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

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2010
Open to Public Inspection
A For the calendar year, or tax year beginning 07-01-2010 and ending 06-30-2011
BCheck if applicable:
CName of organization
MERCY MEDICAL CENTER
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
1301 15th Ave W
 
Room/suite
City or town, state or country, and ZIP + 4
Williston, ND58801
D Employer identification number

45-0231183
E Telephone number

G Gross receipts $ 53,800,270
F Name and address of principal officer:
MATTHEW GRIMSHAW CEO
1301 15th Ave W
Williston,ND58801
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.MERCY-WILLISTON.ORG
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet0928
K Form of organization:
 
L Year of formation: 1920
M State of legal domicile: ND
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: MERCY MEDICAL CENTER IS A CRITICAL ACCESS HOSPITAL SERVING A LARGE GEOGRAPHICAL AREA. COMMUNITY BENEFITS INCLUDE: UNCOMPENSATED CARE, MEDICAL EDUCATION AND AWARENESS, SUPPORT SERVICES, AND COMMUNITY OUTREACH.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) .... 3 10
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 7
5 Total number of individuals employed in calendar year 2010 (Part V, line 2a) ... 5 538
6 Total number of volunteers (estimate if necessary) .... 6 100
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 59,012
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b -5,798
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 1,564,912 395,220
9 Program service revenue (Part VIII, line 2g) ......... 46,402,444 51,496,416
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 513,636 665,286
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 1,056,251 1,234,588
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 49,537,243 53,791,510
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 17,587 41,017
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) 24,156,162 23,846,553
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).... 21,372,017 25,475,831
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 45,545,766 49,363,401
19 Revenue less expenses. Subtract line 18 from line 12...... 3,991,477 4,428,109
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............ 32,041,745 40,376,416
21 Total liabilities (Part X, line 26)............ 6,545,222 5,230,606
22 Net assets or fund balances. Subtract line 21 from line 20 ..... 25,496,523 35,145,810
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: THE ORGANIZATION'S MISSION IS TO NURTURE THE HEALING MINISTRY OF THE CHURCH BY BRINGING IT NEW LIFE, ENERGY AND VIABILITY IN THE 21ST CENTURY. FIDELITY TO THE GOSPEL URGES US TO EMPHASIZE HUMAN DIGNITY AND SOCIAL JUSTICE AS WE MOVE TOWARD THE CREATION OF HEALTHIER COMMUNITIES.
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 $ 44,622,296 including grants of $ 19,424 ) (Revenue $ 51,496,416 )
SEE SCHEDULE H
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$ 44,622,296
Form 990 (2010)
Form 990 (2010)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment........
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part I..........
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 I.......................
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 II...
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 ....................
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 IV...................
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 V
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
Yes
 
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.
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If “Yes,” complete Schedule D, Parts XI, XII, and XIII
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, and program service activities outside the United States? If “Yes,” complete Schedule F, Part I......... Click to see attachment
14b
Yes
 
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.. Click to see attachment
15
Yes
 
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.....
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
 
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I......
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........................... Click to see attachment
26
Yes
 
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor, or a grant selection committee member, or to a person related to such an individual? If “Yes,” complete Schedule L, Part III...............
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................... Click to see attachment
28b
Yes
 
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........
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35
Is any related organization a controlled entity within the meaning of section 512(b)(13)? .....
35
Yes
 
a
Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2...........
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 VI
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
39
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
538
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2010)
Form 990 (2010)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI . . . . . . . . . .
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year ..............
1a
10
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
7
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? ..
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Does the organization have members or stockholders? ................
6
Yes
 
7a
Does the organization have members, stockholders, or other persons who may elect one or more members of the governing body? .........................
7a
Yes
 
b
Are any decisions of the governing body subject to approval by members, stockholders, or other persons? ..
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Does the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” does the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with those of the organization? ....
10b
 
 
11a
Has the organization provided a copy of this Form 990 to all members of its governing body before filing the form?
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Does the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Are officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ...........................
12b
Yes
 
c
Does the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this is done ....................
12c
Yes
 
13
Does the organization have a written whistleblower policy? ...............
13
Yes
 
14
Does the organization have a written document retention and destruction policy? .........
14
 
No
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line a or b, describe the process in Schedule O. (See instructions.)
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If “Yes,” has the organization adopted a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and taken steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
ND
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
Kerry Monson
1301 W 15th Ave W
Williston,ND58801
(701) 774-7408
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) DAVID BRENDSEL
BOARD MEMBER
 1 X           0 0 0
(2) JEFFREY DROP
SVP DIVISION OFFICER
 1 X           0 684,808 74,336
(3) LAURIE FURUSETH
CHAIR
 1 X   X       0 0 0
(4) DENNIS GOEBEL
FORMER PRESIDENT/CEO
 0           X 0 174,357 24,986
(5) MATTHEW GRIMSHAW
PRESIDENT/CEO
 40 X   X       0 122,906 16,229
(6) ROBERT KEMP
BOARD MEMBER/PHYSICIAN
 40 X           286,421 0 39,164
(7) SISTER MARIE MICHELETTO
BOARD MEMBER
 1 X           0 0 0
(8) CRAIG OKSOL
VICE CHAIR
 1 X   X       0 0 0
(9) STEVE OYLOE
BOARD MEMBER
 1 X           0 0 0
(10) PATRICK SOGARD
BOARD MEMBER
 1 X           0 0 0
(11) NANCY HOFFELT
BOARD MEMBER
 1 X           0 0 0
(12) KERRY MONSON
CFO/VP OF FINANCE
 40     X       148,187 0 24,068
(13) MICHAEL BOULTER
ER PHYSICIAN
 40         X   641,760 0 10,358
(14) MORRIS BELLIS
ENT PHYSICIAN
 40         X   369,402 0 30,037
(15) DAVID SKURDAL
PHYSICIAN
 40         X   434,319 0 32,981
(16) BRETT VIBETO
GENERAL SURGEON
 40         X   420,420 0 26,805
(17) TERRY OLSON
BOARD MEMBER
 1 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;
(18) DAVID LANOUE
ORTHOPEDIC SURGEON
 40         X   666,169 0 39,589
























1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 2,966,678 982,071 318,553
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 in reportable compensation from the organizationMediumBullet24
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
RUDOLF LOPERENA
PO BOX 71
LISBON,ND58054 		ER PHYSICIAN 284,997
PAUL OLSON
1551 COOK DRIVE
MINOT,ND587016866 		ER PHYSICIAN 207,393
DAKOTA TRAVEL NURSE
502 WEST MAIN STREET
MANDAN,ND58554 		LOCUM NURSES 166,687
PENNY WILKIE
4650 TOMAHAWK TRAIL S
MANDAN,SD58554 		ER PHYSICIAN 157,320
BILLINGS CLINIC
PO BOX 30977
BILLINGS,MT591070977 		ONCOLOGY PHYSICIANS 151,875
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization MediumBullet8
Form 990 (2010)
Form 990 (2010)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, gifts, grants and other similar amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 380,577
e Government grants (contributions)1e 7,750
f All other contributions, gifts, grants, and
similar amounts not included above1f 		6,893
g Noncash contributions included in lines 1a-1f:$  
h Total. Add lines 1a-1f.......MediumBullet 395,220
Program Service Revenue Business Code
2a PATIENT SERVICES 900,099 51,173,674 51,173,674    
b RENTAL INCOME 532,000 293,918 293,918    
c REHAB SERVICES REVENUE 621,400 28,824 28,824    
d
e
f All other program service revenue . 0 0 0 0
g Total. Add lines 2a–2f........MediumBullet 51,496,416
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 229,904   586 229,318
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties............MediumBullet 0      
(i) Real (ii) Personal
6a Gross Rents    
b Less: rental expenses    
c Rental income or (loss) 0 0
d Net rental income or (loss).......MediumBullet 0      
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 441,642 2,500
b Less: cost or other basis and sales expenses   8,760
c Gain or (loss) 441,642 -6,260
d Net gain or (loss)..........MediumBullet 435,382     435,382
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 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a LABORATORY SERVICES 621,500 776,080     776,080
b CAFETERIA 722,100 133,588     133,588
c INTERCOMPANY TRANSACTIONS 900,099 77,613     77,613
d All other revenue .... 247,307 0 58,426 188,881
e Total. Add lines 11a–11d ......MediumBullet 1,234,588
12 Total revenue. See Instructions....MediumBullet 53,791,510 51,496,416 59,012 1,840,862
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 19,124 19,124
2 Grants and other assistance to individuals in the U.S. See Part IV, line 22 0  
3 Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 15 and 16 21,893 21,893
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 476,304 312,780 163,524  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0      
7 Other salaries and wages 19,317,393 17,918,796 1,398,597  
8 Pension plan contributions (include section 401(k) and section 403(b) employer contributions) .... 938,945 865,613 73,332  
9 Other employee benefits ....... 1,891,570 1,743,838 147,732  
10 Payroll taxes ........... 1,222,341 1,126,876 95,465  
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 0      
c Accounting ........... 0      
d Lobbying ........... 0      
e Professional fundraising. See Part IV, line 17.. 0  
f Investment management fees ...... 0      
g Other .......... 8,245,405 7,193,151 1,052,254  
12 Advertising and promotion .... 0      
13 Office expenses ....... 7,824,210 7,653,305 170,905  
14 Information technology ...... 0      
15 Royalties .. 0      
16 Occupancy ........... 709,831 701,377 8,454  
17 Travel ............ 265,063 215,999 49,064  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 0      
20 Interest ........... 81,985 81,985    
21 Payments to affiliates ....... 1,085,580   1,085,580  
22 Depreciation, depletion, and amortization ..... 1,551,770 1,498,400 53,370  
23 Insurance .............. 454,289 135,987 318,302  
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 INCOME/SALES/PROPERTY TAXES 44,398 42,754 1,644  
b BAD DEBTS 4,217,243 4,217,243    
c RECRUITMENT AND RELOCATION 445,152 445,152    
d REPAIRS AND MAINTENANCE 303,093 300,860 2,233  
e RENOVATIONS 96,509 96,509    
f All other expenses 151,303 30,654 120,649 0
25 Total functional expenses. Add lines 1 through 24f 49,363,401 44,622,296 4,741,105 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 		0      
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 .......... 2,709 1 4,005
2 Savings and temporary cash investments ....... 0 2 522,299
3 Pledges and grants receivable, net .........   3  
4 Accounts receivable, net ......... 6,759,185 4 8,650,719
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L .......... 21,654 5 80,435
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 ............. 726,169 7 454,694
8 Inventories for sale or use .............. 953,699 8 926,271
9 Prepaid expenses and deferred charges ............ 46,644 9 137,032
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 46,241,139
b Less: accumulated depreciation. ..... 10b 32,996,644 12,777,075 10c 13,244,495
11 Investments—publicly traded securities ..........   11  
12 Investments—other securities. See Part IV, line 11 ...... 8,352,518 12 9,385,772
13 Investments—program-related. See Part IV, line 11 ..   13 0
14 Intangible assets .........   14  
15 Other assets. See Part IV, line 11 ........... 2,402,092 15 6,970,694
16 Total assets. Add lines 1 through 15 (must equal line 34)... 32,041,745 16 40,376,416
Liabilities 17 Accounts payable and accrued expenses . 3,963,782 17 4,354,906
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..... 2,581,440 25 875,700
26 Total liabilities. Add lines 17 through 25..... 6,545,222 26 5,230,606
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 ..... 23,454,204 27 28,534,889
28 Temporarily restricted net assets ..... 2,042,319 28 6,610,921
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 ..... 25,496,523 33 35,145,810
34 Total liabilities and net assets/fund balances ..... 32,041,745 34 40,376,416
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
53,791,510
2
Total expenses (must equal Part IX, column (A), line 25) . . . . .
2
49,363,401
3
Revenue less expenses. Subtract line 2 from line 1 . . . .
3
4,428,109
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) . .
4
25,496,523
5
Other changes in net assets or fund balances (explain in Schedule O) . . . .
5
5,221,178
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
35,145,810
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII . . . . . . . . . .
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?..
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O............................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
 
 
Form 990 (2010)
Additional Data


Software ID: 10000128
Software Version: v2010.1.0
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
MERCY MEDICAL CENTER
 
Employer identification number

45-0231183
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: 10000128
Software Version: v2010.1.0
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2010
Name of organization
MERCY MEDICAL CENTER
 
Employer identification number

45-0231183
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule—
Special Rules
......................... Arrow Bullet   $    
Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990, or check the box in the heading of its
Form 990-EZ, or on line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part I
Name of organization
MERCY MEDICAL CENTER
  		Employer identification number

45-0231183
Part I
Contributors (see Instructions)
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED




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

     
 
   

$  




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

     
 
   

$  




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

     
 
   

$  




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

     
 
   

$  




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

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part II
Name of organization
MERCY MEDICAL CENTER
  		Employer identification number

45-0231183
Part II
Noncash Property (see Instructions)
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part III
Name of organization
MERCY MEDICAL CENTER
  		Employer identification number

45-0231183
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
aggregating more than $1,000 for the year. (Complete columns (a) through (e) and the following line entry.)
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet $  
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Additional Data


Software ID: 10000128
Software Version: v2010.1.0
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
MERCY MEDICAL CENTER
 
Employer identification number

45-0231183
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? .......................
Yes
 
1,517
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 ..........................
 
No
 
j
Total. lines 1c through 1i ...................................
1,517
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 LOBBYING ACTIVITIES SCHEDULE C, PART II-B THE ENTITY'S CONTROLLING ORGANIZATION PAYS ANNUAL DUES TO THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND CATHOLIC HEALTH ASSOCIATION (CHA), A PORTION OF WHICH IS ALLOCATED TO LOBBYING. IN ADDITION, MERCY MEDICAL CENTER PAID DUES TO THE NORTH DAKOTA HOSPITAL ASSOCIATION. THE AMOUNT SHOWN ON LINE 1F REPRESENTS THIS ENTITY'S SHARE OF ALLOCATED LOBBYING EXPENSES: AHA $155, CHA $466, NDHA $896.
Schedule C (Form 990 or 990EZ) 2010

Additional Data


Software ID: 10000128
Software Version: v2010.1.0

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
MERCY MEDICAL CENTER
 
Employer identification number

45-0231183
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 .................   328,028 328,028
b Buildings ................   27,177,284 19,219,871 7,957,413
c Leasehold improvements ............       0
d Equipment ................   17,200,303 13,406,209 3,794,094
e Other .................   1,535,524 370,564 1,164,960
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........SchDMdBullet 13,244,495
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 0  
(2)Closely-held equity interests 0  
(3)Other
(A) CHI OIP - FIXED INCOME 		4,470,073 F

(B) CHI OIP - EQUITY SECURITIES 		4,915,699 F







Total. (Column (b) should equal Form 990, Part X, col.(B) line 12.)Small Bullet 9,385,772
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) should equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) INVESTMENT IN UNCONSOLIDATED ORGS 6,970,694








Total. (Column (b) should equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 6,970,694
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Amount
Federal Income Taxes 0
INTERCOMPANY PAYABLE - CHI DEBT PROGRAM 875,700








Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)Small Bullet 875,700
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 58,336,112
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2 49,363,401
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3 8,972,711
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 0
9 Total adjustments (net). Add lines 4 - 8 ............................. 9 0
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10 8,972,711
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 0
e Add lines 2a through 2d ..................... 2e 0
3 Subtract line 2e from line 1..................... 3 0
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 0
c Add lines 4a and 4b....................... 4c 0
5 Total Revenue. Add lines 3 and 4c. (This should equal Form 990, Part I, line 12.) ...... 5 0
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 0
e Add lines 2a through 2d...................... 2e 0
3 Subtract line 2e from line 1..................... 3 0
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 0
c Add lines 4a and 4b....................... 4c 0
5 Total expenses. Add lines 3 and 4c. (This should equal Form 990, Part I, line 18.) ...... 5 0
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
FIN 48 (ASC 740) footnote Schedule D, Part X, Line 2 MERCY MEDICAL CENTER'S FINANCIAL INFORMATION IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF CATHOLIC HEALTH INITIATIVES (CHI), A RELATED ORGANIZATION. CHI'S FIN 48 (ASC 740) FOOTNOTE FOR THE YEAR ENDED JUNE 30, 2011 READS AS FOLLOWS: "CHI IS A TAX-EXEMPT COLORADO CORPORATION AND HAS BEEN GRANTED AN EXEMPTION FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. CHI OWNS CERTAIN TAXABLE SUBSIDIARIES AND ENGAGES IN CERTAIN ACTIVITIES THAT ARE UNRELATED TO ITS EXEMPT PURPOSE AND THEREFORE SUBJECT TO INCOME TAX. AS OF JUNE 30, 2011, CHI HAS CURRENT NET DEFERRED TAX ASSETS OF $2.1 MILLION AND A NONCURRENT NET DEFERRED TAX LIABILITY OF $5.4 MILLION RELATED TO THESE TAXABLE ACTIVITIES. MANAGEMENT REVIEWS ITS TAX POSITIONS ANNUALLY AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION IN THE CONSOLIDATED FINANCIAL STATEMENTS."
Schedule D (Form 990) 2010

Additional Data


Software ID: 10000128
Software Version: v2010.1.0




SCHEDULE F
(Form 990)

Department of the Treasury
Internal Revenue Service
Statement of Activities Outside the United States
Right pointing arrow large image Complete if the organization answered "Yes" to Form 990,
Part IV, line 14b, 15, or 16.
Right pointing arrow large image Attach to Form 990. Right pointing arrow large image See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
MERCY MEDICAL CENTER
 
Employer identification number

45-0231183
Part I
General Information on Activities Outside the United States. Complete if the organization answered
“Yes” to Form 990, Part IV, line 14b.
1
For grantmakers. Does the organization maintain records to substantiate the amount of the grants or
assistance, the grantees' eligibility for the grants or assistance, and the selection criteria used to award
the grants or assistance? ...................................
2
For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of grant funds outside the
United States.
3
Activites per Region. (Use Part V if additional space is needed.)
(a) Region (b) Number of offices in the region (c) Number of employees or agents in region or independent contractors (d) Activities conducted in region (by type) (e.g., fundraising, program services, investments, grants to recipients located in the region) (e) If activity listed in (d) is a program service, describe specific type of
service(s) in region		 (f) Total
expenditures for region/investments
in region
CENTRAL AMERICA AND THE CARIBBEAN 0 0 GRANTS   663
EUROPE (INCLUDING ICELAND AND GREENLAND) 0 0 GRANTS   30
NORTH AMERICA (CANADA & MEXICO ONLY) 0 0 GRANTS   30
SOUTH AMERICA 0 0 GRANTS   30
SOUTH ASIA 0 0 GRANTS   871
SUB SAHARAN AFRICA 0 0 GRANTS   21,010
           
           
           
           
           
           
           
           
           
           
           
3a Sub-total .....      
b Total from continuation sheets to Part I ...      
c Totals (add lines 3a and 3b) 0 0 22,634
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2010
Schedule F (Form 990) 2010
Page 2
Part II
Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" to Form 990,
Part IV, line 15, for any recipient who received more than $5,000. Check this box if no one recipient received more than $5,000 ........ MediumBullet
Use Part V if additional space is needed.
1 (a) Name of organization (b) IRS code section
and EIN (if applicable)		 (c) Region (d) Purpose of
grant 		(e) Amount of
cash grant 		(f) Manner of
cash
disbursement 		(g) Amount of
of non-cash
assistance 		(h) Description
of non-cash
assistance 		(i) Method of
valuation
(book, FMV,
appraisal, other)
CENTRAL AMERICA AND THE CARIBBEAN IMPROVE MEDICAL SERVICE 0 N/A 199 MEDICAL SUPPLIES BOOK
NORTH AMERICA (CANADA & MEXICO ONLY) IMPROVE MEDICAL SERVICE 0 N/A 663 MEDICAL SUPPLIES BOOK
SOUTH ASIA IMPROVE MEDICAL SERVICE 0 N/A 871 MEDICAL SUPPLIES BOOK
SUB SAHARAN AFRICA IMPROVE MEDICAL SERVICE 0 N/A 19,860 MEDICAL SUPPLIES BOOK
             
             
             
             
             
             
             
             
             
             
             
             
2
Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .....MediumBullet
1
3
Enter total number of other organizations or entities ........................MediumBullet
0
Schedule F (Form 990) 2010
Schedule F (Form 990) 2010Page 3
Part III
Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 16.
Use Part V if additional space is needed.
(a) Type of grant or assistance (b) Region (c) Number of recipients (d) Amount of
cash grant 		(e) Manner of cash
disbursement 		(f) Amount of
non-cash
assistance 		(g) Description
of non-cash
assistance 		(h) Method of
valuation
(book, FMV,
appraisal, other)
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
Schedule F (Form 990) 2010
Schedule F (Form 990) 2010
Page 4
Part IV
Foreign Forms
1 Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 926 (see instructions for Form 926).................
2 Did the organization have an interest in a foreign trust during the tax year? If " Yes," the organization may be required to file Form 3520 and/or Form 3520-A. (see instructions for Forms 3520 and 3520-A)..........
3 Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with respect to Certain Foreign Corporations. (see instructions for Form 5471)..............................
4 Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If "Yes," the organization may be required to file Form 8621, Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see instructions for Form 8621)
5 Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with respect to Certain Foreign Partnerships. (see instructions for Form 8865)....................................
6 Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to file Form 5713, International Boycott Report (see instructions for Form 5713)................................................
Schedule F (Form 990) 2010
Schedule F (Form 990) 2010
Page 5
Part V
Supplemental Information
Complete this part to provide the information (see instructions) required in Part I, line 2, and any additional information.
Identifier ReturnReference Explanation
Procedures for monitoring use of grant funds Schedule F, Part I, Line 2 MERCY MEDICAL CENTER ("MMC") DONATES EXCESS MEDICAL SUPPLIES TO A DOMESTIC 501(C)(3) ORGANIZATION. THESE MEDICAL SUPPLIES ARE THEN DISTRIBUTED TO UNDERPROVIDED NATIONS. MMC RELIES ON THE RECIPIENT ORGANIZATION TO MONITOR THE USE OF FUNDS OUTSIDE THE UNITED STATES.
METHOD USED TO ACCOUNT FOR EXPENDITURES SCHEDULE F, PART I, COLUMN F THE METHOD USED TO ACCOUNT FOR THE EXPENDITURES IS THE ACCRUAL METHOD WHICH IS CONSISTENT WITH THE ORGANIZATION'S FINANCIAL STATEMENTS.
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
Schedule F (Form 990) 2010
Additional Data


Software ID: 10000128
Software Version: v2010.1.0



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
MERCY MEDICAL CENTER
 
Employer identification number

45-0231183
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
 
No
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
 
No
c
If the organization does not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization uses an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.
4
Does the organization's policy provide free or discounted care to the "medically indigent"? ......
4
Yes
 
5a
Does the organization budget amounts for free or discounted care provided under its charity care policy? ...
5a
Yes
 
b
If "Yes," did the organization's charity care expenses exceed the budgeted amount?.........
5b
 
No
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discounted
care to a patient who was eligibile for free or discounted care?...............
5c
 
 
6a
Does the organization prepare an annual community benefit report?.............
6a
Yes
 
6b
If "Yes," does the organization make it available to the public? ..............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Charity Care and Certain Other Community Benefits at Cost
Charity Care and
Means-Tested Government Programs		 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Charity care at cost (from
Worksheets 1 and 2) .. 		  1,426 767,116   767,116 1.700 %
b Unreimbursed Medicaid (from
Worksheet 3, column a) . 		  1,810     0 0 %
c Unreimbursed costs—other means-tested government programs (from Worksheet 3, column b) ....         0 0 %
dTotal Charity Care and
Means-Tested Government Programs ..... 		0 3,236 767,116 0 767,116 1.700 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) .... 		22 5,963 110,045 1,510 108,535 0.240 %
f Health professions education
(from Worksheet 5) .. 		7 97 105,124   105,124 0.230 %
g Subsidized health services
(from Worksheet 6) .. 		3 553 9,476   9,476 0.020 %
h Research (from Worksheet 7)         0 0 %
i Cash and in-kind contributions
to community groups
(from Worksheet 8) .. 		18 14,139 222,586   222,586 0.490 %
jTotal Other Benefits ... 50 20,752 447,231 1,510 445,721 0.980 %
kTotal. Add lines 7d and 7j. .. 50 23,988 1,214,347 1,510 1,212,837 2.680 %
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         0 0 %
2 Economic development 1 1,800 6,959   6,959 0.010 %
3 Community support 2 797 9,451   9,451 0.020 %
4 Environmental improvements         0 0 %
5 Leadership development and training for community members 1 40 2,951   2,951 0.010 %
6 Coalition building 1 25 191   191 0 %
7 Community health improvement advocacy         0 0 %
8 Workforce development 2 26 375,523   375,523 0.760 %
9 Other         0 0 %
10 Total 7 2,688 395,075 0 395,075 0.800 %
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
1,815,945
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
0
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
9,968,753
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
9,870,052
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
98,701
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.
Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.
Check the box that describes the method used:
Section C. Collection Practices
9a
Does the organization have a written debt collection policy? ...............
9a
Yes
 
b
If "Yes," does the organization's collection policy contain provisions on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance? Describe in Part VI......
9b
Yes
 
Part IV
Management Companies and Joint Ventures
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership% 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 3
Part VFacility Information
Section A. Hospital Facilities
(list in order of size, measured by total revenue per facility, from largest to smallest)
How many hospital facilities did the organization operate during the tax year?1
Name and address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe)
1 MERCY MEDICAL CENTER
1301 15TH AVE W
WILLISTON,ND58801 		X X     X   X   OP CLINICS (PSYCH, FAMILY PRACTICE, GENERAL SURGERY, ORTHO)
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:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):  

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?1
Name and address Type of Facility (Describe)
1 MERCY MEDICAL CENTER - HOME HEALTH
1301 15TH AVE W
WILLISTON,ND58801 		HOME HEALTH AGENCY
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
Eligibility criteria for free or discounted care Schedule H, Part I, Line 3c WHEN CATHOLIC HEALTH INITIATIVES (THE ULTIMATE PARENT ORGANIZATION TO MERCY MEDICAL CENTER ESTABLISHED ITS FINANCIAL ASSISTANCE POLICY, IT WAS DETERMINED THAT ESTABLISHING A HOUSEHOLD INCOME SCALE BASED ON THE HUD VERY LOW INCOME GUIDELINES MORE ACCURATELY REFLECTS THE SOCIOECONOMIC DISPERSIONS AMONG THE 69 URBAN AND RURAL COMMUNITIES IN 19 STATES SERVED BY CHI HOSPITALS AND HEALTH CARE FACILITIES. MERCY MEDICAL CENTER BASES ITS FINANCIAL ASSISTANCE ELIGIBILITY ON HUD'S 130% OF VERY LOW INCOME GUIDELINES BASED ON GEOGRAPHY, AND AFFORDS THE UNINSURED AND UNDERINSURED THE ABILITY TO OBTAIN FINANCIAL ASSISTANCE WRITE-OFFS, BASED ON A SLIDING SCALE, RANGING FROM 25%-100% OF CHARGES. AN INDIVIDUAL'S INCOME UNDER THE HUD GUIDELINES IS A SIGNIFICANT FACTOR IN DETERMINING ELIGIBILITY FOR FINANCIAL ASSISTANCE. HOWEVER, IN DETERMINING WHETHER TO EXTEND DISCOUNTED OR FREE CARE TO A PATIENT, THE PATIENT'S ASSETS MAY ALSO BE TAKEN INTO CONSIDERATION. FOR EXAMPLE, A PATIENT SUFFERING A CATASTROPHIC ILLNESS MAY HAVE A REASONABLE LEVEL OF INCOME, BUT A LOW LEVEL OF LIQUID ASSETS SUCH THAT THE PAYMENT OF MEDICAL BILLS WOULD BE SERIOUSLY DETRIMENTAL TO THE PATIENT'S BASIC FINANCIAL (AND ULTIMATELY PHYSICAL) WELL-BEING AND SURVIVAL. SUCH A PATIENT MAY BE EXTENDED DISCOUNTED OR FREE CARE BASED UPON THE FACTS AND CIRCUMSTANCES.
Bad Debt Expense excluded from financial assistance calculation Schedule H, Part I, Line 7, column(f) 4,217,243
Costing Methodology used to calculate financial assistance Schedule H, Part I, Line 7 A COST ACCOUNTING SYSTEM WAS NOT USED TO COMPUTE AMOUNTS IN THE TABLE; RATHER COSTS IN THE TABLE WERE COMPUTED USING THE ORGANIZATION'S COST-TO-CHARGE RATIO. THE COST-TO-CHARGE RATIO COVERS ALL PATIENT SEGMENTS. THE COST-TO-CHARGE RATIO FOR THE YEAR ENDED 6/30/11 WAS COMPUTED USING THE FOLLOWING FORMULA: OPERATING EXPENSE (BEFORE RESTRUCTURING, IMPAIRMENT AND OTHER LOSSES) DIVIDED BY GROSS PATIENT REVENUE. WORKSHEET 2 WAS NOT USED TO DERIVE THE COST-TO-CHARGE RATIO.
Bad debt expense - financial statement footnote Schedule H, Part III, Line 4 COSTING METHODOLOGY FOR AMOUNTS REPORTED ON LINE 2 IS DETERMINED USING THE ORGANIZATION'S COST/CHARGE RATIO OF 59%. WHEN DISCOUNTS ARE EXTENDED TO SELF-PAY PATIENTS, THESE PATIENT ACCOUNT DISCOUNTS ARE RECORDED AS A REDUCTION IN REVENUE, NOT AS BAD DEBT EXPENSE. MERCY MEDICAL CENTER DOES NOT BELIEVE THAT ANY PORTION OF BAD DEBT EXPENSE COULD REASONABLY BE ATTRIBUTED TO PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE SINCE AMOUNTS DUE FROM THOSE INDIVIDUALS' ACCOUNTS WILL BE RECLASSIFIED FROM BAD DEBT EXPENSE TO CHARITY CARE WITHIN 30 DAYS FOLLOWING THE DATE THAT THE PATIENT IS DETERMINED TO QUALIFY FOR CHARITY CARE. MERCY MEDICAL CENTER DOES NOT ISSUE SEPARATE COMPANY AUDITED FINANCIAL STATEMENTS. HOWEVER, THE ORGANIZATION IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF CATHOLIC HEALTH INITIATIVES. THE CONSOLIDATED FOOTNOTE READS AS FOLLOWS: "THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING HISTORICAL BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. MANAGEMENT ROUTINELY ASSESSES THE ADEQUACY OF THE ALLOWANCES FOR UNCOLLECTIBLE ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE BY PAYOR CATEGORY. THE RESULTS OF THESE REVIEWS ARE USED TO MODIFY, AS NECESSARY, THE PROVISION FOR BAD DEBTS AND TO ESTABLISH APPROPRIATE ALLOWANCES FOR UNCOLLECTIBLE NET PATIENT ACCOUNTS RECEIVABLE. AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE, CHI FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PATIENT BALANCES WITH COLLECTION AGENCIES, SUBJECT TO THE TERMS OF CERTAIN RESTRICTIONS ON COLLECTION EFFORTS AS DETERMINED BY EACH FACILITY."
Community benefit & methodology for determining medicare costs Schedule H, Part III, Line 8 MERCY MEDICAL CENTER IS DESIGNATED AS A CRITICAL ACCESS HOSPITAL ("CAH"). CAHS ARE RURAL COMMUNITY HOSPITALS THAT ARE CERTIFIED TO RECEIVE COST-BASED REIMBURSEMENT FROM MEDICARE. THE REIMBURSEMENT THAT CAHS RECEIVE IS INTENDED TO IMPROVE THEIR FINANCIAL PERFORMANCE AND THEREBY REDUCE HOSPITAL CLOSURES. CAHS ARE CERTIFIED UNDER A DIFFERENT SET OF MEDICARE CONDITIONS OF PARTICIPATION (COP). SHORTFALLS ARE CREATED WHEN A FACILITY RECEIVES PAYMENTS THAT ARE LESS THAN THE COSTS OF CARING FOR PROGRAM BENEFICIARIES. BECAUSE SHORTFALLS ARE BASED ON COSTS, NOT CHARGES, MERCY MEDICAL CENTER, DUE TO THEIR DESIGNATION AS A CAH, RECEIVED COST-BASED REIMBURSEMENT FOR MEDICARE PURPOSES, MERCY MEDICAL CENTER WILL NOT EXPERIENCE MEDICARE RELATED SHORTFALLS. ALTHOUGH NOT PRESENTED ON THE MEDICARE COST REPORT, IN ORDER TO FACILITATE A MORE ACCURATE UNDERSTANDING OF THE "TRUE" COST OF SERVICES (FOR "SHORTFALL" PURPOSES) THE CHI WORKBOOK ALLOWS A HEALTH CARE FACILITY NOT TO OFFSET COSTS THAT MEDICARE CONSIDERS TO BE NON-ALLOWABLE, BUT FOR WHICH THE FACILITY CAN LEGITIMATELY ARGUE ARE RELATED TO THE CARE OF THE FACILITY'S PATIENTS. IN ADDITION, ALTHOUGH NOT REPORTABLE ON THE MEDICARE COST REPORT, THE CHI WORKBOOK INCLUDES THE COST OF SERVICES THAT ARE PAID VIA A SET FEE-SCHEDULE RATHER THAN BEING REIMBURSED BASED ON COSTS (E.G. OUTPATIENT CLINICAL LABORATORY). FINALLY, THE CHI WORKBOOK ALLOWS A FACILITY TO INCLUDE OTHER HEALTH CARE SERVICES PERFORMED BY A SEPARATE FACILITY (SUCH AS A PHYSICIAN PRACTICE) THAT ARE MAINTAINED ON SEPARATE BOOKS AND RECORDS (AS OPPOSED TO THE MAIN FACILITY'S BOOKS AND RECORDS WHICH HAS ITS COSTS OF SERVICE INCLUDED WITHIN A COST REPORT).
Collection practices for patients eligible for financial assistance Schedule H, Part III, Line 9b MERCY MEDICAL CENTER'S DEBT COLLECTION POLICY PROVIDES THAT MERCY MEDICAL CENTER WILL PERFORM A REASONABLE REVIEW OF EACH INPATIENT ACCOUNT PRIOR TO TURNING AN ACCOUNT OVER TO A THIRD-PARTY COLLECTION AGENT AND PRIOR TO INSTITUTING ANY LEGAL ACTION FOR NON-PAYMENT, TO ASSURE THAT THE PATIENT AND PATIENT GUARANTOR ARE NOT ELIGIBLE FOR ANY ASSISTANCE PROGRAM (E.G. MEDICAID) AND DO NOT QUALIFY FOR COVERAGE THROUGH MERCY MEDICAL CENTER'S COMMUNITY ASSISTANCE POLICY. AFTER HAVING BEEN TURNED OVER TO A THIRD-PARTY COLLECTION AGENT, ANY PATIENT ACCOUNT THAT IS SUBSEQUENTLY DETERMINED TO MEET THE MERCY MEDICAL CENTER COMMUNITY ASSISTANCE POLICY IS REQUIRED TO BE RETURNED IMMEDIATELY BY THE THIRD-PARTY COLLECTION AGENT TO MERCY MEDICAL CENTER FOR APPROPRIATE FOLLOW-UP. MERCY MEDICAL CENTER REQUIRES ITS THIRD-PARTY COLLECTION AGENTS TO INCLUDE A MESSAGE ON ALL STATEMENTS INDICATING THAT IF A PATIENT OR PATIENT GUARANTOR MEETS CERTAIN STIPULATED INCOME REQUIREMENTS, THE PATIENT OR PATIENT GUARANTOR MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE. ALL OF CATHOLIC HEALTH INITIATIVES' HOSPITALS' CONTRACTS WITH THIRD PARTY COLLECTION AGENCIES INCLUDE THE FOLLOWING STANDARDS: * NEITHER CHI HOSPITALS NOR THEIR COLLECTION AGENCIES WILL REQUEST BENCH OR ARREST WARRANTS AS A RESULT OF NON-PAYMENT; * NEITHER CHI HOSPITALS NOR THEIR COLLECTION AGENCIES WILL SEEK LIENS THAT WOULD REQUIRE THE SALE OR FORECLOSURE OF A PRIMARY RESIDENCE; AND * NO CATHOLIC HEALTH INITIATIVES' COLLECTION AGENCY MAY SEEK COURT ACTION WITHOUT HOSPITAL APPROVAL. FINALLY, COLLECTION AGENCIES ARE TRAINED ON THE CATHOLIC HEALTH INITIATIVES MISSION, CORE VALUES AND STANDARD OF CONDUCT TO MAKE SURE ALL PATIENTS ARE TREATED WITH DIGNITY AND RESPECT.
Patient education of eligibility for assistance. Schedule H, Part VI, Line 3 MERCY MEDICAL CENTER INCLUDES INFORMATION CONCERNING ITS FINANCIAL ASSISTANCE POLICY ON ITS WEBSITE. IN ADDITION, MMC PROMINENTLY DISPLAYS ITS FINANCIAL ASSISTANCE POLICY IN BOTH ENGLISH AND SPANISH IN OBVIOUS LOCATIONS THROUGHOUT THE HOSPITALS, INCLUDING THE EMERGENCY ROOMS AND OTHER PATIENT INTAKE AREAS, AS WELL AS IN MMC OUTPATIENT FACILITIES. IN ADDITION, MMC REGISTRATION CLERKS ARE TRAINED TO PROVIDE CONSULTATION TO THOSE WHO HAVE NO INSURANCE OR POTENTIALLY INADEQUATE INSURANCE CONCERNING THEIR FINANCIAL OPTIONS INCLUDING APPLICATION FOR MEDICAID AND FOR FINANCIAL ASSISTANCE UNDER MMC'S FINANCIAL ASSISTANCE POLICY. UPON REGISTRATION (AND ONCE ALL EMTALA REQUIREMENTS ARE MET), PATIENTS WHO ARE IDENTIFIED AS UNINSURED (AND NOT COVERED BY MEDICARE OR MEDICAID) ARE PROVIDED WITH A PACKET OF INFORMATION THAT ADDRESSES THE FINANCIAL ASSISTANCE POLICY AND PROCEDURES INCLUDING AN APPLICATION FOR ASSISTANCE. MMC REGISTRATION CLERKS READ THE ORGANIZATION'S MEDICAL ASSISTANCE POLICY TO THOSE WHO APPEAR TO BE INCAPABLE OF READING, AND PROVIDE TRANSLATORS FOR NON ENGLISH-SPEAKING INDIVIDUALS. MMC'S STAFF WILL ALSO ASSIST THE PATIENT/GUARANTOR WITH APPLYING FOR OTHER AVAILABLE COVERAGE (SUCH AS MEDICAID), IF NECESSARY. COUNSELORS ASSIST MEDICARE ELIGIBLE PATIENTS IN ENROLLMENT BY PROVIDING REFERRALS TO THE APPROPRIATE GOVERNMENT AGENCIES.
Affiliated health care system Schedule H, Part VI, Line 6 MERCY MEDICAL CENTER, ALONG WITH ITS AFFILIATED OUTPATIENT FACILITIES ARE PART OF CATHOLIC HEALTH INITIATIVES. CATHOLIC HEALTH INITIATIVES (CHI) IS A NATIONAL FAITH-BASED NONPROFIT HEALTH CARE ORGANIZATION WITH HEADQUARTERS IN ENGLEWOOD, COLORADO. CHI'S EXEMPT PURPOSE IS TO SERVE AS AN INTEGRAL PART OF ITS NATIONAL SYSTEM OF HOSPITALS AND OTHER CHARITABLE ENTITIES, WHICH ARE DESCRIBED AS MARKET-BASED ORGANIZATIONS, OR MBOS. AN MBO IS A DIRECT PROVIDER OF CARE OR SERVICES WITHIN A DEFINED MARKET AREA THAT MAY BE AN INTEGRATED HEALTH SYSTEM AND/OR A STAND-ALONE HOSPITAL OR OTHER FACILITY OR SERVICE PROVIDER. CHI SERVES AS THE PARENT CORPORATION OF ITS MBOS WHICH ARE COMPRISED OF 73 HOSPITALS; 40 LONG-TERM CARE, ASSISTED- AND RESIDENTIAL-LIVING FACILITIES; TWO COMMUNITY HEALTH-SERVICES ORGANIZATIONS; TWO ACCREDITED NURSING COLLEGES; AND HOME HEALTH AGENCIES. TOGETHER, THESE FACILITIES PROVIDED $612 MILLION IN CHARITY CARE AND COMMUNITY BENEFIT IN THE 2011 FISCAL YEAR, INCLUDING SERVICES FOR THE POOR, FREE CLINICS, EDUCATION AND RESEARCH. CHI PROVIDES STRATEGIC PLANNING AND MANAGEMENT SERVICES AS WELL AS CENTRALIZED "SHARED SERVICES" FOR THE MBOS. THE PROVISION OF CENTRALIZED MANAGEMENT AND SHARED SERVICES - INCLUDING AREAS SUCH AS ACCOUNTING, HUMAN RESOURCES, PAYROLL AND SUPPLY CHAIN -- PROVIDES ECONOMIES OF SCALE AND PURCHASING POWER TO THE MBOS. THE COST SAVINGS ACHIEVED THROUGH CHI'S CENTRALIZATION ENABLE MBOS TO DEDICATE ADDITIONAL RESOURCES TO HIGH-QUALITY HEALTH CARE AND COMMUNITY OUTREACH SERVICES TO THE MOST VULNERABLE MEMBERS OF OUR SOCIETY. MERCY MEDICAL CENTER OPERATES WITH ITS WHOLLY OWNED AFFILIATES AND COMMUNITY PARTNERS, ALONG WITH ITS FUNDRAISING ARM, THE MERCY MEDICAL FOUNDATION, TO SERVE THE HEALTH CARE NEEDS OF THE WILLISTON, ND COMMUNITIES.
NEEDS ASSESSMENT AND COMMUNITY INFORMATION SCHEDULE H, PART VI, LINES 1,2,4 AND 5 MERCY MEDICAL CENTER ("MMC") IS A SOLE COMMUNITY HOSPITAL LOCATED IN WILLISTON, NORTH DAKOTA, WITH A SERVICE POPULATION OF OVER 60,000 PEOPLE AND GROWING. OUR COMMUNITY HAS FOUND IT DIFFICULT TO SECURE AN ACCURATE CENSUS DUE TO THE CURRENT "OIL BOOM" ECONOMY. THE ROOTS OF MERCY MEDICAL CENTER ORIGINATED IN DUBLIN, IRELAND, WHERE CATHERINE MCAULEY ESTABLISHED THE SISTERS OF MERCY IN 1831. CATHERINE'S MISSION WAS TO GIVE BACK TO THE COMMUNITY BY PROVIDING FOR THE NEEDS OF THE POOR. IN ORDER TO BRING HEALTHCARE TO WESTERN NORTH DAKOTA, THE SISTERS OF MERCY FOUNDED MERCY HOSPITAL IN 1920. SINCE THEN, MMC HAS CONTINUED THE LEGACY OF GIVING BACK TO THE COMMUNITIES IT SERVES AND CARRYING ON THE MISSION OF PROVIDING FOR THOSE IN NEED. IN 1974, MERCY HOSPITAL MOVED TO ITS CURRENT LOCATION AT 1301 15TH AVENUE WEST. ALONG WITH THE MOVE, CAME NEW CHANGES AND AN EXPANSION OF SERVICES. TODAY, MMC IS COMPOSED OF GENERAL ACUTE CARE SERVICES, LEONARD P. NELSON FAMILY CANCER TREATMENT CENTER, CRAVEN-HAGAN CLINIC (MULTI-SPECIALTY GROUP), AND BEHAVIORAL HEALTH SERVICES. MMC PROVIDES HEALTHCARE FOR A REGION WHICH HAS A POPULATION OF APPROXIMATELY 60,000 AND PROVIDES EMPLOYMENT FOR NEARLY 460 PEOPLE. IN 1996, MMC AND ALL OF ITS SERVICE LINES BECAME A PART OF THE CATHOLIC HEALTH INITIATIVES ("CHI") SYSTEM. MMC AND CHI CONTINUE THE ESSENTIAL HEALTHCARE COMMITMENT OF ITS FOUNDING CONGREGATIONS: TO BUILD HEALTHY COMMUNITIES BY CARING FOR THE VULNERABLE; CARING FOR THE WHOLE PERSON IN BODY, MIND AND SPIRIT; AND GOING OUTSIDE THE WALLS OF ITS FACILITIES TO CARE FOR PEOPLE IN NEED. THE MISSION OF MMC AND CHI IS TO NURTURE THE HEALING MINISTRY OF THE CHURCH BY BRINGING IT NEW LIFE, ENERGY, AND VIABILITY IN THE 21ST CENTURY. FIDELITY TO THE GOSPEL URGES US TO EMPHASIZE HUMAN DIGNITY AND SOCIAL JUSTICE AS WE MOVE TOWARD THE CREATION OF HEALTHIER COMMUNITIES. MMC IS THE PREFERRED REGIONAL HEALTHCARE PROVIDER AND WORK COMMUNITY, DELIVERING HIGH QUALITY, PATIENT CENTERED CARE AND EXCELLENT SERVICE IN A WELCOMING AND SAFE ENVIRONMENT. IT IS MMC'S GOAL TO HOLD TRUE TO OUR CORE VALUES OF REVERENCE, INTEGRITY, COMPASSION, AND EXCELLENCE, AND IN DOING SO WE STRIVE TO PARTNER WITH REGIONAL ORGANIZATIONS, AGENCIES, AND ENTITIES TO PROVIDE COMMUNITY BENEFITS SO THAT TOGETHER WE CAN BUILD A HEALTHIER COMMUNITY. THE FOLLOWING REPORT OUTLINES THE COMMUNITY BENEFITS AND SERVICES MMC HAS PROVIDED TO THE REGION THIS PAST YEAR. AS A NON-PROFIT, CATHOLIC HEALTHCARE ORGANIZATION, WE TREAT PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THIS IS CONSISTENT WITH OUR MISSION AND CORE VALUES. IN ADDITION, MMC PROVIDES THOUSANDS OF DOLLARS IN RESOURCES, INCLUDING TIME AND CONTRIBUTIONS, TO MANY ORGANIZATIONS THROUGHOUT THE REGION. COMMUNITY SERVICE HAS BEEN A VITAL COMPONENT OF MMC SINCE ITS INCEPTION. MMC OPERATES A 24-HOUR EMERGENCY ROOM 365 DAYS PER YEAR. THAT EMERGENCY ROOM IS OPEN TO ALL INDIVIDUALS REGARDLESS OF ABILITY TO PAY. MMC HAS AN OPEN MEDICAL STAFF, PARTICIPATES IN MEDICARE AND MEDICAID, AND HAS AN ACTIVE CHARITY CARE PROGRAM. MMC IS INCLUDED IN THE OFFICIAL CATHOLIC DIRECTORY AS A TAX-EXEMPT HOSPITAL. COMMUNITY BENEFIT APPROACH: THROUGHOUT ITS HISTORY, MMC HAS BEEN INTIMATELY INVOLVED IN COMMUNITY HEALTH COLLABORATION AND HAS PLAYED A KEY ROLE IN EVALUATING AREA HEALTH ISSUES BY SETTING PRIORITIES AND PLANS FOR IMPROVEMENT. MMC CONTINUES OUR DEEP COMMITMENT AND INVOLVEMENT IN THE COMMUNITY HEALTH COLLABORATIVE. PROCESS: MMC'S COMMUNITY BENEFIT PLAN IS BASED ON OUR UNDERSTANDING OF UNIQUE COMMUNITY NEEDS DERIVED FROM COLLABORATIVE NEEDS ASSESSMENTS, FOCUS GROUPS, AND SURVEYS CONDUCTED WITH OUR COMMUNITY PARTNERS. IT IS GENERALLY RECOGNIZED THAT THE HEALTH OF THE COMMUNITY IS NOT THE RESPONSIBILITY OF ANY ONE ENTITY, BUT RATHER REQUIRES THE COORDINATED EFFORTS OF BOTH PRIVATE AND PUBLIC ENTITIES TO REALIZE AN IMPROVED HEALTH STATUS OF A COMMUNITY. MMC HAS BEEN WORKING WITH PUBLIC AND PRIVATE ENTITIES IN OUR SERVICE AREA TO MEASURE AND IMPROVE THE HEALTH STATUS OF THE COMMUNITY. THE MOST RECENT ASSESSMENT, COMPLETED IN 2004 REFLECTS THE COMPILATION AND ANALYSIS OF EXTENSIVE DATA SOURCES TO IDENTIFY ISSUES HAVING A SIGNIFICANT IMPACT ON THE HEALTH AND GENERAL WELL BEING OF AREA RESIDENTS. INFORMATION RELATING TO COMMUNITY HEALTH ISSUES WAS GATHERED FROM FOUR FOCUS GROUPS. THERE WERE 32 PARTICIPANTS INCLUDING NINE CONSUMER REPRESENTATIVES, SIX HEALTH CARE PROVIDERS, TEN BUSINESS AND INDUSTRY REPRESENTATIVES, AND SEVEN CLERGY AND RELIGIOUS LEADERS. FOCUS GROUP PARTICIPANTS WERE ASKED TO IDENTIFY THOSE SEGMENTS OF THE COMMUNITY THAT DO NOT HAVE READY ACCESS TO HEALTH CARE SERVICES; THE TYPES OF SERVICES THEY HAVE DIFFICULTY ACCESSING; THE ROOT CAUSES BEHIND THESE ACCESS ISSUES; AND GAPS IN THE SERVICES THAT COULD BE ADDRESSED TO BETTER MEET THESE ACCESS NEEDS. SUMMARY OF ASSESSMENT FINDINGS: ALL FOUR OF THE GROUPS HAD INDIVIDUALS THAT EXPRESSED GRATITUDE FOR THE HOSPITAL AND PRIMARY CARE SERVICES THAT ARE AVAILABLE THROUGH MMC AND ITS PHYSICIANS. THEY BELIEVED THAT EXISTING ACCESS-TO-CARE ISSUES CAN BE IMPROVED THROUGH COMMUNITY COLLABORATION. MOST PARTICIPANTS REMARKED THAT ACCESS TO HEALTH CARE IN WILLISTON IS NOT AN OVERWHELMING PROBLEM, BUT ONE THAT IS CERTAINLY CHALLENGED BY THE COMMUNITY'S REMOTE LOCATION IN WESTERN NORTH DAKOTA. NINE KEY FACTORS HAVING THE GREATEST IMPACT ON THE OVERALL WELLNESS OF THE AREA EMERGED IN THE REVIEW: (1) READY ACCESS TO PRIMARY CARE, (2) READY ACCESS TO SPECIALTY CARE, (3) READY ACCESS TO QUALITY CARE, (4) AVAILABILITY AND COST OF HEALTH INSURANCE, (5) DENIAL OF CARE, (6) CHARITY CARE, (7) ACCESS TO AFFORDABLE PRESCRIPTION DRUGS, (8) ACCESS TO HOME CARE, ADULT DAY CARE, ASSISTED LIVING AND TRANSPORTATION, (9) ACCESS TO ADEQUATE PARENTING AND APPROPRIATE HOME CARE. UNCOMPENSATED CARE FOR THE POOR: DURING THE FISCAL YEAR ENDING JUNE 30, 2011, MMC PROVIDED BENEFITS TO THE POOR AND BROADER COMMUNITY OF $1,607,912. APPROXIMATELY 23,988 PEOPLE BENEFITED FROM THESE SERVICES. AS A NON-PROFIT HEALTHCARE FACILITY, MMC PROVIDES HEALTHCARE SERVICES TO ALL THOSE IN NEED, REGARDLESS OF THEIR ABILITY TO PAY. MMC RECOGNIZES THE COST OF PROVIDING SERVICES WHEN QUANTIFYING ITS CHARITY CARE BENEFIT. FOR FISCAL YEAR 2011, MMC PROVIDED $767,116 IN DISCOUNTS TO THE UNINSURED AND UNDERINSURED. COMMUNITY OUTREACH FOR THE POOR: THE MERCY RIDER PROGRAM BEGAN OPERATIONS IN 1990 AS A PROGRAM TO ASSIST WOMEN AND CHILDREN WITH TRANSPORTATION TO DOCTOR'S APPOINTMENTS. SINCE THEN, IT HAS GROWN INTO A PROGRAM THAT ASSISTS THOSE WITH VERY LOW INCOME, WHICH INCLUDES ADULTS AND CHILDREN, DISABLED, ELDERLY, AND OTHERS WHO REQUIRE COUNSELING AND OTHER ESSENTIAL LIVING SERVICES. INDIVIDUALS MUST QUALIFY FOR THE PROGRAM. UPON APPROVAL, THEY ARE ELIGIBLE FOR A SPECIFIC NUMBER OF TICKETS PER MONTH, BASED ON THEIR NEEDS. EACH TICKET IS GOOD FOR A ONE-WAY RIDE WITHIN THE CITY OF WILLISTON THAT IS PROVIDED BY BASIN CAB COMPANY OR SENIOR CITIZEN CENTER TRANSPORTATION. THE PROGRAM PAYS $7.25 PER TICKET. INDIVIDUALS WHO RECEIVE THE TICKETS ARE ASKED TO DONATE $1.00-$2.00 PER TICKET, DEPENDING UPON THEIR ABILITY TO PAY; THIS MONEY IS USED TO OFFSET OPERATING COSTS. ADDITIONAL FUNDING FOR THE PROGRAM COMES FROM UNITED WAY AND NORTH DAKOTA STATE AID. WILLISTON SENIOR CITIZEN CENTER SERVES AS THE ADMINISTRATIVE ORGANIZATION AND SECURES A CONTRACT WITH BASIN CAB COMPANY. MERCY RIDER PROVIDED MORE THAN 6,000 RIDES DURING THE FISCAL YEAR. THIS PROGRAM PROVIDES MUCH NEEDED TRANSPORTATION ASSISTANCE IN THE COMMUNITY FOR INDIVIDUALS WHO WOULD OTHERWISE HAVE SIGNIFICANT CHALLENGES RELATING TO ESSENTIAL TRANSPORTATION. COMMUNITY OUTREACH FOR THE BROADER COMMUNITY: MMC IS A MAJOR EMPLOYER IN THE WILLISTON REGION, AND OUR EMPLOYEES CONTRIBUTE SIGNIFICANTLY TO OUR COMMUNITY SERVICE ORGANIZATIONS BY DONATING THEIR TIME AND TALENTS. MMC TAKES GREAT PRIDE IN PROVIDING LEADERSHIP IN THESE IMPORTANT ORGANIZATIONS. HUNDREDS OF HOURS ARE SPENT IN CIVIC ORGANIZATIONS INCLUDING THE ROTARY AND LIONS CLUBS, ECONOMIC DEVELOPMENT GROUPS SUCH AS THE WILLISTON AREA DEVELOPMENT FOUNDATION, CHAMBER OF COMMERCE, JAYCEES, YOUTH ASSESSMENT ADVISORY BOARD, WORKFORCE TRAINING ADVISORY BOARD, UNITED WAY BOARD, WILLISTON MINISTERIAL ASSOCIATION, SOCIAL SERVICE BOARD, AND HOMETOWN WILLISTON COMMITTEE. MMC ALSO PROVIDES CHAPEL SERVICES TO THE COMMUNITY TO ENRICH SPIRITUAL NEEDS. ONE OF MMC'S LARGEST COMMUNITY OUTREACH PROGRAMS IS THE MERCY COMMUNITY SALE HELD ANNUALLY IN THE SPRING. THIS EVENT BRINGS THE "MERCY FAMILY" AND THE LARGER COMMUNITY TOGETHER IN AN EFFORT TO RAISE MONEY TO SUPPORT PROGRAMS FOR OUR YOUTH. (CONTINUED ON NEXT PAGE)
NEEDS ASSESSMENT AND COMMUNITY INFORMATION SCHEULDE H, PART VI, LINES 1,2,4 AND 5 (CONTINUED FROM ABOVE) MMC DONATES EXCESS MEDICAL SUPPLIES AND EQUIPMENT TO UNDERPROVIDED NATIONS. IN ADDITION, MMC HAS A COMMUNITY OUTREACH COORDINATOR AVAILABLE TO HELP PATIENTS WITH REIMBURSEMENT ISSUES. MMC'S CRAVEN-HAGAN CLINIC OFFERS A SPORTS PHYSICAL EVENT EACH YEAR. PHYSICIANS AND STAFF MEMBERS VOLUNTEER THEIR TIME TO PROVIDE THIS VALUABLE SERVICE. STUDENTS PAY A FEE OF $20, WHICH IS DONATED BACK TO THE SCHOOL OF THEIR CHOICE. MMC ALSO PARTICIPATES IN MANY LOCAL EVENTS THAT ARE INSTRUMENTAL IN ADDRESSING COMMUNITY BUILDING NEEDS INCLUDING THE MAKE-A-WISH FOUNDATION, UNITED WAY, MENTORS AND FRIENDS, CASUAL FOR CHARITY DAY, AG OPEN, HEALTH FAIR, BIBLE CAMPS, SCIENCE FAIRS, LOCAL PTOS, AS WELL AS CHURCH AND YOUTH GROUPS. MMC EMPLOYEES ARE ACTIVE SUPPORTERS OF THE BASIN UNITED WAY CAMPAIGN. MMC REPRESENTATIVES TRAVEL TO SURROUNDING RURAL COMMUNITIES TO HELP ADDRESS HEALTH AND SAFETY NEEDS. MMC ALSO PROVIDES RESOURCES AND FUNDING FOR MANY RURAL SCHOOLS AND COMMUNITY ORGANIZATIONS IN AN EFFORT TO ENHANCE THEIR HEALTHIER COMMUNITY INITIATIVES, INCLUDING AFTER PROM AND AFTER GRADUATION DRUG AND ALCOHOL FREE EVENTS. MMC PARTICIPATES IN THE REGIONAL INTERVENTION STRATEGIES GROUP WHICH DEVELOPS LOCAL STRATEGIES TO DEAL, TREAT, AND INTERVENE WITH THOSE THAT HAVE MENTAL HEALTH AND SUBSTANCE ABUSE ISSUES. OTHER COMMUNITY OUTREACH MEASURES INCLUDE: * CHRISTIAN AWARENESS COMMITTEE WHICH ANNUALLY DONATES SCHOOL SUPPLIES TO AREA SCHOOLS AND CONDUCTS A FOOD DRIVE FOR THE HOLIDAYS. * THE CHRISTIAN AWARENESS COMMITTEE AND MERCY EMPLOYEES SUPPORT CHILDREN IN THIRD WORLD COUNTRIES WITH FUNDS TO HELP WITH THEIR EDUCATION AND NUTRITION NEEDS. * MMC AND ITS EMPLOYEES AND FAMILY MEMBERS ARE ACTIVE SUPPORTERS OF THE RELAY FOR LIFE THROUGH DONATIONS OF CASH AND TIME TO THE EVENT. * MMC PROVIDES CLOSED CAPTIONING ON LOCAL TELEVISION NEWS STATIONS FOR THE HEARING IMPAIRED. * MMC PROVIDES A TRAINED SEXUAL ASSAULT NURSE EXAMINER. THIS PERSON IS ON CALL AND AVAILABLE TO PROVIDE ASSISTANCE IN CASES OF SEXUAL ASSAULT. * MMC IS ACTIVE IN LOCAL DISASTER TRAINING AND POST-911 PREPAREDNESS ACTIVITIES. * MMC CANCER TREATMENT EMPLOYEES MAKE GAS AND FOOD COUPONS AVAILABLE TO PATIENTS IN NEED OF ASSISTANCE. MMC EMPLOYEES CONDUCT FOOD AND TOY DRIVES ESPECIALLY DURING THE HOLIDAY SEASON. * DURING THE 4TH OF JULY CELEBRATIONS ORGANIZED BY THE HOMETOWN WILLISTON COMMITTEE, MMC SPONSORED A FREE FEED FOR OVER 1800 PEOPLE. ALL FOOD AND LABOR WAS DONATED BY MMC FOR THIS EVENT. THE PURPOSE OF THIS EVENT IS TO SHOWCASE WILLISTON FOR FORMER AND CURRENT RESIDENTS. THIS EVENT ALLOWED MMC TO SHOW OUR COMMITMENT TO THE COMMUNITY AND OUR DESIRE TO PARTICIPATE IN LOCAL EVENTS. COLLABORATIVE EFFORTS TO IMPROVE COMMUNITY HEALTH: MMC UNDERSTANDS ITS ROLE IN PROVIDING SUPPORT SERVICES IN AN EFFORT TO BUILD A HEALTHIER COMMUNITY. MMC COORDINATES SUPPORT GROUPS FOR PATIENTS AND FAMILIES IN WHICH WE SERVE. THIS PAST YEAR, MMC SPONSORED SEVERAL SUPPORT PROGRAMS SUCH AS DIABETES SUPPORT GROUP, GRIEF SUPPORT GROUP, AND THE CANCER SUPPORT GROUP. THESE GROUPS HAVE PROVIDED A COMMUNITY BENEFIT TO WELL OVER 400 PEOPLE. IN ADDITION, OUR HOSPICE PROGRAM SERVES A LARGE GEOGRAPHICAL AREA, AND ALTHOUGH IT IS A SUBSIDIZED PROGRAM, NUMEROUS DONATIONS ARE RECEIVED, THROUGH MEMORIALS, IN APPRECIATION OF THE EXCELLENT CARE FAMILY MEMBERS RECEIVED. A UNIQUE EVENT, SPONSORED BY THE HOSPICE PROGRAM, IS CAMP MEND-A-HEART. THIS CAMP HELPS GRIEVING CHILDREN COPE WITH THEIR DEVASTATING LOSS AND GAIN SUPPORT FROM OTHERS WITH SIMILAR NEEDS. HOSPICE MAKES PRESENTATIONS TO THE COMMUNITY ON THE BENEFITS AND SERVICES OF THE HOSPICE PROGRAM. HOSPICE ALSO PROVIDES TELEPHONE COUNSELING TO THE REGION. ONE OF OUR PHYSICIANS ALSO SERVES AS MEDICAL DIRECTOR OF THE HOSPICE PROGRAM WITHOUT CHARGING FOR HIS SERVICES. MMC PARTICIPATES IN AN ANNUAL EVENT HEALTH FAIR HELD IN CONJUNCTION WITH THE UPPER MISSOURI VALLEY FAIR ("UMVF"). THE HEALTH FAIR ATTRACTED OVER 1200 PEOPLE AND PROVIDED FREE SERVICES SUCH AS BODY MASS INDEX (BMI), ADVANCE DIRECTIVES, PROPER HAND WASHING, AND BLOOD PRESSURE SCREENINGS. MERCY COLLABORATES WITH INDEPENDENT PHYSICIANS AND OTHER AREA HEALTHCARE PROVIDERS TO OFFER THESE VALUABLE SERVICES TO THE COMMUNITY. MMC OFFERS DISCOUNTED MEALS TO THE ELDERLY PROVIDED THROUGH OUR HOSPITAL CAFETERIA. THIS SERVICE PROMOTES EATING A WELL BALANCED MEAL AND GETS THE ELDERLY UP AND OUT OF THEIR RESIDENCES. MMC PROMOTES MEDICAL EDUCATION & AWARENESS THROUGH: * FREE PRENATAL EDUCATION * BABY BASICS * LAMAZE * BABY SITTING CLINICS * SEAT BELT AWARENESS * SMOKING CESSATION PROGRAMS * HEARING SCREENINGS FOR NEWBORNS * HEALTH CAREERS CLASSES (JOB SHADOWING) * UPPER MISSOURI VALLEY HEALTH FAIR MMC ALSO PROVIDES FREE MEETING ROOM SPACE FOR: PARENTING EDUCATION PROGRAMS, CANCER SUPPORT GROUP, DIABETES SUPPORT GROUP, AND MORE. THE HALLORAN HOUSE, LOCATED ON MMC'S CAMPUS, OFFERS PATIENTS AND THEIR FAMILIES A LOCAL PLACE TO STAY WHILE BEING TREATED IN OUR LEONARD P. NELSON FAMILY CANCER TREATMENT CENTER OR RECEIVING OTHER SERVICES AT MMC. GIVEN OUR LARGE GEOGRAPHIC AREA, THIS SERVICE IS WELL RECEIVED BY OUR PATIENTS. HOUSING AND MEALS AT THE HALLORAN HOUSE ARE PROVIDED FREE OF CHARGE TO THOSE WHO QUALIFY. COMMUNITY BUILDING ACTIVITIES: MMC CONTINUES TO HOST THE ANNUAL COMMUNITY SALE. THE COMMUNITY SALE PROVIDES AN OPPORTUNITY FOR THE COMMUNITY TO WORK TOGETHER, PROVIDE HOUSEHOLD AND CLOTHING ITEMS AT INEXPENSIVE PRICES AND INFUSE MONEY BACK INTO THE COMMUNITY. THE REVENUE FROM THE COMMUNITY SALE IS RETURNED TO THE COMMUNITY AS IT IS AWARDED TO OTHER NON-PROFIT ENTITIES THAT SERVE THE YOUTH OF WILLISTON. THIS YEAR, THE COMMUNITY SALE RAISED $61,725 FOR THE WILLISTON COMMUNITY BUILDERS TO BUILD A NEW YOUTH SPLASH PARK. WHILE IT IS NOT POSSIBLE TO SHARE ALL OF MMC'S EFFORTS TO GIVE BACK TO THE COMMUNITY, THIS REPORT DOES OUTLINE THE LARGE CONTRIBUTIONS GIVEN ON BEHALF OF OUR ORGANIZATION TO WILLISTON AND THE REGION. MMC, IN ITS TRADITION OF FAITH, WILL CONTINUE TO PROVIDE COMMUNITY BENEFITS AND ULTIMATELY BUILD A STRONGER, SAFER, AND HEALTHIER COMMUNITY.
Schedule H (Form 990) 2010
Additional Data


Software ID: 10000128
Software Version: v2010.1.0
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
MERCY MEDICAL CENTER
 
Employer identification number
45-0231183
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
Procedures for monitoring use of grant funds Schedule I, Part I, Line 2 GRANTS AND DONATIONS ARE GIVEN AS NEEDED TO ORGANIZATIONS IN THE LOCAL AREA. THE AMOUNTS GIVEN ARE REVIEWED BY THE FOUNDATION DIRECTOR. A RECORD OF ALL GRANTS AND DONATIONS ARE CONTINUALLY MONITORED. NO GRANT IS MORE THAN $5,000.
Schedule I (Form 990) 2010


Additional Data


Software ID: 10000128
Software Version: v2010.1.0


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
MERCY MEDICAL CENTER
 
Employer identification number

45-0231183
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement orprovision of all the expenses described above? If "No," complete Part III to explain....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....
2
 
 
3
Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ...............
4a
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
Yes
 
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
Yes
 
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regs. section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use Schedule J-1 if additional space needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) must equal the applicable column (D) or column (E) amounts on Form 990, Part VII, line 1a.
(A) Name (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported in prior
Form 990 or
Form 990-EZ
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) JEFFREY DROP (i)
(ii)		 0
349,509 		0
146,330 		0
188,969 		0
53,996 		0
20,340 		0
759,144 		0
0
(2) DENNIS GOEBEL (i)
(ii)		 0
0 		0
0 		0
174,357 		0
14,300 		0
10,686 		0
199,343 		0
0
(3) ROBERT KEMP (i)
(ii)		 108,642
0 		177,206
0 		573
0 		25,128
0 		14,036
0 		325,585
0 		0
0
(4) KERRY MONSON (i)
(ii)		 126,928
0 		20,834
0 		425
0 		15,997
0 		8,071
0 		172,255
0 		0
0
(5) MICHAEL BOULTER (i)
(ii)		 636,216
0 		0
0 		5,544
0 		0
0 		10,358
0 		652,118
0 		0
0
(6) MORRIS BELLIS (i)
(ii)		 346,264
0 		17,982
0 		5,156
0 		20,228
0 		9,809
0 		399,439
0 		0
0
(7) DAVID SKURDAL (i)
(ii)		 425,728
0 		3,047
0 		5,544
0 		22,678
0 		10,303
0 		467,300
0 		0
0
(8) BRETT VIBETO (i)
(ii)		 398,580
0 		21,084
0 		756
0 		20,228
0 		6,577
0 		447,225
0 		0
0
(9) DAVID LANOUE (i)
(ii)		 639,632
0 		22,925
0 		3,612
0 		0
0 		39,589
0 		705,758
0 		0
0







Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
Severance or change-of-control payment Schedule J, Part I, Line 4a POST-TERMINATION PAYMENTS ARE ADDRESSED IN EXECUTIVE EMPLOYMENT AGREEMENTS FOR CATHOLIC HEALTH INITIATIVES ("CHI") AND RELATED ORGANIZATIONS' EMPLOYEES AT THE LEVEL OF VICE PRESIDENT AND ABOVE, INCLUDING THE MBO CEOS. THESE EMPLOYMENT AGREEMENTS REQUIRE THAT IN ORDER FOR THE EXECUTIVE TO RECEIVE POST-TERMINATION PAYMENTS, THESE INDIVIDUALS MUST EXECUTE A GENERAL RELEASE AND SETTLEMENT AGREEMENT. POST-TERMINATION PAYMENT ARRANGEMENTS ARE PERIODICALLY REVIEWED FOR OVERALL REASONABLENESS IN LIGHT OF THE EXECUTIVE'S OVERALL COMPENSATION PACKAGE. THE FOLLOWING REPORTABLE INDIVIDUALS RECEIVED SEVERANCE PAYMENTS FROM CATHOLIC HEALTH INITIATIVES DURING THE 2010 CALENDAR YEAR, AND THESE SEVERANCE PAYMENTS WERE INCLUDED IN THE INDIVIDUAL'S W-2 INCOME AND REPORTABLE COMPENSATION ON SCHEDULE J: DENNIS GOEBEL $177,446.
Supplemental nonqualified retirement plan Schedule J, Part I, Line 4b DURING THE 2010 CALENDAR YEAR CATHOLIC HEALTH INITIATIVES ("CHI"), A RELATED ORGANIZATION, MAINTAINED A SUPPLEMENTAL NON-QUALIFIED DEFERRED COMPENSATION PLAN FOR MBO CEOS AND OTHER CHI EMPLOYEES AT THE LEVEL OF SENIOR VICE PRESIDENT AND ABOVE. THE FOLLOWING REPORTABLE INDIVIDUALS WERE ELIGIBLE TO PARTICIPATE IN THAT PLAN : JEFFREY DROP, MATTHEW GRIMSHAW. DURING 2010, THE FOLLOWING CONTRIBUTIONS WERE MADE BY CHI TO THE DEFERRED COMPENSATION PLAN: JEFFREY DROP $28,868, MATTHEW GRIMSHAW $8,820.
Compensation contingent on revenues of the organization Schedule J, Part I, Line 5a MERCY MEDICAL CENTER PROVIDED INCENTIVE COMPENSATION FOR CERTAIN PHYSICIANS BASED UPON "NET REVENUE." THESE AMOUNTS WERE NOT DETERMINED WITH REFERENCE TO ORGANIZATIONAL NET REVENUE OR ORGANIZATIONAL NET INCOME. RATHER, THESE AMOUNTS WERE DETERMINED BASED UPON THE PHYSICIAN'S CONTRIBUTION TO NET REVENUE BASED ON SERVICES PERFORMED BY THAT INDIVIDUAL PHYSICIAN IN EXCESS OF A THRESHOLD. TOTAL PHYSICIAN COMPENSATION IS APPROVED IN ADVANCE BY A COMMITTEE OF THE BOARD OF DIRECTORS OF MERCY MEDICAL CENTER FOLLOWING IRC SEC. 4958 REBUTTABLE PRESUMPTION OF REASONABLENESS PROCEDURES.
Non-fixed payments Schedule J, Part I, Line 7 MERCY MEDICAL CENTER MAINTAINS A VARIABLE PAY PLAN FOR EMPLOYEES AT THE LEVEL OF VICE PRESIDENT AND ABOVE (EXCEPT FOR PHYSICIANS) THAT PUTS A CERTAIN AMOUNT OF COMPENSATION AT RISK. AWARDS OF INCENTIVE COMPENSATION UNDER THE VARIABLE PAY PLAN ARE MADE BASED UPON ACHIEVEMENT OF ORGANIZATIONAL OBJECTIVES INCLUDING PERFORMANCE IN RELATION TO BUDGET, AND ACHIEVEMENT OF INDIVIDUAL GOALS. ALL COMPENSATION, INCLUDING ANY INCENTIVE COMPENSATION, IS CAPPED TO ENSURE THAT COMPENSATION REMAINS AT FAIR MARKET VALUE.
METHODS USED TO ESTABLISH CEO COMPENSATION SCHEDULE J, PART I, LINE 3A COMPENSATION FOR THE TOP MANAGEMENT OFFICIAL WAS ESTABLISHED AND PAID BY CATHOLIC HEALTH INITIATIVES (CHI), A RELATED ORGANIZATION. CHI USED THE FOLLOWING TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION: (1) COMPENSATION COMMITTEE; (2) INDEPENDENT COMPENSATION CONSULTANT; (3) WRITTEN EMPLOYMENT CONTRACTS; (4) COMPENSATION SURVEY OR STUDY; (5) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE.
Schedule J (Form 990) 2010

Additional Data


Software ID: 10000128
Software Version: v2010.1.0
Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBulletSee separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
MERCY MEDICAL CENTER
 
Employer identification number

45-0231183
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Description of transaction (c) Corrected?
Yes No





2
Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.
(a) Name of interested person and purpose (b) Loan to or from the organization? (c)Original principal amount (d)Balance due (e) In default? (f) Approved by board or committee? (g)Written agreement?
To From Yes No Yes No Yes No
(1) DR BRETT VIBETO SIGN ON BONUS
 
  		  X 50,000 1,743   No Yes   Yes  
(2) DR DAVID LANOUE SIGN ON BONUS
 
  		  X 100,000 71,292   No Yes   Yes  
(3) DR MORRIS BELLIS SIGN ON BONUS
 
  		  X 50,000 7,400   No Yes   Yes  
Total ...............Small Bullet $ 80,435
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b)Relationship between interested person and the organization (c)Amount of grant or type of assistance
For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2010
Schedule L (Form 990 or 990-EZ) 2010
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) KRIS KEMP
  		SISTER-IN-LAW OF ROBERT KEMP 34,662 COMPENSATION OF EARNED WAGES   No
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
Schedule L (Form 990 or 990-EZ) 2010

Additional Data


Software ID: 10000128
Software Version: v2010.1.0




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
MERCY MEDICAL CENTER
 
Employer identification number

45-0231183
Identifier Return Reference Explanation
Significant changes in program services Form 990, Part III, Line 3 DURING THE FISCAL YEAR ENDING JUNE 30, 2011, CATHOLIC HEALTH INITIATIVES ("CHI"), A RELATED ORGANIZATION, CREATED CHI HEALTH CONNECT AT HOME - FARGO ("CHCH"), A MINNESOTA NONPROFIT CORPORATION. CHCH WAS CREATED TO NURTURE THE HEALING MINISTRY OF THE ROMAN CATHOLIC CHURCH BY BRINGING TOGETHER 10 EXISTING HOME CARE BUSINESSES INTO ONE LEGAL ENTITY. THESE EXISTING HOME CARE BUSINESSES, LOCATED IN VARIOUS COMMUNITIES IN NORTH DAKOTA, MINNESOTA & SOUTH DAKOTA, WERE DEPARTMENTS OF HOSPITALS OWNED BY CHI. MERCY MEDICAL CENTER TRANSFERRED THEIR HOME CARE SERVICE DIVISION TO CHCH DURING THE FISCAL YEAR ENDING JUNE, 30 2011. CENTRALIZING THE HOME CARE SERVICES INTO CHCH WILL REDUCE DUPLICATION OF SERVICES AMONG INDIVIDUAL AGENCIES AND PROVIDE AN INFRASTRUCTURE FOR STREAMLINED ADMINISTRATIVE PROCESSES AND ALSO ALLOWS FOR HIRING OF MORE SPECIALIZED STAFF IN THE AREAS OF CASE MANAGEMENT, PROCESS IMPROVEMENT AND FINANCIAL ANALYSIS. THROUGH CONSOLIDATION, CHCH EXPECTS TO INCREASE PRODUCTIVITY AND PROVIDE THE ABILITY TO SHARE RESOURCES, CREATE CLINICAL BEST PRACTICES, BETTER MANAGE OUTCOMES AND GAIN EFFICIENCIES FROM STANDARDIZATION.
Classes of members or stockholders Form 990, Part VI, Section A, Line 6 ACCORDING TO THE BYLAWS OF MERCY MEDICAL CENTER, THE ENTITY'S SOLE MEMBER IS CATHOLIC HEALTH INITIATIVES, A COLORADO NONPROFIT CORPORATION.
Members or stockholders electing members of governing body Form 990, Part VI, Section A, Line 7a PURSUANT TO SECTION 6.5 OF THE ORGANIZATION'S BYLAWS, DIRECTORS OF THE CORPORATION SHALL BE APPOINTED BY THE CORPORATE MEMBER NO LATER THAN JUNE 30 OF EACH YEAR. PRIOR TO EACH ANNUAL MEETING OF THE CORPORATE MEMBER, OR SUCH OTHER MEETING CALLED FOR THE PURPOSE OF APPOINTING DIRECTORS OF THE CORPORATION, THE NOMINATING COMMITTEE SHALL SELECT AND SUBMIT TO THE BOARD OF DIRECTORS A SLATE OF NOMINEES QUALIFIED TO SERVE ON THE BOARD OF DIRECTORS OF THE CORPORATION. THE BOARD OF DIRECTORS SHALL REVIEW THE NAMES AND QUALIFICATIONS OF EACH INDIVIDUAL ON THE RECOMMENDED SLATE AND SHALL VOTE TO ACCEPT OR REFUSE EACH NOMINEE. THE NAMES AND QUALIFICATIONS OF EACH INDIVIDUAL ACCEPTED BY THE BOARD OF DIRECTORS SHALL THEN BE SUBMITTED TO THE CORPORATE MEMBER, WHO SHALL THEN APPOINT OR REFUSE EACH NOMINEE IN ACCORDANCE WITH THE CORPORATE MEMBER'S BYLAWS AND WITH THE ENDORSEMENT OF THE SENIOR VICE PRESIDENT OF OPERATIONS. NOTWITHSTANDING ANYTHING IN THE BYLAWS, THE CORPORATE MEMBER MAY UNILATERALLY APPOINT ONE OR MORE INDIVIDUALS TO THE BOARD OF DIRECTORS SHOULD THE BOARD FAIL TO FURNISH THE CORPORATE MEMBER WITH A LIST OF INDIVIDUALS QUALIFIED TO SERVE ON THE BOARD OF DIRECTORS OF THE CORPORATION.
Decisions requiring approval by members or stockholders Form 990, Part VI, Section A, Line 7b MERCY MEDICAL CENTER'S (MMC) CORPORATE MEMBER IS CATHOLIC HEALTH INITIATIVES ("CHI"). PURSUANT TO SECTION 5.4 OF THE ORGANIZATION'S BYLAWS, THE CORPORATE MEMBER SHALL HAVE THE SPECIFIC RIGHTS SET FORTH IN THE GOVERNANCE MATRIX. PURSUANT TO THE GOVERNANCE MATRIX, THE FOLLOWING RIGHTS ARE RESERVED TO THE CHI BOARD DIRECTLY OR THROUGH POWERS DELEGATED TO THE CHI CHIEF EXECUTIVE OFFICER: * SUBSTANTIAL CHANGE IN THE MISSION OR PHILOSOPHY OF MMC * AMENDMENT OF THE CORPORATE DOCUMENTS OF MMC * APPROVE MEMBERS OF MMC * REMOVAL OF A MEMBER OF THE GOVERNING BODY OF MMC * APPROVAL OF ISSUANCE OF DEBT BY MMC * APPROVAL OF PARTICIPATION OF MMC IN A JOINT VENTURE * APPROVAL OF FORMATION OF A NEW CORPORATION BY MMC * APPROVAL OF A MERGER INVOLVING MMC * APPROVAL OF THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF MMC * TO REQUIRE THE TRANSFER OF ASSETS BY MMC TO CHI TO ACCOMPLISH CHI'S GOALS AND OBJECTIVES, AND TO SATISFY CHI DEBTS * ADOPTION OF LONG RANGE AND STRATEGIC PLANS FOR MMC PURSUANT TO SECTION 5.5.2 OF THE ORGANIZATION'S BYLAWS, CHI MAY, IN EXERCISE OF ITS APPROVAL POWERS, GRANT OR WITHHOLD APPROVAL IN WHOLE OR IN PART, OR MAY, IN ITS COMPLETE DISCRETION, AFTER CONSULTATION WITH THE BOARD AND THE PRESIDENT AND CHIEF EXECUTIVE OFFICER OF THE ORGANIZATION, RECOMMEND SUCH OTHER OR DIFFERENT ACTIONS AS IT DEEMS APPROPRIATE.
Review of form 990 by governing body Form 990, Part VI, Section B, Line 11a ONCE THE RETURN IS PREPARED, THE RETURN IS REVIEWED BY THE CHIEF FINANCIAL OFFICER. AN ELECTRONIC COPY OF THE RETURN IS SENT TO EACH BOARD MEMBER BY EMAIL FOR THEIR REVIEW. SUBSEQUENT TO THE RETURN BEING PROVIDED TO THE BOARD, THE TAX DEPARTMENT FILES THE RETURN WITH THE APPROPRIATE FEDERAL AND STATE AGENCIES, MAKING ANY NON-SUBSTANTIVE CHANGES NECESSARY TO EFFECT E-FILING. ANY SUCH CHANGES ARE NOT RE-SUBMITTED TO THE BOARD.
Conflict of interest policy Form 990, Part VI, Section B, Line 12c IT IS THE POLICY OF MERCY MEDICAL CENTER THAT: (1) EACH OF THE CORPORATION'S DIRECTORS, OFFICERS, AND EMPLOYEES ACT AT ALL TIMES IN A MANNER THAT FURTHERS THE CORPORATION'S CHARITABLE PURPOSE OF SERVICE TO THE COMMUNITY AND EXERCISES CARE THAT HE OR SHE DOES NOT ACT IN A MANNER THAT FURTHERS HIS OR HER PRIVATE INTERESTS TO THE DETRIMENT OF THE CORPORATION'S COMMUNITY BENEFIT PURPOSES, AND (2) EACH OF THE CORPORATION'S DIRECTORS, OFFICERS, AND EMPLOYEES AVOIDS CONFLICTS OF INTEREST AND OTHERWISE FULLY DISCLOSES TO THE CORPORATION ANY POTENTIAL OR ACTUAL CONFLICTS OF INTEREST IF SUCH CONFLICTS CANNOT BE AVOIDED SO THAT SUCH CONFLICTS ARE DEALT WITH IN THE BEST INTERESTS OF THE CORPORATION. THIS POLICY: (1) COVERS ALL DIRECTORS, OFFICERS, AND EMPLOYEES OF MERCY MEDICAL CENTER; (2) APPLIES TO ALL AFFILIATES OF THE CORPORATION; AND (3) IS INTENDED TO SUPPLEMENT, BUT NOT REPLACE, ANY APPLICABLE STATE LAWS GOVERNING CONFLICTS OF INTEREST APPLICABLE TO NONPROFIT CORPORATIONS. "AFFILIATE" INCLUDES ANY ENTITY DIRECTLY OR INDIRECTLY CONTROLLING, CONTROLLED BY, OR UNDER COMMON CONTROL WITH THE CORPORATION WHETHER THROUGH MEMBERSHIP OR STOCK OWNERSHIP. IF A DIRECTOR, OFFICER, OR EMPLOYEE HAS A POTENTIAL OR ACTUAL CONFLICT WITH THE CORPORATION AND/OR ANY OF ITS AFFILIATES, SUCH INDIVIDUAL IS DEEMED TO ALSO HAVE A POTENTIAL OR ACTUAL CONFLICT WITH RESPECT TO THE CORPORATION AND ALL OF ITS AFFILIATES. EACH INDIVIDUAL MUST PROMPTLY AND FULLY REPORT TO THE BOARD CHAIR SITUATIONS THAT MAY CREATE A CONFLICT OF INTEREST WHEN HE OR SHE BECOMES AWARE OF SUCH SITUATIONS. IN THE CASE OF AN OFFICER, DISCLOSURE MUST BE MADE TO THE CORPORATION'S PRESIDENT AND CEO WHO WILL REPORT SUCH DISCLOSURE TO THE BOARD CHAIR. IN ANY SITUATION WHERE AN INDIVIDUAL IS IN DOUBT, FULL DISCLOSURE SHOULD BE MADE SO AS TO PERMIT AN IMPARTIAL AND OBJECTIVE DETERMINATION. A WRITTEN RECORD OF THE DISCLOSURE WILL BE MADE. IN ADDITION TO THE ONGOING DISCLOSURE OBLIGATION, THE CORPORATION'S PRESIDENT AND CEO SHALL ANNUALLY SEND TO ALL DIRECTORS, OFFICERS, AND EMPLOYEES A COPY OF THIS POLICY STATEMENT AND THE CONFLICT OF INTEREST DISCLOSURE STATEMENT. EACH INDIVIDUAL MUST PROMPTLY COMPLETE, SIGN, AND RETURN THE STATEMENT TO THE CORPORATION'S PRESIDENT AND CEO. THE COMPLETED STATEMENTS WILL BE REVIEWED BY THE PRESIDENT AND CEO AND THE BOARD CHAIR. THE BOARD CHAIR OR DESIGNEE SHALL MAKE SUCH FURTHER INVESTIGATION OF CONFLICTS OF INTEREST DISCLOSURES AS HE OR SHE MAY DEEM APPROPRIATE. IF THE CONFLICT INVOLVES THE BOARD CHAIR, THE VICE CHAIR WILL ASSUME THE CHAIR'S ROLE OUTLINED IN THIS POLICY. BASED ON REVIEW AND EVALUATION OF THE RELEVANT FACTS AND CIRCUMSTANCES, THE BOARD CHAIR WILL MAKE AN INITIAL DETERMINATION AS TO WHETHER A CONFLICT OF INTEREST EXISTS AND WHETHER, PURSUANT TO THIS POLICY STATEMENT, REVIEW AND APPROVAL OR OTHER ACTION BY THE BOARD OF DIRECTORS IS REQUIRED. A WRITTEN RECORD OF THE BOARD CHAIR'S DETERMINATION, INCLUDING RELEVANT FACTS AND CIRCUMSTANCES, WILL BE MADE. THE BOARD CHAIR SHALL THEN MAKE AN APPROPRIATE REPORT TO THE EXECUTIVE COMMITTEE OF THE BOARD CONCERNING SUCH REVIEW, EVALUATION AND DETERMINATION. IF THERE IS A DIFFERENCE OF OPINION BETWEEN THE BOARD CHAIR AND ANOTHER DIRECTOR, OFFICER, OR EMPLOYEE AS TO WHETHER THE FACTS AND CIRCUMSTANCES OF A GIVEN SITUATION CONSTITUTE A CONFLICT OF INTEREST OR WHETHER BOARD OF DIRECTORS REVIEW AND APPROVAL OR OTHER ACTION IS REQUIRED WITHIN THIS POLICY STATEMENT, THE MATTER SHALL BE SUBMITTED TO THE BOARD'S EXECUTIVE COMMITTEE, WHICH SHALL MAKE A FINAL DETERMINATION AS TO THE MATTER PRESENTED. SUCH DETERMINATION, INCLUDING RELEVANT FACTS AND CIRCUMSTANCES, WILL BE REFLECTED IN THE COMMITTEE MINUTES AND WILL BE REPORTED TO THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS SHALL CAREFULLY SCRUTINIZE AND MUST IN GOOD FAITH APPROVE OR DISAPPROVE ANY TRANSACTION IN WHICH THE CORPORATION AND/OR ANY OF ITS AFFILIATES IS A PARTY AND IN WHICH ONE OR MORE OF THE CORPORATION'S DIRECTORS, OFFICER, OR EMPLOYEES EITHER (1) HAS A MATERIAL FINANCIAL INTEREST; OR (2) IS A DIRECTOR, OFFICER, OR EMPLOYEE OF THE OTHER PARTY (OTHER THAN THE CORPORATION'S OWN AFFILIATES). THE BOARD OF DIRECTORS MUST APPROVE THE TRANSACTION BY A MAJORITY OF THE DIRECTORS ON THE BOARD, WITHOUT COUNTING THE VOTE OF ANY DIRECTOR WHO HAS AN INTEREST IN THE TRANSACTION. IN REVIEWING SUCH TRANSACTIONS BETWEEN THE CORPORATION AND VENDORS OR OTHER CONTRACTORS WHO ARE, OR ARE AFFILIATED WITH, DIRECTORS, OFFICERS OR EMPLOYEES, THE BOARD SHALL ACT NO MORE OR LESS FAVORABLY THAN IT WOULD IN REVIEWING TRANSACTIONS WITH UNRELATED THIRD PARTIES. THE TRANSACTION WILL NOT BE APPROVED UNLESS THE BOARD DETERMINES THAT THE TRANSACTION IS FAIR TO THE CORPORATION. THE BOARD SHALL CAREFULLY REVIEW AND SCRUTINIZE NON-TRANSACTIONAL CONFLICTS OF INTERESTS (E.G., DISCLOSURE OF NONPUBLIC INFORMATION, COMPETITION WITH THE CORPORATION, FAILURE TO DISCLOSE A CORPORATE OPPORTUNITY, EXCESSIVE GIFTS OR ENTERTAINMENT, ETC.). BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS, THE BOARD SHALL TAKE WHATEVER ACTION IS DEEMED APPROPRIATE UNDER THE CIRCUMSTANCES WITH RESPECT TO THE INDIVIDUAL IN ORDER TO BEST PROTECT THE INTERESTS OF THE CORPORATION INCLUDING POSSIBLE DISCIPLINARY OR CORRECTIVE ACTION. THE BOARD SHOULD CONSULT WITH A MEMBER OF THE CHI LEGAL RESOURCE GROUP WHEN CONSIDERING DISCIPLINARY OR CORRECTIVE ACTION. WHEN CONFLICTS OF INTEREST ARE CONSIDERED BY THE BOARD, THE INDIVIDUAL MUST DISCLOSE ALL OF THE MATERIAL FACTS TO THE BOARD. THE INDIVIDUAL SHALL NOT VOTE OR USE HIS OR HER PERSONAL INFLUENCE ON THE MATTER. HOWEVER, IF REQUESTED, SUCH INDIVIDUAL IS NOT PREVENTED FROM BRIEFLY STATING HIS OR HER POSITION IN THE MATTER, NOR FROM ANSWERING PERTINENT QUESTIONS FROM BOARD MEMBERS, AS HIS OR HER KNOWLEDGE MAY BE OF SIGNIFICANT IMPORTANCE. THE INDIVIDUAL SHALL BE EXCUSED FROM THE MEETING DURING DISCUSSION AND VOTE ON THE CONFLICT OF INTEREST. MINUTES OF THE BOARD OF DIRECTORS SHALL REFLECT THE FOLLOWING: THE INDIVIDUAL MAKING THE DISCLOSURE, THE NATURE OF THE DISCLOSURE, DISCUSSION REGARDING ANY PROPOSED TRANSACTION, THE DECISION MADE BY THE BOARD, AND THAT THE INTERESTED DIRECTOR ABSTAINED FROM VOTING. IMPLEMENTATION AND INTERPRETATION QUESTIONS REGARDING THE IMPLEMENTATION AND INTERPRETATION OF THIS POLICY SHALL BE REFERRED TO A MEMBER OF THE CHI LEGAL RESOURCE GROUP. IF THE BOARD REASONABLY BELIEVES THAT A DIRECTOR, OFFICER, OR EMPLOYEE HAS FAILED TO DISCLOSE EITHER AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST, OR ALL MATERIAL FACTS SURROUNDING AN ACTUAL OR POSSIBLE CONFLICT AS REQUIRED BY THIS POLICY, THE INDIVIDUAL WILL BE GIVEN AN OPPORTUNITY TO EXPLAIN SUCH ALLEGED FAILURE TO DISCLOSE. AFTER HEARING THE RESPONSE OF THE INDIVIDUAL, THE BOARD WILL CONDUCT SUCH ADDITIONAL INVESTIGATION AS MAY BE APPROPRIATE. IF THE BOARD DETERMINES THAT THE INDIVIDUAL HAS IN FACT FAILED TO DISCLOSE AS REQUIRED BY THIS POLICY, THE BOARD SHALL TAKE APPROPRIATE DISCIPLINARY OR CORRECTIVE ACTION.
Process used to establish compensation of top management official Form 990, Part VI, Section B, Line 15a THE ORGANIZATION'S CEO'S COMPENSATION IS PAID BY CHI. CHI HAS A DEFINED COMPENSATION PHILOSOPHY. BOTH THE EXECUTIVE AND NON-EXECUTIVE COMPENSATION STRUCTURES AND RANGES ARE REVIEWED ANNUALLY IN COMPARISON TO MARKET DATA. CHI USES THE HAY GROUP AS THE INDEPENDENT THIRD PARTY TO ASSESS EXECUTIVE COMPENSATION PROGRAMS AND TO ENSURE THE REASONABLENESS OF ACTUAL SALARIES AND TOTAL COMPENSATION PACKAGES. COMPENSATION OF THE SENIOR MOST EXECUTIVES IS REVIEWED ANNUALLY. THE HAY GROUP REVIEWS BOTH CASH AND TOTAL COMPENSATION FOR OVERALL REASONABLENESS, FOR ADHERENCE TO CHI'S COMPENSATION PHILOSOPHY, AND FOR COMPARABILITY TO THE NOT-FOR-PROFIT HEALTHCARE MARKET. THIS INDEPENDENT REVIEW IS DELIVERED BY HAY GROUP TO THE HR COMMITTEE OF THE CHI BOARD OF STEWARDSHIP TRUSTEES ANNUALLY AT THEIR SEPTEMBER MEETING AND MINUTES ARE SHARED WITH THE FULL BOARD AT THE DECEMBER MEETING. THE LAST REVIEW WAS SEPTEMBER 2011. IN ADDITION, IN DECEMBER 2009, HAY GROUP COMPLETED A COMPREHENSIVE REVIEW OF ALL POSITIONS AT THE LEVEL OF VICE PRESIDENT AND ABOVE TO DETERMINE AND VALIDATE APPROPRIATE COMPENSATION LEVELS.
Process used to establish compensation of other officers/key employees Form 990, Part VI, Section B, Line 15b THE CHIEF FINANCIAL OFFICER REPORTS TO A DIVISION CHIEF FINANCIAL OFFICER WHO REVIEWS AND ADJUSTS THE COMPENSATION FOR SENIOR LEADERSHIP. COMPENSATION FOR SENIOR LEADERSHIP IS ALSO INTERNALLY REVIEWED BY A COMPENSATION COMMITTEE ON THE BOARD OF DIRECTORS. A MARKET COMPARISON IS DONE ANNUALLY.
Public Disclosure Form 990, Part VI, Section C, Line 19 THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT PUBLICLY AVAILABLE. THE ORGANIZATION'S FINANCIAL STATEMENTS ARE INCLUDED IN THE CATHOLIC HEALTH INITIATIVES' CONSOLIDATED AUDITED FINANCIAL STATEMENTS THAT ARE AVAILABLE AT WWW.CATHOLICHEALTHINT.ORG OR AT WWW.DACBOND.ORG.
EXECUTIVE COMMITTEE COMPOSITION AND AUTHORITY FORM 990, PART VI, LINE 1A THE EXECUTIVE COMMITTEE SHALL CONSIST OF ONLY DIRECTORS OF THE CORPORATION AND SHALL BE COMPOSED OF THE CHAIRPERSON OF THE BOARD, THE VICE CHAIRPERSON OF THE BOARD, THE CHAIRPERSON OF THE FINANCE AND AUDIT COMMITTEE, AND THE PRESIDENT AND CHIEF EXECUTIVE OFFICER, EACH OF WHOM SHALL SERVE AS AN EX OFFICIO VOTING MEMBER OF THE EXECUTIVE COMMITTEE. EACH INDIVIDUAL APPOINTED TO THE EXECUTIVE COMMITTEE SHALL SERVE FOR A TERM OF ONE YEAR AND UNTIL HIS OR HER SUCCESSOR IS DULY APPOINTED BY THE BOARD OF DIRECTORS. ANY VACANCY OF AN APPOINTED EXECUTIVE COMMITTEE MEMBERSHIP MAY BE FILLED FOR THE UNEXPIRED PORTION OF THE TERM IN THE MANNER THAT THE ORIGINAL COMMITTEE MEMBER WAS APPOINTED. EXCEPT AS PROVIDED BY LAW, THE EXECUTIVE COMMITTEE SHALL HAVE AND MAY EXERCISE SUCH POWERS AS MAY BE DELEGATED TO IT BY THE BOARD OF DIRECTORS. ADDITIONALLY, THE EXECUTIVE COMMITTEE SHALL HAVE AND MAY EXERCISE SUCH POWERS TO TRANSACT ROUTINE BUSINESS OF THE CORPORATION IN THE INTERIM PERIOD BETWEEN REGULARLY SCHEDULE MEETINGS OF THE BOARD OF DIRECTORS, PROVIDED THAT SUCH ACTIONS TAKEN SHALL BE CONSISTENT WITH AND NOT CONFLICT WITH ANY ACTIONS OR POLICIES OF THE BOARD OF DIRECTORS OR OF THE CORPORATE MEMBER, WITH THESE BYLAWS, OR WITH APPLICABLE LAW. ALL ACTIONS TAKEN BY THE EXECUTIVE COMMITTEE SHALL BE PROMPTLY REPORTED TO THE BOARD OF DIRECTORS AT THE NEXT REGULAR OR ANNUAL MEETING OF THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE SHALL MEET AT SUCH TIMES AS SHALL BE DETERMINED BY THE CHAIRPERSON. THE EXECUTIVE COMMITTEE SHALL KEEP REGULAR MINUTES OF ITS PROCEEDINGS AND REPORT THE SAME TO THE BOARD OF DIRECTORS AT EACH REGULAR MEETING OF THE BOARD.
ESTIMATE OF HOURS DEVOTED TO RELATED ORGANIZATIONS FORM 990, PART VII COMPENSATION REPORTED ON FORM 990, PART VII WAS PAID TO THESE INDIVIDUALS BY RELATED ORGANIZATIONS IN EXCHANGE FOR THE FULFILLMENT OF THEIR DUTIES AS FULL-TIME, 60 HOUR-PER-WEEK EMPLOYEES.
Other changes in net assets or fund balances Form 990, Part XI, Line 5 NET UNREALIZED GAINS (LOSSES) ON INVESTMENTS - 5373777; PRIOR PERIOD ADJUSTMENTS - 4000; CAPITAL RESOURCE POOL CONTRIBUTIONS - -207024; CHI CONNECT DEPRECIATION - 50425;
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: 10000128
Software Version: v2010.1.0
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
MERCY MEDICAL CENTER
 
Employer identification number

45-0231183
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) ALEGENT HEALTH - BERGAN MERCY HEALTH SYS

7500 MERCY ROAD

OMAHA,NE68124
47-0484764 		HEALTHCARE NE 501(C)(3) 3 CHI
 
Yes
 
(2) ALEGENT HEALTH - MERCY HOSPITAL CORNING

PO BOX 368

CORNING,IA50841
42-0782518 		HEALTHCARE IA 501(C)(3) 3 AHBMHS
 
Yes
 
(3) ALVERNA APARTMENTS

300 SE 8TH AVENUE

LITTLE FALLS,MN56345
41-1351177 		LTERM CARE MN 501(C)(3) 9 CHI
 
Yes
 
(4) APPLETREE COURT

601 OAK STREET

BRECKENRIDGE,MN56520
41-1850500 		SENIOR HOMES MN 501(C)(3) 9 SFH
 
Yes
 
(5) BISHOP DRUMM RETIREMENT CENTER

1111 6TH AVENUE

DES MOINES,IA50314
42-0725196 		LTERM CARE IA 501(C)(3) 9 CHI-IA CORP
 
Yes
 
(6) BORNEMANN HEALTHCARE CORPORATION

2500 BERNVILLE RD PO BOX 316

READING,PA19603
23-2187242 		HEALTHCARE PA 501(C)(3) 11 - Type I CHI
 
Yes
 
(7) CARRINGTON HEALTH CENTER

800 NORTH 4TH STREET

CARRINGTON,ND58421
45-0227311 		HEALTHCARE ND 501(C)(3) 3 CHI
 
Yes
 
(8) CATHOLIC HEALTH CARE FEDERATION

198 INVERNESS DRIVE WEST

ENGLEWOOD,CO80112
20-8473567 		JURIDIC PERSON CO 501(C)(3) 11 - Type I CHI
 
Yes
 
(9) CATHOLIC HEALTH INITIATIVES

198 INVERNESS DRIVE WEST

ENGLEWOOD,CO80112
47-0617373 		HEALTHCARE CO 501(C)(3) 9 CHI
 
Yes
 
(10) CATHOLIC HEALTH INITIATIVES COLORADO FOUNDATION

961 EAST COLORADO AVENUE

COLORADO SPRINGS,CO80903
84-0902211 		FUNDRAISING CO 501(C)(3) 7 CHI COLORADO
 
Yes
 
(11) CENTENNIAL MEDICAL GROUP INC

2700 STEWART PARKWAY

ROSEBURG,OR97470
90-0433062 		PHYSICIANS OR 501(C)(3) 9 MMC
 
Yes
 
(12) CHI COLORADO

188 INVERNESS DRIVE WEST

ENGLEWOOD,CO80112
84-0405257 		HEALTHCARE CO 501(C)(3) 3 CHI
 
Yes
 
(13) CHI HEALTH CONNECT AT HOME - FARGO

4816 AMBER VALLEY PARKWAY

FARGO,ND58104
27-1966847 		HEALTHCARE ND 501(C)(3) 3 CHI
 
Yes
 
(14) CHI INSTITUTE FOR RESEARCH AND INNOVATION

198 INVERNESS DRIVE WEST

ENGLEWOOD,CO80112
27-1050565 		HEALTHCARE CO 501(C)(3) 11 - Type I CHI
 
Yes
 
(15) CHI KENTUCKY INC

3900 OLYMPIC BLVD SUITE 400

ERLANGER,KY41018
20-2741651 		HEALTHCARE KY 501(C)(3) 11 - Type I CHI
 
Yes
 
(16) CHI NATIONAL FOUNDATION

198 INVERNESS DRIVE WEST

ENGLEWOOD,CO80112
27-0930004 		FUNDRAISING CO 501(C)(3) 11 - Type I CHI
 
Yes
 
(17) CHI NATIONAL HOME CARE

198 INVERNESS DRIVE WEST

ENGLEWOOD,CO80112
45-1261716 		HEALTHCARE CO 501(C)(3) 11 - Type I CHI
 
Yes
 
(18) CHI NATIONAL SERVICES

198 INVERNESS DRIVE WEST

ENGLEWOOD,CO80112
45-2532084 		HEALTHCARE CO 501(C)(3) 9 CHI
 
Yes
 
(19) CHI NEBRASKA

555 SOUTH 70TH STREET

LINCOLN,NE68510
36-3233121 		HEALTHCARE NE 501(C)(3) 11 - Type I CHI
 
Yes
 
(20) CHI-IOWA CORP

1111 6TH AVENUE

DES MOINES,IA50314
42-0680448 		HEALTHCARE IA 501(C)(3) 3 MHN
 
Yes
 
(21) CONTINUING CARE HOSPITAL

150 NORTH EAGLE CREEK DRIVE

LEXINGTON,KY40509
61-1400619 		LTACH KY 501(C)(3) 3 SJHS
 
Yes
 
(22) ENUMCLAW REGIONAL HOSPITAL ASSOCIATION

1450 BATTERSBY AVENUE

ENUMCLAW,WA98022
91-0715805 		HEALTHCARE WA 501(C)(3) 3 FHS
 
Yes
 
(23) FLAGET HEALTHCARE DBA FLAGET MEMORIAL HOSPITAL

4305 NEW SHEPHERDSVILLE ROAD

BARDSTOWN,KY40004
61-1345363 		HEALTHCARE KY 501(C)(3) 3 CHI
 
Yes
 
(24) FLAGET MEMORIAL HOSPITAL FOUNDATION INC

4305 NEW SHEPHERDSVILLE ROAD

BARDSTOWN,KY40004
56-2351341 		FUNDRAISING KY 501(C)(3) 11 - Type I FH
 
Yes
 
(25) FRANCISCAN FOUNDATION

1717 SOUTH J STREET

TACOMA,WA98405
91-1145592 		FUNDRAISING WA 501(C)(3) 9 FHS
 
Yes
 
(26) FRANCISCAN HEALTH SYSTEM FKA FRANCISCAN HEALTH SYSTEM WEST

1717 SOUTH J STREET

TACOMA,WA98405
91-0564491 		HEALTHCARE WA 501(C)(3) 3 CHI
 
Yes
 
(27) FRANCISCAN MEDICAL GROUP

1708 SOUTH YAKIMA AVENUE

TACOMA,WA98405
91-1939739 		HEALTHCARE WA 501(C)(3) 9 FHS
 
Yes
 
(28) FRANCISCAN VILLA OF SOUTH MILWAUKEE INC

3601 SOUTH CHICAGO AVENUE

SOUTH MILWAUKEE,WI53172
39-1093829 		HEALTHCARE WI 501(C)(3) 9 CHI
 
Yes
 
(29) GETTYSBURG MEDICAL CENTER

606 EAST GARFIELD AVENUE

GETTYSBURG,SD57442
46-0234354 		HEALTHCARE SD 501(C)(3) 3 SMHC
 
Yes
 
(30) GLOBAL HEALTH INITIATIVES

198 INVERNESS DRIVE WEST

ENGLEWOOD,CO80112
20-1536108 		MINISTRIES CO 501(C)(3) 11 - Type I CHI
 
Yes
 
(31) GOOD SAMARITAN COLLEGE OF NURSING & HEALTH SCIENCE

375 DIXMYTH AVE

CINCINNATI,OH45220
31-1778403 		EDUCATION KY 501(C)(3) 2 GHS
 
Yes
 
(32) GOOD SAMARITAN FOUNDATION OF CINCINNATI INC

619 OAK STREET ACCOUNTING-3 W

CINCINNATI,OH45206
31-1206047 		FUNDRAISING OH 501(C)(3) 11 - Type I GSH
 
Yes
 
(33) GOOD SAMARITAN HOSPITAL

PO BOX 1990

KEARNEY,NE68848
47-0379755 		HEALTHCARE NE 501(C)(3) 3 CHI NEBRASKA
 
Yes
 
(34) GOOD SAMARITAN HOSPITAL FOUNDATION

PO BOX 1810

KEARNEY,NE68848
47-0659443 		FUNDRAISING NE 501(C)(3) 7 GSH
 
Yes
 
(35) HEALTH SET

4200 WEST CONEJOS PLACE 436

DENVER,CO80204
84-1102943 		LOW INC.CARE CO 501(C)(3) 7 CHI COLORADO
 
Yes
 
(36) HEALTHCARE AND WELLNESS FOUNDATION

2400 ST FRANCIS DRIVE

BRECKENRIDGE,MN56520
76-0761782 		FUNDRAISING MN 501(C)(3) 11 - Type I SFMC
 
Yes
 
(37) HOSPITAL ASSOCIATION FOR ST JOSEPH HOSPITAL

7601 OSLER DRIVE

TOWSON,MD21204
52-6050777 		HEALTHCARE MD 501(C)(3) 9 SJMC
 
Yes
 
(38) HOUSE OF MERCY

1111 6TH AVENUE

DES MOINES,IA50314
42-1323808 		SHELTER IA 501(C)(3) 7 CHI-IA CORP
 
Yes
 
(39) LAKEWOOD HEALTH CENTER

600 MAIN AVENUE SOUTH

BAUDETTE,MN56623
41-0758434 		LTERM CARE MN 501(C)(3) 3 CHI
 
Yes
 
(40) LINUS OAKES INC

2700 STEWART PARKWAY

ROSEBURG,OR97470
93-0821381 		SENIOR LIVING OR 501(C)(3) 9 MMC
 
Yes
 
(41) LISBON AREA HEALTH SERVICES

905 MAIN STREET

LISBON,ND58054
82-0558836 		HEALTHCARE ND 501(C)(3) 3 CHI
 
Yes
 
(42) MEMORIAL HEALTH CARE SYSTEM FOUNDATION

2525 DE SALES AVENUE

CHATTANOOGA,TN37404
62-1839548 		FUNDRAISING TN 501(C)(3) 7 MHCS
 
Yes
 
(43) MEMORIAL HEALTH CARE SYSTEM INC

2525 DE SALES AVENUE

CHATTANOOGA,TN37404
62-0532345 		HEALTHCARE TN 501(C)(3) 3 CHI
 
Yes
 
(44) MEMORIAL HEALTH PARTNERS FOUNDATION INC

6028 SHALLOWFORD ROAD

CHATTANOOGA,TN37421
03-0417049 		HEALTHCARE TN 501(C)(3) 9 MHCS
 
Yes
 
(45) MERCY AUXILIARY OF CENTRAL IOWA

1111 6TH AVENUE

DES MOINES,IA50314
42-6076069 		AUXILIARY IA 501(C)(3) 11 - Type I CHI-IA CORP
 
Yes
 
(46) MERCY CLINICS INC

1111 6TH AVENUE

DES MOINES,IA50314
42-1193699 		PHYSICIAN IA 501(C)(3) 9 CHI-IA CORP
 
Yes
 
(47) MERCY COLLEGE OF HEALTH SCIENCES

1111 6TH AVENUE

DES MOINES,IA50314
42-1511682 		EDUCATION IA 501(C)(3) 2 CHI-IA CORP
 
Yes
 
(48) MERCY FOUNDATION OF DES MOINES IA

1111 6TH AVENUE

DES MOINES,IA50314
23-7358794 		FUNDRAISING IA 501(C)(3) 7 CHI-IA CORP
 
Yes
 
(49) MERCY FOUNDATION INC

2700 STEWART PARKWAY

ROSEBURG,OR97470
93-6088946 		FUNDRAISING OR 501(C)(3) 7 MMC
 
Yes
 
(50) MERCY HEALTH CARE FOUNDATION

PO BOX 368

CORNING,IA50841
42-1461064 		FUNDRAISING NE 501(C)(3) 11 - Type I AHMH
 
Yes
 
(51) MERCY HOSPITAL FOUNDATION COUNCIL BLUFFS

800 MERCY DRIVE

COUNCIL BLUFFS,IA51503
42-1178204 		FUNDRAISING IA 501(C)(3) 11 - Type I AHBMHS
 
Yes
 
(52) MERCY HOSPITAL OF DEVILS LAKE

1031 EAST SEVENTH STREET

DEVILS LAKE,ND58301
45-0227012 		HEALTHCARE ND 501(C)(3) 3 CHI
 
Yes
 
(53) MERCY HOSPITAL OF VALLEY CITY

570 CHAUTAUQUA BOULEVARD

VALLEY CITY,ND58072
45-0226553 		HEALTHCARE ND 501(C)(3) 3 CHI
 
Yes
 
(54) MERCY LIFECARE SYSTEMS

2727 MCCLELLAND BLVD

JOPLIN,MO64804
43-1305163 		PROPERTY MGMT MO 501(C)(3) 11 - Type I SJRMC
 
Yes
 
(55) MERCY MEDICAL CENTER

1301 15TH AVENUE WEST

WILLISTON,ND58801
45-0231183 		HEALTHCARE ND 501(C)(3) 3 CHI
 
Yes
 
(56) MERCY MEDICAL CENTER

2700 STEWART PARKWAY

ROSEBURG,OR97470
93-0386868 		HEALTHCARE OR 501(C)(3) 3 CHI
 
Yes
 
(57) MERCY MEDICAL CENTER - CENTERVILLE

1 ST JOSEPHS DRIVE

CENTERVILLE,IA52544
42-0680308 		HEALTHCARE IA 501(C)(3) 3 CHI-IA CORP
 
Yes
 
(58) MERCY MEDICAL FOUNDATION

1301 15TH AVENUE WEST

WILLISTON,ND58801
45-0381803 		FUNDRAISING ND 501(C)(3) 11 - Type I MMC
 
Yes
 
(59) MERCY PROFESSIONAL PRACTICE ASSOCIATES INC

1111 6TH AVENUE

DES MOINES,IA50314
42-1470935 		PHYSICIAN IA 501(C)(3) 9 CHI-IA CORP
 
Yes
 
(60) MERCY REGIONAL MEDICAL CENTER OF DURANGO

1010 THREE SPRINGS BLVD

DURANGO,CO81301
84-0405515 		HEALTHCARE CO 501(C)(3) 3 CHI
 
Yes
 
(61) MNMCH INC

220 NORTH PENNSYLVANIA

COLUMBUS,KS66725
48-1216238 		HEALTHCARE KS 501(C)(3) 3 SJRMC
 
Yes
 
(62) MT ST JOSEPH INC

3060 SE STARK STREET

PORTLAND,OR97214
93-0386870 		NURSING CARE OR 501(C)(3) 9 CHI
 
Yes
 
(63) OAKES COMMUNITY HOSPITAL

314 SOUTH 8TH STREET

OAKES,ND58474
45-0231675 		HEALTHCARE ND 501(C)(3) 3 CHI
 
Yes
 
(64) OAKES COMMUNITY HOSPITAL FOUNDATION

314 SOUTH 8TH STREET

OAKES,ND58474
71-0966606 		FUNDRAISING ND 501(C)(3) 11 - Type I OCH
 
Yes
 
(65) PUEBLO STEPUP

1925 EAST ORMAN AVE SUITE G52

PUEBLO,CO81004
84-1234295 		COMMUNITY CO 501(C)(3) 7 CHI
 
Yes
 
(66) SET OF COLORADO SPRINGS INC

825 E PIKES PEAK AVENUE BLDG 29

COLORADO SPRINGS,CO80903
84-1183335 		LTERM CARE CO 501(C)(3) 7 CHI COLORADO
 
Yes
 
(67) SAINT CLARE'S COMMUNITY CARE

66 FORD ROAD

DENVILLE,NJ07834
22-2876836 		HEALTHCARE NJ 501(C)(3) 11 - Type II SCHS
 
Yes
 
(68) SAINT CLARE''S FOUNDATION INC

66 FORD ROAD

DENVILLE,NJ07834
22-2502997 		FUNDRAISING NJ 501(C)(3) 7 SCHS
 
Yes
 
(69) SAINT CLARE''S HEALTH SERVICES INC

25 POCONO ROAD

DENVILLE,NJ07834
22-3639733 		MANAGEMENT NJ 501(C)(3) 7 CHI
 
Yes
 
(70) SAINT CLARE'S HOSPITAL

66 FORD ROAD

DENVILLE,NJ07834
22-3319886 		HEALTHCARE NJ 501(C)(3) 3 CHI
 
Yes
 
(71) SAINT ELIZABETH FOUNDATION

555 SOUTH 70TH STREET

LINCOLN,NE68510
47-0625523 		FUNDRAISING NE 501(C)(3) 7 SERMC
 
Yes
 
(72) SAINT ELIZABETH HEALTH SERVICES

555 SOUTH 70TH STREET

LINCOLN,NE68510
36-3233120 		HEALTHCARE NE 501(C)(3) 3 SERMC
 
Yes
 
(73) SAINT ELIZABETH REGIONAL MEDICAL CENTER

555 SOUTH 70TH STREET

LINCOLN,NE68510
47-0379836 		HEALTHCARE NE 501(C)(3) 3 CHI NEBRASKA
 
Yes
 
(74) SAINT FRANCIS MEDICAL CENTER

PO BOX 9804

GRAND ISLAND,NE68802
47-0376601 		HEALTHCARE NE 501(C)(3) 3 CHI NEBRASKA
 
Yes
 
(75) SAINT FRANCIS MEDICAL CENTER FOUNDATION

PO BOX 9804

GRAND ISLAND,NE68802
47-0630267 		FUNDRAISING NE 501(C)(3) 7 SFMC
 
Yes
 
(76) SAINT JOSEPH BEREA HOSPITAL FOUNDATION INC

305 ESTILL STREET

BEREA,KY40403
26-0152877 		FUNDRAISING KY 501(C)(3) 7 SJHS
 
Yes
 
(77) SAINT JOSEPH HEALTH SYSTEM INC

150 N EAGLE CREEK DR

LEXINGTON,KY40509
61-1334601 		HEALTHCARE KY 501(C)(3) 3 CHI
 
Yes
 
(78) SAINT JOSEPH LONDON FOUNDATION INC

310 EAST NINTH STREET

LONDON,KY40741
26-0438748 		FUNDRAISING KY 501(C)(3) 11 - Type I SJHS
 
Yes
 
(79) SAINT JOSEPH MEDICAL FOUNDATION INC

ONE ST JOSEPH DRIVE

LEXINGTON,KY40504
31-1539059 		PHY PRACTICES KY 501(C)(3) 3 SJHS
 
Yes
 
(80) SAINT JOSEPH MOUNT STERLING FOUNDATION INC

50 STERLING AVENUE

MOUNT STERLING,KY40353
27-2884584 		FUNDRAISING KY 501(C)(3) 7 SJHS
 
Yes
 
(81) SAINT JOSEPH'S HOSPITAL FOUNDATION

30 WEST 7TH STREET

DICKINSON,ND58601
36-3418207 		FUNDRAISING ND 501(C)(3) 11 - Type I SJHHC
 
Yes
 
(82) SAMARITAN BEHAVIORAL HEALTH

601 S EDWIN C MOSES BLVD

DAYTON,OH45408
02-0633634 		HEALTHCARE OH 501(C)(3) 3 SHP
 
Yes
 
(83) SAMARITAN HEALTH FOUNDATION

2222 PHILADELPHIA DRIVE

DAYTON,OH45406
23-7296923 		FUNDRAISING OH 501(C)(3) 7 SHP
 
Yes
 
(84) SAMARITAN HEALTH PARTNERS

2222 PHILADELPHIA DRIVE

DAYTON,OH45406
31-1107411 		HEALTHCARE OH 501(C)(3) 11 - Type I CHI
 
Yes
 
(85) ST JOSEPH HEALTH MINISTRIES

1929 LINCOLN HWY E STE 150

LANCASTER,PA17602
23-2342997 		HEALTH PA 501(C)(3) 11 - Type I CHI
 
Yes
 
(86) ST JOSEPH HEALTH MINISTRIES FOUNDATION

1929 LINCOLN HWY E STE 150

LANCASTER,PA17602
23-2605579 		FUNDRAISING PA 501(C)(3) 11 - Type I SJHM
 
Yes
 
(87) ST ANTHONY HOSPITAL

1601 SE COURT AVENUE

PENDLETON,OR97801
93-0391614 		HEALTHCARE OR 501(C)(3) 3 CHI
 
Yes
 
(88) ST ANTHONY HOSPITAL FOUNDATION

1601 SE COURT AVENUE

PENDLETON,OR97801
93-0992727 		FUNDRAISING OR 501(C)(3) 11 - Type I SA HOSPITAL
 
Yes
 
(89) ST ANTHONY'S HOSPITAL ASSOCIATION

4 HOSPITAL DRIVE

MORRILTON,AR72110
71-0245507 		HEALTHCARE AR 501(C)(3) 3 SVIMC
 
Yes
 
(90) ST CATHERINE HOSPITAL

401 EAST SPRUCE STREET

GARDEN CITY,KS67846
48-0543721 		HEALTHCARE KS 501(C)(3) 3 CHI
 
Yes
 
(91) ST CATHERINE HOSPITAL DEVELOPMENT FOUNDATION

401 EAST SPRUCE STREET

GARDEN CITY,KS67846
20-0598702 		FUNDRAISING KS 501(C)(3) 11 - Type I SCH
 
Yes
 
(92) ST DOMINIC AT ONTARIO

351 SW 9TH STREET

ONTARIO,OR97914
93-0433692 		HEALTHCARE OR 501(C)(3) 3 CHI
 
Yes
 
(93) ST FRANCIS HOME

2400 ST FRANCIS DRIVE

BRECKENRIDGE,MN56520
41-0729978 		LTERM CARE MN 501(C)(3) 9 CHI
 
Yes
 
(94) ST FRANCIS LIFE CARE CORPORATION

19 POCONO ROAD

DENVILLE,NJ07834
22-2536017 		ELDERLY CARE NJ 501(C)(3) 9 SCHS
 
Yes
 
(95) ST FRANCIS MEDICAL CENTER

2400 ST FRANCIS DRIVE

BRECKENRIDGE,MN56520
41-0695598 		HEALTHCARE MN 501(C)(3) 3 CHI
 
Yes
 
(96) ST FRANCIS OF BAKER CITY

3325 POCAHONTAS ROAD

BAKER CITY,OR97814
93-0412495 		HEALTHCARE OR 501(C)(3) 3 CHI
 
Yes
 
(97) ST JOHN'S MEDICAL GROUP

2727 MCCLELLAND BLVD

JOPLIN,MO64804
43-1882377 		PHYS PRACTICE MO 501(C)(3) 9 SJRMC
 
Yes
 
(98) ST JOHN'S MERCY REGIONAL FOUNDATION

2727 MCCLELLAND BLVD

JOPLIN,MO64804
43-1308084 		FUNDRAISING MO 501(C)(3) 7 SJRMC
 
Yes
 
(99) ST JOHN'S REGIONAL MEDICAL CENTER

2727 MCCLELLAND BLVD

JOPLIN,MO64804
44-0545809 		HEALTHCARE MO 501(C)(3) 3 CHI
 
Yes
 
(100) ST JOSEPH COMMUNITY HEALTH SERVICES

300 CENTRAL AVE SW SUITE 3000W

ALBUQUERQUE,NM87102
71-0897107 		COMMUNITY NM 501(C)(3) 11 - Type I CHI
 
Yes
 
(101) ST JOSEPH HEALTH SERVICES INC

1929 LINCOLN HWY E STE 150

LANCASTER,PA17602
20-1425375 		DENTAL CARE PA 501(C)(3) 11 - Type I SJHM
 
Yes
 
(102) ST JOSEPH HOSPITAL FOUNDATION INC

ONE ST JOSEPH DRIVE

LEXINGTON,KY40504
61-1159649 		FUNDRAISING KY 501(C)(3) 11 - Type I SJHS
 
Yes
 
(103) ST JOSEPH MEDICAL CENTER FOUNDATION

2500 BERNVILLE ROAD PO BOX 316

READING,PA19603
23-2649362 		FUNDRAISING PA 501(C)(3) 11 - Type I SJRHN
 
Yes
 
(104) ST JOSEPH MEDICAL CENTER FOUNDATION INC

7601 OSLER DRIVE

TOWSON,MD21204
52-1681044 		FUNDRAISING MD 501(C)(3) 7 SJMC
 
Yes
 
(105) ST JOSEPH MEDICAL CENTER INC

7601 OSLER DRIVE

TOWSON,MD21204
52-0591461 		HEALTHCARE MD 501(C)(3) 3 CHI
 
Yes
 
(106) ST JOSEPH MEDICAL GROUP

2500 BERNVILLE ROAD PO BOX 316

READING,PA19603
20-8544021 		HEALTHCARE PA 501(C)(3) 9 BHC
 
Yes
 
(107) ST JOSEPH PHYSICIAN ENTERPRISES

7601 OSLER DRIVE

TOWSON,MD21204
52-1311775 		PHYSICIANS MD 501(C)(3) 11 - Type I CHI
 
Yes
 
(108) ST JOSEPH REGIONAL HEALTH NETWORK

2500 BERNVILLE ROAD PO BOX 316

READING,PA19603
23-1352211 		HEALTHCARE PA 501(C)(3) 3 CHI
 
Yes
 
(109) ST JOSEPH'S AREA HEALTH SERVICES

600 PLEASANT AVENUE

PARK RAPIDS,MN56470
41-0695603 		HEALTHCARE MN 501(C)(3) 3 CHI
 
Yes
 
(110) ST JOSEPH'S HOSPITAL AND HEALTH CENTER

30 WEST 7TH STREET

DICKINSON,ND58601
45-0226429 		HEALTHCARE ND 501(C)(3) 3 CHI
 
Yes
 
(111) ST MARY'S HEALTHCARE CENTER

801 EAST SIOUX AVENUE

PIERRE,SD57501
46-0230199 		HEALTHCARE SD 501(C)(3) 3 CHI
 
Yes
 
(112) ST MARY'S HOSPITAL

1314 3RD AVENUE

NEBRASKA CITY,NE68410
47-0443636 		HEALTHCARE NE 501(C)(3) 3 CHI NEBRASKA
 
Yes
 
(113) ST MARY'S HOSPITAL FOUNDATION

1314 3RD AVENUE

NEBRASKA CITY,NE68410
47-0707604 		FUNDRAISING NE 501(C)(3) 7 SMH
 
Yes
 
(114) ST ROSE AMBULATORY AND SURGERY CENTER FKA CENTRAL KANSAS MEDICAL CENTER

3515 BROADWAY

GREAT BEND,KS67530
48-0543724 		SURGERY CNTR KS 501(C)(3) 3 CHI
 
Yes
 
(115) ST VINCENT FOUNDATION

TWO ST VINCENT CIRCLE

LITTLE ROCK,AR72205
51-0169537 		FUNDRAISING AR 501(C)(3) 11 - Type I SVIMC
 
Yes
 
(116) ST VINCENT INFIRMARY MEDICAL CENTER

2 ST VINCENT CIRCLE

LITTLE ROCK,AR72205
71-0236917 		HEALTHCARE AR 501(C)(3) 3 CHI
 
Yes
 
(117) ST VINCENT MEDICAL GROUP

2 ST VINCENT CIRCLE

LITTLE ROCK,AR72205
71-0830696 		HEALTHCARE AR 501(C)(3) 9 SVIMC
 
Yes
 
(118) THE COMMUNITY LIMITED CARE DIALYSIS CENTER

619 OAK STREET ACCOUNTING-3 W

CINCINNATI,OH45206
23-7419853 		DIALYSIS OH 501(C)(2) N/A GSH
 
Yes
 
(119) THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OH

619 OAK STREET ACCOUNTING-3 W

CINCINNATI,OH45206
31-0537486 		HEALTHCARE OH 501(C)(3) 3 TRI-HEALTH
 
Yes
 
(120) THE MERCY HOSPITAL OF DEVILS LAKE FDN

1031 EAST SEVENTH STREET

DEVILS LAKE,ND58301
35-2367360 		FUNDRAISING ND 501(C)(3) 11 - Type I MHDL
 
Yes
 
(121) THE PHYSICIAN NETWORK

8055 O STREET SUITE 300

LINCOLN,NE68510
47-0780857 		PHYS PRACTICE NE 501(C)(3) 11 - Type I CHI NEBRASKA
 
Yes
 
(122) TOTAL HEALTHCARE

PO BOX 7021

COLORADO SPRINGS,CO80933
84-0927232 		HEALTHCARE CO 501(C)(3) 3 CHI COLORADO
 
Yes
 
(123) UNITY FAMILY HEALTHCARE

815 2ND STREET SE

LITTLE FALLS,MN56345
41-0721642 		HEALTHCARE MN 501(C)(3) 3 CHI
 
Yes
 
(124) VILLA NAZARETH INC

801 PAGE DRIVE

FARGO,ND58103
45-0226714 		LT CARE ND 501(C)(3) 9 CHI
 
Yes
 
(125) VISITING NURSE ASSOCIATION OF SAINT CLARE'S

191 WOODPORT ROAD

SPARTA,NJ07871
22-1768334 		HOME HEALTH NJ 501(C)(3) 9 SCHS
 
Yes
 
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



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

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




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



 		(k)
Percentage
ownership
Yes No Yes No
(1) AUDUBON LAND COMPANY LLC

5390 N ACADEMY BLVD SUITE 300
COLORADO SPRINGS,CO80918
84-1513085 		REAL ESTATE CO THC
  		RELATED -157,673 14,390,550   No 0   No 50.1 %
(2) AVANTAS LLC

1207 SOUTH 13 STREET
OMAHA,NE68108
39-2045003 		HEALTHCARE NE AHMH
  		UNRELATED       No     No 95 %
(3) BERYWOOD OFFICE PROPERTIES LLC

400 BERYWOOD TRAIL
CLEVELAND,TN37312
62-1875199 		PHYS OFFICE TN MHCS
  		RELATED       No   Yes   63 %
(4) BLUEGRASS REGIONAL IMAGING CENTER

1218 SOUTH BROADWAY SUITE 310
LEXINGTON,KY40504
61-1386736 		DIAGNOSTIC KY SJ HOSPITAL LEX
  		RELATED       No     No 65 %
(5) CENTRAL NEBRASKA HOME CARE SERVICES

PO BOX 1146-4510 SECOND AVENUE
KEARNEY,NE68848
47-0692112 		HEALTHCARE SRVC NE HSE INC
  		RELATED -99,941 1,021,498   No -48,712 Yes   100 %
(6) CENTRAL NEBRASKA REHAB SERVICE

3004 W FAIDLEY AVE
GRAND ISLAND,NE68802
81-0653461 		PHYSICAL THERAPY NE CHI
  		RELATED 1,857,991 2,262,775   No 0   No 51 %
(7) CHI OPERATING INVESTMENT PROGRAM LP

198 INVERNESS DRIVE WEST
ENGLEWOOD,CO80112
47-0727942 		INVESTMENTS CO CHI
  		UNRELATED 139,679,805 2,069,974,790   No 371,292 Yes   100 %
(8) HEALTHCARE SUPPORT SERVICES

PO BOX 9804
GRAND ISLAND,NE68802
72-1546196 		LAUNDRY NE CHI
  		RELATED 196,124 3,913,481   No -58,436   No 100 %
(9) NORTH RIVER SURGERY CENTER LLC

2209 WILDWOOD AVENUE
SHERWOOD,AR72120
71-0799771 		AMBUL SURG CTR AR SVIMC
  		RELATED 198,313 1,758,688   No 0   No 57.45 %
(10) ORTHOCOLORADO LLC

11650 WEST 2ND PLACE
LAKEWOOD,CO80255
37-1577105 		ORTHO HOSPITAL CO THC
  		RELATED -3,249,314 10,905,384   No 0   No 60 %
(11) PENINSULA RADIATION ONCOLOGY

314 MARTIN LUTHER KING JR WAY 11
TACOMA,WA98405
87-0808610 		HEALTHCARE SRVC WA FHS
  		RELATED 131,195 3,052,504   No 0   No 60 %
(12) PENRAD IMAGING

1139 KELLY JOHNSON BLVD
COLORADO SPRINGS,CO80920
84-1072619 		MEDICAL IMAGING CO THC
  		RELATED 1,857,228 5,457,224   No 0   No 70 %
(13) RUXTON SURGICENTER LLC

8322 BELLONA AVENUE SUITE 201
BALTIMORE,MD21204
52-2095835 		SURGERY CENTER MD SJMC
  		RELATED       No   Yes   51 %
(14) SAINT JOSEPH - SCA HOLDINGS LLC

424 LEWIS HARGETT CIRCLE STE 160
LEXINGTON,KY40503
45-3801157 		OP SURGERY DE SJHS
  		RELATED 0 0   No 0   No 51 %
(15) ST ANTHONY REGIONAL MTN CANCER CENTER

4231 W 16TH AVENUE
DENVER,CO80112
37-1568013 		CANCER CENTER CO THC
  		RELATED -290,552 0   No 0   No 51 %
(16) ST FRANCIS LAND COMPANY

5390 N ACADEMY BLVD SUITE 300
COLORADO SPRINGS,CO80918
26-3134100 		REAL ESTATE CO THC
  		RELATED -180,979 14,886,022   No 0   No 51 %
(17) ST FRANCIS MEDICAL CENTER ASSOCIATES

1717 SOUTH J STREET
TACOMA,WA98405
91-1352698 		MED. OFFICE WA FHS
  		RELATED 116,948 1,652,280   No 0   No 54 %
(18) ST JOSEPH-PAML LLC

424 LEWIS HARGETT CIRCLE STE 160
LEXINGTON,KY40503
45-2116736 		MGMT SERVICES KY SJHS
  		RELATED 0 0   No 0 Yes   62.5 %
(19) SUPERIOR MEDICAL IMAGING LLC

5000 NORTH 26TH STREET
LINCOLN,NE68521
26-2884555 		OP DIAGNOSTICS NE SERMC
  		RELATED       No     No 51 %
(20) SURGERY CENTER OF LEXINGTON LLC

1451 HARRODSBURG ROAD
LEXINGTON,KY40504
62-1179539 		SURGERY CENTER DE SJHS
  		RELATED 808,840 4,236,901   No 0   No 51 %
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) ALTERNATIVE INSURANCE MANAGEMENT SERVICES
3900 OLYMPIC BOULEVARD SUITE 400
ERLANGER,KY41018
84-1112049 		MANAGEMENT SERVICES CO CHI
  		C CORPORATION 0 3,267,441 100 %
(2) AMERICAN NURSING CARE
1700 EDISON DRIVE
MILFORD,OH45150
31-1085414 		HOME HEALTH OH CHS
  		C CORPORATION 1,778,617 44,470,358 100 %
(3) AMERIMED INC
1700 EDISON DRIVE
MILFORD,OH45150
31-1158699 		HOME HEALTH OH ANC
  		C CORPORATION 2,395,230 11,869,657 100 %
(4) CADUCEUS MEDICAL ASSOCIATES INC
6028 SHALLOWFORD ROAD SUITE D
CHATTANOOGA,TN37422
62-1570736 		HEALTHCARE TN MHCS
  		C CORPORATION 0 1,008 100 %
(5) CAPTIVE MANAGEMENT INITIATIVES
PO BOX 10073 APO
GEORGETOWN,GEORGETOWN, GRAND CAYMANKY1-1001
CJ
98-0663022 		CAPTIVE MANAGEMENT CJ CHI
  		C CORPORATION 0 0 100 %
(6) CENTER FOR TRANSLATIONAL RESEARCH
198 INVERNESS DRIVE WEST
ENGLEWOOD,CO80112
27-2269511 		HEALTHCARE CO CHI
  		C CORPORATION -2,247,962 1,668,589 100 %
(7) CENTRAL KANSAS HEALTH SERVICES ASSOCIATION
3515 BROADWAY
GREAT BEND,KS67530
48-1042853 		MEDICAL EQUIPMENT KS CKMC
  		C CORPORATION 0 0 100 %
(8) CGH REALTY COMPANY INC
215 N 12TH ST
READING,PA19603
23-2326801 		REAL ESTATE PA SJHM
  		C CORPORATION 1,007 42,415 100 %
(9) COMCARE SERVICES
4231 W 16TH AVENUE
DENVER,CO80204
84-0904813 		INACTIVE CO CHIC
  		C CORPORATION 0 0 100 %
(10) CONSOLIDATED HEALTH SERVICES
1700 EDISON DRIVE
MILFORD,OH45150
31-1378212 		HOME HEALTH OH CHI
  		C CORPORATION 0 11,595,125 100 %
(11) DAVID DEYLE CHARITABLE REMAINDER UNITRUST
PO BOX 1810
KEARNEY,NE68848
47-6192395 		INVESTMENTS NE GSHF
  		TRUST 4,880 166,425 100 %
(12) DES MOINES MEDICAL CENTER INC
1111 6TH AVENUE
DES MOINES,IA50314
42-0837382 		REAL ESTATE IA CHI-IA CORP
  		C CORPORATION 0 1,253,452 92.98 %
(13) FIRST INITIATIVES INSURANCE LTD
PO BOX 10073 APO
GEORGETOWN,GEORGETOWN, GRAND CAYMANKY1-1001
CJ
98-0203038 		INSURANCE CJ CHI
  		C CORPORATION 0 0 100 %
(14) FRANCISCAN SERVICES INC
198 INVERNESS DRIVE WEST
ENGLEWOOD,CO80112
23-2487967 		HEALTHCARE CO CHI
  		C CORPORATION -507,578 11,914,284 100 %
(15) GOOD SAMARITAN OUTREACH SERVICES
PO BOX 1990
KEARNEY,NE68848
47-0659440 		MEDICAL CLINIC NE CHI NEBRASKA
  		C CORPORATION -2,921,063 355,110 100 %
(16) HAROLD W RASE 1995 CHARITABLE UNITRUST
30 WEST 7TH STREET
DICKINSON,ND58601
45-6090420 		INVESTMENTS ND SJHHC
  		TRUST 1,240 21,553 100 %
(17) HAROLD W RASE 1996 CHARITABLE UNITRUST
30 WEST 7TH STREET
DICKINSON,ND58601
20-6037112 		INVESTMENTS ND SJHHC
  		TRUST 900 15,495 100 %
(18) HAROLD W RASE 1997 CHARITABLE UNITRUST
30 WEST 7TH STREET
DICKINSON,ND58601
20-6037104 		INVESTMENTS ND SJHHC
  		TRUST 1,025 20,261 100 %
(19) HAROLD W RASE 1999 CHARITABLE UNITRUST
30 WEST 7TH STREET
DICKINSON,ND58601
20-6037099 		INVESTMENTS ND SJHHC
  		TRUST 1,313 25,027 100 %
(20) HEALTH SYSTEMS ENTERPRISES INC
PO BOX 1990
KEARNEY,NE68848
47-0664558 		MANAGEMENT NE GSH
  		C CORPORATION 25,289 1,443,049 100 %
(21) HEALTHCARE MGMT SERVICES ORG INC
1149 MARKET ST
TACOMA,WA98402
91-1865474 		HEALTH ORG. WA FHS
  		C CORPORATION 0 0 100 %
(22) JAMES & HENRIETTA NISTLER UNITRUST
30 WEST 7TH STREET
DICKINSON,ND58601
20-6021899 		INVESTMENTS ND SJHHC
  		TRUST -16,708 41,455 100 %
(23) JEANNE DEYLE CHARITABLE REMAINDER UNITRUST
PO BOX 1810
KEARNEY,NE68848
47-6192398 		INVESTMENTS NE GSHF
  		TRUST 4,880 166,320 100 %
(24) JOSEPH A SCHUSTER ANNUITY TRUST #1
400 UNIVERSITY AVENUE
DES MOINES,IA50314
42-1195122 		INVESTMENTS IA MFDM
  		TRUST 18,924 441,488 100 %
(25) LODESCA MILLER CHARITABLE REMAINDER UNITRUST
PO BOX 1810
KEARNEY,NE68848
47-6186933 		INVESTMENTS NE GSHF
  		TRUST 3,387 86,367 100 %
(26) MEDQUEST
1301 15TH AVENUE WEST
WILLISTON,ND58801
45-0392137 		SALE OF DME ND MH OF WILLISTON
  		C CORPORATION 9,852 962,554 100 %
(27) MERCY HEALTH SERVICES CORPORATION
2727 MCCLELLAND BLVD
JOPLIN,MO64804
43-1457881 		DME MO ST JOHN'S RMC
  		C CORPORATION -1,533,371 1,369,083 100 %
(28) MERCY PARK APARTMENTS LTD
1111 6TH AVENUE
DES MOINES,IA50314
42-1202422 		HOUSING IA CHI-IA CORP
  		C CORPORATION 264,489 1,796,053 100 %
(29) MERCY SERVICES CORP
2700 STEWART PARKWAY
ROSEBURG,OR97470
93-0824308 		RETAIL SALES OR MMC
  		C CORPORATION -690,267 954,798 100 %
(30) MOUNTAIN MANAGEMENT SERVICES INC
6028D SHALLOWFORD ROAD
CHATTANOOGA,TN37422
62-1570739 		MGMT SVC ORG TN MHCS
  		C CORPORATION -386,020 4,667,998 100 %
(31) NAZARETH ASSURANCE COMPANY
76 ST PAUL STREET SUITE 500
BURLINGTON,VT05401
03-0304831 		INSURANCE VT CHI
  		C CORPORATION -379 123,535 100 %
(32) PATIENT TRANSPORT SERVICES INC
1700 EDISON DRIVE
MILFORD,OH45150
31-1100798 		HOME HEALTH OH ANC
  		C CORPORATION 662,425 5,325,941 100 %
(33) PHYSICIAN HEALTH SYSTEM NETWORK
1149 MARKET ST
TACOMA,WA98402
91-1746721 		HEALTH ORG. WA FHS
  		C CORPORATION 0 0 100 %
(34) RAY & SHIRLEY DAVID 1999 UNITRUST
30 WEST 7TH STREET
DICKINSON,ND58601
20-6037077 		INVESTMENTS ND SJHHC
  		TRUST 1,250 24,194 100 %
(35) ROBERT & WANDA CHARITABLE REMAINDER UNITRUST
PO BOX 1810
KEARNEY,NE68848
26-6191916 		INVESTMENTS NE GSHF
  		TRUST 13,030 537,775 100 %
(36) SAINT CLARE''S PRIMARY CARE INC
66 FORD ROAD
DENVILLE,NJ07834
22-2441202 		BILLING SERVICES NJ SCCC
  		C CORPORATION -342,970 2,177,166 100 %
(37) SAMARITAN FAMILY CARE INC
40 W FOURTH ST 1700
DAYTON,OH45402
31-1299450 		HEALTHCARE OH SHP
  		C CORPORATION     100 %
(38) SJH SERVICES CORPORATION
198 INVERNESS DRIVE WEST
ENGLEWOOD,CO80112
23-2307408 		HEALTHCARE CO FSI
  		C CORPORATION -518,360 3,180,100 100 %
(39) SJL PHYSICIAN MANAGEMENT SERVICES INC
424 LEWIS HARGETT CR 160
LEXINGTON,KY40503
27-0164198 		MANAGEMENT KY SJHS
  		C CORPORATION 0 0 100 %
(40) ST ANTHONY DEVELOPMENT COMPANY
1415 SOUTHGATE
PENDLETON,OR97801
93-1216943 		ATHLETIC CLUB OR ST ANTHONY H
  		C CORPORATION 53,891 3,007,554 100 %
(41) ST VINCENT COMMUNITY HEALTH SERVICES INC
TWO ST VINCENT CIRCLE
LITTLE ROCK,AR72205
71-0710785 		HEALTHCARE AR SVIMC
  		C CORPORATION 2,309,129 14,049,375 100 %
(42) ST JOSEPH DEVELOPMENT COMPANY
1717 SOUTH J STREET
TACOMA,WA98405
91-1480569 		RENTAL WA FSI
  		C CORPORATION -36,395 12,168,022 100 %
(43) ST JOSEPH OFFICE PARK ASSOCIATION
1401 HARRODSBURG ROAD BLDG B70
LEXINGTON,KY40504
61-1079899 		MANAGEMENT KY SJHS
  		C CORPORATION 16,644 882,139 85 %
(44) TOM DEYLE CHARITABLE REMAINDER UNITRUST
PO BOX 1810
KEARNEY,NE68848
47-6192393 		INVESTMENTS NE GSHF
  		TRUST 4,884 166,321 100 %
(45) TOWSON MANAGEMENT INC
7601 OSLER DRIVE
TOWSON,MD21204
52-1710750 		MANAGEMENT SERVICES MD FSI
  		C CORPORATION -469,016 498,393 100 %
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
Yes
 
b Gift, grant, or capital contribution to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
Yes
 
k Performance of services or membership or fundraising solicitations for other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1k
Yes
 
l Performance of services or membership or fundraising solicitations by other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
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
Yes
 
p Reimbursement paid by other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Other transfer of cash or property to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type(a-r) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) MERCY MEDICAL FOUNDATION

 A 3,972 FMV
(2) MEDQUEST

 A 64,125 FMV
(3) MERCY MEDICAL FOUNDATION

 C 380,577 FMV
(4) MEDQUEST

 K 52,236 FMV
(5) CATHOLIC HEALTH INITIATIVES

 L 6,175,322 FMV
(6) CATHOLIC HEALTH INITIATIVES

 O 524,734 FMV
(7) MEDQUEST

 P 447,687 FMV
(8) CATHOLIC HEALTH INITIATIVES

 Q 1,787,725 FMV
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Are all
partners
section
501(c)(3)
organizations? 		(e)
Share of
end-of-year
assets 		(f)
Disproprtionate allocations? 		(g)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065) 		(h)
General or
managing
partner?
Yes No Yes No Yes No






























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


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