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 10-01-2010 and ending 09-30-2011
BCheck if applicable:
CName of organization
ADVANCE CARE HOSPITAL
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
300 WERNER STREET 3RD FLOOR
 
Room/suite
City or town, state or country, and ZIP + 4
HOT SPRINGS, AR71913
D Employer identification number

71-0816634
E Telephone number

G Gross receipts $ 16,061,092
F Name and address of principal officer:
JOHN SELIG
300 WERNER STREET 3RD FLOOR
HOT SPRINGS,AR71913
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
N/A
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 MediumBullet  
K Form of organization:
 
L Year of formation: 1998
M State of legal domicile: AR
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: TO CONTINUE THE HEALING MINISTRY OF JESUS CHRIST TO PATIENTS WHO REQUIRE AN EXTENDED HOSPITALIZATION.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) .... 3 5
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 4
5 Total number of individuals employed in calendar year 2010 (Part V, line 2a) ... 5 0
6 Total number of volunteers (estimate if necessary) .... 6 6
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 0
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) ......... 0 413
9 Program service revenue (Part VIII, line 2g) ......... 22,336,111 16,055,284
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 16,633 3,909
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 814 1,486
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 22,353,558 16,061,092
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 1,067,044 8,789
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) 9,915,500 7,570,827
16a Professional fundraising fees (Part IX, column (A), line 11e).... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 12,190,817 6,808,037
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 23,173,361 14,387,653
19 Revenue less expenses. Subtract line 18 from line 12...... -819,803 1,673,439
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............ 8,078,468 7,189,616
21 Total liabilities (Part X, line 26)............ 4,148,160 1,585,869
22 Net assets or fund balances. Subtract line 21 from line 20 ..... 3,930,308 5,603,747
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: CONSISTENT WITH THE SISTERS OF MERCY HEALTH SYSTEM - ST. LOUIS, THE MISSION OF ADVANCE CARE HOSPITAL IS TO CONTINUE THE HEALING MINISTRY OF JESUS CHRIST.
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 $ 12,103,390 including grants of $ 8,789 ) (Revenue $ 16,055,284 )
SEE SCHEDULE O
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$ 12,103,390
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? ........
2
 
No
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
 
No
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
 
No
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.. Click to see attachment
21
Yes
 
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..... Click to see attachment
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................
23
 
No
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......
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................
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...........................
26
 
No
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...............
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 .........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV...................
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..
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
 
No
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
41
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
Yes
 
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
0
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
 
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
 
 
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
5
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
4
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
Yes
 
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
 
No
b
Other officers or key employees of the organization ................
15b
 
No
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
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
PAUL VEILLON
1700 W LOOP SOUTH SUITE 1100A
HOUSTON,TX770270000
(713) 277-2300
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) JOHN SELIG
BOARD MEMBER/PRESIDENT
 4.00 X   X       32,688 0 0
(2) MIKE FINLEY
BOARD MEMBER
 1.00 X           0 0 0
(3) TONY HOLOHAN
BOARD MEMBER
 1.00 X           0 0 0
(4) HELEN HARRIS
BOARD MEMBER
 1.00 X           0 0 0
(5) JOHN SIMPSON
BOARD MEMBER
 1.00 X           0 0 0
(6) MARIE MARQUEZ
SECRETARY
 1.00     X       0 0 0
(7) PAUL VEILLON
TREASURER
 1.00     X       0 0 0
(8) ERICK SMITH
SECRETARY/TREASURER
 1.00           X 0 0 0


















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;


























1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 32,688 0 0
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 in reportable compensation from the organizationMediumBullet3
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
 
No
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
 
No
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
CHRISTUS DUBUIS HEALTH SYSTEM
1700 WEST LOOP SOUTH STE 1100A
HOUSTON,TX77027 		MANAGEMENT SERVICES 4,364,898
ST JOSEPH'S MERCY HEALTH CENTER
300 WERNER STREET
HOT SPRINGS,AR71903 		ANCILLARY SERVICES 3,132,496
ST EDWARD MERCY MEDICAL CENTER
5501 EUPER LANE
FORT SMITH,AR72903 		ANCILLARY SERVICES 1,462,687
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization MediumBullet3
Form 990 (2010)
Form 990 (2010)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, gifts, grants and other similar amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d  
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		413
g Noncash contributions included in lines 1a-1f:$  
h Total. Add lines 1a-1f.......MediumBullet 413
Program Service Revenue Business Code
2a INPATIENT REVENUES 900,099 16,055,284 16,055,284    
b
c
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 16,055,284
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 3,909     3,909
4 Income from investment of tax-exempt bond proceeds..MediumBullet        
5 Royalties............MediumBullet        
(i) Real (ii) Personal
6a Gross Rents    
b Less: rental expenses    
c Rental income or (loss)    
d Net rental income or (loss).......MediumBullet        
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory    
b Less: cost or other basis and sales expenses    
c Gain or (loss)    
d Net gain or (loss)..........MediumBullet        
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 VENDING MACHINE INCOME 900,099 822     822
b MEDICAL RECORDS FEES 900,099 664     664
c            
d All other revenue ....        
e Total. Add lines 11a–11d ......MediumBullet 1,486
12 Total revenue. See Instructions....MediumBullet 16,061,092 16,055,284 0 5,395
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 8,789 8,789
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 .... 32,688   32,688  
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 6,307,425 5,743,511 563,914  
8 Pension plan contributions (include section 401(k) and section 403(b) employer contributions) .... 229,948 208,333 21,615  
9 Other employee benefits ....... 670,305 607,296 63,009  
10 Payroll taxes ........... 330,461 289,998 40,463  
11 Fees for services (non-employees):        
a Management ...... 510,829   510,829  
b Legal ......... -520   -520  
c Accounting ........... 605,004   605,004  
d Lobbying ...........        
e Professional fundraising. See Part IV, line 17..    
f Investment management fees ......        
g Other .......... 82,008 103,266 -21,258  
12 Advertising and promotion .... 6,582   6,582  
13 Office expenses ....... 2,552,470 2,277,213 275,257  
14 Information technology ......        
15 Royalties ..        
16 Occupancy ...........        
17 Travel ............ 60,000 25,851 34,149  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ......        
19 Conferences, conventions, and meetings ....        
20 Interest ...........        
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization ..... 121,310 121,310    
23 Insurance .............. 51,662   51,662  
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 PURCHASED SERVICES 2,317,555 2,283,202 34,353 0
b EQUIPMENT RENTAL 296,035 287,915 8,120 0
c BAD DEBT EXPENSE 146,706 146,706 0 0
d TAXES 58,396   58,396 0
e
f All other expenses        
25 Total functional expenses. Add lines 1 through 24f 14,387,653 12,103,390 2,284,263 0
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 .......... 3,293,454 1 4,622,708
2 Savings and temporary cash investments .......   2  
3 Pledges and grants receivable, net .........   3  
4 Accounts receivable, net ......... 1,785,392 4 1,936,053
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..........   5  
6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
Schedule L ..........   6  
7 Notes and loans receivable, net .............   7  
8 Inventories for sale or use .............. 347,713 8 155,623
9 Prepaid expenses and deferred charges ............ 13,475 9  
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 1,550,604
b Less: accumulated depreciation. ..... 10b 1,075,372 596,542 10c 475,232
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 ........... 2,041,892 15 0
16 Total assets. Add lines 1 through 15 (must equal line 34)... 8,078,468 16 7,189,616
Liabilities 17 Accounts payable and accrued expenses . 1,449,950 17 1,130,225
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..... 2,698,210 25 455,644
26 Total liabilities. Add lines 17 through 25..... 4,148,160 26 1,585,869
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 ..... 3,930,308 27 5,603,747
28 Temporarily restricted net assets .....   28  
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 ..... 3,930,308 33 5,603,747
34 Total liabilities and net assets/fund balances ..... 8,078,468 34 7,189,616
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
16,061,092
2
Total expenses (must equal Part IX, column (A), line 25) . . . . .
2
14,387,653
3
Revenue less expenses. Subtract line 2 from line 1 . . . .
3
1,673,439
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) . .
4
3,930,308
5
Other changes in net assets or fund balances (explain in Schedule O) . . . .
5
0
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
5,603,747
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
 
No
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
 
 
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
ADVANCE CARE HOSPITAL
 
Employer identification number

71-0816634
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 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
ADVANCE CARE HOSPITAL
 
Employer identification number

71-0816634
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
 
809
j
Total. lines 1c through 1i ...................................
809
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: A PORTION OF ANNUAL DUES PAID TO THE NATIONAL ASSOCIATION OF LONG TERM HOSPITALS IS ALLOCATED TO LOBBYING ACTIVITIES ON BEHALF OF THE MEMBERSHIP.
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
ADVANCE CARE HOSPITAL
 
Employer identification number

71-0816634
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 .................      
b Buildings ................        
c Leasehold improvements ............   27,626 21,782 5,844
d Equipment ................   1,522,978 1,053,590 469,388
e Other .................        
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........SchDMdBullet 475,232
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








Total. (Column (b) should equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Amount
Federal Income Taxes  
THIRD PARTY PAYOR SETTLEMENTS -191,264
PAYABLE TO HOST FACILITIES 206,909
PAYABLE TO CHRISTUS DUBUIS HEALTH SYSTEM 403,704
MISC TAXES PAYABLE 36,295





Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)Small Bullet 455,644
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
ADVANCE CARE HOSPITAL
 
Employer identification number

71-0816634
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
 
No
6b
If "Yes," does the organization make it available to the public? ..............
6b
 
 
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) .. 		    531,783   531,783 3.730 %
b Unreimbursed Medicaid (from
Worksheet 3, column a) . 		           
c Unreimbursed costs—other means-tested government programs (from Worksheet 3, column b) ....            
dTotal Charity Care and
Means-Tested Government Programs ..... 		    531,783   531,783 3.730 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) .... 		    13,578   13,578 0.100 %
f Health professions education
(from Worksheet 5) .. 		           
g Subsidized health services
(from Worksheet 6) .. 		           
h Research (from Worksheet 7)            
i Cash and in-kind contributions
to community groups
(from Worksheet 8) .. 		    8,789   8,789 0.060 %
jTotal Other Benefits ...     22,367   22,367 0.160 %
kTotal. Add lines 7d and 7j. ..     554,150   554,150 3.890 %
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 2
Part II
Community Building Activities Complete this table if the organization conducted any community building activities.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total            
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Does the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense (at cost).....
2
146,706
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
141,997
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
10,791,639
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
10,445,227
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
346,412
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?2
Name and address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe)
1 ADVANCE CARE HOSPITAL OF HOT SPRINGS
300 WERNER STREET 3RD FLOOR
HOT SPRINGS,AR71913 		X               LONG TERM ACUTE CARE HOSPITAL
2 ADVANCE CARE HOSPITAL OF FORT SMITH
7301 ROGERS AVE 4TH FLOOR
FORT SMITH,AR72917 		X               LONG TERM ACUTE CARE HOSPITAL
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 7: THE COMMUNITY BENEFIT OF COST OF CHARITY CARE WAS CALCULATED AS THE TOTAL VOLUNTARY FREE CARE TIMES THE RATIO OF COST TO GROSS PATIENT BILLING. THE COMMUNITY BENEFIT FOR IN-KIND CONTRIBUTIONS TO HEALTH PROFESSIONS WAS CALCULATED BASED ON THE NUMBER OF EMPLOYEE HOURS.
    PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 146706.
    PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE ARE FROM PATIENTS AND THIRD-PARTY PAYORS FOR MEDICAL SERVICES AND ARE NET OF ALLOWANCES FOR CONTRACTUAL ADJUSTMENTS AND DOUBTFUL ACCOUNTS. ALLOWANCES ARE ESTIMATED BASED ON ESTABLISHED BILLING RATES AND HISTORICAL EXPERIENCE. IN ORDER TO DETERMINE THE BAD DEBT EXPENSE AT COST FOR PART III SECTION A LINE 2, THE ORGANIZATION'S TOTAL BAD DEBT EXPENSE IN ACCORDANCE WITH THE ORGANIZATION'S FINANCIAL STATEMENTS WAS MULTIPLIED BY THE COST-TO-CHARGE RATIO.
    PART III, LINE 9B: ADVANCE CARE HOSPITAL DOES NOT OUTSOURCE PATIENT BALANCES TO A THIRD PARTY DEBT COLLECTION AGENCY. ALL COLLECTIONS ARE DONE BY IN-HOUSE COLLECTORS USING COLLECTION LETTERS. PATIENTS ARE NOT SUBJECT TO HARASSMENT OR LEGAL ACTION DUE TO THEIR INCAPACITY TO PAY. UPON ADMISSION, PATIENTS WHO HAVE NO INSURANCE COVERAGE AND NO ABILITY TO PAY WILL BE GIVEN CONSIDERATION FOR CHARITY CARE. EVERY EFFORT WILL BE MADE TO OBTAIN THE APPROPRIATE FINANCIAL DOCUMENTATION TO DETERMINE THE ABILITY TO PAY FOR SERVICES. PATIENTS RECEIVE PRIVATE LETTERS/BILLS EACH MONTH INDICATING THEIR BALANCE DUE. PATIENTS WHO HAVE NOT MADE PAYMENTS FOR A 30-DAY PERIOD WILL RECEIVE A LETTER REQUESTING PAYMENT. PATIENTS WHO ARE UNABLE TO PAY THEIR BALANCE WILL BE CONSIDERED FOR CHARITY CARE IF APPROPRIATE. COLLECTION EFFORTS WILL CONTINUE FOR 120 DAYS WITH THE PATIENT/GUARANTOR RECEIVING AT LEAST THREE LETTERS REQUESTING PAYMENT WITHIN SAID 120 DAY PERIOD. ACCOUNTS THAT ARE NOT DEEMED ELIGIBLE FOR CHARITY CARE OR MEDICAL INDIGENCE WILL BE WRITTEN OFF AS BAD DEBT FOLLOWING THE 120 DAY COLLECTION PERIOD.
    PART VI, LINE 2: ADVANCE CARE HOSPITAL ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES SERVED THROUGH REGULAR EXCHANGES WITH CIVIC, COMMUNITY AND RELIGIOUS LEADERS, AS WELL AS PATIENT SURVEYS THAT SOLICIT INFORMATION ON SPECIFIC AND GENERAL ONGOING AND UPCOMING NEEDS.
    PART VI, LINE 3: ALL PATIENTS ARE ASSESSED DURING THE REGISTRATION PROCESS. PATIENTS IDENTIFIED AS POSSIBLE CHARITY CASES WILL BE ASKED TO COMPLETE AN APPLICATION FOR FINANCIAL ASSISTANCE. PATIENTS WHO MAY QUALIFY FOR FINANCIAL ASSISTANCE FROM A GOVERNMENTAL PROGRAM BUT ARE NOT CURRENTLY ENROLLED ARE REFERRED TO THE APPROPRIATE PROGRAM. PATIENTS WHO CAN PROVE ELIGIBILITY FOR MEDICAID WILL BE DEEMED AS INDIGENT AND AUTOMATICALLY QUALIFY FOR CHARITY CARE. PATIENTS ADMITTED TO THE HOSPITAL WITH MEDICARE AS THE ONLY INSURANCE WILL BE MONITORED AS MEDICARE DAYS NEAR DEPLETION. THIRTY DAYS PRIOR TO THE END OF THE MEDICARE COVERAGE, AN INTERVIEW AND AN APPLICATION FOR FINANCIAL ASSISTANCE WILL BE REQUESTED AS APPROPRIATE. THESE PATIENTS ARE ASSESSED AS TO MEETING THE GUIDELINES FOR RECEIVING CHARITY CARE IF THE STAY SHOULD EXCEED MEDICARE COVERAGE LIMITS. AS SOON AS SUFFICIENT INFORMATION IS AVAILABLE CONCERNING THE PATIENT'S FINANCIAL RESOURCES AND ELIGIBILITY FOR GOVERNMENT ASSISTANCE, A DETERMINATION IS MADE CONCERNING THE PATIENT'S ELIGIBILITY FOR CHARITY. NO COLLECTION EFFORT IS PURSUED ON A CHARITY ACCOUNT AFTER SUCH DETERMINATIONS ARE MADE.
    PART VI, LINE 4: ADVANCE CARE HOSPITAL'S SERVICE AREAS IN ARKANSAS INCLUDE LONG-TERM ACUTE CARE HOSPITALS IN FORT SMITH AND HOT SPRINGS. THE ADVANCE CARE HOSPITAL COMMUNUITY IS COMPRISED OF PATIENTS FROM LOCAL COMMUNITIES WHO ARE MEDICALLY COMPLEX AND MAY REQUIRE DAILY MONITORING; VENTILATOR DEPENDENT PATIENTS, OXYGEN DEPENDENT PATIENTS NEEDING RESPIRATORY REHABILITATION, PATIENTS WITH SLOW HEALING WOUNDS, PATIENTS BENEFITING FROM PHYSICAL, OCCUPATIONAL OR SPEECH THERAPHY, AND FOR PATIENTS REQUIRING PALLIATIVE AND END OF LIFE CARE. SPECIAL EFFORTS ARE TAKEN TO ENSURE THAT POOR AND OTHER UNDERSERVED INDIVIDUALS ARE INCLUDED IN THE COMMUNITY SERVED. ADVANCE CARE HOSPITAL OF FORT SMITH IS LOCATED IN SEBASTIAN COUNTY. TOTAL POPULATION IN THE COUNTY IS 125,127 OF WHICH 13.3% ARE AGES 65 AND OVER ACCORDING TO THE 2010 CENSUS BUREAU. IN ADDITION, 18.0% OF THE POPULATION IS BELOW THE POVERTY LEVEL. ADVANCE CARE HOSPITAL OF HOT SPRINGS IS LOCATED IN GARLAND COUNTY. TOTAL POPULATION IN THE COUNTY IS 97,124 OF WHICH 21.1% ARE AGE 65 AND OVER ACCORDING TO THE 2010 CENSUS BUREAU. IN ADDITION, 17.7% OF THE POPULATION IS BELOW POVERTY LEVEL.
    PART VI, LINE 6: IN ADDITION TO ITS PRIMARY MISSION TO PROVIDE LONG-TERM ACUTE MEDICAL CARE TO THE COMMUNITY INCLUDING THE POOR AND UNDERSERVED, ADVANCE CARE HOSPITAL ANNUALLY PROVIDES CASH AND/OR IN-KIND SUPPORT TO TAX-EXEMPT CHARITABLE ORGANIZATIONS WITH ESTABLISHED NEED.
    PART VI, LINE 7: THE ADVANCE CARE HOSPITAL IS PRIMARILY FOCUSED ON THE PROVISION OF LONG-TERM ACUTE CARE WHICH IS DIRECTED TO PERSONS WHO ARE MEDICALLY COMPLEX AND MAY REQUIRE DAILY MONITORING; VENTILATOR DEPENDENT PATIENTS, OXYGEN DEPENDENT PATIENTS NEEDING RESPIRATORY REHABILITATION, PATIENTS WITH SLOW HEALING WOUNDS, PATIENTS BENEFITING FROM PHYSICAL, OCCUPATIONAL OR SPEECH THERAPY, AND FOR PATIENTS REQUIRING PALLIATIVE AND END OF LIFE CARE. BY CONTRAST THE SISTERS OF MERCY HEALTH SYSTEM INCLUDES OVER 400 CLINIC AND HOSPITAL LOCATIONS IN THE MIDWEST OF THE UNITED STATES PROVIDING MEDICAL CARE AT ALL LEVELS. NEITHER ADVANCE CARE HOSPITAL NOR THE SISTERS OF MERCY HEALTH SYSTEM WILL REFUSE TO PROVIDE NECESSARY MEDICAL TEATMENT DUE TO A PATIENT'S INABILITY TO PAY.
REPORTS FILED WITH STATES PART VI, LINE 7 AR
Schedule H (Form 990) 2010
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
ADVANCE CARE HOSPITAL
 
Employer identification number
71-0816634
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance






















2
Enter total number of section 501(c)(3) and government organizations ......................... Bullet Image
 
3
Enter total number of other organizations ................................ . Bullet Image
 
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2010

Schedule I (Form 990) 2010
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance













Part IV
Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.
Identifier Return Reference Explanation
PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: DONATIONS ARE PROVIDED TO TAX-EXEMPT CHARITABLE ORGANIZATIONS WITH AN ESTABLISHED NEED. THE DECISION TO DONATE AND TO WHICH CHARITY TO DONATE IS DETERMINED BY THE HOSPITAL ADMINISTRATOR AND/OR THE BOARD OF DIRECTORS. ALL DONATIONS ARE DOCUMENTED.
Schedule I (Form 990) 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
ADVANCE CARE HOSPITAL
 
Employer identification number

71-0816634
Identifier Return Reference Explanation
PROGRAM SERVICE STATEMENT FORM 990, PART III, LINE 4A, PROGRAM SERVICE ACCOMPLISHMENTS: GENERAL INFORMATION THE GOSPEL VALUES UNDERLYING THE MISSION STATEMENT CHALLENGES ADVANCE CARE HOSPITAL TO MAKE CHOICES WHICH RESPOND TO THE PATIENT'S NEEDS IN PROVIDING THE NECESSARY SETTING FOR THE APPROPRIATE CONTINUUM OF CARE. SPECIAL CONSIDERATION IS GIVEN TO THOSE WHO ARE ECONOMICALLY DISADVANTAGED AND UNDERSERVED. THE HOSPITAL CARES FOR PATIENTS WHO ARE MEDICALLY COMPLEX AND MAY REQUIRE DAILY MONITORING; VENTILATOR DEPENDENT PATIENTS, OXYGEN DEPENDENT PATIENTS NEEDING RESPIRATORY REHABILITATION, PATIENTS WITH SLOW HEALING WOUNDS, PATIENTS BENEFITING FROM PHYSICAL, OCCUPATIONAL OR SPEECH THERAPY, AND FOR PATIENTS REQUIRING PALLIATIVE AND END OF LIFE CARE. THE MEDICAL AND THERAPEUTIC NEEDS OF THE PATIENTS ARE MET USING AN INTERDISCIPLINARY, HOLISTIC TEAM APPROACH INCORPORATING MEDICAL MANAGEMENT, PHYSICAL, RESPIRATORY, OCCUPATIONAL AND SPEECH THERAPIES IN AN EFFORT TO RESTORE INDIVIDUAL QUALITY OF LIFE TO AS HIGH A DEGREE AS POSSIBLE AND TO PROMOTE SELF-HELP AND INDEPENDENCE TO THE EXTENT FEASIBLE. THE SPIRITUAL NEEDS OF THE PATIENTS, FAMILIES AND SIGNIFICANT OTHERS ARE PROVIDED FOR AS WELL. THE GROWTH AND DEVELOPMENT OF ADVANCE CARE HOSPITAL IS DETERMINED BY THE HEALTH CARE NEEDS OF THE COMMUNITIES THAT IT SERVES, AVAILABLE RESOURCES, AND THE INTERRELATIONSHIP OF THOSE SERVING AND THOSE BEING SERVED. RESPONSIBLE STEWARDSHIP MANDATES THAT ADVANCE CARE HOSPITAL SEARCH OUT NEW, EFFECTIVE MEANS TO DELIVER QUALITY HEALTH CARE AND TO PROMOTE WHOLENESS IN THE HUMAN PERSON FOR THOSE WHO REQUIRE THIS LONG-TERM ACUTE CONTINUUM OF CARE. THE VISION OF ADVANCE CARE HOSPITAL IS TO PROVIDE HEALTH CARE THAT IS SPIRITUALLY ROOTED, FULLY INTEGRATED IN THE CONTINUUM OF CARE, SUPPORTIVE OF HEALTHIER COMMUNITIES, INNOVATIVE AND INTERDISCIPLINARY IN A HOLISTIC APPROACH TO CARE, AND COMPASSIONATE IN RESPONSE TO THE NEEDS OF PATIENTS IN THEIR LIFE JOURNEY. ADVANCE CARE HOSPITAL'S APPROACH TO STRENGTHEN CURRENT MINISTRIES AND TO EXPAND INTO NEW LOCATIONS AND SERVICES; TO IMPLEMENT INNOVATIVE APPROACHES TO CARING FOR THE WHOLE PERSON; TO INCREASE ACCESS TO HEALTH CARE FOR THE POOR AND UNDERSERVED THROUGH ADVOCACY AND OTHER INITIATIVES; TO MAKE A CONTRIBUTION TO CREATING HEALTHY COMMUNITIES; AND TO CREATE A WORK ENVIRONMENT FILLED WITH HOPE, DIGNITY, AND MUTUAL RESPECT. COMMUNITY BENEFITS IN SUPPORT OF ITS MISSION AND PHILOSOPHY REGARDING SOCIAL ACCOUNTABILITY, ADVANCE CARE HOSPITAL PROVIDES CARE TO PATIENTS WHO BEAR A SIGNIFICANT HEALTH-CARE FINANCIAL BURDEN RELATIVE TO THEIR FINANCIAL RESOURCES. ADVANCE CARE HOSPITAL CLASSIFIES THE RESOURCES UTILIZED FOR THE CARE OF PATIENTS BEARING A SIGNIFICANT HEALTH CARE FINANCIAL BURDEN AS COMPARED TO THEIR RESOURCES AS CHARITY CARE. CHARITY CARE INCLUDES THE COST OF SERVICES PROVIDED TO PERSONS WHO CANNOT AFFORD HEALTH CARE BECAUSE OF THE FINANCIAL BURDEN OF THE HEALTH CARE SERVICES AND/OR WHO ARE UNINSURED OR UNDERINSURED. CHARITY CARE IS PROVIDED WITHOUT CHARGE OR AT A CHARGE THAT IS LESS THAN THE USUAL CHARGE FOR SUCH SERVICES. THE DETERMINATION AS TO THE AMOUNT TO BE CHARGED, IF ANY, IS MADE ACCORDING TO A PATIENT'S ABILITY TO PAY, CONSIDERATION OF THE PATIENT'S ASSETS AND LIABILITIES, AND DETERMINED BY THE ESTABLISHED ELIGIBILITY CRITERIA BASED ON THE MOST CURRENT FEDERAL POVERTY GUIDELINES. A FINANCIALLY INDIGENT PATIENT IS ONE WHO IS UNINSURED OR UNDERINSURED AND WHOSE ECONOMIC CIRCUMSTANCES PLACE THEM AT OR UNDER 200% OF THE FEDERAL POVERTY GUIDELINES. A MEDICALLY INDIGENT PATIENT IS A PERSON WHO'S MEDICAL OR HOSPITAL BILLS AFTER PAYMENT BY THIRD-PARTY PAYERS EXCEEDS 25% OF THEIR ANNUAL GROSS INCOME. NO PATIENT IS REFUSED NECESSARY MEDICAL CARE ON THE BASIS OF THEIR INABILITY TO PAY. IN ADDITION TO UNCOMPENSATED COSTS, ADVANCE CARE HOSPITAL SUPPORTS AND PARTICIPATES IN COMMUNITY BENEFIT PROGRAMS DESIGNED TO POSITIVELY IMPACT THE HEALTH STATUS OF THE COMMUNITIES SERVED. REIMBURSED GOVERNMENT SPONSORED PROGRAMS IN ADDITION TO THE PROVISION OF CARE WITHOUT EXPECTATION OF PAYMENT (CHARITY CARE), ADVANCE CARE HOSPITAL PROVIDES SERVICES TO PERSONS COVERED UNDER GOVERNMENT SPONSORED PROGRAMS, INCLUDING MEDICARE, TRICARE (FORMERLY CHAMPUS WHICH PROVIDES CIVILIAN HEALTH CARE BENEFITS TO MILITARY PERSONNEL, MILITARY RETIREES AND THEIR DEPENDENTS, AND SOME MEMBERS OF THE RESERVE COMPONENT) AND TRICARE FOR LIFE (A MEDICARE SUPPLEMENT INSURANCE PROGRAM AVAILABLE TO INDIVIDUALS WHO HAD BEEN ELIGIBLE FOR TRICARE). AS ALREADY CITED, ADVANCE CARE HOSPITAL PROVIDED MEDICAL SERVICES TO PERSONS COVERED UNDER THE FEDERAL MEDICARE PROGRAM WHICH, IN FACT, COMPRISED THE LARGEST SINGLE PAYER CLASSIFICATION OF PATIENTS SERVED BY THIS HEALTH SYSTEM. THE PAYMENT RATE FOR INPATIENT SERVICES IS ON A PER DISCHARGE RATE, CALCULATED BASED ON THE DIAGNOSTIC-RELATED GROUP INTO WHICH THE PATIENT IS CATEGORIZED. NUMBER OF PATIENTS SERVED BY THE LTACH: 436 NUMBER OF PATIENT DAYS OF CARE PROVIDED BY THE LTACH: 12,927 NUMBER OF PATIENT DAYS OF CHARITY CARE PROVIDED BY THE LTACH: 544 CHARITY CARE COST: $531,783 TOTAL PROGRAM SERVICE EXPENSES (GRANTS $8,789) $12,103,390
FORM 990, PART VI, SECTION A, LINE 3   ADVANCE CARE HOSPITAL IS MANAGED BY CHRISTUS DUBUIS HEALTH SYSTEM, AN UNRELATED TAX-EXEMPT ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 6   ADVANCE CARE HOSPITAL'S CORPORATE MEMBER IS SISTERS OF MERCY HEALTH SYSTEM, ST. LOUIS, INC.
FORM 990, PART VI, SECTION A, LINE 7A   THE BYLAWS OF ADVANCE CARE HOSPITAL PERMIT THE CORPORATE MEMBER TO APPOINT ONE NON-VOTING MEMBER OF THE BOARD WHO SERVES EX-OFFICIO, WITHOUT VOTE. THE CORPORATE MEMBER DOES NOT CONTROL THE DAILY OPERATIONS OF THE ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 7B   THE BYLAWS PROVIDE TO THE CORPORATE MEMBER THE POWER TO APPROVE OR DISAPPROVE AMENDMENTS, MODIFICATIONS OR RESTATEMENTS TO THE ARTICLES OF INCORPORATION AND BYLAWS OF THE CORPORATION AND CORPORATIONS CONTROLLED BY IT; TO APPOINT THE INITIAL MEMBERS OF THE BOARD; TO APPOINT ONE NON-VOTING MEMBER OF THE BOARD WHO SERVES EX-OFFICIO, WITHOUT VOTE; AND TO APPROVE OR DISAPPROVE THE FOLLOWING ACTIONS OF THE CORPORATION: 1. ADOPTION OF, OR AMENDMENTS TO, THE MISSION, VISION AND VALUES OF THE CORPORATION; 2. ADOPTION OF A PLAN OF MERGER, CONSOLIDATION OR DISSOLUTION OF CORPORATION; AND 3. AUTHORIZATION OF ANY PROPOSED CHANGES IN THE TAX STATUS OF THE CORPORATION.
FORM 990, PART VI, SECTION B, LINE 11   THE RETURN IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM. THE ORGANIZATION REVIEWS THE PREPARED RETURN FOR ACCURACY. UPON COMPLETION OF THE FINAL FORM 990 BY THE INDEPENDENT ACCOUNTING FIRM, THE FORM 990 IS SUBMITTED TO THE BOARD OF DIRECTORS PRIOR TO FILING THE RETURN WITH THE IRS.
  FORM 990, PART VI, SECTION B, LINE 12C ADVANCE CARE HOSPITAL IS MANAGED BY CHRISTUS DUBUIS HEALTH SYSTEM (CDHS), AN UNRELATED EXEMPT ORGANIZATION. THE MANAGEMENT AGREEMENT STATES THAT CDHS SHALL PROVIDE ALL STAFFING REQUIREMENTS TO THE ORGANIZATION. CDHS MAINTAINS A CONFLICT OF INTEREST POLICY FOR THEIR EMPLOYEES WHICH REQUIRES COMPLETION OF AN ANNUAL DISCLOSURE OF ANY CONFLICTS OF INTEREST. THE POLICY INCLUDES OFFICERS, MEDICAL DIRECTORS AND OTHER DIRECTORS, AND ALL OTHER ASSOCIATES. THE EMPLOYEE DISCLOSURES ARE REVIEWED BY THE EMPLOYEES' IMMEDIATE SUPERVISORS. IN ADDITION, KEY LEADERS MUST CERTIFY ANNUALLY THEIR RECEIPT AND UNDERSTANDING OF THE CONFLICT OF INTEREST POLICY. IF ANY CONFLICTS ARE PRESENT, THE EMPLOYEE AND THE CDHS ADMINISTRATION WILL IMPLEMENT A MUTUALLY AGREED UPON PLAN TO RESOLVE THE CONFLICT. IN ADDITION, CDHS IMPLEMENTS AN INTEGRITY PROGRAM TO SUPPORT AND MAINTAIN THE CORPORATE INTEGRITY OF THE ORGANIZATION. ADVANCE CARE HOSPITAL MAINTAINS A POLICY FOR THE MEMBERS OF THE BOARD OF DIRECTORS WHICH REQUIRES ANNUAL DISCLOSURE OF ANY CONFLICTS OF INTEREST. THE POLICY FOR THE MEMBERS OF THE BOARD OF DIRECTORS REQUIRES ANY BOARD MEMBER UPON DETERMINATION OF A CONFLICT OF INTEREST, TO ABSENT HIMSELF OR HERSELF WITHOUT COMMENT FROM NOT ONLY THE VOTE BUT ALSO FROM THE DELIBERATION. BOARD MEMBERS ARE NOT ALLOWED TO BE EMPLOYED BY ADVANCE CARE HOSPITAL UNLESS THEY HAVE FIRST RESIGNED FROM THE BOARD. IN ADDITION, AT THE BEGINNING OF EACH BOARD MEETING, THE BOARD CHAIR ASKS THE BOARD MEMBERS TO REVIEW THE AGENDA AND SHARE ANY POTENTIAL CONFLICTS OF INTEREST PRIOR TO THE BEGINNING OF BUSINESS.
    FORM 990, PART VI, LINE 15: COMPENSATION FOR THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL WAS INITIALLY DETERMINED BY THE ORGANIZATION UPON FORMATION IN 1998. IT WAS REEVALUATED AND ADJUSTED IN 2004 AND 2006 TO ENSURE REASONABLENESS AND ADHERANCE TO ADVANCE CARE HOSPITAL'S COMPENSATION PHILOSOPHY.
  FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. THE ARTICLES OF INCORPORATION ARE AVAILABLE TO THE PUBLIC FROM THE ARKANSAS SECRETARY OF STATE.
EXPLANATION OF FINANCIAL STATEMENTS: FORM 990, PART XII, LINE 2A & 2B: THE BOARD OF ADVANCE CARE HOSPITAL ELECTED TO RETAIN THE SERVICES OF AN INDEPENDENT PUBLIC ACCOUNTING FIRM TO PERFORM AGREED UPON PROCEDURES RELATED TO PATIENT FILE TESTING, THIRD PARTY LIABILITIES AND MANAGEMENT FEE EXPENSES FOR THE YEAR ENDED SEPTEMBER 30, 2011.
DESCRIPTION OF METHOD USED TO DETERMINE THE VALUE OF THE SERVICES, ETC: SCHEDULE R, PART V, LINE 2: ADVANCE CARE HOSPITAL RENTS FACILITIES FROM ST. JOSEPH REGIONAL HEALTH CENTER AND ST. EDWARD MERCY MEDICAL CENTER AT THE FAIR MARKET VALUE RENT RATE. ADVANCE CARE HOSPITAL ALSO RECEIVES ANCILLARY SERVICES FROM ST JOSEPH REGIONAL HEALTH CENTER AND ST. EDWARD MERCY MEDICAL CENTER AT COST. ANCILLARY SERVICES INCLUDE PHYSICAL, RESPIRATORY AND OCCUPATIONAL THERAPY, RADIOLOGY, DIETARY, PHARMACY, SURGERY, DIALYSIS, ANESTHESIOLOGY, CENTRAL SERVICES AND LAUNDRY.
  FORM 990, PART V, LINE 2A AND PART IX, LINES 7-10: ADVANCE CARE HOSPITAL IS MANAGED BY CHRISTUS DUBUIS HEALTH SYSTEM (CDHS), AN UNRELATED EXEMPT ORGANIZATION. IN KEEPING WITH THE TERMS OF THE MANAGEMENT AGREEMENT, CDHS PROVIDES ALL OF ADVANCE CARE HOSPITAL'S STAFFING REQUIREMENTS VIA ITS OWN CDHS EMPLOYEES. CDHS APPROPRIATELY ISSUES ALL FORMS W-2 TO ITS EMPLOYEES. ADVANCE CARE HOSPITAL'S ASSOCIATED SALARY COSTS ARE REFLECTED ON FORM 990, PART IX, LINES 7-10.
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
ADVANCE CARE HOSPITAL
 
Employer identification number

71-0816634
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) BREECH REGIONAL MEDICAL CENTER

100 HOSPITAL DRIVE

LEBANON,MO65536
43-1767432 		HOSPITAL MO 501(C)(3) LINE 3: 170(B)(1)(A) ST JOHNS HS
 
 
No
(2) CARROLL HEALTH FOUNDATION

214 CARTER STREET

BERRYVILLE,AR72616
71-0759301 		FOUNDATION AR 501(C)(3) 11A OZARK RG HS
 
 
No
(3) CASA DE MISERICORDIA

1602 MCCLELLAND STREET

LAREDO,TX78044
74-2912461 		WOMEN'S SHELTER TX 501(C)(3) 7 MM LAREDO
 
 
No
(4) HEALDTON MERCY HOSPITAL CORPORATION

918 SOUTH STREET

HEALDTON,OK73438
26-3173902 		HOSPITAL OK 501(C)(3) LINE 3: 170(B)(1)(A) MMHC
 
 
No
(5) LAREDO MEDICAL GROUP

14528 S OUTER FORTY SUITE 100

CHESTERFIELD,MO63017
74-2764726 		INACTIVE TX 501(C)(3) LINE 9: 509(A)(2) MHS-TX
 
 
No
(6) MCAULEY PORTFOLIO MANAGEMENT COMPANY

14528 S OUTER FORTY SUITE 100

CHESTERFIELD,MO63017
26-1708048 		INVESTMENT MANAGEMENT MO 501(C)(3) 11B SMHS
 
 
No
(7) MERCY EL RENO HOSPITAL CORPORATION

2115 PARKVIEW DRIVE

EL RENO,OK73036
73-6617948 		LEASED HOSPITAL OK 501(C)(3) 3 MHS
 
 
No
(8) MERCY EMERGENCY MEDICAL SERVICES INC

4300 W MEMORIAL ROAD

OKLAHOMA CITY,OK73120
81-0627035 		INACTIVE OK 501(C)(3) LINE 9: 509(A)(2) MHC
 
 
No
(9) MERCY FOUNDATION FOR HEALTH INNOVATION

14528 S OUTER FORTY STE 100

CHESTERFIELD,MO63017
20-0901499 		FOUNDATION MO 501(C)(3) 11B SMHS
 
 
No
(10) MERCY HEALTH CENTER FOUNDATION

401 WOODLAND HILLS BLVD

FORT SCOTT,KS66701
48-1077073 		FOUNDATION KS 501(C)(3) 11C MHS-KS
 
 
No
(11) MERCY HEALTH CENTER FOUNDATION INC

4300 W MEMORIAL ROAD

OKLAHOMA CITY,OK73120
73-1593024 		FOUNDATION OK 501(C)(3) 11A MHC
 
 
No
(12) MERCY HEALTH CENTER INC

4300 W MEMORIAL ROAD

OKLAHOMA CITY,OK73120
73-0579285 		HOSPITAL OK 501(C)(3) 3 MHS
 
 
No
(13) MERCY HEALTH MHMCH INC

220 PENNSYLVANIA AVENUE

COLUMBUS,KS66725
27-0842031 		HOSPITAL MO 501(C)(3) 9 MHS-JOPLIN
 
 
No
(14) MERCY HEALTH OF JOPLIN FOUNDATION

2727 MCCLELLAND BLVD

JOPLIN,MO64804
27-0906136 		FOUNDATION MO 501(C)(3) 11A MHS-JOPLIN
 
 
No
(15) MERCY HEALTH OF JOPLIN INC

2727 MCCLELLAND BLVD

JOPLIN,MO64804
27-0814858 		HOSPITAL MO 501(C)(3) 9 MHS-JOPLIN
 
 
No
(16) MERCY HEALTH SERVICES INC

4300 W MEMORIAL ROAD

OKLAHOMA CITY,OK73120
14-1838609 		DISSOLVED 6/30/10 OK 501(C)(3) 9 MHC
 
 
No
(17) MERCY HEALTH SYSTEM OF KANSAS INC

401 WOODLAND HILLS BLVD

FORT SCOTT,KS66701
48-0956045 		HOSPITAL KS 501(C)(3) 3 MHS-JOPLIN
 
 
No
(18) MERCY HEALTH SYSTEM OF NORTHWEST ARKANSAS

2710 RIFE MEDICAL DRIVE

ROGERS,AR72758
62-1684203 		PHYSICIAN GROUP AR 501(C)(3) 11B SMHS
 
 
No
(19) MERCY HEALTH SYSTEM OF TEXAS INC

14528 S OUTER FORTY STE 100

CHESTERFIELD,MO63017
74-2764727 		INACTIVE TX 501(C)(3) 11B SMHS
 
 
No
(20) MERCY HEALTH SYSTEM INC

4300 W MEMORIAL ROAD

OKLAHOMA CITY,OK73120
73-1453048 		HOLDING COMPANY OK 501(C)(3) 11B SMHS
 
 
No
(21) MERCY HEALTH SYSTEM-JOPLIN INC

2727 MCCLELLAND BLVD

JOPLIN,MO64804
30-0584463 		HEALTH SYSTEM MO 501(C)(3) 11B SMHS
 
 
No
(22) MERCY HOSPITAL FOUNDATION OF INDEPENDENCE

800 W MYRTLE

INDEPENDENCE,KS67301
48-1079981 		FOUNDATION KS 501(C)(3) 11A MHS-KS
 
 
No
(23) MERCY HOSPITAL OF LAREDO

14528 S OUTER FORTY STE 100

CHESTERFIELD,MO63017
74-1189682 		INACTIVE TX 501(C)(3) 3 MHS-TX
 
 
No
(24) MERCY MEDICAL GROUP

645 MARYVILLE CENTRE STE 100

ST LOUIS,MO63141
43-1771217 		PHYSICIAN GROUP MO 501(C)(3) 9 ST JOHN MHC
 
 
No
(25) MERCY MEMORIAL HEALTH CENTER FOUNDATION

1011 14TH AVENUE NW

ARDMORE,OK73401
71-0962525 		FOUNDATION OK 501(C)(3) 11A MMHC
 
 
No
(26) MERCY MEMORIAL HEALTH CENTER INC

1011 14TH AVENUE NW

ARDMORE,OK73401
73-1500629 		HOSPITAL OK 501(C)(3) 3 MHS
 
 
No
(27) MERCY MINISTRIES OF LAREDO

2500 ZACATECAS

LAREDO,TX78043
20-0198462 		OUTREACH TX 501(C)(3) 7 SMHS
 
 
No
(28) MERCY PHYSICIANS OF OKLAHOMA INC

4300 W MEMORIAL ROAD

OKLAHOMA CITY,OK73120
27-0473057 		PHYSICIAN GROUP OK 501(C)(3) 9 MHS
 
 
No
(29) MHM SUPPORT SERVICES

14528 S OUTER FORTY STE 100

CHESTERFIELD,MO63017
20-2553101 		SUPPORT HEALTH SYSTEM MO 501(C)(3) 11B SMHS
 
 
No
(30) MISSION CLINICAL SERVICES

300 WERNER STREET

HOT SPRINGS,AR71913
13-4239691 		PHYSICIAN GROUP AR 501(C)(3) 9 ST JOS MHS
 
 
No
(31) OZARKS REGIONS HEALTH SYSTEM INC

214 CARTER STREET

BERRYVILLE,AR72616
71-0759299 		HOSPITAL AR 501(C)(3) 3 ST JOHNS HS
 
 
No
(32) SISTERS OF MERCY HEALTH SYSTEM

14528 S OUTER FORTY SUITE 100

CHESTERFIELD,MO63017
43-1423050 		SUPPORT HEALTH SYSTEM MO 501(C)(3) LINE 1: 170(B)(1)(A) N/A
 
No
(33) SISTERS OF MERCY MINISTRIES

14528 S OUTER FORTY STE 100

CHESTERFIELD,MO63017
72-1069468 		OUTREACH MO 501(C)(3) 7 SMHS
 
 
No
(34) ST EDWARD HLTH FAC-FRANKLIN CO

801 W RIVER STREET

OZARK,AR72949
71-0689680 		HOSPITAL AR 501(C)(3) 3 SEMMC
 
 
No
(35) ST EDWARD HLTH FAC-LOGAN CO

500 E ACADEMY

PARIS,AR72855
71-0655753 		HOSPITAL AR 501(C)(3) 3 SEMMC
 
 
No
(36) ST EDWARD HLTH FAC-SCOTT CO

1341 W 6TH STREET

WALDRON,AR72958
71-0557895 		HOSPITAL AR 501(C)(3) 3 SEMMC
 
 
No
(37) ST EDWARD MERCY FOUNDATION

PO BOX 17000

FORT SMITH,AR72917
23-7330425 		FOUNDATION AR 501(C)(3) 7 SEMMC
 
 
No
(38) ST EDWARD MERCY CLINIC INC

7301 ROGERS AVENUE

FORT SMITH,AR72917
26-1318597 		PHYSICIAN GROUP AR 501(C)(3) 9 SEMHS
 
 
No
(39) ST EDWARD MERCY HEALTH SYSTEM INC

7301 ROGERS AVENUE

FORT SMITH,AR72917
26-1318515 		HOLDING COMPANY AR 501(C)(3) 11B SMHS
 
 
No
(40) ST EDWARD MERCY MEDICAL CENTER

7301 ROGERS AVE

FORT SMITH,AR72917
71-0240352 		HOSPITAL AR 501(C)(3) LINE 3: 170(B)(1)(A) SEMHS
 
 
No
(41) ST FRANCIS HOSPITAL

100 W HIGHWAY 60

MOUNTAIN VIEW,MO65548
44-0607149 		HOSPITAL MO 501(C)(3) 3 ST JOHNS HS
 
 
No
(42) ST JOHN'S AURORA INC

500 PORTER AVENUE

AURORA,MO65605
43-1936696 		LEASE HOSPITAL MO 501(C)(3) 3 ST JOHNS HS
 
 
No
(43) ST JOHN'S CASSVILLE INC

94 MAIN STREET

CASSVILLE,MO65625
43-1936699 		LEASE HOSPITAL MO 501(C)(3) 3 ST JOHNS HS
 
 
No
(44) ST JOHN'S CHILDREN'S HOSPITAL INC

1235 E CHEROKEE STREET

SPRINGFIELD,MO65804
 INACTIVE MO 501(C)(3) 3 ST JOHNS HS
 
 
No
(45) ST JOHN'S CLINIC INC

1965 FREMONT STREET SUITE 2950

SPRINGFIELD,MO65804
43-1560263 		PHYSICIAN GROUP MO 501(C)(3) 9 ST JOHNS HS
 
 
No
(46) ST JOHN'S FDN FOR COMM HEALTH INC

1235 E CHEROKEE STREET

SPRINGFIELD,MO65804
32-0195818 		FOUNDATION MO 501(C)(3) 11B ST JOHNS HS
 
 
No
(47) ST JOHN'S HEALTH SYSTEM INC

1235 E CHEROKEE STREET

SPRINGFIELD,MO65804
43-1856028 		HOLDING COMPANY MO 501(C)(3) 11B SMHS
 
 
No
(48) ST JOHN'S HOME CARE OF BERRYVILLE INC

214 CARTER STREET

BERRYVILLE,AR72616
87-0781247 		HOME HEALTH AR 501(C)(3) 11C ST JOHNS RHC
 
 
No
(49) ST JOHN'S MEDICAL RESEARCH INST INC

1235 E CHEROKEE STREET

SPRINGFIELD,MO65804
87-0796305 		RESEARCH MO 501(C)(3) 4 ST JOHN HS
 
 
No
(50) ST JOHN'S MERCY FOUNDATION

645 MARYVILLE CENTRE STE 100

ST LOUIS,MO63141
56-2410022 		FOUNDATION MO 501(C)(3) 11B ST JOHNS MHC
 
 
No
(51) ST JOHN'S MERCY HEALTH CARE

645 MARYVILLE CENTRE STE 100

ST LOUIS,MO63141
43-1718408 		HEALTH SYSTEM MO 501(C)(3) 11B SMHS
 
 
No
(52) ST JOHN'S MERCY HEALTH SYSTEM

645 MARYVILLE CENTRE STE 100

ST LOUIS,MO63141
43-0653493 		HOSPITAL MO 501(C)(3) 3 ST JOHNS MHC
 
 
No
(53) ST JOHN'S MERCY HOSPITAL FOUNDATION

901 E FIFTH STREET

WASHINGTON,MO63090
56-2410020 		FOUNDATION MO 501(C)(3) 11B ST JOHNS MHC
 
 
No
(54) ST JOHN'S MERCY SUPPORT SERVICES

615 S NEW BALLAS ROAD

ST LOUIS,MO63141
43-1677952 		INACTIVE MO 501(C)(3) 11C ST JOHNS MHS
 
 
No
(55) ST JOHN'S REGIONAL HEALTH CENTER

1235 E CHEROKEE STREET

SPRINGFIELD,MO65804
44-0552485 		HOSPITAL MO 501(C)(3) 3 ST JOHNS HS
 
 
No
(56) ST JOSEPH'S MERCY CLINIC INC

1 MERCY LANE

HOT SPRINGS,AR71913
26-1125131 		PHYSICIAN GROUP AR 501(C)(3) 9 ST JOS MHS
 
 
No
(57) ST JOSEPH'S MERCY HEALTH CENTER

300 WERNER STREET

HOT SPRINGS,AR71913
71-0236913 		HOSPITAL AR 501(C)(3) LINE 3: 170(B)(1)(A) ST JOS MHS
 
 
No
(58) ST JOSEPH'S MERCY HEALTH FOUNDATION

300 WERNER STREET

HOT SPRINGS,AR71913
71-0804718 		FOUNDATION AR 501(C)(3) 11B ST JOS MHC
 
 
No
(59) ST JOSEPH'S MERCY HEALTH SYSTEM INC

300 WERNER STREET

HOT SPRINGS,AR71913
26-1125064 		HOLDING COMPANY AR 501(C)(3) 11B SMHS
 
 
No
(60) ST MARY-ROGERS MEMORIAL HOSPITAL INC

2710 RIFE MEDICAL DRIVE

ROGERS,AR72758
71-0294390 		HOSPITAL AR 501(C)(3) 3 MHS-NWA
 
 
No
(61) ST MARY'S HOSPITAL FOUNDATION

2710 RIFE MEDICAL DRIVE

ROGERS,AR77858
71-0601687 		FOUNDATION AR 501(C)(3) 11C ST MARY RMC
 
 
No
(62) ST MARY'S HOSPITAL OF ENID OKLAHOMA INC

14528 S OUTER FORTY STE 100

CHESTERFIELD,MO63017
73-0614655 		INACTIVE OK 501(C)(3) 3 MHS
 
 
No
(63) THE SISTER M CORNELIA BLASKO FNDN

100 W HIGHWAY 60

MOUNTAIN VIEW,MO65548
43-1873914 		FOUNDATION MO 501(C)(3) 11A ST FRAN HOS
 
 
No
(64) UNITY AMBULATORY CARE

645 MARYVILLE CENTRE STE 100

ST LOUIS,MO63141
43-1861745 		INACTIVE MO 501(C)(3) 11C ST JOHN MHC
 
 
No
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
(1) HORIZONTAL PROPERTY

7301 ROGERS AVENUE
FORT SMITH,AR72903
71-0554050 		OFFICE BUILDING AR N/A
                  
(2) HOT SPRINGS EQUIP

300 WERNER STREET
HOT SPRINGS,AR71913
20-4340915 		DISSOLVED 9/30/09 AR N/A
                  
(3) HOT SPRINGS MRI

100 RIDGEWAY PLACE
HOT SPRINGS,AR72901
71-0675196 		DISSOLVED 8/05/09 AR N/A
                  
(4) MERC AMBU SURG CTR

7301 ROGERS AVENUE
FORT SMITH,AR72917
71-0827721 		AMB. SURG. CENTER AR N/A
                  
(5) RES OPT & INNOVA

645 MARYVILLE CENTER
ST LOUIS,MO63141
46-0468368 		DISTRIBUTION CENTER MO N/A
                  
(6) SO OK DIAG CTR

1011 14TH AVENUE NW
ARDMORE,OK73401
43-1971232 		MRI SERVICES OK N/A
                  
(7) FORT SMITH EMERG MEDICAL SERVICES

1701 GREENWOOD
FORT SMITH,AR72901
71-0416615 		EMERGENCY MEDICAL AR N/A
                  
(8) SO OK PHY HP ORG

1011 14TH AVENUE NW
ARDMORE,OK73401
73-1462104 		DISSOLVED 12/31/09 OK N/A
                  
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) CONSOLIDATED LOGISTICS INC
2710 RIFE MEDICAL LANE
ROGERS,AR72758
71-0474406 		DISSOLVED 8/04/09 AR N/A
 C      
(2) FRONTENAC PROPERTIES INC
14528 S OUTER FORTY SUITE 100
CHESTERFIELD,MO63017
52-1914421 		HOLDING COMPANY DE N/A
 C      
(3) INVENO HEALTH INC
1235 E CHEROKEE STREET
SPRINGFIELD,MO65804
26-4509571 		IT SERVICES MO N/A
 C      
(4) MERCY COMMUNITY SERVICES INC
401 WOODLAND HILLS BLVD
FORT SMITH,KS66701
48-1078101 		CATERING KS N/A
 C      
(5) MERCY HEALTH CENTER CONDOMINIUMS
4300 W MEMORIAL RD
OKLAHOMA CITY,OK73120
68-0640970 		REAL ESTATE OK N/A
 C      
(6) MERCY HEALTH NETWORK OF THE SOUTHERN REGION
1011 14TH AVENUE NW
ARDMORE,OK73401
73-1580607 		HEALTH CARE OK N/A
 C      
(7) MERCY HEALTH NETWORK INC
4300 W MEMORIAL ROAD
OKLAHOMA CITY,OK73120
73-1381689 		HEALTH CARE OK N/A
 C      
(8) MERCY MANAGED CARE CORPORATION
4300 W MEMORIAL ROAD
OKLAHOMA CITY,OK73120
73-1441665 		HOLDING COMPANY OK N/A
 C      
(9) MERCY MEDICAL SERVICES INC
14528 S OUTER FORTY SUITE 100
CHESTERFIELD,MO63017
71-0641246 		DISSOLVED 7/01/09 MO N/A
 C      
(10) MHP INC
14528 S OUTER FORTY SUITE 100
CHESTERFIELD,MO63017
43-1697048 		HOLDING COMPANY DE N/A
 C      
(11) ST EDWARD MEDICAL SERVICES INC
7301 ROGERS AVENUE
FORT SMLTH,AR72903
20-2965518 		DISSOLVED 7/01/09 AR N/A
 C      
(12) UH L CORP INC
645 MARYVILLE CENTRE DRIVE SUITE 10
ST LOUIS,MO63141
74-2499535 		HOLDING COMPANY MO N/A
 C      
(13) UNITY SUPPORT SERVICES INC
645 MARYVILLE CENTRE DRIVE SUITE 10
ST LOUIS,MO63141
43-1797042 		MANAGEMENT MO 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
 
No
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
 
No
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)
(2)
(3)
(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
  SCHEDULE R, PART V ADVANCE CARE HOSPITAL IS NOT UNDER THE CONTROL OF THE HOSPITALS WITH WHICH IT SHARES SPACE. ADVANCE CARE HOSPITAL MAINTAINS A SEPARATE AND INDEPENDENT GOVERNING BODY, CHIEF EXECUTIVE OFFICER, CHIEF OPERATING OFFICER, ADMINISTRATORS, AND DIRECTORS OF PATIENT CARE. COSTS FOR FACILITY RENTAL IS BASED ON A FIXED COST REIMBURSEMENT FORMULA. SERVICES ARE PRICED BASED ON A VARIABLE COST REIMBURSEMENT FORMULA.
Additional Data


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