ..... 9,470,609 34 9,883,434
Form 990 (2010)
Form 990 (2010)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI . . . . . . . . . .
1
Total revenue (must equal Part VIII, column (A), line 12) . . .
1
25,092,810
2
Total expenses (must equal Part IX, column (A), line 25) . . . . .
2
27,973,198
3
Revenue less expenses. Subtract line 2 from line 1 . . . .
3
-2,880,388
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) . .
4
3,988,776
5
Other changes in net assets or fund balances (explain in Schedule O) . . . .
5
-55,745
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) . . . . . .
6
1,052,643
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII . . . . . . . . . .
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?..
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O............................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
 
 
Form 990 (2010)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE 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.
right arrow 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
Holy Cross Hospital Inc
 
Employer identification number

86-0575938
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.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
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.)
10
11
e
f
g
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
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)
 
 
h
(i)
Name of supported organization 		(ii)
EIN 		(iii)
Type of organization (described on lines 1- 9 above or IRC section (see instructions)) 		(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?
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
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).            
12
12
 
13
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Schedule A (Form 990 or 990-EZ) 2010
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.).            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2010
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:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2010
Name of organization
Holy Cross Hospital Inc
 
Employer identification number

86-0575938
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




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—
Special Rules
......................... 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)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part I
Name of organization
Holy Cross Hospital Inc
  		Employer identification number

86-0575938
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




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
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 II
Name of organization
Holy Cross Hospital Inc
  		Employer identification number

86-0575938
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
Holy Cross Hospital Inc
  		Employer identification number

86-0575938
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		 (c)
Use 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		 (c)
Use 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		 (c)
Use 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		 (c)
Use 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:  
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
Holy Cross Hospital Inc
 
Employer identification number

86-0575938
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
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.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c) except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt funtion activities ....................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
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

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
B Check
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
Organization's
Totals 		(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? ......................................

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


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
No
(b)
Amount
1
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:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? If "Yes," describe in Part IV ..........................
Yes
 
17,830
j
Total. lines 1c through 1i ...................................
17,830
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
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
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carryover lobbying and political expenditures from the prior year? ..........
3
 
 
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”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
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).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ...........................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
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? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
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
Explanation of Other Lobbying Activities: Part II-B, Line 1i: Lobby expenses represent the portion of dues paid to national and state hospital associations that is specifically allocable to lobbying.
Schedule C (Form 990 or 990EZ) 2010

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11, or 12.
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Holy Cross Hospital Inc
 
Employer identification number

86-0575938
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .......    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) ...    
4 Aggregate value at end of year .......    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds may be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit. ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a–2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06 ........ 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the taxable year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................
9
In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116, not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116, to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 52283D
Schedule D (Form 990) 2010

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

Yes
No
(i) unrelated organizations ........................
3a(i)
 
 
(ii) related organizations ........................
3a(ii)
 
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Investments—Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of investment (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   1,016,496 1,016,496
b Buildings ................   6,758,862 2,941,139 3,817,723
c Leasehold improvements ............   3,887 1,798 2,089
d Equipment ................   3,741,363 2,903,756 837,607
e Other .................   164,662 145,895 18,767
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........SchDMdBullet 5,692,682
Schedule D (Form 990) 2010

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








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








Total. (Column (b) should equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) Other Receivables 484,829
(2) Donor Restricted Funds 18,052







Total. (Column (b) should equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 502,881
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Amount
Federal Income Taxes  
Due to Affiliates 7,375,167
Self Insurance Liability 237,172
Other Current Liabilities 103,347
Other Non-Current Liabilities 98,931
Estimated Settlement Liability 9,722




Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)Small Bullet 7,824,339
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).
Schedule D (Form 990) 2010

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

Additional Data


Software ID:  
Software Version:  




SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet 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
Holy Cross Hospital Inc
 
Employer identification number

86-0575938
Part I
Charity Care and Certain Other Community Benefits at Cost
Yes
No
1a
Does the organization have a charity care policy? If "No," skip to question 6a...........
1a
Yes
 
b
If "Yes," is it a written policy? .......................
1b
Yes
 
2
If the organization has multiple hospitals, indicate which of the following best describes application of the charity care policy to the various hospitals.
3
Answer the following based on the charity care eligibility criteria that applies to the largest number of the organization's patients.
a
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:
3a
Yes
 
b
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: .....
3b
Yes
 
c
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.
4
Does the organization's policy provide free or discounted care to the "medically indigent"? ......
4
Yes
 
5a
Does the organization budget amounts for free or discounted care provided under its charity care policy? ...
5a
Yes
 
b
If "Yes," did the organization's charity care expenses exceed the budgeted amount?.........
5b
 
No
c
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?...............
5c
 
 
6a
Does the organization prepare an annual community benefit report?.............
6a
Yes
 
6b
If "Yes," does the organization make it available to the public? ..............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Charity Care and Certain Other Community Benefits at Cost
Charity Care and
Means-Tested Government Programs		 (a) Number of activities or programs (optional) (b) Persons served (optional) (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) .. 		    297,301   297,301 1.160 %
b Unreimbursed Medicaid (from
Worksheet 3, column a) . 		    11,508,980 9,065,009 2,443,971 9.540 %
c Unreimbursed costs—other means-tested government programs (from Worksheet 3, column b) ....            
dTotal Charity Care and
Means-Tested Government Programs ..... 		    11,806,281 9,065,009 2,741,272 10.700 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) .... 		12 1,351 69,797 902 68,895 0.270 %
f Health professions education
(from Worksheet 5) .. 		2   4,347   4,347 0.020 %
g Subsidized health services
(from Worksheet 6) .. 		2 731 2,454,285 1,606,512 847,773 3.310 %
h Research (from Worksheet 7)            
i Cash and in-kind contributions
to community groups
(from Worksheet 8) .. 		6 20 9,794   9,794 0.040 %
jTotal Other Benefits ... 22 2,102 2,538,223 1,607,414 930,809 3.640 %
kTotal. Add lines 7d and 7j. .. 22 2,102 14,344,504 10,672,423 3,672,081 14.340 %
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 1   1,459   1,459 0.010 %
2 Economic development 2          
3 Community support 2   2,407   2,407 0.010 %
4 Environmental improvements            
5 Leadership development and training for community members 1 35 1,011   1,011 0 %
6 Coalition building 4 450 3,290   3,290 0.010 %
7 Community health improvement advocacy 3   8,510   8,510 0.030 %
8 Workforce development     3,160   3,160 0.010 %
9 Other            
10 Total 13 485 19,837   19,837 0.070 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Does the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
 
No
2
Enter the amount of the organization's bad debt expense (at cost).....
2
784,744
3
Enter the estimated amount of the organization's bad debt expense (at cost) attributable to patients eligible under the organization's charity care policy ..
3
515,170
4
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
5
Enter total revenue received from Medicare (including DSH and IME).....
5
5,182,041
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
6,259,499
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
-1,077,458
8
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:
Section C. Collection Practices
9a
Does the organization have a written debt collection policy? ...............
9a
Yes
 
b
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......
9b
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
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 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe)
1 Holy Cross Hospital Inc
2202 N Forbes Blvd
Tucson,AZ857451412 		X X     X   X    
Schedule H (Form 990) 2010
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:NA
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
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
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
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?  
Name and address Type of Facility (Describe)
1
2
3
4
5
6
7
8
9
10
Schedule H (Form 990) 2010
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 6a: The organization prepares and files an annual Community Benefit Plan Report. This report is prepared on a consolidated basis and includes data for Carondelet Health Network, Holy Cross Hospital, Carondelet Foundation, and Carondelet Heart & Vascular Institute.
    Part I, Line 7: The cost of providing charity care, means tested government programs, and community benefit programs is estimated using internal cost data, and is calculated in compliance with Catholic Health Association ("CHA") guidelines. The organization uses a costing accounting system that addresses all patient segments (for example, inpatient, outpatient, emergency room, private insurance, Medicaid, Medicare, uninsured, or self pay). The best available data was used to calculate the amounts reported in the table.
    Part I, Line 7g: The organization has included costs attributable to Women & Children and Skilled Nursing facility services.
    Part I, L7 Col(f): The amount of bad debt expense reported on Form 990, Part IX, Line 25, column (A), but subtracted for purposes of calculating the percentages in Part I, Line 7, column (f) is $2,352,351.
    Part II: Rebuilding Together helps low income families fix their homes. The Director of Planning/Community Relations serves on the board.Arizona/Mexico Commission: Outreach from both sides of the border regarding the health issues.Governor's Council on Workforce Development: State representative for workforce development in Santa Cruz County. The Director of Planning/Community Relations serves on the board. The Exchange Club is an organization for people who want to serve the community and develop leadership skills. Encourage parents and caregivers to make healthy choices and prevent child abuse. A Holy Cross Hospital worker serves on the Board of Directors. Santa Cruz Co. Coordinated Response Team (SCCRT) is a committee of several agencies in the community, come together to bring agency updates and develop programs to assist each other and the community. A Holy Cross Hospital social worker serves on the Board of Directors. Santa Cruz Council on Aging: Representing the hospital on issues regarding the elderly in our community. The Holy Cross Hospital Administrator serves on the board (24 hours annually).United Way of Santa Cruz County: Special projects and discussions on fundraising, partnering with various community members for the good of the community. The Director of Planning/Community Relations serves on the board. Child & Family Resources, Inc. is a private, community-based, nonprofit agency offering dozens of programs throughout Arizona investing in quality early childhood care and education training, which saves money by increasing the likelihood that children will be literate, employed, enrolled in post secondary education, and less likely to be school dropouts, dependent on welfare, or arrested for criminal activity. A Holy Cross Hospital Nurse Case Manager serves on the board for Child and Family Resources.Community Presentations/Outreach: Evaluated Senior Class Projects. Home Health Professional Advisory Group: The group is presented with financials, operational information, and issues going on within the community. Brainstorming on solving problems with professionals from Carondelet, Mariposa and Social Services. A Holy Cross Hospital physical therapist serves on the board of directors (8 hours annually).Nogales Lions Club: To strategize for community outreach, eye clinics, eyeglasses. Director of Planning/Community Relations serves on the board. Nogales Sonora Lions Club: Cooperation between Nogales, AZ and Nogales, Sonora; collaborative effort to bring the poor for needed eye surgery in the United States. The Director of Planning/Community Relations serves on the board.Workforce Investment-WIA: To expand regions knowledge of workforce. The Director of Planning/Community Relations serves on the board.
    Part III, Line 4: The organization is a part of the Carondelet Health Network consolidated audit. The footnote that references bad debt expense in the 6/30/2011 consolidated audit is as follows:The provision for bad debt expense is based upon management's assessment of expected net collections, taking into consideration economic conditions, historical experience, trends in health care coverage, and other collection indicators. Periodically throughout the year, management assesses the adequacy of the allowance for uncollectible accounts based upon historical write-off experience by payor category, including those amounts not covered by insurance. The results of this review are then used to make any modifications to the provision for bad debt expense and establish an appropriate allowance for uncollectible accounts. After satisfaction of amounts due from insurance and reasonable efforts to collect from the patient have been exhausted, CHN follows established guidelines for placing certain past-due patient balances with collection agencies, subject to the terms of certain restrictions on collection efforts as determined by Ascension Health. Accounts receivable are written off after collection efforts have been followed in accordance with CHN's policies.The organization's share of bad debt expense in 2010 was $2,352,351 at charges and $784,744 at cost.
    Part III, Line 8: Holy Cross Hospital follows the Catholic Health Association ("CHA") guidelines for determining community benefit. CHA community benefit reporting guidelines suggest that Medicare shortfall is not treated as community benefit.
    Part III, Line 9b: The organization has a written debt collection policy that also includes a provision on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance. Patients who are coopoerating in good faith to resolve their hospital bills wil not receive from Holy Cross Hospital liens on primary residences or wage garnishments and unpaid bills will not be sent to collection agencies.
    Part VI, Line 2: Holy Cross Hospital follows the Catholic Healthcare Association Guidelines which state that a Community Needs Assessment ("CNA") should be completed every three years. The last Community Needs Assessment was commissioned in 2007 and delivered in December of 2009 from an outside research center affiliated with Arizona State University. The research center worked with an internal committee for guidance of the needs assessment. Other internal strategic documents are used to identify community needs and hospital data support the work community outreach programs do in Tucson. In June 2010, an outside consultant provided a senior Community Assessment with senior groups and community and health agencies. The results were shared at a community presentation attended by community agencies and health care providers.
    Part VI, Line 3: Upon admission, patients are encouraged to apply for the state Medicaid program if they are uninsured as well as other public benefits such as TANF or SNAP if the patient has a need. If patients prove they meet at least one (1) of eight (8) criteria outlined in the policy, they will be eligible for charity care. The patient will be placed in pre-emptive charity care status and after all bills are finalized a request for the total amount to be billed and written-off as charity care will be made on the patients behalf by their financial counselor. Trained financial counselors will work with patients if it is not easily determined that a patient qualifies for charity care or to what level of financial assistance a patient may qualify for. The Pre-emptive Charity Care Policy is posted in the Emergency Department, Admitting, hospital lobbies, other public areas as well as summarized on the Carondelet Health Network website and is to be included in a patient's financial statements when sent. The hospital also works with Tu Salud, a Southern AZ community Collaboration CHIPRA funded community outreach program, and provides a community outreach worker/financial counselor at community events to facilitate enrollment into government and community assistance programs.
    Part VI, Line 4: The primary and secondary service area includes Pima, Santa Cruz and Cochise Counties. The population is 1.21 million individuals based on 2010 census data. This growth is 2.05% from 2000. The average household size is 2.53. The median age is 37.4, which is at the national average. 51.7% of the population earns less than $50,000 with the median household income at $48,208 and the per capita income at $24,171. 27.2% of the population is over the age of 55. Eighty-one percent of the population are households with 2+ members, and 77.7% are family households. Husband-Wife families comprise 55.7% of this, and 26.7% with children. The average household size is 3.1 members.The demographics of the area with regard to ethnicity is as follows: 36% of Hispanic origin, 3.8% two or more races, 15.6% some other race alone, 0.2% Pacific Islander alone, 2.2% Asian American, 2.8% American Indian Alone, 3.5% Black and 36% White alone.
    Part VI, Line 6: Holy Cross Hospital ("HCH") provides a wide variety of services to the communities where it has a presence. Activities include social service enrollment, support groups for patients, families and the community at large, chronic disease education to patients, families and outside medical professionals, spiritual care services and parish nursing program. HCH works with community partners to provide mobile health services for the area homeless, border health outreach, promotion of state Medicaid enrollment, education on chronic diseases to schools, patients, churches and health and human service organizations. Associates serve on various Boards of Directors for local and regional organizations. Additional community outreach includes health screenings, health fairs and educational conferences and events throughout the year.
    Part VI, Line 7: Holy Cross Hospital, Inc. is a wholly owned subsidiary of Carondelet Health Network, which is a member of Ascension Health. Ascension Health is a Catholic, national health system consisting primarily of nonprofit corporations that own and operate local health care facilities, or Health Ministries, located in 20 of the United States and the District of Columbia. Ascension Health is sponsored by the Northeast, Southeast, East Central, and West Central Provinces of the Daughters of Charity of St. Vincent de Paul, the Congregation of St. Joseph, and the Sisters of St. Joseph of Carondelet.Holy Cross Hospital, Inc., located in Tucson, Arizona, is a nonprofit acute care hospital. Holy Cross Hospital, Inc. provides inpatient, outpatient, and emergency care services for the residents of Tucson, Arizona. Admitting physicians are primarily practitioners in the local area. Holy Cross Hospital, Inc. is related to Ascension Health's other sponsored organizations through common control. Substantially all expenses of Ascension Health are related to providing health care services. Mission:Ascension Health directs its governance and management activities toward strong, vibrant, Catholic Health Ministries united in service and healing and dedicates its resources to spiritually centered care that sustains and improves the health of the individuals and communities it serves. In accordance with Ascension Health's mission of service to those persons living in poverty and other vulnerable persons, each Health Ministry accepts patients regardless of their ability to pay. Ascension Health uses four categories to identify the resources utilized for the care of persons living in poverty and community benefit programs:1. Traditional charity care includes the cost of services provided to persons who cannot afford health care because of inadequate resources and/or those who are uninsured or underinsured.2. Unpaid cost of public programs, excluding Medicare, represents the unpaid cost of services provided to persons covered by public programs for persons living in poverty and other vulnerable persons.3. Cost of other programs for persons living in poverty and other vulnerable persons includes unreimbursed costs of programs intentionally designed to serve persons living in poverty and other vulnerable persons of the community, including substance abusers, the homeless, victims of child abuse, and persons with acquired immune deficiency syndrome.4. Community benefit consists of the unreimbursed costs of community benefit programs and services for the general community, not solely for persons living in poverty, including health promotion and education, health clinics and screenings, and medical research. Discounts are provided to all uninsured patients, including those with the means to pay. Discounts provided to those patients who did not qualify for assistance under charity care guidelines are not included in the cost of providing care of persons who are living in poverty and community benefit programs. The cost of providing care of persons who are poor and community benefit programs is estimated using internal cost data and is calculated in compliance with guidelines established by both the Carondelet Health Network ("CHA") and the Internal Revenue Service ("IRS").
Schedule H (Form 990) 2010
Additional Data


Software ID:  
Software Version:  
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
Holy Cross Hospital Inc
 
Employer identification number

86-0575938
Part I
Questions Regarding Compensation
Yes
No
1a
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.
b
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....
1b
 
 
2
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? ....
2
 
 
3
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.
4
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:
a
Receive a severance payment or change-of-control payment? ...............
4a
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
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.
5
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:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
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:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
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 ............
7
 
No
8
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 .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2010

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
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) Ruth Brinkley Sch O (i)
(ii)		 0
673,820 		0
631,788 		0
23,823 		0
11,025 		0
19,330 		0
1,359,786 		0
0
(2) Odette Bolano Sch O (i)
(ii)		 0
368,458 		0
80,500 		0
6,164 		0
43,236 		0
7,147 		0
505,505 		0
31,184
(3) Wanona Fritz Sch O (i)
(ii)		 0
375,976 		0
51,329 		0
7,882 		0
26,114 		0
12,258 		0
473,559 		0
0
(4) Neil Carolan Sch O (i)
(ii)		 0
178,290 		0
38,759 		0
1,082 		0
22,962 		0
15,989 		0
257,082 		0
17,494
(5) Roy Farrell (i)
(ii)		 183,446
0 		0
0 		1,089
0 		0
0 		11,533
0 		196,068
0 		0
0
(6) Anthony Fonze Sch O (i)
(ii)		 0
220,068 		0
53,520 		0
893 		0
12,250 		0
16,665 		0
303,396 		0
0
(7) Daisy Jenkins Sch O (i)
(ii)		 0
245,450 		0
40,000 		0
6,516 		0
6,519 		0
15,054 		0
313,539 		0
0
(8) Jude Magers Sch O (i)
(ii)		 0
160,737 		0
22,776 		0
3,758 		0
20,740 		0
9,825 		0
217,836 		0
0
(9) Patricia Martinez Sch O (i)
(ii)		 0
196,307 		0
61,848 		0
8,704 		0
5,219 		0
11,322 		0
283,400 		0
0
(10) Tracy Prigmore Sch O (i)
(ii)		 0
160,589 		0
76,059 		0
75,526 		0
6,492 		0
5,119 		0
323,785 		0
0
(11) Irma Ramirez Sch O (i)
(ii)		 0
185,113 		0
31,466 		0
708 		0
23,185 		0
6,206 		0
246,678 		0
10,144
(12) Judy Tatman Sch O (i)
(ii)		 0
239,234 		0
39,693 		0
41,266 		0
8,575 		0
12,598 		0
341,366 		0
0
(13) Linda Werbylo Sch O (i)
(ii)		 0
234,402 		0
0 		0
7,827 		0
28,908 		0
18,469 		0
289,606 		0
0
(14) Donna Zazworsky Sch O (i)
(ii)		 0
163,090 		0
2,934 		0
516 		0
5,881 		0
6,845 		0
179,266 		0
0
(15) Stephen Henefield (i)
(ii)		 176,132
0 		7,057
0 		7,019
0 		6,242
0 		11,746
0 		208,196
0 		0
0
(16) Jacinto Orozco (i)
(ii)		 223,382
0 		4,201
0 		903
0 		0
0 		5,718
0 		234,204
0 		0
0
(17) Wesley Colvin (i)
(ii)		 0
0 		0
0 		0
415,301 		0
0 		0
3,474 		0
418,775 		0
0
(18) Richard Polheber (i)
(ii)		 0
708 		0
0 		0
147,535 		0
2,914 		0
107 		0
151,264 		0
0
(19) Andrew Guarni (i)
(ii)		 0
42,770 		0
128,700 		0
18,391 		0
653 		0
1,583 		0
192,097 		0
0
(20) Thomas Murphy (i)
(ii)		 0
0 		0
0 		0
139,955 		0
0 		0
0 		0
139,955 		0
0
(21) Marlene Wade (i)
(ii)		 162,094
0 		20,442
0 		14,639
0 		22,559
0 		13,555
0 		233,289
0 		0
0
Schedule J (Form 990) 2010

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
  Part I, Lines 4a-b Severance Payments: Wesley Colvin - $415,301 Richard Polheber - $147,535 Thomas Murphy - $139,955 Part I, Line 4a-b Eligible Executives participate in a program that provides for supplemental retirement benefits. The payment of benefits under the program, if any, is entirely dependent upon the facts and circumstances under which the executive terminates employment with the organization. Benefits under the program are unfunded and non-vested. Due to the substantial risk of forfeiture provision, there is no guarantee that these executives will ever receive any benefit under the program. Any amount ultimately paid under the program to the executive is reported as compensation on Form 990, Schedule J, Part II, Column B in the year paid. A related organization made contributions to the supplemental nonqualified retirement plan in the amounts as noted: Odette Bolano - $34,661 Neil Carolan - $15,863 Jude Magers - $14,144 Irma Ramirez - $15,905 Linda Werbylo - $20,459 Wanona Fritz - $17,539 A related organization made distributions from the supplemental nonqualified retirement plan in the amounts as noted: Irma Ramirez - $10,144 Odette Bolano - $31,184 Neil Carolan - $17,494
Supplemental Information Part III Part I, Line 3: Carondelet Health Network, a related organization of Holy Cross Hospital, Inc., uses the following to establish the compensation of the organization's CEO: -Compensation Committee, -Independent Compensation Committee, -Written Employment Contract, -Compensation Survey or Study, and -Approval by the Board or Compensation Committee.
Schedule J (Form 990) 2010

Additional Data


Software ID:  
Software Version:  
Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet 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. MediumBulletSee separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Holy Cross Hospital Inc
 
Employer identification number

86-0575938
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?
Yes No





2
Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image$
 
3
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?
To From Yes No Yes No Yes No
(1) Alfredo Guevara MD
 
To purchase medical office building 		  X 296,766 92,740   No Yes   Yes  
(2) Jose Duran MD
 
To purchase medical office building 		  X 245,735 78,263   No Yes   Yes  
Total ...............Small Bullet $ 171,003
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
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?
Yes 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
Schedule L (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  




SCHEDULE O
(Form 990 or 990-EZ)

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

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
Holy Cross Hospital Inc
 
Employer identification number

86-0575938
Identifier Return Reference Explanation
Form 990, Part VI, Section A, line 6   Holy Cross Hospital, Inc. has a single corporate member, Carondelet Health Network.
Form 990, Part VI, Section A, line 7a   Holy Cross Hospital, Inc. has a single corporate member, Carondelet Health Network, who has the ability to elect members to the governing body of Holy Cross Hospital, Inc.
Form 990, Part VI, Section A, line 7b   All decisions that have a material impact to Holy Cross Hospital, Inc. financial information or corporation as a whole are subject to approval by its sole corporate member, Carondelet Health Network.
Form 990, Part VI, Section B, line 11   Management, including certain officers, works diligently to complete the Form 990 and attached schedules in a thorough manner. Management presents the Form to the Board, or a designated committee, to review and answer any questions. Prior to filing the return, all Board Members are provided the Form 990 and management team members are available to answer any Board Members questions.
  Form 990, Part VI, Section B, line 12c The organization regularly and consistently monitors and enforces compliance with the conflict of interest policy in that any director, principal officer, or member of a committee with governing board delegated powers, who has a direct or indirect financial interest, must disclose the existence of the financial interest and be given the opportunity to disclose all material facts to the directors and members of the committees with governing board delegated powers considering the proposed transaction or arrangement. The remaining individuals on the governing board or committee meeting will decide if conflicts of interest exist. Each director, principal officer and member of a committee with governing board delegated powers annually signs a statement which affirms such person has received a copy of the conflict of interest policy, has read and understands the policy, has agreed to comply with the policy, and understands that the organization is charitable and in order to maintain its federal tax exemption it must engage primarily in activities which accomplish its tax-exempt purpose.
  Form 990, Part VI, Section B, line 15 In determining compensation of the organization's CEO, the process, performed by Carondelet Health Network, a related organization, included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. The audit committee reviewed and approved the compensation. In the review of the compensation, the CEO was compared to individuals at other hospitals in the area that hold the same title. During the review and approval of the compensation, documentation of the decision was recorded in the board minutes. The individual was not present when her compensation was decided. In determining compensation of other officers or key employees of the organization, the process, performed by Carondelet Health Network, a related organization, included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. The audit committee reviewed and approved the compensation. In the review of the compensation, the other officers or key employees of the organization were compared to other hospitals' employees in the area that hold the same title. During the review and approval of the compensation, documentation of the decision was recorded in the board minutes.
  Form 990, Part VI, Section C, line 19 The organization will provide any documents open to public inspection upon request.
Explanation of Average Hours Worked for Organization: Form 990, Part VII, Section A: Officers and Key Employees for Holy Cross Hospital, Inc. provide services to Carondelet Health Network and its subsidiaries. Hours worked are not tracked on an entity by entity basis. Therefore where noted with a "Sch O" reference, all hours are reported on Form 990, Part VII, Compensation of Officers, Directors, Trustees, key Employees, Highest Compensated Employees, and Independent Contractors represent aggregate hours worked per week for all entities.
Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Transfers to Sponsor - Ascension Health -55,745. Total to Form 990, Part XI, Line 5: -55,745.
Community Benefit Report: Form 990, Part III, Line 4a: Carondelet Health Network 2011 Community Benefit Report Brain Academy Offers Students a Glimpse into the Future: All parents ponder the possibilities of what our children may become. Scientists...doctors...brain surgeons? But consider actually providing them a firsthand look at the realities of those possibilities. In May 2011, a dozen students from Tucson's largest school district participated in the first-ever Brain Academy, sponsored by Carondelet Health Network. The two-day event was held in tandem with Carondelet Neurological Institute's annual Neurosciences Conference. On the first day of the Brain Academy, students toured the Carondelet Neurological Institute at St. Joseph's Hospital. They got to see the neurosurgical operating room suites-the first of their kind in North America. They also visited the biplane angiography suite, where aneurysms are treated, and the Stereotactic Radiosurgery Suite, which is used for targeted radiation treatment of brain and spinal tumors. The second day, students had the unique opportunity to meet with top neurologists and neurosurgeons at the Neurosciences Conference. Conference leaders discussed the latest developments in the treatment of Alzheimer's disease, stroke, movement disorders, disorders of the spine, and brain concussions. Brain Academy was conceived in an effort to spark interest in the medical sciences among Tucson's youth. "In the educational community, we certainly recognize the need to generate more interest among today's students in the fields of science and technology," said Tucson Unified School District Superintendent John J. Pedicone, Ph.D. "Carondelet Neurological Institute's outreach to our students is a wonderful gift that allows students to see the possibilities that exist in their futures through science and medicine." Robert P. Goldfarb, M.D., Chairman of Carondelet Neurological Institute noted, "The Brain Academy is a valuable next effort to invest in and strengthen this region's future through the students we encourage to pursue careers in our field." Carondelet Health Network is expanding the program to engage students in a number of local school systems in 2012. A few comments from students' evaluation forms: -It was such a great opportunity to talk with doctors and have questions answered. -I really enjoyed touring the hospital. -The student discussion groups and activities were fun-such a fantastic opportunity. -It was great to learn about conditions applicable to teenage lives, like concussions in sports. Habitat For Humanity & Carondelet Health Network Team up to Build a Dream: Carondelet Health Network is always actively working to improve the lives of those in Southern Arizona. In addition to providing excellent medical care and a broad spectrum of health resources, Carondelet also works with Habitat for Humanity to build homes for those in need. In the fall of 2010, Carondelet associates from across the Ministry volunteered to help build a house for a deserving Tucson family. Turns out, they were building for one of their own. Gina Beltran, an office coordinator in the Carondelet Diabetes Center, was the joyful recipient of the new home, located in Southeast Tucson. Beltran has four children: Jessica, 23, and Pedro, 19, who have left the nest, and Cassandra, 17, and Angela, 14, who live with Beltran in their new Habitat home. "My kids are everything to me," Beltran said. "I always wanted to do this-buy a home-but I was scared." Carondelet associates-from clinical workers to physicians to executives-pounded nails and raised the first walls at the home's groundbreaking held September 11, 2010, as part of "Building Freedom Day." Every year on the anniversary of the 9/11 attacks, Habitat for Humanity Tucson begins construction on several homes to memorialize the victims and to celebrate hope, community and the American dream. Groups of Carondelet volunteers continued to lend time and muscle on weekends for several months. Working alongside the volunteers, Beltran and her children contributed many required "sweat equity" hours during construction. "I am just so happy about this opportunity, and I am grateful that anybody would help," Beltran said. "It means a lot to me and my children-so much that I can't even express my thanks in words." The Beltrans got the keys, and their home was dedicated on May 26, 2011. Not only was it the ultimate homecoming for the family, that date holds added significance. It was the 141st anniversary of the day the Sisters of St. Joseph of Carondelet first arrived in Tucson in 1870. The Sisters started St. Mary's Hospital a decade later. Finding Faith through Good Health and Wellness: Reaching out to engage an entire community in the pursuit of good health and wellness can be an overwhelming task. One way to do this is by partnering with religious groups, which have already established ties to their members: ties of faith, trust and fellowship. To take advantage of an excellent opportunity to help more people in Southern Arizona, Carondelet Health Network has teamed up with local religious congregations to train their leaders on how best to provide health and wellness outreach to church members. "Basic Training for Congregational Health Leaders" (CHL training) was created to teach the essentials of starting or improving an existing health ministry program, with a focus on promoting whole-person health within religious organizations. A health ministry can include such elements as prayer groups, visiting the sick, nutrition classes, health screenings and evaluations and other wellness initiatives. By October 2011, Carondelet, in partnership with Interfaith Community Services, had completed its fifth session of CHL training. Thus far, 70 individuals from 45 faith-based organizations have participated in the training. One example is Rising Star Missionary Baptist Church. It has used the training, along with technical assistance from Carondelet's Parish Nurse Program, to implement a health ministry program. Rising Star's first initiative was a health screening in February 2011, where 65 members were screened to assess their risk for diabetes and high blood pressure. Rising Star then used the results from the health screenings as a guide for further activities. Next, Rising Star kicked off its "Biggest Winner" challenge to lose pounds, exercise more and reduce the risk of developing diabetes, heart disease, stroke and certain cancers. More than 100 church members signed up to participate in this program. Each member was assigned to one of eight teams that are encouraging one another to eat healthy diets, exercise and attend Bible study and prayer services. Don't you realize that your body is the temple of the Holy Spirit, who lives in you and was given to you by God? You do not belong to yourself, for God bought you with a high price. So you must honor God with your body. 1 Corinthians 6:19-20 Heart Failure Transitional Care Team Celebrates First Year of Successful, Challenging Care: Patients who have been diagnosed with heart failure are on a precarious journey-one that frequently leads right back to the hospital. To improve their health and help avoid repeat hospitalizations, Carondelet Health Network created a special Heart Failure Transitional Care team last year. The team is composed of two experienced cardiac nurses, Rose Quiroga, RN, and Amy Salgado, RN. The first year of the program's existence was challenging but successful. Patients with heart failure have definitely benefited from the education, medication, understanding and coordination of care that the nurses in Carondelet's program provide. Heart Failure Transitional Care begins when patients are released from the hospital. A nurse follows up with each patient at home, working with them to develop a plan of care that will help them become independent in managing their care. These plans include the following elements: -Home visits to provide self-management education -Education to increase patients' understanding of their condition and medications -Care coordination for follow-up medical appointments -Other community or social services care coordination as needed. The nurses work with heart failure patients for two months, providing consistent and ongoing care and education. During this critical time, nurses are able to monitor patients' weight via tele-monitoring and educate patients about the significance and potential dangers posed by weight gains. During the past year, the team nurses cared for a number of patients with complex health needs. Some were homeless, without insurance, lacking money and food and had many other needs.
    Thanks to the collaboration of many community organizations, including St. Elizabeth's Clinic, El Rio Health Care, Carondelet's Van of Hope, Dependable Home Health, La Frontera, Tucson Community Food Bank, Pima Council on Aging and others, the team was able to help connect their patients with the care and resources they needed. It wasn't always easy, but the rewards were significant. One patient explained, "I gave up all hope and just wanted to die. Then you came and showed me how I can still live a good life with just a few adjustments in my daily living." This patient thought heart failure was a death sentence until Amy Salgado came into his life. She was able to provide the resources and education he needed to understand and manage his health condition. In another case, Rose Quiroga cared for a homeless patient, with the help of El Rio discharge nurse planners and physicians, the Van of Hope and Primavera Homeless Shelter. This patient is now living comfortably and independently at St. Luke's Assisted Living. "I needed a lot of help and would never have made it without Rose," he said. Carondelet's exceptional nurses were able to help these patients avoid going back into the hospital. In addition, the team cared for 19 other patients, also preventing readmissions to the hospital for all of them during the first year of the Heart Failure Transitional Care program. Thanks to this program, the future looks a lot brighter for many Tucson residents with heart failure. Behavioral Health Patients Who Are Homeless Get Vital Care: Behavioral health issues, including psychiatric illnesses and substance abuse problems, are often factors that prevent people from holding a job. All too often, this ultimately causes them to become homeless. Unfortunately, having a serious psychiatric illness, such as schizophrenia, post-traumatic stress disorder (PTSD), panic attacks or addiction can make homelessness even more terrifying and overwhelming. Some homeless individuals also have serious medical issues that make their lives that much more difficult. These issues commonly include heart attacks, strokes, chronic obstructive pulmonary disease (COPD), back injuries and diabetes, among many others. With the past several years of our country's economic downturn, many more people have become homeless. The behavioral health services offered via Carondelet Health Network's Van of Hope are often a lifesaver for those in great need. The van, with its medical and behavioral health staff, routinely travels to 17 locations where the homeless congregate-primarily shelters and meal sites. One man who had lost his job, house, wife and children tried to walk from Mesa to Tucson in the summertime and had been hospitalized for dehydration. When he encountered staff on the Van of Hope, he was disoriented and suicidal. After counseling, he was willing to return to Phoenix, where he had the most support, and was connected with behavioral health services there. Carondelet's follow-up efforts indicate that he is now doing well. Another man had significant psychiatric symptoms resulting from severe abuse by his mother and grandmother throughout childhood. He had grown tall, but could not defend himself from the intrusion of horrible memories and nightmares because of his PTSD. He found relief only by cutting and burning himself, and he had thoughts of both suicide and homicide. He knew he needed to control these thoughts, but could not do it alone. He had no health care and no money. This patient was connected to the Crisis Response Center/SAMHC for emergency assessment and then referred to a behavioral health network center. After therapeutic encounters, he reported that his anxiety and anger were diminished. With the regular treatment and medication he now receives, he is doing much better. The Van of Hope has provided an ever-increasing number of services to people like these. A total of 54 behavioral health patients received 74 therapeutic encounters. Most were in person; 14 were conducted via telemedicine sessions. During the past year, 18 patients were referred to behavioral health network centers; 13 were seriously mentally ill, and three were referred to the Crisis Response Center/SAMHC for emergency assessments. Of those referred, 39 percent did follow up on their referrals. Nine patients with both serious medical and behavioral health issues received help; 44 percent of those followed up on referrals. Van staffers work hard to ensure that patients go to their follow-up appointments to get the best and most thorough care. Carondelet's Van of Hope serves a community of people in great need, most of whom have no other options or behavioral health services available to them. Not only are these patients getting the help they desperately need, they also report being very happy with their care and grateful for the services. In the words of one homeless person, "It means a lot to me to have someone professional to talk to." Post-Hospital Program for Those Who Are Homeless: Jose C., aged 73, was in a tough spot. He had been homeless for many years, had no financial resources and had recently been hospitalized for heart failure. Jose needed a place to stay while he recuperated. He also needed meals and follow-up medical care. His only family member was a brother who lived out of state and was unable to provide assistance. Fortunately, Jose was able to enroll in the Homeless Post-hospital pilot program. The Homeless Post-hospital program is part of the Health Village (Southern Arizona Health Village for the Homeless) program, which also includes the Van of Hope. The Van of Hope is a mobile clinic providing medical, social and behavioral health services for people who are homeless. Partners in the Health Village collaborative are Carondelet Health Network, El Rio Community Health Center, Primavera Foundation, Interfaith Coalition for the Homeless, Pima Community Access Program, Salvation Army, Dependable Health Services, St. Elizabeth's Health Center and the Veterans Administration. While in the Homeless Post-hospital program, Jose stayed at the Primavera Men's Shelter and also received his meals there. Dependable Health Services sent in skilled nurses to provide the follow-up care he needed, and an El Rio Community Health Center Nurse Practitioner checked in with Jose every week. A Carondelet Heart Failure Team nurse also visited Jose to help monitor his progress. Members of the Van of Hope staff rounded out Jose's post-hospital support team, visiting him twice a week to insure that all his needs (medical, social and behavioral health) were being met. When Jose first arrived at the Primavera Men's Shelter, he had been in and out of hospitals and was very weak. After a couple of weeks, he began to feel better. Before the end of his three-month stay, he began to thrive. Case managers at the shelter worked closely with Jose to find a home for him to transition into once he had recuperated. Ultimately they suggested St. Luke's Home; Jose visited there and thought it was a great fit. Today Jose is doing very well. He reports that he feels great and is really enjoying living at St. Luke's. The pilot for the Homeless Post-hospital program was launched at Carondelet St. Mary's Hospital. St. Mary's case managers were instrumental in identifying homeless patients who were in need of post-hospital services and recommending them for the program. Once the pilot is complete, the program will open at other area hospitals, giving another helping hand to our community's most vulnerable residents. Carondelet Offers Shadowing, Hiring Events to Boost Workforce: Carondelet Health Network engages in a variety of professional outreach efforts to find people considering a career in healthcare, or those who might be returning to a career in the hospital environment. Events are organized by the health ministry's Student Services, Management Development and Human Resources teams. At the lead is Lynda Gallagher. One great opportunity for those who want an up-close look at the hospital environment is called "shadowing." This allows individuals considering a healthcare career to follow a physician or nurse around during a typical day in the hospital. Similarly, "RN refreshers" are four-hour shadowing periods that help nurses get reacquainted with the intricacies of hospital care. Carondelet Volunteer Services also gets involved by coordinating unique, up-close visits or volunteer experiences at Carondelet hospitals or other facilities that span Southern Arizona.
    As the healthcare industry experiences dynamic fluctuations in hiring, coupled with an ongoing need for specialized clinicians, Carondelet also hosts career fairs or other hiring events whenever needed. Even as the industry changes and evolves, healthcare recruiting for those with specialized skills and experienced caregivers will likely remain a constant. Two hiring events in late 2010 and 2011 saw tremendous turnout with long lines of interested job applicants. Openings ranged from experienced RNs, therapists and patient care technicians. Some attendees scored interviews on the spot and job offers shortly thereafter to join the Carondelet family. Carondelet Community Outreach to the Rescue: At 20 years old, Sislynne Langbata has had to grow up fast. She moved to Arizona from Colorado in June 2010 with her daughter. As a new mother, Langbata knew she needed an education to be able to have a good career. Her parents, who live in Phoenix, were happy to care for their two-year-old granddaughter while Langbata attended the Fred Giacosta Job Corps Center here in Tucson. She was working hard to earn a medical receptionist certificate when she discovered she was pregnant again. Without health insurance, she felt lost and afraid. "I didn't tell anyone I was pregnant. I was so stressed and depressed because I didn't have the means to see a doctor," Langbata said. The next three months were torture. "I went to see a doctor in one office, but he couldn't do anything to help me with my pregnancy since I had no health insurance." In America today, approximately 13 percent of pregnant women do not have health insurance. The percentages are higher for minorities, and the consequences can be severe. Unfortunately, without health insurance, pregnant women are at greatly increased risk for miscarriage, birth defects, infant mortality and maternal death. But Langbata's story is happier than most in a similar situation. Renee Perez, Community Health Outreach Coordinator for Carondelet Health Network, visited the Job Corps Center and met Langbata. Perez assisted her in taking the necessary steps to apply electronically for AHCCCS coverage, Arizona's Medicaid program. Within weeks of Perez's intervention, Langbata was insured through the Mercy Care Plan. "It is such a huge weight off my shoulders. This means everything to me." Perez also helped Langbata make her first appointment at Carondelet Health Network's Primeros Pasos prenatal clinic. Now, Langbata receives regular checkups and the prenatal care and vitamins she needs to ensure that her second child will be born healthy. With health insurance coverage, Langbata now has the peace of mind to focus on her future. She's concentrating on school, getting her employment certificate, finding a job and building a life for herself and her children. Corazon de Maria Extends Vital Help Across the Boarder: At Holy Cross Hospital in Nogales, Arizona, young women facing the realities of a teenage pregnancy are invited to participate in a unique program that teaches them about the role and responsibility of becoming a mother. This community outreach and education project, called Corazon de Maria, is made possible by a grant from the Sisters of St. Joseph of Carondelet. The effort focuses on educating teenagers about the need to protect and ensure human dignity-both their own and their child's. It also promotes the Sisters' values: respect, integrity, wisdom and leadership. The program helps young people appreciate the importance of a good quality of life for everyone-the poor, the vulnerable, themselves and their children. In collaboration with a number of community organizations, the Corazon de Maria team has created a curriculum focused on teenage mothers and their infants, although young fathers and others who may play a supporting role in raising the child are also encouraged to attend. Class topics include the following: -What to Expect When You Turn 18 -Infant CPR -Shaken Baby Syndrome -Identifying and Building Healthy Relationships -Personal Identity -The Happiest Baby on the Block The Corazon de Maria curriculum includes hands-on activities, medical and social educational presentations, an explanation of available community resources, lots of conversation and a tremendous amount of compassion. Teenagers feeling the pressure of parenthood find a sense of value and empowerment. One young girl who participated in the program explained, "You realize that you are not alone in your fear, confusion and thoughts about what to do now. Corazon de Maria helps teen mothers learn to take care of a baby, from changing diapers to giving CPR." Corazon de Maria classes are held at Carondelet Holy Cross Hospital and Cima Vista High School in Rio Rico, Arizona. Many thanks to the following organizations whose collaboration make the Corazon de Maria program possible: -Mariposa Community Health Center -Child & Family Resources -U of A Cooperative Extension -Catholic Community Services -Community Intervention Associates -Nuestra Casa -Santa Cruz Valley Unified School District Hospice & Palliative Care Program Uses Family-centered Care to Enhance Patients' Comfort and Well-being: Carondelet St. Mary's Hospital's Hospice and Palliative Care Program, aligned with the mission and ministry of Carondelet Health Network, is a model of care that is patient- and family-centered for those who suffer with chronic disease or who may be at the end of their life. This care optimizes patients' quality of life by anticipating, preventing and treating suffering, while also addressing the physical, emotional and spiritual needs of each patient. Palliative care can be provided in the hospital setting at any time during a serious illness in conjunction with curative or life-prolonging medical care. The Palliative program team consists of a full-time registered nurse and physicians, plus other interdisciplinary team members, such as hospital chaplains, social workers and case managers. As a faith-based organization, Carondelet Health Network's mission is to provide compassionate medical and spiritual care for patients and families as they navigate their life's journeys. One example of a collaborative effort by the Palliative care team and the Spiritual Care department is the prayer blanket ministry. Prayer blankets are created by volunteers, associates and community partners as a gift of love for patients who may be at the end of life. The thought of losing a life is heartbreaking for everyone involved-patients, family and friends, and even the medical team, hospital associates and volunteers who have served the patient. But sometimes a kind gesture can make a difference. Thus the Prayer Blanket Ministry was born. This collaborative effort began in March 2008 at St. Mary's Hospital in an effort to ease a stressful time for patients and their families. Volunteers and associates crochet or knit blankets as gifts for patients at the end of their lives. The blankets are then lovingly presented, along with special blessings for both the patient and family, by the Hospital's Spiritual Care chaplains, Palliative nurse and sometimes even the volunteer who created the blanket. Many who have received a prayer blanket described the experience as "being wrapped in the arms of God." The project began with a single knitter and has since expanded to dozens of volunteers and staff members who create handmade blankets. The impact has been significant. The daughter of a recent patient said, "Words cannot convey our gratitude for your gift of love. The blanket, your gentle kindness and thoughtful counsel were so wonderful as we went through a remarkable farewell journey with our mom. We will forever cherish the beautiful blue and white blanket that warmed our mother during our last days together. It warms us still. Thank you, and bless you." Carondelet Hospice and Palliative Care was blessed to receive its largest donation ever last summer. A gift of $4.5 million was gratefully accepted from the estate of Winifred Q. Witt, a longtime Tucsonan who passed away in September 2010 at age 94. This gift allows the program to continue its helpful and loving ministry in the Tucson community.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2010

Additional Data


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

OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Holy Cross Hospital Inc
 
Employer identification number

86-0575938
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)
(a)
Name, address, and EIN of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

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


 		(f)
Direct controlling
entity

















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


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

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

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled organization
Yes No
(1) Ascension Health

PO Box 45998

St Louis,MO63145
31-1662309 		National Health System MO Section 501(c)(3) Schedule A, Line 11a N/A
 
No
(2) Carondelet Health Network

2202 N Forbes Blvd

Tucson,AZ85745
86-0455920 		Hospital AZ Section 501(c)(3) Schedule A, Line 3 Ascension Health
 
 
No
(3) Carondelet Heart & Vascular Institute

4888 N Stone Ave

Tucson,AZ85704
56-1943271 		Hospital AZ Section 501(c)(3) Schedule A, Line 3 Carondelet Health Network
 
Yes
 
(4) Carondelet Foundation Inc

120 N Tucson Blvd

Tucson,AZ85716
86-0749574 		Foundation AZ Section 501(c)(3) Schedule A, Line 11a Carondelet Health Network
 
Yes
 
(5) Southwest Catholic Health Network (DBA Mercy Care Plan)

4350 E Cotton Center Blvd Bldg D

Phoenix,AZ85040
86-0527381 		Insurance AZ Section 501(c)(3) Schedule A, Line 11a CHN & Cthlc Hlthcare W AZ
 
Yes
 
(6) Chalon Living Inc

8553 E San Alberto Dr

Scottsdale,AZ85258
86-0805615 		Elderly/Disabled Housing AZ Section 501(c)(3) Schedule A, Line 7 Holy Cross Hospital Inc
 
Yes
 


For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



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

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




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



 		(k)
Percentage
ownership
Yes No Yes No












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of related organization



 		(b)
Primary activity



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


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

 		(f)
Share of total income



 		(g)
Share of
end-of-year
assets

 		(h)
Percentage
ownership
(1) Carondelet Medical Group PC
2202 N Forbes Blvd
Tucson,AZ85745
86-0836126 		Medical Group AZ N/A
 C      
(2) Carondelet Specialist Group Inc
2202 N Forbes Blvd
Tucson,AZ85745
28-1558773 		Physician Practice AZ N/A
 C      










Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III or IV.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Performance of services or membership or fundraising solicitations for other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations by other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Sharing of facilities, equipment, mailing lists, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of paid employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Reimbursement paid to other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
 
No
p Reimbursement paid by other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Other transfer of cash or property to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type(a-r) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) Carondelet Health Network

 Q 20,383,687 Actual Amount Transferred
(2) Ascension Health

 Q 55,745 Actual Amount Transferred
(3) Carondelet Foundation Inc

 C 175,997 Actual Amount Transferred
(4)
(5)
(6)
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Are all
partners
section
501(c)(3)
organizations? 		(e)
Share of
end-of-year
assets 		(f)
Disproprtionate allocations? 		(g)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065) 		(h)
General or
managing
partner?
Yes No Yes No Yes No






























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


Software ID:  
Software Version: