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
2011
Open to Public Inspection
A For the calendar year, or tax year beginning 07-01-2011 and ending 06-30-2012
BCheck if applicable:
CName of organization
MUNSTER MEDICAL RESEARCH FOUNDATION INC
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
901 MACARTHUR BOULEVARD
 
Room/suite
City or town, state or country, and ZIP + 4
MUNSTER, IN46321
D Employer identification number

35-1107009
E Telephone number

G Gross receipts $ 465,556,962
F Name and address of principal officer:
MARY ANN SHACKLETT
10010 DONALD S POWERS DRIVE
MUNSTER,IN46321
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.comhs.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 MediumBullet  
K Form of organization:
 
L Year of formation: 1964
M State of legal domicile: IN
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: COMMUNITY HOSPITAL IS COMMITTED TO PROVIDE THE HIGHEST QUALITY CARE IN THE MOST COST-EFFICIENT MANNER, RESPECTING THE DIGNITY OF THE INDIVIDUAL, PROVIDING FOR THE (CONTINUED ON Part III, LINE 1)
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a)..... 3 22
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 10
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ... 5 3,490
6 Total number of volunteers (estimate if necessary) .... 6 170
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 2,352,589
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b  
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 524,273 1,528,783
9 Program service revenue (Part VIII, line 2g) ......... 425,281,675 450,681,002
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 167,777 1,068,207
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 7,057,015 11,616,552
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 433,030,740 464,894,544
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 80,000 80,000
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) 207,968,439 212,743,702
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).... 203,707,827 218,925,948
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 411,756,266 431,749,650
19 Revenue less expenses. Subtract line 18 from line 12....... 21,274,474 33,144,894
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 246,359,812 253,047,288
21 Total liabilities (Part X, line 26)............. 123,312,453 166,649,435
22 Net assets or fund balances. Subtract line 21 from line 20..... 123,047,359 86,397,853
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 use only
Print/type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name Right pointing arrowhead image

Firm's EIN Right pointing arrowhead image
Firm's address Right pointing arrowhead image



Phone no.
May the IRS discuss this return with the preparer shown above? See instructions .........bullet
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2011)
Form 990 (2011)
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 NEEDS OF ALL PEOPLE, INCLUDING THE POOR AND DISADVANTAGED.
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 organization’s program service accomplishments for each of its three largest program services, as measured 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 $ 56,189,665 including grants of $   ) (Revenue $ 31,265,405 )
Nursing Patient Days 120,528
4b (Code:   ) (Expenses $ 54,777,047 including grants of $   ) (Revenue $ 64,795,730 )
Surgery Operations 16,520
4c (Code:   ) (Expenses $ 41,162,665 including grants of $   ) (Revenue $ 67,056,544 )
Outpatient Visits 266,268
(Code:   ) (Expenses $ 29,031,094 including grants of $   ) (Revenue $ 39,900,827 )
Pharmacy
(Code:   ) (Expenses $ 28,403,401 including grants of $   ) (Revenue $ 32,819,500 )
Cardiology
(Code:   ) (Expenses $ 27,034,765 including grants of $   ) (Revenue $ 9,159,500 )
Physical Therapy
(Code:   ) (Expenses $ 20,606,077 including grants of $   ) (Revenue $   )
Medicaid Assessment Fee
(Code:   ) (Expenses $ 20,088,404 including grants of $   ) (Revenue $ 56,292,020 )
Laboratory
(Code:   ) (Expenses $ 15,660,072 including grants of $   ) (Revenue $ 11,515,821 )
IMCU
(Code:   ) (Expenses $ 13,864,262 including grants of $   ) (Revenue $ 57,011,635 )
Radiology
(Code:   ) (Expenses $ 11,457,233 including grants of $   ) (Revenue $ 27,678,630 )
Emergency Room
(Code:   ) (Expenses $ 9,628,171 including grants of $   ) (Revenue $ 12,029,000 )
Physician Offices
(Code:   ) (Expenses $ 9,391,869 including grants of $   ) (Revenue $   )
Dietary
(Code:   ) (Expenses $ 7,857,000 including grants of $   ) (Revenue $   )
Health Information Management
(Code:   ) (Expenses $ 6,388,392 including grants of $   ) (Revenue $ 5,547,586 )
Oncology
(Code:   ) (Expenses $ 5,813,051 including grants of $   ) (Revenue $ 3,095,654 )
ICU
(Code:   ) (Expenses $ 5,444,503 including grants of $   ) (Revenue $ 11,203,886 )
Respiratory Therapy
(Code:   ) (Expenses $ 5,154,157 including grants of $   ) (Revenue $ 505,784 )
Central Sterilization
(Code:   ) (Expenses $ 4,668,613 including grants of $   ) (Revenue $ 2,604,923 )
Home Health
(Code:   ) (Expenses $ 4,551,744 including grants of $   ) (Revenue $ 3,802,757 )
Neoatology
(Code:   ) (Expenses $ 3,628,271 including grants of $   ) (Revenue $   )
Patient Financial and Registration Services
(Code:   ) (Expenses $ 3,201,029 including grants of $   ) (Revenue $   )
Admitting
(Code:   ) (Expenses $ 3,058,935 including grants of $   ) (Revenue $ 1,622,605 )
CVU
(Code:   ) (Expenses $ 2,917,669 including grants of $   ) (Revenue $ 8,424,774 )
Noninvasive Cardiology
(Code:   ) (Expenses $ 2,769,690 including grants of $   ) (Revenue $ 4,299,229 )
Occupational Therapy
(Code:   ) (Expenses $ 2,472,573 including grants of $   ) (Revenue $ 5,052,794 )
Nuclear Medicine
(Code:   ) (Expenses $ 2,226,970 including grants of $   ) (Revenue $   )
Security
(Code:   ) (Expenses $ 1,481,385 including grants of $   ) (Revenue $   )
Medical Staff
(Code:   ) (Expenses $ 1,479,327 including grants of $   ) (Revenue $   )
Central Supply
(Code:   ) (Expenses $ 998,961 including grants of $   ) (Revenue $   )
Social Services
(Code:   ) (Expenses $ 909,364 including grants of $   ) (Revenue $ 638,483 )
Speech Therapy
(Code:   ) (Expenses $ 841,358 including grants of $   ) (Revenue $   )
Medical Based Fitness Center
(Code:   ) (Expenses $ 582,215 including grants of $   ) (Revenue $   )
Cancer
(Code:   ) (Expenses $ 540,021 including grants of $   ) (Revenue $   )
Public Relations
(Code:   ) (Expenses $ 392,928 including grants of $   ) (Revenue $   )
Audiology
(Code:   ) (Expenses $ 389,317 including grants of $   ) (Revenue $ 1,748,176 )
EEG
(Code:   ) (Expenses $ 80,000 including grants of $ 80,000 ) (Revenue $   )
Grants and Allocations
(Code:   ) (Expenses $ 4,406 including grants of $   ) (Revenue $   )
Occupational Health
4d Other program services (Describe in Schedule O.)
(Expenses $ 253,017,227 including grants of $ 80,000 ) (Revenue $ 294,953,584 )
4e Total program service expensesMediumBullet$ 405,146,604
Form 990 (2011)
Form 990 (2011)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment........
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part IIClick to see attachment.........................
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part III........................
5
 
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part IClick to see attachment....................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IVClick to see attachment...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
Yes
 
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
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, investment, and program service activities outside the United States or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Part I.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II..
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III..
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II..........
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H..... Click to see attachment
20a
Yes
 
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statement to this return? Note. All Form 990 filers that operated one or more hospitals must attach audited financial statements. Click to see list of attachments
20b
Yes
 
Form 990 (2011)
Form 990 (2011)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.. Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III..... Click to see attachment
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
 
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I...... Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................ Click to see attachment
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II......................... Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III......... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ......................... Click to see attachment
28a
Yes
 
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.. Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, 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
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2........... Click to see attachment
36
Yes
 
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2011)
Form 990 (2011)
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
215
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
3,490
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 (2011)
Form 990 (2011)
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
If the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
1a
22
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
10
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
Yes
 
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
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? .................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ............
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
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes? ....
10b
 
 
11a
Has the organization provided a complete 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
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done ....................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
 
No
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes," to line 15a or 15b, 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,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take 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
IN
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 made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
MARY ANN SHACKLETT
10010 DONALD S POWERS DRIVE
Munster,IN463212959
(219) 934-8250
Form 990 (2011)
Form 990 (2011)
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 (do not check more than one box, unless person is both an officer and a director/trustee) 		(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) THOMAS BRUBAKER MD
DIRECTOR
 1.0 X           14,361 0 0
(2) STEVE CHOVANEC
DIRECTOR
 1.0 X           0 0 0
(3) ERIC COMPTON DDS
DIRECTOR
 1.0 X           0 0 0
(4) FRANKIE FESKO
DIRECTOR
 1.0 X           18,000 79,967 0
(5) WILLIAM HASSE III
DIRECTOR
 1.0 X           0 31,100 0
(6) DON HENRY MD
DIRECTOR
 1.0 X           0 0 0
(7) R LITCHFIELD DO
DIRECTOR
 1.0 X           0 3,488 0
(8) S N MAKAM MD
DIRECTOR
 1.0 X           1,320 36,980 0
(9) DONNA PANICH
DIRECTOR
 1.0 X           0 0 0
(10) GAYLE PARR
DIRECTOR
 1.0 X           0 0 0
(11) DONALD S POWERS
DIRECTOR
 1.0 X           0 1,217,604 48,265
(12) HON JAMES RICHARDS
DIRECTOR
 1.0 X           24,000 47,542 0
(13) NITIN SARDESAI MD
DIRECTOR
 1.0 X           0 0 0
(14) WILLIAM SCHENCK
DIRECTOR
 1.0 X           0 40,042 0
(15) M NABIL SHABEEB MD FACS
DIRECTOR
 1.0 X           0 28,000 0
(16) DONALD TORRENGA
DIRECTOR
 1.0 X           0 49,854 0
(17) JAY ZANDSTRA
DIRECTOR
 1.0 X           0 26,500 0
Form 990 (2011)
Form 990 (2011)
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 (do not check more than one box, unless person is both an officer and a director/trustee) 		(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 WICKLAND
PRESIDENT
 1.0 X   X       24,000 47,542 0
(19) JOSEPH MORROW
VICE PRESIDENT
 1.0 X   X       0 16,300 0
(20) RICHARD MCLAUGHRY
SECRETARY
 1.0 X   X       0 68,542 0
(21) DAVID BOCHNOWSKI
TREASURER
 1.0 X   X       0 28,200 0
(22) DONALD P FESKO
ADMINISTRATOR
 41.0 X   X       0 502,726 40,256
(23) MARY ANN SHACKLETT
SR VP & SYSTEM CFO
 1.0     X       0 546,591 56,960
(24) LUIS MOLINA
VP OF FINANCE/CFO
 40.0     X       489,018 0 60,156
(25) RONDA MCKAY
VP & CNO
 40.0     X       244,532 0 9,790
(26) MARC LEVIN MD
PHYSICIAN
 40.0         X   1,159,623 0 39,699
(27) WAYEL KAAKAJI MD
PHYSICIAN
 40.0         X   1,100,540 0 7,770
(28) MOHAMMAD SHUKAIRY MD
PHYSICIAN
 40.0         X   728,472 0 20,129
(29) DOUGLAS DEDELOW DO
PHYSICIAN
 40.0         X   584,601 10,614 34,457
(30) RICHARD BERKOWITZ MD
MEDICAL DIRECTOR
 40.0         X   541,986 0 62,543
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 4,930,453 2,781,592 380,025
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet199
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
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
Yes
 
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. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
Rehabcare Group Inc
PO Box 502096
ST LOUIS,MO63150 		Rehab Care Services 4,415,220
Siemens Medical Solutions
51 Valley Stream Parkway
MALVERN,PA19355 		Medical Svcs/Repairs 1,270,453
Franciscan ST Margaret Health
5454 Hohman Avenue
HAMMOND,IN46320 		Laundry Services 1,228,818
Komyatte Casbon PC
9650 Gordon Drive
HIGHLAND,IN46322 		Collections 1,205,013
TRC Indiana LLC
PO BOX 403008
ATLANTA,GA303843008 		Dialysis Services 1,075,517
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet44
Form 990 (2011)
Form 990 (2011)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 472,329
e Government grants (contributions)1e 891,604
f All other contributions, gifts, grants, and
similar amounts not included above1f 		164,850
g Noncash contributions included in lines 1a-1f:$  
h Total. Add lines 1a-1f.......MediumBullet 1,528,783
Program Service Revenue Business Code
2a NET PATIENT SERVICE REVENUE 900,099 450,681,002 450,032,400 648,602  
b
c
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 450,681,002
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 391,576     391,576
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties............MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents 211,840  
b Less: rental expenses 144,168  
c Rental income or (loss) 67,672  
d Net rental income or (loss).......MediumBullet 67,672     67,672
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory   1,194,881
b Less: cost or other basis and sales expenses   518,250
c Gain or (loss)   676,631
d Net gain or (loss)..........MediumBullet 676,631     676,631
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 CAFETERIA SALES 722,210 1,925,115     1,925,115
b FITNESS/SPA POINT REVENUE 900,099 4,188,421 3,729,590 458,831  
c PHARMACY SALES 446,110 4,719,584 3,474,428 1,245,156  
d All other revenue .... 715,760 186,243   529,517
e Total. Add lines 11a–11d ......MediumBullet 11,548,880
12 Total revenue. See Instructions....MediumBullet 464,894,544 457,422,661 2,352,589 3,590,511
Form 990 (2011)
Form 990 (2011)
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).
Check if Schedule O contains a response to any question in this Part IX. .........
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 United States. See Part IV, line 21 80,000 80,000
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 0  
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16 0  
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 1,056,522 14,634 1,041,888  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 207,364 207,364    
7 Other salaries and wages 166,348,691 156,328,049 10,020,642  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 15,111,901 14,353,136 758,765  
9 Other employee benefits ....... 18,513,688 17,688,698 824,990  
10 Payroll taxes ........... 11,505,536 10,927,846 577,690  
11 Fees for services (non-employees):        
a Management ...... 2,456,575 2,231,661 224,914  
b Legal ......... 591,335   591,335  
c Accounting ........... 24,000   24,000  
d Lobbying ........... 5,549   5,549  
e Professional fundraising. See Part IV, line 17.. 0  
f Investment management fees ...... 0      
g Other .......... 20,756,937 16,828,417 3,928,520  
12 Advertising and promotion .... 712,582 542,244 170,338  
13 Office expenses ....... 8,500,151 7,427,170 1,072,981  
14 Information technology ...... 364,653 335,948 28,705  
15 Royalties .. 0      
16 Occupancy ........... 4,679,806 4,563,337 116,469  
17 Travel ............ 194,307 171,150 23,157  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 153,991 148,705 5,286  
20 Interest ........... 745,799 745,799    
21 Payments to affiliates ....... 2,316,756 1,972,840 343,916  
22 Depreciation, depletion, and amortization ..... 19,207,527 18,319,542 887,985  
23 Insurance .............. 3,293,478 3,176,045 117,433  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)
a MEDICAL SUUPLIES 79,800,541 79,800,541    
b CORP SUPP SRVCS ALLOCATION 43,121,620 40,956,495 2,165,125  
c MEDICAID ASSESSMENT FEE 20,587,824 20,587,824    
d LEASE & RENTALS 4,089,542 4,070,649 18,893  
e
f All other expenses 7,322,975 3,668,510 3,654,465  
25 Total functional expenses. Add lines 1 through 24f 431,749,650 405,146,604 26,603,046 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2011)
Form 990 (2011)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .......... 0 1 0
2 Savings and temporary cash investments ....... 19,602,283 2 13,076,610
3 Pledges and grants receivable, net ......... 1,845 3 0
4 Accounts receivable, net ......... 54,443,125 4 62,562,812
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L .......... 0 5 0
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 .......... 0 6 0
7 Notes and loans receivable, net ............. 0 7 0
8 Inventories for sale or use .............. 8,454,200 8 8,253,829
9 Prepaid expenses and deferred charges ............ 2,439,208 9 2,323,256
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 420,697,278
b Less: accumulated depreciation. ..... 10b 265,663,521 161,419,151 10c 155,033,757
11 Investments—publicly traded securities .......... 0 11 0
12 Investments—other securities. See Part IV, line 11 ...... 0 12 0
13 Investments—program-related. See Part IV, line 11 .. 0 13 0
14 Intangible assets ......... 0 14 0
15 Other assets. See Part IV, line 11 ........... 0 15 11,797,024
16 Total assets. Add lines 1 through 15 (must equal line 34)... 246,359,812 16 253,047,288
Liabilities 17 Accounts payable and accrued expenses . 42,403,656 17 42,618,032
18 Grants payable .......... 0 18 0
19 Deferred revenue .......... 91,824 19 72,826
20 Tax-exempt bond liabilities .......... 0 20 0
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L.......... 0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 0 23 0
24 Unsecured notes and loans payable to unrelated third parties .... 0 24 0
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D..... 80,816,973 25 123,958,577
26 Total liabilities. Add lines 17 through 25..... 123,312,453 26 166,649,435
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 ..... 122,421,865 27 85,890,135
28 Temporarily restricted net assets ..... 523,148 28 405,372
29 Permanently restricted net assets ..... 102,346 29 102,346
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 ..... 123,047,359 33 86,397,853
34 Total liabilities and net assets/fund balances ..... 246,359,812 34 253,047,288
Form 990 (2011)
Form 990 (2011)
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
464,894,544
2
Total expenses (must equal Part IX, column (A), line 25) ....
2
431,749,650
3
Revenue less expenses. Subtract line 2 from line 1 ...
3
33,144,894
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
123,047,359
5
Other changes in net assets or fund balances (explain in Schedule O) ...
5
-69,794,400
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
86,397,853
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 (2011)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
MUNSTER MEDICAL RESEARCH FOUNDATION INC
 
Employer identification number

35-1107009
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) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (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) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (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) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (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) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (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) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2011

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2011
Name of organization
MUNSTER MEDICAL RESEARCH FOUNDATION INC
 
Employer identification number

35-1107009
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 on line H of its
Form 990-EZ or on Part I, 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) (2011)

Page 2
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
MUNSTER MEDICAL RESEARCH FOUNDATION INC
  		Employer identification number

35-1107009
Part I
Contributors (see Instructions). Use duplicate copies of Part I if additional space is needed.
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total 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)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




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

     
 
   

$  




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

     
 
   

$  




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

     
 
   

$  




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

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 3
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
MUNSTER MEDICAL RESEARCH FOUNDATION INC
  		Employer identification number

35-1107009
Part II
Noncash Property (see Instructions). Use duplicate copies of Part II if additional space is needed.
     
(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) (2011)

Page 4
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
MUNSTER MEDICAL RESEARCH FOUNDATION INC
  		Employer identification number

35-1107009
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total 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 $  
Use duplicate copies of Part III if additional space is needed
(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) (2011)

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.
SchCMd Bullet Attach to Form 990 or Form 990-EZ. SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2011
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, line 35c (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
MUNSTER MEDICAL RESEARCH FOUNDATION INC
 
Employer identification number

35-1107009
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 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 function 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) 2011

Schedule C (Form 990 or 990-EZ) 2011
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 expenses, and share of excess lobbying expenditures).
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) 2008 (b) 2009 (c) 2010 (d) 2011 (e) Total
             
2a Lobbying non-taxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots nontaxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2011


Schedule C (Form 990 or 990-EZ) 2011
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)).
For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
Yes
No
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? ..........................
Yes
 
 
j
Total. Add lines 1c through 1i ...............................
 
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 carry over 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) and if either (a) BOTH Part III-A, lines 1 and 2 are answered “No” OR (b) Part III-A, line 3 is answered “Yes”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible 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, Part II-A; line 5; and Part ll-B, line 1.
Also, complete this part for any additional information.
Identifier Return Reference Explanation
SUPPLEMENTAL INFORMATION   PT II-B LINE 1I THE INDIANA HOSPITAL ASSOCIATION ESTIMATED THAT 5.44% OF ITS DUES ARE ATTRIBUTABLE TO LOBBYING.
Schedule C (Form 990 or 990EZ) 2011

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
MUNSTER MEDICAL RESEARCH FOUNDATION INC
 
Employer identification number

35-1107009
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 can 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 through 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, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax 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 (ASC 958), 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 (ASC 958), 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 (ASC 958), 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) 2011

Schedule D (Form 990) 2011
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 .... 96,330 86,723 96,624 107,819
b Contributions ........        
c Net investment earnings, gains, and losses ... -1,163 9,757 -9,751 -11,045
d Grants or scholarships .....        
e Other expenditures for facilities
and programs ........ 		       
f Administrative expenses .... -150 150 150 150
g End of year balance ...... 95,317 96,330 86,723 96,624
2
Provide the estimated percentage of the year end balance (line 1g) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet100.000 %
c
Temporarily restricted endowment SchDMd Bullet  
The percentages in lines 2a, 2b, and 2c should equal 100%.
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)
 
No
(ii) related organizations ........................
3a(ii)
 
No
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
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   2,809,397 2,809,397
b Buildings ................   288,221,965 173,218,712 115,003,253
c Leasehold improvements ............   1,070,558 844,596 225,962
d Equipment ................   118,842,728 85,347,138 33,495,590
e Other .................   9,752,630 6,253,075 3,499,555
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 155,033,757
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








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








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Book value
Federal Income Taxes 0
PENSION LIABILITY 99,045,891
EST 3RD PARTY SETTLEMENTS 14,074,505
DUE TO AFFILIATES 6,446,692
CAPITAL LEASES 4,034,324
ASSET RETIREMENT OBLIGATION 357,165




Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 123,958,577
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) 2011

Schedule D (Form 990) 2011
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1  
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2  
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3  
4 Net unrealized gains (losses) on investments .......................... 4  
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV.) ................................. 8  
9 Total adjustments (net). Add lines 4 through 8 ......................... 9  
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10  
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIV.) ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total Revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIV.) ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIV.) ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIV
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
SUPPLEMENTAL INFORMATION   PT V LINE 4 ENDOWMENT FUNDS ARE TO BE USED TO SUPPORT THE NEEDS OF MMRF, INC PT X THE ADOPTION OF ASC 740 DID NOT MATERIALLY IMPACT THE FINANCIAL STATEMENTS
Schedule D (Form 990) 2011

Additional Data


Software ID:  
Software Version:  




SCHEDULE H (Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
MUNSTER MEDICAL RESEARCH FOUNDATION INC
 
Employer identification number

35-1107009
Part I
Charity Care and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a....
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Did the organization use FPG to determine eligibility for providing discounted care? If "Yes," indicate which of the
following was the family income limit for eligibility for discounted care: ............
3b
Yes
 
c
If the organization did 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 used an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount?......
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care?...............
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year?...........
6a
Yes
 
b
If "Yes," did 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
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance
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 Financial Assistance at cost
(from Worksheet 1) .. 		  6,200 6,457,071 67,737 6,389,334 1.480 %
b Medicaid (from Worksheet 3, column a) .....   30,456 55,269,942 33,693,140 21,576,802 5.000 %
c Costs of other means-tested government programs (from Worksheet 3, column b) .            
dTotal Financial Assistance and
Means-Tested Government Programs ..... 		  36,656 61,727,013 33,760,877 27,966,136 6.480 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) .... 		107 14,115 599,770 13,164 586,606 0.140 %
f Health professions education
(from Worksheet 5) .. 		34 657 520,016   520,016 0.120 %
g Subsidized health services
(from Worksheet 6) .. 		  892 1,831,184 1,301,951 529,233 0.120 %
h Research (from Worksheet 7)   11,186 1,077,809 252,871 824,938 0.190 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) .... 46   196,257 1,047 195,210 0.050 %
jTotal Other Benefits ... 187 26,850 4,225,036 1,569,033 2,656,003 0.620 %
kTotal. Add lines 7d and 7j. .. 187 63,506 65,952,049 35,329,910 30,622,139 7.100 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support     87,573 38,275 49,298 0.010 %
4 Environmental improvements            
5 Leadership development and training for community members     10,101   10,101  
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total     97,674 38,275 59,399 0.010 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did 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........
2
6,359,033
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy .....
3
63,590
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
173,369,527
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
209,642,006
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
-36,272,479
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
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures
(see instructions)
(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) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size 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 MUNSTER MEDICAL RESEARCH FOUNDATION INC
901 MACARTHUR BOULEVARD
MUNSTER,IN46321 		X X         X    
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
MUNSTER MEDICAL RESEARCH FOUNDATION INC
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?19
Name and address Type of Facility (describe)
1 COMMUNITY SURGERY CENTER
801 MACARTHUR BLVD
MUNSTER,IN46321 		OP SURGERY CENTER
2 COMMUNITY CARDIOLOGY CENTER
801 MACARTHUR BLVD
MUNSTER,IN46321 		CARDIAC CATH LAB
3 COMMUNITY DIAGNOSTIC CENTER
10020 DONALD S POWERS DRIVE
MUNSTER,IN46321 		OP ANCILLARY SERVICE
4 ST JOHN OUTPATIENT CENTER
9660 WICKER AVE
ST JOHN,IN46373 		OP ANCILLARY SERVICES & PHYSICIAN PRACTICE
5 FITNESS POINTE
9550 CALUMET AVE
MUNSTER,IN46321 		CARDIAC REHAB SERVICES
6 COMMUNITY SPINE & NEUROSURGERY INSTITUTE
801 MACARTHUR BLVD SUITE 405
MUNSTER,IN46321 		PHYSICIAN PRACTICE
7 HOEHN MEDICAL GROUP
505 W LINCOLN HWY
SCHERERVILLE,IN46375 		PHYSICIAN PRACTICE
8 COMMUNITY CARE CENTER FOR WOMEN
9100 COLUMBIA AVE
MUNSTER,IN46321 		PHYSICIAN PRACTICE
9 COMMUNITY CARE CENTER FOR WOMEN
929 RIDGE ROAD
MUNSTER,IN46321 		PHYSICIAN PRACTICE
10 COMMUNITY CARE CENTER FOR WOMEN
800 MACARTHUR BLVD SUITE 6
MUNSTER,IN46321 		PHYSICIAN PRACTICE
11 COMMUNITY CARE CENTER
13963 MORSE STREET
CEDAR LAKE,IN46303 		PHYSICIAN PRACTICE
12 COMMUNITY CARE NETWORK INTERNISTS
9122 COLUMBIA AVE
MUNSTER,IN46321 		PHYSICIAN PRACTICE
13 FAMILY CARE CENTER
8731 INDIANAPOLIS BLVD
HIGHLAND,IN46322 		PHYSICIAN PRACTICE
14 COMMUNITY CARE CENTER
800 MACARTHUR BLVD SUITE 11
MUNSTER,IN46321 		PHYSICIAN PRACTICE
15 COMMUNITY CARE NETWORK
1650 45TH STREET SUITE C
MUNSTER,IN46321 		PHYSICIAN PRACTICE
16 COMMUNITY CARE CENTER FOR WOMEN
9124A COLUMBIA AVE
MUNSTER,IN46321 		PHYSICIAN PRACTICE
17 COMMUNITY CARE NETWORK
9307 CALUMET AVE Suite 2A
MUNSTER,IN46321 		PHYSICIAN PRACTICE
18 COMMUNITY SPINE & NEUROSURGERY INSTITUTE
1600 SOUTH LAKE PARK AVE SUITE 11
HOBART,IN46342 		PHYSICIAN PRACTICE
19 COMMUNITY HOME HEALTH SERVICES
9104 COLUMBIA AVE
MUNSTER,IN46321 		HOME HEALTH
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the descriptions 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, 3, 4, 5c, 6i, 7, 9, 10, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Identifier ReturnReference Explanation
PART I, LINE 6A   N/A
PART I, LINE 7G   COMPLETED THE IRS WORKSHEETS AND USED COST ACCOUNTING FOR THE METHODOLOGY. WE DID NOT INCLUDE ANY PHYSICIAN PRACTICE INFORMATION WHEN CALCULATING SUBSIDIZED SERVICES.
PART I, LINE 7, COLUMN F   BAD DEBT OF $19,799,032 IS EXCLUDED FROM THE CALCULATION.
PART I, LINE 7A   THE METHODOLOGY USED TOOK THE FINANCIAL STATEMENT COST TO CHARGE RATIO AND MULTIPLIED IT BY THE RELATED CHARGES. THIS NUMBER WAS THEN REDUCED BY THE ACTUAL PAYMENT RECEIVED.
PART II   COMMUNITY HOSPITAL PROVIDES SUPPORT FOR BIOTERRORISM READINESS. THESE MEASURES HELP ENSURE THE SAFETY OF THE PATIENTS AND THE COMMUNITY IN THE EVENT OF A BIOTERRORISM EVENT. ALSO INCLUDED HERE ARE COSTS TO PROVIDE INTERPRETERS FOR PATIENTS WHO ARE DEAF.
PART III, LINE 4   COMMUNITY HOSPITAL EVALUATES THE COLLECTIBILITY OF ITS ACCOUNTS RECEIVABLE BASED ON THE LENGTH OF TIME THE RECEIVABLE IS OUTSTANDING AND THE ANTICIPATED FUTURE UNCOLLECTIBLE AMOUNTS BASED ON HISTORICAL EXPERIENCE. ACCOUNTS RECEIVABLE ARE CHARGED TO THE ALLOWANCE FOR DOUBTFUL ACCOUNTS WHEN THEY ARE DEEMED UNCOLLECTIBLE. COMMUNITY HOSPITAL DOES NOT REQUIRE COLLATERAL. THE FINANCIAL STATEMENT COST-TO-CHARGE RATIO WAS USED TO CALCULATE THE ESTIMATED COST OF BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS THAT ARE REPORTED ON LINE 2. DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS ARE RECORDED AS AN ADJUSTMENT TO REVENUE, NOT BAD DEBT EXPENSE. AS A TAX-EXEMPT HOSPITAL, WE MUST PROVIDE NECESSARY SERVICES REGARDLESS OF THE PATIENT'S ABILITY TO PAY FOR THE SERVICE PROVIDED. WE ESTIMATED A PERCENTAGE OF BAD DEBTS BASED UPON THE PORTION OF UNINSURED INDIVIDUALS THAT WOULD BE ELIGIBLE FOR THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. THIS AMOUNT ENTERED ON PART III, LINE 3 SHOULD BE COUNTED AS A COMMUNITY BENEFIT.
PART III, LINE 8   THE TOTAL REVENUE RECEIVED FROM MEDICARE WAS CALCULATED BY USING THE COST TO CHARGE RATIO. WE PROVIDE NECESSARY SERVICES REGARDLESS OF THE PATIENT'S ABILITY TO PAY FOR THE SERVICE PROVIDED OR THE REIMBURSEMENT RECEIVED FROM MEDICARE, QUALIFYING THE $36,272,479 OF MEDICARE SHORTFALL AS A COMMUNITY BENEFIT.
PART III, LINE 9B   COLLECTION POLICIES ARE THE SAME FOR ALL PATIENTS. PATIENTS ARE SCREENED FOR ELIGIBILITY FOR FINANCIAL ASSISTANCE BEFORE COLLECTION PROCEDURES BEGIN. IF AT ANY POINT IN THE COLLECTION PROCESS, DOCUMENTATION IS RECEIVED THAT INDICATES THE PATIENT IS POTENTIALLY ELIGIBLE FOR FINANCIAL ASSISTANCE BUT HAS NOT APPLIED FOR IT, THE ACCOUNT IS REFERRED BACK FOR A FINANCIAL ASSISTANCE REVIEW.
PART V, LINE 1J   N/A
PART V, LINE 3   N/A
PART V, LINE 4   N/A
PART V, LINE 5C   N/A
PART V, LINE 6I   N/A
PART V, LINE 7   N/A
PART V, LINE 11H   N/A
PART V, LINE 13G   N/A
PART V, LINE 15E   N/A
PART V, LINE 16E   N/A
PART V, LINE 17E   N/A
PART V, LINE 18D   N/A
PART V, LINE 19D   Our maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care is based on a sliding scale. Up to 200% of federal poverty guidelines (FPG) is 100% free care. 201% -250% is charged based on Medicare rates. 251%-300% is charged based on average of lowest managed care rates. 301%-400% is charged based on average managed care rates.
PART V, LINE 20   N/A
PART V, LINE 21   N/A
NEEDS ASSESSMENT   COMMUNITY HOSPITAL USES A THIRD-PARTY CONSULTING FIRM TO ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITY. COMMUNITY HOSPITAL SERVES ONE OF THE LARGEST POPULATIONS IN NW INDIANA AND IS THE OLDEST POPULATION IN THE AREA WITH AN EXPECTED LOSS OF POPULATION IN THE NEXT FIVE YEARS. COMMUNITY HAS DOMINANT MARKET POSITION IN ALL PRODUCT LINES AND CONTINUES TO SEE GROWTH IN AREAS SUCH AS ORTHOPEDICS, ONCOLOGY AND GENERAL SURGERY.
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE   PATIENTS WHO ARE ADMITTED WITHOUT INSURANCE ARE REFERRED TO THE HOSPITAL'S FINANCIAL COUNSELORS. THE FINANCIAL COUNSELORS PERFORM AN INTERVIEW WITH THE PATIENT TO EXPLAIN TO THEM THE PROCESS NECESSARY TO RECEIVE FINANCIAL ASSISTANCE. THIS PROCESS INCLUDES APPLYING FOR MEDICAID OR OTHER GOVERNMENT AID. THE APPLICANT THEN MUST FILL OUT A FINANCIAL INFORMATION WORKSHEET AND SUBMIT VARIOUS INFORMATION TO DETERMINE IF THEY QUALIFY FOR FINANCIAL ASSISTANCE IN ACCORDANCE WITH THE FINANCIAL ASSISTANCE POLICY. THE FINANCIAL ASSISTANCE POLICY IS POSTED AT EACH INPATIENT WAITING DESK.
COMMUNITY INFORMATION   THE COMMUNTIY SERVED INCLUDES NORTHWEST INDIANA AND ADJACENT COMMUNITIES IN ILLINOIS. OUR MARKET SHARE FOR THE CORE AREA IS 72.2%. THE POPULATION IS OLDER THAN MOST MARKETS BUT HAS A HIGHER MEDIAN HOUSEHOLD INCOME. COMMUNITY'S POPULATION CONSISTS OF AN UNINSURED POPULATION OF 9.9% AND MEDICAID OF 11.3%.
PROMOTION OF COMMUNITY HEALTH   SEE COMMUNITY BENEFITS STATEMENT IN SCHEDULE O.
AFFILIATED HEALTH CARE SYSTEM   COMMUNITY HOSPITAL IS PART OF AN AFFILIATED SYSTEM. EACH HOSPITAL IN THE SYSTEM PROVIDES MEDICAL SERVICES TO THEIR COMMUNITIES AND ADJOINING COMMUNITIES. EACH ENTITY'S PURPOSE IS TO PROVIDE HEALTH CARE TO THOSE WHO NEED IT, INCLUDING THE UNINSURED OR UNDERINSURED.
PART III, LINE 7   Cost Report (12,666,442) Physician practices (5,436,908) Medicare Managed Care (1,775,209) Fee-based Outpatient charges (5,940,264) Disallowed Medicare expenses (10,453,656) Total (Shortfall) (36,272,479)
Part III, Line 2   Bad Debt of 19,799,032 was multiplied by the cost to charge ratio, resulting in 6,359,033 in Bad Debt at cost.
Schedule H (Form 990) 2011
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
MUNSTER MEDICAL RESEARCH FOUNDATION INC
 
Employer identification number
35-1107009
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
(1) THEATER AT THE CENTER905 RIDGE ROAD
MUNSTER,IN46321 		35-1939427 501(C)(3) 80,000   CASH   FINANCIAL ASSISTANCE






















2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
1
3
Enter total number of other organizations listed in the line 1 table ......................... . Bullet Image
 
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2011

Schedule I (Form 990) 2011
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
SUPPLEMENTAL INFORMATION   PT I LINE 2 GRANT IS PROVIDED TO RELATED TAX-EXEMPT ORGANIZATION TO FINANCIALLY ASSIST IN IT'S EXEMPT PURPOSE
Schedule I (Form 990) 2011


Additional Data


Software ID:  
Software Version:  


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
MUNSTER MEDICAL RESEARCH FOUNDATION INC
 
Employer identification number

35-1107009
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 or provision of all the expenses described above? If "No," complete Part III to explain....
1b
Yes
 
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
Yes
 
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. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
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
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
 
No
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations 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) 2011

Schedule J (Form 990) 2011
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is 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) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and column (E) for that individual.
(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 as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) DONALD S POWERS (i)
(ii)		 0
937,646 		0
273,214 		0
6,744 		0
34,787 		0
13,478 		0
1,265,869 		0
0
(2) HON JAMES RICHARDS (i)
(ii)		 24,000
47,542 		0
0 		0
0 		0
0 		0
0 		24,000
47,542 		0
0
(3) DONALD P FESKO (i)
(ii)		 0
429,074 		0
47,868 		0
25,784 		0
13,653 		0
26,603 		0
542,982 		0
0
(4) MARY ANN SHACKLETT (i)
(ii)		 0
369,682 		0
148,077 		0
28,832 		0
34,787 		0
22,173 		0
603,551 		0
0
(5) LUIS MOLINA (i)
(ii)		 331,876
0 		146,250
0 		10,892
0 		41,828
0 		18,328
0 		549,174
0 		0
0
(6) RONDA MCKAY (i)
(ii)		 191,508
0 		51,239
0 		1,785
0 		7,161
0 		2,629
0 		254,322
0 		0
0
(7) MARC LEVIN MD (i)
(ii)		 1,136,265
0 		0
0 		23,358
0 		18,350
0 		21,349
0 		1,199,322
0 		0
0
(8) WAYEL KAAKAJI MD (i)
(ii)		 1,100,000
0 		0
0 		540
0 		7,350
0 		420
0 		1,108,310
0 		0
0
(9) MOHAMMAD SHUKAIRY MD (i)
(ii)		 727,986
0 		0
0 		486
0 		8,124
0 		12,005
0 		748,601
0 		0
0
(10) DOUGLAS DEDELOW DO (i)
(ii)		 378,309
10,614 		193,678
0 		12,614
0 		10,339
0 		24,118
0 		619,058
10,614 		0
0
(11) RICHARD BERKOWITZ MD (i)
(ii)		 540,744
  		0
0 		1,242
0 		34,787
0 		27,756
0 		604,529
0 		0
0





Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
SUPPLEMENTAL INFORMATION PT 1 LINE 1A THE ORGANIZATION PAYS HEALTH/SOCIAL CLUB DUES ON BEHALF OF THE INDIVIDUAL WHICH IS THEN TAXED AS A FRINGE BENEFIT TO THE INDIVIDUAL.
Schedule J (Form 990) 2011

Additional Data


Software ID:  
Software Version:  
Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBulletSee separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
MUNSTER MEDICAL RESEARCH FOUNDATION INC
 
Employer identification number

35-1107009
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
Total ...............Small Bullet $  
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) 2011
Schedule L (Form 990 or 990-EZ) 2011
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) COMMUNITY CARDIOLOGY CENTER SN MAKAM PRTNR MORE THAN 5,876,342 INDEPENDENT CONTRACTOR   No
(2) COMM CARD CTNR CON'T 5% OWNED   INDEPENDENT CONTRACTOR    
(3) SARN II DR. SHABEEB PART-OWNER 176,932 RENTAL OF OFFICE SPACE   No
(4) CARDIOLOGY ASSOC OF NW IN SN MAKAM OFFICER 131,845 INDEPENDENT CONTRACTOR   No
(5) HASSE CONSTRUCTION OWNED BY WILLIAM HASSE 43,430 INDEPENDENT CONTRACTOR   No
(6) KAY TORRENGA FAM MEM OF DONALD TORRENG 68,230 EMPLOYMENT   No
(7) GARY MCKAY FAM MEM OF RONDA MCKAY 64,921 EMPLOYMENT   No
(8) STEVEN PAUL CHOVANEC FAM MEM STEVEN G CHOVANEC 47,452 EMPLOYMENT   No
(9) SYLVIA HENRY FAM MEM OF DR. DON HENRY 26,762 EMPLOYMENT   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) 2011

Additional Data


Software ID:  
Software Version:  




SCHEDULE O
(Form 990 or 990-EZ)

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

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
MUNSTER MEDICAL RESEARCH FOUNDATION INC
 
Employer identification number

35-1107009
Identifier Return Reference Explanation
FAMILY OR BUSINESS RELATIONSHIPS PT VI-A, LINE 2 FRANKIE FESKO, FAMILY MEMBER OF DONALD S. POWERS AND DONALD P. FESKO. PAULA NELLANS, FAMILY MEMBER OF DAVID NELLANS.
DESCRIPTION OF THE CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS PT VI-A, LINE 7A COMMUNITY FOUNDATION OF NORTHWEST INDIANA, INC IS THE PARENT COMPANY OF MUNSTER MEDICAL RESEARCH FOUNDATION, INC AND HAS CONTROL TO ELECT MEMBERS OF THEIR GOVERNING BODY.
DESCR CLASSES OF PERSONS, DECISIONS REQUIRING APPR & TYPE OF VOTING RIGHTS PT VI-A, LINE 7B COMMUNITY FOUNDATION OF NORTHWEST INDIANA, INC IS THE PARENT COMPANY OF MUNSTER MEDICAL RESEARCH FOUNDATION, INC AND HAS RIGHTS TO APPROVE DECISIONS MADE BY MMRF.
DESCRIBE THE PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990 PT VI-A, LINE 11A THE 990 IS SUBMITTED TO THE SENIOR VP AND CFO FOR REVIEW. ONCE THIS REVIEW IS COMPLETE THE RETURNS ARE THEN PRESENTED TO SENIOR LEADERSHIP TO REVIEW. THE 990 IS ALSO REVIEWED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM BEFORE IT IS POSTED TO A SECURE WEBSITE TO ALLOW THE BOARD OF DIRECTORS TO REVIEW PRIOR TO FILING.
DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST PT VI-B, LINE 12C AN OFFICER, DIRECTOR OR KEY EMPLOYEE THAT HAS A POTENTIAL CONFLICT OF INTEREST IS REQUIRED TO DISCLOSE THIS, AND THE BOARD OF DIRECTORS, ONE OF THEIR COMMITTEES, OR A DESIGNATED PERSON (SUCH AS THE CHIEF COMPLIANCE OFFICER) WILL REVIEW THE POTENTIAL CONFLICT OF INTEREST TO DETERMINE IF IT EXISTS. IF IT DOES EXIST, THE INVOLVED DIRECTOR, OFFICER OR KEY EMPLOYEE IS ASKED TO LEAVE THE MEETING WITH NO VOTE ON THE TOPIC. THE MEETING MINUTES WILL REFLECT THAT THE INVOLVED PERSON MADE THE DISCLOSURE, LEFT THE MEETING AND HAD NO VOTE. AS PART OF THE ORGANIZATION'S ANNUAL MONITORING & ENFORCEMENT PROCEDURE RELATING TO ITS CONFLICT OF INTEREST POLICY, ALL CONFLICT OF INTEREST QUESTIONNAIRES ARE REVIEWED AND THOSE OFFICERS, DIRECTORS OR KEY EMPLOYEES WHO DO NOT RETURN OR FULLY COMPLETE THE QUESTIONNAIRE ARE CONTACTED TO RECONCILE THE OMISSION.
OFFICES & POSITIONS FOR WHICH PROCESS WAS USED, & YEAR PROCESS WAS BEGUN PT VI-B, LINE 15 CH FOLLOWS THE PARENT (CFNI) POLICY. THE SALARY AND BENEFIT COMMITTEE OF THE CFNI BOARD REQUESTS A REVIEW OF THE COMPENSATION AND BENEFITS TO ASSESS THE REASONABLENESS COMPARED TO MARKET DATA ASSEMBLED BY AN INDEPENDENT THIRD PARTY COMPENSATION CONSULTING FIRM. THEIR PROCESS FOR COLLECTING AND ASSEMBLING MARKET DATA ARE CONSISTENT WITH THE REBUTTABLE PRESUMPTION CHECKLIST AND FAIR MARKET VALUE USED BY THE IRS IN CONDUCTING EXECUTIVE COMPENSATION REVIEWS AS WELL AS CONTEMPORARY COMPENSATION PRACTICES. ALL MARKET DATA ARE ASSEMBLED FROM REPUTABLE, COMMERCIALLY-AVAILABLE SURVEYS.
AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMTS TO GEN PUBLIC PT VI-C, LINE 19 MUNSTER MEDICAL RESEARCH FOUNDATION, INC DOES NOT MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. IN ACCORDANCE WITH BOND COVENANTS, MMRF THROUGH CFNI MAKES IT FINANCIAL STATEMENTS AND DISCLOSURES AVAILABLE TO THE PUBLIC THROUGH THE EMMA DATABASE.
PROGRAM SERVICE ACCOMPLISHMENTS PART III, LINE 4A THE DESIGNATED POPULATION THAT THE COMMUNITY HOSPITAL IS FOCUSING ON INCLUDES THOSE INDIVIDUALS WHOSE LIFE-STYLE BEHAVIORS PUT THEM AT RISK FOR DISEASE AND ILLNESS. OUR PRIMARY FOCUS CONTINUES THIS YEAR ON TWO DISEASES THAT HAVE BEEN IDENTIFIED AS HEALTH DISCREPANCIES IN LAKE COUNTY, INDIANA - CANCER AND HEART DISEASE. THE INCIDENCE OF THESE DISEASES IN OUR REGION SURPASSED STATE AND NATIONAL AVERAGES, AND THEREFORE DEMANDED OUR PRIMARY FOCUS. THE COMMUNITY HOSPITAL HAS INVESTED GREATLY IN RECENT YEARS IN THESE TREATMENT PROGRAMS AND IN OFFERING PATIENTS ACCESS TO TREATMENTS NOT AVAILABLE ELSEWHERE IN THE COUNTY. THE FOCUS OF OUR COMMUNITY BENEFIT IS TO USE RESOURCES TO REACH BEYOND THE TREATMENT OF THESE DISEASES TO HELP EDUCATE, SUPPORT AND EMPOWER INDIVIDUALS TO LOWER THEIR RISKS. I. 2011-2012 ANNUAL PROGRESS REPORT A. THE COMMUNITY HOSPITAL FITNESS POINTE THE GOAL OF FITNESS POINTE IS TO PROVIDE OPPORTUNITIES FOR PERSONS OF NORTHWEST INDIANA TO IMPROVE AND MAINTAIN THEIR HEALTHY LIFE-STYLE HABITS, LOWERING THEIR RISKS FOR HEART DISEASE, STROKES, AND DIABETES. THE FACILITY WAS DEVELOPED TO ADDRESS FINDINGS OF OUR 1995 HEALTH ASSESSMENT THAT IDENTIFIED OPPORTUNITIES TO IMPROVE THE HEALTH STATUS OF OUR COMMUNITY. THE COMMUNITY HOSPITAL OPENED FITNESS POINTE ON NOVEMBER 1, 1998. THE 73,191 SQ. FT. FACILITY HOUSES THE HOSPITAL'S OUTPATIENT PHYSICAL THERAPY , OUTPATIENT DIETARY COUNSELING,OUTPATIENT DIABETIC EDUCATION, CARDIAC REHABILITATION PHASE III AND REHAB PLUS, AND THE FITNESS POINTE DEPARTMENTS. FITNESS POINTE PROGRAMS ADDRESS HEALTH EDUCATION/WELLNESS, AND FITNESS-RELATED CONTENT AREAS. THE COMMUNITY EDUCATION OFFERINGS AND THE CONTRIBUTIONS OF THE HOSPITAL EMPLOYEES AND MEDICAL STAFF ARE VITAL PIECES IN ADDRESSING THE HEALTH DISPARITIES IN LAKE COUNTY, SUPPORTING A VARIETY OF DISEASE PREVENTION GOALS. MANY OF THE COMMUNITY EDUCATION CLASSES ORIGINALLY DEVELOPED AT FITNESS POINTE ARE NOW ALSO OFFERED AT THE COMMUNITY HOSPITAL OUTPATIENT CENTRE IN ST. JOHN, FURTHER EXPANDING THE SCOPE OF SERVICES. HEALTH EDUCATION/WELLNESS SERVICES THE COMMUNITY HEALTH ASSESSMENT INDICATED LAKE COUNTY RESIDENTS HAVE INCREASED RISK FOR HEART DISEASE AND CANCER COMPARED TO STATE AND NATIONAL STATISTICS. A VARIETY OF HEALTH EDUCATION AND WELLNESS PROGRAMS ARE OFFERED TO THE COMMUNITY AT LITTLE OR NO CHARGE TO IMPROVE KNOWLEDGE AND AWARENESS OF LIFE-STYLE RELATED RISKS FOR THESE DISEASES. FITNESS POINTE PROVIDES A SUPPORTIVE ENVIRONMENT FOR AREA RESIDENTS TO MAINTAIN HEALTHY HABITS. RESEARCH INDICATES CERTAIN INDIVIDUALS ARE AT GREATER RISK FOR LIFE-STYLE RELATED DISEASES SUCH AS HEART DISEASE AND DIABETES BASED ON PHYSICAL MEASURES. FITNESS POINTE SCREENINGS FOR THESE RISKS DURING MANDATORY FITNESS PROFILES ARE PERFORMED ON ALL NEW PROGRAM PARTICIPANTS. IN A STUDY IN CONJUNCTION WITH VALPARAISO UNIVERSITY AND THE HEART CENTER AT COMMUNITY, FITNESS POINTE IDENTIFIED 1,321 INDIVIDUALS AT A SIGNIFICANTLY INCREASED RISK FOR DIABETES AND HEART DISEASE. OF THESE INDIVIDUALS, 700 OF THEM AT THE HIGHEST RISK LEVELS FOR HEART DISEASE AND DIABETES WERE INVITED TO UNDERGO ADDITIONAL SCREENING FOR BLOOD CHOLESTEROL, BODY MASS INDEX AND BLOOD PRESSURE. SOME OTHERS AT MODERATE TO HIGH RISK WERE TARGETED, THROUGH ADDITIONAL SCREENING AND LIFE-STYLE MODIFICATION, FOR INTERVENTION TO REDUCE THEIR RISK OF DISEASE. WITH 25% OF WHITE CHILDREN AND 33% OF AFRICAN AMERICAN AND HISPANIC CHILDREN BEING OVERWEIGHT ACCORDING TO 2001 STATISTICS, FITNESS POINTE HAS DEVELOPED PROGRAMS TO HELP ADDRESS THIS ISSUE. TEENS GET FIT IS AN EXERCISE AND NUTRITION INFORMATION PROGRAM THAT TARGETS 12-15 YEAR OLDS, PROVIDING A SETTING TO HELP MODIFY POOR HEALTH HABITS. "FIT TRIP" IS A PROGRAM THAT BRINGS 1ST-3RD GRADE STUDENTS TO FITNESS POINTE FOR A 90 MINUTE INTRODUCTION AND EXPERIENCE WITH DIFFERENT TYPES OF EXERCISE COMBINED WITH BASIC NUTRITION TIPS. "TAKE 5 FOR LIFE" IS A PROGRAM DEVELOPED FOR 5TH GRADERS TO TEACH GOOD HEALTH, NUTRITION AND FITNESS HABITS WITHIN THE SCHOOL SETTING, AS WELL AS TO ENCOURAGE ACTIVITY. BASED ON THE HEALTH NEEDS AND INTERESTS OF THOSE PROGRAM ATTENDEES, PROGRAMS WERE DEVELOPED IN THE AREAS OF: WOMEN'S HEALTH, NUTRITION AND HEALTHY COOKING, RELAXATION, WEIGHT MANAGEMENT, SENIOR HEALTH, BACK AND OTHER ORTHOPEDIC HEALTH ISSUES, DIABETES MANAGEMENT, CANCER AWARENESS AND PREVENTION, HEART DISEASE RISK FACTOR AWARENESS AND SCREENING, MENTAL HEALTH, AND SMOKING CESSATION. A SPECIALIZED FITNESS AND NUTRITION PROGRAM CALLED TEENS GET FIT GEARED TOWARD NUTRITIONALLY CHALLENGED OR OVERWEIGHT 12-15 YEAR-OLDS HAS BEEN DEVELOPED, AS HAS A WELLNESS RESOURCE CENTER THAT INCLUDES INTERNET ACCESS, BOOKS, MAGAZINES AND OTHER INFORMATIVE RESOURCES. THROUGH THE COLLABORATIVE EFFORTS OF THE COMMUNITY HOSPITAL'S WELLNESS SERVICES, PUBLIC RELATIONS, DIETARY SERVICES THERAPY, REHABILITATION, EDUCATION DEPARTMENT, NURSING SERVICES AND OTHERS, A QUARTERLY COMMUNITY EDUCATION CALENDAR CALLED "TAKE CARE!" IS CREATED. THE CALENDAR IS DISTRIBUTED TO MORE THAN 75,000 HOUSEHOLDS IN THE HOSPITAL'S SERVICE AREA, AND TO COMMUNITY CENTERS, PHYSICIAN OFFICERS, LIBRARIES AND OTHER PUBLIC LOCATIONS. IT FEATURES EDUCATIONAL AND SUPPORT PROGRAMS DESIGNED TO IMPROVE THE PHYSICAL, MENTAL, SAFETY, NUTRITIONAL AND SOCIAL WELL-BEING OF THE COMMUNITY. WELLNESS EDUCATION PROGRAM AREAS 1. HEART DISEASE-RELATED PROGRAMMING INCLUDES ONGOING DAILY BLOOD PRESSURE SCREENING BY THE EXERCISE STAFF, BLOOD PRESSURE SCREENING OFFERED DURING PERIODIC EVENTS, A COMPREHENSIVE SERIES ABOUT CHOLESTEROL THAT INCLUDES A SCREENING AND EDUCATION ON CHOLESTEROL MANAGEMENT, SMOKING CESSATION CLASS, A STROKE AWARENESS LECTURE, A PRESENTATION ON NEW ADVANCED GENETIC TESTING FOR HEART DISEASE, PERIPHERAL ARTERIAL DISEASE SCREENINGS, AND A CLASS THAT HELPS INDIVIDUALS MAINTAIN THEIR HEALTH WHILE ON HEART MEDICATIONS. HEART DISEASE-RELATED SUPPORT GROUPS INCLUDE A HEART FAILURE SUPPORT GROUP, A GROUP FOR WOMEN WITH HEART DISEASE, AND MENDED HEARTS - A NATIONAL ORGANIZATION THAT WHEREBY SEASONED HEART DISEASE PATIENTS VISIT NEWLY DIAGNOSED PATIENTS IN THE HOSPITAL AFTER SURGERY OR A PROCEDURE. OTHER COMMUNITY PROGRAMS RELATED TO THE HEART INCLUDED HOW TO RAISE A HEART-SMART CHILD, PROPER NUTRITION FOR LOWERING CHOLESTEROL, INFANT-CHILD CPR, DIABETES AS IT RELATES TO THE HEART, AND A SERIES OF PROGRAMS AND WOMEN AND HEART DISEASE. 2. CANCER AWARENESS AND PREVENTION PROGRAMS INCLUDE: A DAY OF CANCER AWARENESS WITH SKIN CANCER SCREENINGS, AND A VAST PUBLIC AWARENESS CAMPAIGN ABOUT THE LATEST ADVANCES IN PROSTATE CANCER DETECTION AND TREATMENT, INCLUDING THE VALUE OF EARLY DETECTION AND FREE SCREENING SESSIONS. THE COMMUNITY HOSPITAL CANCER RESEARCH FOUNDATION LAUNCHED THE CANCER RESOURCE CENTRE, WHICH HOSTS A VARIETY OF FREE PROGRAMS, CLASSES AND SUPPORT GROUPS ABOUT LIVING WITH CANCER. A SPECIAL SEGMENT OF CLASSES WAS BORN WITH THE OPENING OF THE CANCER RESOURCE CENTRE - A SUPPORT PROGRAM OF THE COMMUNITY HOSPITAL CANCER RESEARCH FOUNDATION. HERE, THOSE FACING CANCER ATTEND FREE CLASSES SUCH AS YOGA, BREATHING THROUGH PAIN, LEARNING ABOUT COMPLEMENTARY THERAPIES, AND A VARIETY OF SUPPORT GROUPS.
PROGRAM SERVICE ACCOMPLISHMENTS (CONT) PART III, LINE 4A 3. DIABETES EDUCATION EFFORTS HAVE EXPANDED TO INCLUDE DIABETES MANAGEMENT CLASSES IN CONJUNCTION WITH EXERCISE. THIS IS IN ADDITION TO A BASIC DIABETES EDUCATION CLASS AND A DIABETES MANAGEMENT CLASS CERTIFIED BY THE AMERICAN DIABETES ASSOCIATION. 4. SENIOR TOPICS OFFERED AT FITNESS POINTE INCLUDE FALL PREVENTION, UNDERSTANDING MANAGED CARE, UNDERSTANDING ADVANCED DIRECTIVES, UNDERSTANDING HOSPICE AND MEDICARE BENEFITS, HELP WITH DIZZINESS, MAKING SENSE OF MEDICAL TECHNOLOGY, MEDICATION SAFETY, URINARY INCONTINENCE PRESENTATION, A GRANDPARENT CLASS, AND A PROGRAM ON OSTEOPOROSIS. 5. ORTHOPEDIC PROGRAMS INCLUDE ARTHRITIS, TENDONITIS AND BURSITIS RECOGNITION AND MANAGEMENT, PREVENTION OF NECK AND LOW BACK PAIN, ATHLETIC FOOT AND ANKLE PROBLEMS, THE CARE AND TREATMENT OF KNEE, HIP, FOOT AND SHOULDER PROBLEMS, CERVICAL AND LUMBAR DISK PROBLEMS, A FALL PREVENTION AND BALANCE SCREENING PROGRAM, AND SPORTS INJURY PREVENTION. 6. NUTRITION PROGRAMS INCLUDE INDIVIDUAL NUTRITIONAL COUNSELING WITH A REGISTERED DIETITIAN, GROUP WEIGHT MANAGEMENT PROGRAMS, LUNCH & LEARN COOKING DEMONSTRATIONS, A CLASS ABOUT EMOTIONAL EATING, AND A CLASS ABOUT FAD DIETS AND PROPER NUTRITION. 7. MENTAL HEALTH RELATED PROGRAMS INCLUDE RELAXATION, STRESS MANAGEMENT, BREATHING EXERCISES, PROGRAMS ON COMPLEMENTARY THERAPIES, RECOGNIZING AND UNDERSTANDING DEPRESSION, AND LIFE MAPPING. 8. WOMEN'S WELLNESS PROGRAMS INCLUDE PRE-AND POST-NATAL EXERCISE, A SERIES ABOUT NUTRITION, SCREENING AND TREATMENT RELATED TO OSTEOPOROSIS, A COMPLETE HEALTH RETREAT FOR WOMEN, FIBROMYALGIA, GENETIC LINKS AND TESTING FOR CANCER, HORMONE REPLACEMENT THERAPY, STRENGTH TRAINING FOR WOMEN, AND HEADACHES IN WOMEN. 9. FAMILY HEALTH PROGRAMS INCLUDE A PRENATAL CLASS, SIBLING CLASS, TAKING CARE OF BABY, KEEPING BABY SAFE AND HEALTHY, INFANT GROWTH AND DEVELOPMENT, FAMILY AND FRIENDS CPR, BREAST FEEDING CLASSES AND LACTATION CONSULTATIONS, LAMAZE, TEEN CHILDBIRTH EDUCATION, GRANDPARENT EDUCATION, FILMS ABOUT CESAREAN SECTIONS, POISON PREVENTION AND TREATMENT, ASK THE PEDIATRICIAN AND HOW TO RAISE A HEART-SMART CHILD, AND A PARENT SUPPORT GROUP. PARTICIPATION IN HEALTH EDUCATION/WELLNESS PROGRAMS RANGES FROM AN AVERAGE OF 300-350 ATTENDEES A MONTH. APPROXIMATELY 20-30% OF THESE ATTENDEES ARE MEMBERS OF THE FITNESS POINTE FACILITY WHILE 70-80% ARE NON-MEMBERS FROM THE GENERAL COMMUNITY. FITNESS PROGRAM AREAS THE AMERICAN HEART ASSOCIATION RECOGNIZES THE LACK OF REGULAR PHYSICAL EXERCISE AS A MAJOR RISK FACTOR FOR HEART DISEASE. REGULAR EXERCISE IS ASSOCIATED WITH BETTER HEART HEALTH, MENTAL WELL-BEING, WEIGHT MANAGEMENT, CANCER PREVENTION, DIABETES CONTROL, LOW BACK PAIN PREVENTION/RELIEF AND OTHER LIFESTYLE-RELATED DISEASES. FITNESS POINTE'S GENERAL FITNESS MEMBERSHIP PROGRAM OFFERS A VARIETY OF EXERCISE PROGRAM OPTIONS DESIGNED TO MEET THE INDIVIDUAL NEEDS. INDIVIDUALS FROM THE COMMUNITY WHO TAKE ADVANTAGE OF THE GENERAL FACILITY MEMBERSHIP PROGRAM INCLUDE TRANSFERS FROM CARDIAC REHABILITATION AND PHYSICAL THERAPY, AND THOSE REFERRED BY THEIR PERSONAL PHYSICIAN. IN ADDITION, MANY ARE CORPORATE CUSTOMERS INTERESTED IN ENCOURAGING HEALTHIER EMPLOYEES, OR INDIVIDUALS LOOKING FOR AN OPPORTUNITY TO IMPROVE THEIR HEALTH ON THEIR OWN OR WITH A FRIEND OR FAMILY MEMBER. PRIOR TO USE OF THE FACILITY, INDIVIDUALS ARE SCREENED BY AN EXERCISE SPECIALIST TO DETERMINE MEDICAL OR PHYSICAL LIMITATIONS AND PRECAUTIONS. MEASUREMENTS COLLECTED ON PARTICIPANTS INCLUDE ENDURANCE, BODY COMPOSITION, RESTING BLOOD PRESSURE, FLEXIBILITY AND A HISTORY OF MEDICAL INFORMATION AND LIFESTYLE HABITS. AN INDIVIDUALIZED PROGRAM OF CARDIOVASCULAR CONDITIONING, MUSCULAR TRAINING AND FLEXIBILITY EXERCISES IS DEVELOPED BASED ON THE INDIVIDUAL INTERESTS AND NEEDS. GROUP EXERCISE CLASSES ARE CONDUCTED ON A WEEKLY BASIS AT FITNESS POINTE. CLASSES INCLUDE TRADITIONAL LOW IMPACT, REGULAR AND STEP AEROBICS, WATER AEROBICS, YOGA, REIKI, PILATES, ROWING, CYCLING, RELAXATION/STRETCHING, ETC. ALL CLASSES ARE AVAILABLE TO MEMBERS. CLASSES ALSO ARE OFFERED ON HOW TO EXERCISE AT HOME, INCLUDING FITNESS AT HOME, PILATES AT HOME, AWESOME ABS, AND YOGA AT HOME. MANY CLASSES ARE ALSO OPEN TO NON-MEMBERS FROM THE COMMUNITY. THESE INCLUDE: A) AWESOME ABS B) FITNESS AT HOME C) FITNESS INSTRUCTOR TRAINING D) TEENS GET FIT E) WOMEN'S FITNESS EXPRESS F) INTRODUCTION TO BASIC SELF DEFENSE AND SELF DEFENSE II G) PILATES AT HOME H) YOGA & DAILY LIFE IN A COOPERATIVE PROGRAM WITH THE TOWN OF MUNSTER PARKS AND RECREATION DEPARTMENT, GROUP EXERCISE CLASSES WERE OFFERED JOINTLY. THE MUNSTER POLICE DEPARTMENT OFFERS BASIC AND ADVANCED SELF DEFENSE CLASSES FOR FREE SEVERAL TIMES A YEAR. COMMUNITY HEALTH/FITNESS EVENTS FITNESS POINTE CELEBRATED NATIONAL GREAT AMERICAN SMOKE-OUT WITH FREE PROGRAMMING & INCENTIVES FOR PEOPLE TO STOP SMOKING. FITNESS POINTE CONTINUES ITS PARTNERSHIPS WITH AREA UNIVERSITIES, OFFERING STAFF AND FACILITIES TO EDUCATE FOR COLLEGE CREDIT NUTRITION AND FITNESS STUDENTS OF PURDUE UNIVERSITY CALUMET AND INDIANA UNIVERSITY; AS WELL AS CLINICAL ROTATIONS FOR POST GRADUATE PHYSICAL THERAPISTS, BACCALAUREATE AND GRADUATE NURSES AND EXERCISE SCIENCE/PHYSIOLOGY STUDENTS FROM OTHER STATE UNIVERSITIES.
PROGRAM SERVICE ACCOMPLISHMENTS (CONT)   FITNESS POINTE PROVIDES A NUTRITION DAY EVENT WHICH INCLUDES HEALTHY NUTRITION DISPLAYS, LECTURES AND DEMONSTRATIONS TO ENCOURADE BETTER NUTRITION HABITS FOR THE PUBLIC. CARDIAC REHABILITATION OUR OWN ASSESSMENT FOUND THAT DESPITE SIGNIFICANT BENEFITS OF CARDIAC REHABILITATION, ONLY ABOUT 45 PERCENT OF OUR INPATIENT HEART SURGERY POPULATION IS REFERRED TO CARDIAC REHABILITATION, PHASE 2. IN RESPONSE TO THE FACT THAT THOSE WHO CONTINUE CARDIAC REHAB THROUGH PHASE 3 ARE LIKELY TO MAINTAIN THEIR LIFESTYLE, FITNESS POINTE NOW OFFERS REHAB PLUS IN PLACE OF PHASE IV CARDIAC REHAB. SINCE FITNESS POINTE HAS OPENED, MORE THAN 575 CARDIAC REHABILITATION GRADUATES AND AN AVERAGE OF 10 PHYSICAL THERAPY GRADUATES PER MONTH HAVE TRANSITIONED TO GENERAL MEMBERS. A DISCOUNT RATE IS OFFERED TO ENCOURAGE AND SUPPORT THEIR CONTINUED REHAB IN A GENERAL FITNESS SETTING. FITNESS POINTE PROGRAM STATISTICS FITNESS POINTE PROGRAMS AND SERVICES ARE OFFERED TO THE PUBLIC. THE AVERAGE AGE OF PROGRAM ATTENDEES IS 49 YEARS OF AGE, WHILE 52% OF PARTICIPANTS WERE 50+ YEARS OF AGE. SINCE FITNESS POINTE IS INTERESTED IN MEETING NEEDS NOT ALREADY BEING MET IN THE COMMUNITY, IT IS IMPORTANT TO NOTE THAT MORE THAN 70% OF PARTICIPANTS REPORT THEY HAVE NEVER PREVIOUSLY BEEN A MEMBER OF A FITNESS FACILITY. FITNESS POINTE SERVICES RECORD MORE THAN 35,000 VISITS PER MONTH. APPROXIMATELY 2,000 INDIVIDUALS HAVE TRANSFERRED TO THE FACILITY MEMBERSHIP PROGRAM FROM CARDIAC REHAB AND PHYSICAL THERAPY TO CONTINUE THEIR REHABILITATIVE MAINTENANCE. SHORT TERM GOALS To OFFER SERVICES THAT MEET THE INTERESTS AND HEALTH NEEDS OF THE COMMUNITY. PROVIDE ONGOING STAFF DEVELOPMENT AND TRAINING TO PROVIDE THE HIGHEST QUALITY CUSTOMER SERVICE. PROVIDE THE BEST SERVICES AT THE LOWEST POSSIBLE PRICE.CONTINUE DATABASE DOCUMENTATION TO DETERMINE SHORT AND LONG TERM EFFECTS OF PROGRAMS. CONTINUE INTEGRATION OF FITNESS POINTE SERVICES WITH OTHER HOSPITAL SERVICES TO BECOME A SIGNIFICANT PART OF THE COMMUNITY HOSPITAL CONTINUUM OF CARE. IDENTIFY APPROPRIATE PARTNERSHIPS TO STRENGTHEN THE QUALITY AND SCOPE OF SERVICES OFFERED. IDENTIFY RESEARCH OPPORTUNITIES IN THE AREAS OF HEALTH PROMOTION AND DISEASE PREVENTION. B. PREVENTION/WELLNESS AT COMMUNITY COMMUNITY'S PREVENTION/WELLNESS PROGRAM FOCUSES ON PROMOTING AWARENESS OF CARDIOVASCULAR DISEASE, REDUCING THE INCIDENCE OF HEART DISEASE AND IMPROVING THE QUALITY OF LIFE THROUGH AN INTEGRATED CARDIOVASCULAR HEALTH SERVICES DELIVERY SYSTEM. CARDIAC AND VASCULAR SCREENINGS DURING THE 2011-2012 FISCAL YEAR, COMMUNITY CONTINUED TO OFFER VARIOUS LEVELS OF CARDIAC AND VASCULAR SCREENINGS AT A SUBSTANTIAL DISCOUNT. ALL LEVELS OF SCREENING PUT AN EMPHASIS ON DIRECTING THE SCREENING PARTICIPANTS TO A VARIETY OF WELLNESS PROGRAMS OFFERED THROUGH THE HOSPITAL AND FITNESS POINTE. FITNESS POINTE CONTINUES TO SUPPORT THE WELLNESS PROGRAMS CREATED TO BETTER SERVE THE HEALTH NEEDS OF OUR COMMUNITY AND SUPPORT THE IMPORTANCE OF RISK FACTOR MODIFICATION THROUGH LIFE-STYLE AND BEHAVIOR CHANGES. THE CORONARY HEALTH APPRAISAL IS OFFERED THROUGHOUT THE COMMUNITY HEALTHCARE SYSTEM. THIS SCREENING NOT ONLY MEASURES CHOLESTEROL LEVELS, GLUCOSE, AND BLOOD PRESSURE, BUT ALSO EVALUATES INDIVIDUALS WHO MEET THE CRITERIA FOR METABOLIC SYNDROME. A TOTAL OF 109 PEOPLE WERE SCREENED BETWEEN COMMUNITY HOSPITAL AND COMMUNITY HOSPITAL OUTPATIENT CENTER-ST. JOHN. NINETEEN PERCENT OF PARTICIPANTS WERE FOUND TO MEET THE CRITERIA FOR METABOLIC SYNDROME. DURING THE 2011-2012 FISCAL YEAR, COMMUNITY HOSPITAL CONTINUED TO OFFER THE FAST CT HEART SCAN. THIS PROCEDURE HELPS TO DETECT HEART DISEASE IN ITS EARLIEST STAGES. DURING THE YEAR, 51 INDIVIDUALS PARTICIPATED IN THE SCREENING. COMMUNITY HEALTHCARE SYSTEM ADDED THE CT HEART SCAN AT ST. MARY MEDICAL CENTER. ONCE A MONTH, THE CARDIAC REHABILITATION STAFF CONDUCTS A SCREENING FOR PERIPHERAL VASCULAR DISEASE, OR PAD. INDIVIDUALS AT RISK FOR PAD ARE SMOKERS, DIABETICS AND CARDIAC PATIENTS. THE SCREENING TARGETS INDIVIDUALS WHO WOULD NEED FURTHER TESTING AND POSSIBLY INTERVENTION TO TREAT THE DISEASE. FOLLOWING THE PUBLIC SCREENING, PARTICIPANTS ARE EDUCATED ON THE DISEASE AND HOW TO PREVENT OR MANAGE IT. THE SCREENING COSTS $8 FOR CARDIAC REHAB PATIENTS AND FITNESS POINTE MEMBERS, AND $10 FOR NON-MEMBERS AND THE GENERAL PUBLIC. FOLLOW-UP EDUCATION LECTURES ARE CONDUCTED PERIODICALLY AT NO CHARGE. THIS PAST FISCAL YEAR, 98 INDIVIDUALS WERE SCREENED. IN ADDITION, EACH SEPTEMBER, COMMUNITY HOSPITAL PARTICIPATES IN THE NATIONAL LEGS FOR LIFE PERIPHERAL ARTERIAL DISEASE SCREENING CAMPAIGN. THIS FREE PAD SCREENING OFFERED TO THE PUBLIC IS ONE MORE WAY WE REACH OUT TO THE COMMUNITY AND PROVIDE A NEEDED SERVICE TO OUR POPULATION. THE SCREENING DRAWS ABOUT 150 PARTICIPANTS FROM AROUND THE AREA. CARDIAC REHAB PHASE 3 OFFERS A MONTHLY BLOOD PRESSURE SCREENING AT FITNESS POINTE. THE CARDIAC REHAB STAFF IS OFTEN ASKED TO TAKE BLOOD PRESSURES OR PARTICIPATE IN OTHER WAYS WHEN OTHER HOSPITAL DEPARTMENTS SPONSOR HEALTH FAIRS. AS AN ADDED SERVICE, FREE OF CHARGE, THE CARDIAC REHAB STAFF OFFERS ITS FORMER MEMBERS THE OPPORTUNITY TO GET A BLOOD PRESSURE, OXIMETER READING, OR HEART RHYTHM QUICK LOOK WHILE THEY ARE EXERCISING AT FITNESS POINTE. TWO DIABETES SCREENINGS WERE CONDUCTED DURING THE YEAR. FORTY-SIX INDIVIDUALS HAD THEIR BLOOD SUGAR TESTED. A FEW INDIVIDUALS MET THE CRITERIA FOR DIABETES, WHILE SEVERAL MORE WERE FOUND TO BE PRE-DIABETIC. BASIC INFORMATION REGARDING PRE-DIABETES WAS GIVEN AND PARTICIPANTS THAT MET THE CRITERIA FOR DIABETES WERE INSTRUCTED TO FOLLOW-UP WITH THEIR PHYSICI AN FOR FURTHER TESTING. WE CONTINUE TO TRACK INDIVIDUALS IN OUR DATABASE WHO GO THROUGH OUR SCREENING PROGRAMS TO DETERMINE TO WHAT DEGREE THIS EARLY INTERVENTION WILL HELP LOWER THE RISK FOR DEVELOPING HEART DISEASE. IN ADDITION TO THE DATABASE, OUR RISK FACTOR ANALYSIS SOFTWARE PROGRAM ALLOWS US TO HAVE THE MOST UP-TO-DATE DATA AVAILABLE. THIS SOFTWARE ENABLES US TO PREPARE REPORTS THAT EDUCATE INDIVIDUALS ABOUT HOW THEIR HEALTH STATUS PLACES THEM AT RISK FOR DEVELOPING HEART DISEASE, AND PROVIDES RECOMMENDATIONS AND SUPPORT IN MAKING HEALTHY LIFE-STYLES CHOICES THAT CAN LOWER THEIR RISK. THEREFORE, WE CAN ASSIST THEM IN PARTICIPATING IN ONE OF OUR WELLNESS EDUCATION PROGRAMS BEST SUITED TO THEIR INDIVIDUAL NEEDS. OUR DATABASE INCLUDES PATIENTS FROM OUR VARIOUS CARDIOVASCULAR OUTPATIENT CLINICS SUCH AS THE HEART FAILURE TREATMENT CLINIC, LIPID CLINIC AND CARDIAC REHABILITATION. THIS ALLOWS US TO TRACK OUR CARDIOVASCULAR PATIENTS AND BETTER MANAGE THEIR OUTCOMES AND TREATMENT OPTIONS. THROUGH THIS DATABASE, WE HAVE BEEN ABLE TO PERFORM INTERNAL RESEARCH ACTIVITIES THAT MEASURE THE OUTCOMES OF PATIENTS WITH HEART DISEASE AND HEART FAILURE SO WE CAN BETTER MANAGE THESE CONDITIONS AND PREVENT RECURRENT EVENTS. TO CONTINUE TO BETTER SERVE OUR PATIENT POPULATION, OUR CARDIOVASCULAR RESEARCH DEPARTMENT FOCUSES ON REDUCING CARDIOVASCULAR MORBIDITY AND MORTALITY IN OUR COMMUNITIES BY PARTICIPATING IN CLINICAL RESEARCH INITIATIVES DESIGNED TO PROMOTE EARLY DETECTION, DIAGNOSIS AND TREATMENT OF CARDIOVASCULAR AND PERIPHERAL VASCULAR DISEASE. FINALLY, PREVENTION/WELLNESS SERVICES DONATES GIFT CERTIFICATES FOR BOTH THE HEART SCAN AND CORONARY HEALTH APPRAISAL. THE CERTIFICATES ARE MADE AVAILABLE TO CHARITABLE ORGANIZATIONS AND CERTAIN COMMUNITY HOSPITAL SPONSORED EVENTS. FOR THE FIRST TIME, CORONARY HEALTH APPRAISAL PARTICIPANTS WERE SELETED TO PARTICIPATE AS SUBJECTS IN A RESEARCH STUDY. THE STUDY WAS CONDUCTED BY A NURSE WHO IS PURSUING HER DOCTORATE IN NURSING. HER AREA OF STUDY RELEATED TO HOW PEOPLE PERCEIVE THEIR RISK OF HEART DISEASE. OVER 100 SUBJECTS WERE RECRUITED.
PROGRAM SERVICE ACCOMPLISHMENTS (CONT)   C. CANCER PROGRAM COMMUNITY HOSPITAL CANCER PROGRAM IS APPROVED BY THE AMERICAN COLLEGE OF SURGEONS COMMISSION ON CANCER IN THEIR "COMMUNITY HOSPITAL COMPREHENSIVE CANCER PROGRAM" CATEGORY. APPROVAL OF OUR CANCER PROGRAM QUALIFIES COMMUNITY HOSPITAL TO PARTNER WITH THE COMMISSION ON CANCER IN THE AMERICAN CANCER SOCIETY'S NATIONAL CANCER INFORMATION AND REFERRAL PROJECT, SHARING INFORMATION ON RESOURCES AND CANCER EXPERIENCE FOR THE AMERICAN CANCER SOCIETY'S NATIONAL CALL CENTER AND WEB SITE, KEY SOURCES OF CANCER INFORMATION AND GUIDANCE FOR THE PUBLIC. THIS INDICATES THAT COMMUNITY HOSPITAL MEETS THE STANDARDS OF THE COMMISSION ON CANCER IN ORGANIZATION AND MANAGEMENT OF OUR PROGRAM ENSURING MULTIDISCIPLINARY, INTEGRATED AND COMPREHENSIVE ONCOLOGY SERVICES. IN ADDITION, COMMUNITY HOSPITAL MEETS THEIR PERFORMANCE MEASURES FOR HIGH-QUALITY CANCER CARE. AN APPROVED PROGRAM ENSURES OUR PATIENTS RECEIVE QUALITY CARE CLOSE TO HOME AND ACCESS TO A MULTI-SPECIALTY TEAM APPROACH TO COORDINATE THE BEST TREATMENT OPTIONS. THE PROGRAM ALSO PROVIDES THE COMMUNITY WITH ACCESS TO CANCER-RELATED INFORMATION, EDUCATION AND SUPPORT, AND OFFERS LIFELONG PATIENT FOLLOW-UP, ONGOING MONITORING AND IMPROVEMENT OF CARE AND INFORMATION ABOUT ONGOING CANCER CLINICAL TRIALS AND NEW TREATMENT OPTIONS. A REGISTRY COLLECTS DATA ON TYPE AND STAGE OF CANCERS AND TREATMENT RESULTS. CANCER PROGRAM LEADERSHIP USES CANCER REGISTRATION DATA INCLUDING LIFELONG FOLLOW UP TO EVALUATE CLINICAL OUTCOMES COMPARED TO THOSE IN OTHER PROGRAMS. THEY ALSO USE THE DATA TO TRACK PATTERNS OF ACCESS, CARE AND REFERRAL, ALLOCATE AND PRIORITIZE RESOURCES, AND TARGET SERVICES AND PROGRAMS TO ADDRESS THE HEALTH CARE NEEDS OF OUR SERVICE AREA. AMERICAN COLLEGE OF SURGEONS ACCREDITED CANCER PROGRAM PROVIDING A WIDE RANGE OF SERVICES TO OUR PATIENTS WITH CANCER IS THE MULTIDISCIPLINARY CANCER COMMITTEE. THIS COMMITTEE COMPOSED OF PATHOLOGISTS, SURGEONS, ONCOLOGISTS, RADIATION ONCOLOGISTS, CLINICAL AND NURSING STAFF, AND CANCER REGISTRY PERSONNEL, HOSTS WEEKLY TUMOR CONFERENCES TO REVIEW CLINICAL FINDINGS, PAST HISTORY AND RADIOLOGIC AND PATHOLOGIC TREATMENT OPTIONS. CANCER EDUCATION CANCER EDUCATION PROGRAMS HELD OVER THE PAST YEAR INCLUDE THOSE DIRECTED AT COLON CANCER PREVENTION, BREAST SELF-EXAMINATION, THE IMPORTANCE OF PAP SMEARS, SMOKING CESSATION, AND THE IMPORTANCE OF EARLY DETECTION OF PROSTATE CANCER. IN ADDITION, SEVERAL NEW COMMUNITY EDUCATION PROGRAMS WERE INTRODUCED TO RAISE PUBLIC AWARENESS OF ISSUES AFFECTING THE PREVENTION AND EARLY DETECTION OF CANCER. SOME OF THESE NEW PROGRAMS ALSO HELPED MEMBERS OF THE COMMUNITY BETTER MANAGE SIDE EFFECTS FROM CANCER TREATMENTS, WHILE OTHER EFFORTS WERE DIRECTED AT HELPING PATIENTS MAKE COMPLEX TREATMENT DECISIONS. THE COMMUNITY HOSPITAL CANCER RESEARCH FOUNDATION OPENED THE CANCER RESOURCE CENTRE IN MUNSTER - A NON-MEDICAL RESOURCE HAVEN FOR THOSE SEEKING INFORMATION ABOUT CANCER. THE CENTRE HOLDS FREE COMMUNITY PROGRAMS AND SUPPORT/NETWORKING GROUPS, AND HAS AN EXTENSIVE LIBRARY WITH TWO COMPUTER TERMINALS FOR INTERNET ACCESS. THE CENTRE OPENED IN JUNE OF 2003, AND ALL SERVICES AND PROGRAMS ARE FREE. CLINICAL TRIALS/RESEARCH IN LOOKING TO EXPAND ON RESEARCH INITIATIVES AND TO BROADEN PATIENT ACCESS TO CLINICAL TRIALS, THE HOSPITAL HAS FORMED THE COMMUNITY HOSPITAL CANCER RESEARCH FOUNDATION, A SEPARATE NOT-FOR-PROFIT CORPORATION TO RAISE OUTSIDE SUPPORT. THE PURPOSE OF THIS FOUNDATION IS TO REDUCE CANCER MORBIDITY AND MORTALITY IN THE COMMUNITY BY SUPPORTING AND ADVANCING CANCER DETECTION, DIAGNOSIS, TREATMENT AND EDUCATION/PREVENTION AND BY PROMOTING THE ACQUISITION OF KNOWLEDGE THROUGH CLINICAL RESEARCH. CLINICAL TRIALS OFFERED INCLUDED THOSE FOR ALL STAGES OF BREAST AND COLON CANCER, LYMPHOMA, LEUKEMIA, MULTIPLE MYELOMA AND PANCREATIC CANCER. IN THE EFFORT TO IMPROVE PATIENT AND PHYSICIAN ACCESS TO CANCER RESEARCH TRIALS, THE HOSPITAL MAINTAINS ASSOCIATION IN A GOVERNMENT PROGRAM TO IMPROVE PATIENT AND PHYSICIAN ACCESS TO CANCER RESEARCH TRIALS. SPONSORED BY THE NATIONAL CANCER INSTITUTE (NCI), THE PROGRAM IS KNOWN AS THE CANCER TRIALS SUPPORT UNIT. IT IS SUPPORTING THE DEVELOPMENT OF A NATIONAL NETWORK OF PATIENTS AND PHYSICIANS TO PARTICIPATE IN NCI-SPONSORED PHASE III CANCER TREATMENT TRIALS. NCI HAS TAKEN STEPS THROUGH THIS PROGRAM TO BRING TOGETHER RESEARCH COOPERATIVES FROM AROUND THE U.S. AND CANADA. THE EFFORT RECOGNIZES THAT MORE PATIENTS AND PHYSICIANS COULD BECOME INVOLVED IN CANCER RESEARCH TRIALS WITH ADDED SUPPORT. TYPICALLY NCI RESEARCH COOPERATIVES OPEN TRIALS ONLY TO INDIVIDUAL MEMBERS, WHICH ARE OFTEN ACADEMIC INSTITUTIONS THAT CAN ACQUIRE LARGE NUMBERS OF PATIENTS AND HAVE THE FINANCIAL BACKING TO FACILITATE THE WORK. THROUGH THE CLINICAL TRIALS SUPPORT UNIT, COMMUNITY HOSPITAL GAINS ACCESS TO CLINICAL RESEARCH TRIALS FROM EIGHT DIFFERENT RESEARCH COOPERATIVES. THE PILOT PROGRAM ALSO IS PROVIDING FINANCIAL ASSISTANCE AND IS WORKING TO REDUCE REGULATORY AND ADMINISTRATIVE BURDENS, AND TO STREAMLINE AND STANDARDIZE DATA COLLECTION AND REPORTING. BREAST CANCER AN ON-GOING COMMUNITY-BASED EDUCATION INITIATIVE CONTINUES TO IDENTIFY WOMEN WHO ARE AT HIGH RISK FOR DEVELOPING BREAST CANCER. A COMPUTERIZED MODEL DEVELOPED BY THE NATIONAL CANCER INSTITUTE WAS USED AS A BASIS FOR IDENTIFYING WOMEN AND EDUCATING THE PUBLIC ON FACTORS THAT MOST DIRECTLY INCREASE THE RISK OF DEVELOPING BREAST CANCER. IN OCTOBER 1999, COMMUNITY HOSPITAL BEGAN CONDUCTING A FREE BREAST CANCER RISK ASSESSMENT ON ALL MAMMOGRAPHY PATIENTS OVER THE AGE OF 35 TO IDENTIFY PATIENTS WHO MAY BE AT HIGH RISK FOR BREAST CANCER. A BREAST CANCER RISK ASSESSMENT REPORT WAS DEVELOPED BY THE HOSPITAL TO COMMUNICATE TEST RESULTS TO PATIENTS, EDUCATING THEM ABOUT THE RISK FACTORS FOR BREAST CANCER AND VARIOUS TREATMENT OPTIONS THEY MAY DISCUSS WITH THEIR PHYSICIAN. THE HOSPITAL ALSO OFFERS FREE CONSULTATION SERVICES OF OUR NURSE PRACTITIONER/BREAST HEALTH NAVIGATOR AT THE WOMEN'S DIAGNOSTIC CENTER IN CONJUNCTION WITH THESE TEST RESULTS. MORE THAN 15,500 WOMEN COMPLETED THE BREAST CANCER RISK ASSESSMENT THROUGH THE FISCAL YEAR ENDING JUNE 30, 2012. ABOUT 3% OF THE WOMEN WHO COMPLETED THE BREAST RISK ASSESSMENT AT COMMUNITY HOSPITAL WERE IDENTIFIED TO HAVE A LIFETIME RISK ASSESSMENT OF GREATER THAN 20%. THE INTENT OF THESE EFFORTS IS TO BETTER INFORM WOMEN OF THE RISK FACTORS THAT INCREASE THEIR CHANCES OF DEVELOPING BREAST CANCER AND TO PROVIDE EDUCATION ABOUT ADDITIONAL TREATMENT OPTIONS IF THEY ARE AT ELEVATED RISK. THE AMERICAN CANCER SOCIETY RECOMMENDS ANNUAL BREAST MRI IN ADDITION TO YEARLY MAMMOGRAPHY FOR WOMEN WHO HAVE A LIFETIME RISK ASSESSMENT FOR BREAST CANCER OF 20% OR GREATER, AND THIS RECOMMENDATION IS COMMUNICATED IN EACH HIGH RISK PATIENT'S REPORT. IN ADDITION TO A BREAST MRI, PATIENTS WITH AN ELEVATED LIFETIME RISK FOR BREAST CANCER MAY ALSO BENEFIT FROM CONSULTATION WITH A MEDICAL GENETICIST. PROSTATE CANCER A FREE PROSTATE CANCER SCREENING FOR THE PUBLIC WAS HELD IN SEPTEMBER OF 2011 WITH 95 PARTICIPANTS TAKING ADVANTAGE OF THE DIGITAL RECTAL EXAM AND PSA. THE SCREENING WAS MADE POSSIBLE THROUGH A JOINT EFFORT ON BEHALF OF THE HOSPITAL AND THE PHYSICIANS WHO DONATED THEIR TIME. OF THOSE TAKING PART IN THE SCREENING 2% HAD ABNORMAL DIGITAL RECTAL EXAMS, 11% HAD ABNORMAL PSA RESULTS THESE RESULTS ARE FORWARDED FOR EVALUATION AND TREATMENT. CANCER SCREEENING: iN APRIL 2012, 36 PARTICIPANTS WERE SCREENED FOR ORAL ,HEAD AND NECK CANCER. SIXTEEN (44%) WERE REFERRED FOR FURTHER EVALUATION.
PART VII, SECTION A   CFNI SCH SMMC CH CVI TATC CVPA CCRF Total Frankie Fesko 7 1 1 1 1 1 12 William Hasse, III 1 1 2 R. Litchfield, DO 1 1 2 S. N. Makam, MD 3 1 4 Donald S. Powers 41 1 1 43 Hon. James Richards 20 1 21 William Schenck 1 1 1 1 4 M. Nabil Shabeeb, MD, 1 1 1 3 Donald Torrenga 1 1 1 3 Jay Zandstra 1 1 2 David Wickland 15 1 16 Joseph Morrow 1 1 2 Richard McLaughry 1 1 1 3 David Bochnowski 1 1 2 Donald P. Fesko 41 1 42 Mary Ann Shacklett 41 1 1 1 1 1 1 1 48 Frankie Fesko - Related organization hours and compensation is for attending monthly BOD and committee meetings. William Hasse, III - Related organization hours and compensation is for attending CFNI monthly BOD and committee meetings R. Litchfield, DO - Related organization hours and compensation is for EPIC Consulting for CFNI S. N. Makam, MD - Related organization hours and compensation is for Medical Directorships Donald S. Powers - Related organization compensation is for hours worked as the system President & CEO Hon. James Richards - Related organization hours and compensation is for attending CFNI monthly BOD and committee meetings. Hours also include biweekly senior team meetings. William Schenck - Related organization hours are for attending SMMC, CFNI and CVI monthly BOD and committee meetings, compensation is for CFNI M. Nabil Shabeeb, MD, FACS - Related organization hours are for attending CFNI and CCRF monthly BOD and committee meetings, compensation is from CFNI Donald Torrenga - Related organization compensation is for attending CFNI monthly BOD and committee meetings, hours are for CFNI and CVI Jay Zandstra - Related organization hours and compensation is for attending CFNI monthly BOD and committee meetings David Wickland - Related organization hours and compensation is for attending CFNI monthly BOD and committee meetings. Hours also include biweekly senior team meetings. Joseph Morrow - Related organization hours and compensation is for attending CFNI monthly BOD and committee meetings Richard McLaughry - Related organization compensation is for attending CFNI monthly BOD and committee meetings and serving as President of the BOD at CVI, hours are for both David Bochnowski - Related organization hours and compensation is for attending CFNI monthly BOD and committee meetings Donald P. Fesko - Related organization hours are for attending CCRF BOD and committee meeting Mary Ann Shacklett - Compensation is for hours worked as the system CFO. Related organization hours are for attending BOD and committee meetings
PART XI, LINE 5   OTHER CHANGES IN NET ASSETS INCLUDE THE FOLLOWING: MINIMUM PENSION LIABILITY (29,181,297) TRANSFERS TO CFNI, INC. (40,360,971) CHANGES IN TEMP RESTRICTED FUNDS (790,000) NET ASSETS RELEASED FROM RESTRICTION (46,000) INDIRECT PUBLIC SUPPORT FROM COMMUNITY CANCER RESEARCH FOUNDATION, INC. 584,845 ROUNDING (347) TOTAL CHANGES IN NET ASSETS (69,794,400)
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2011

Additional Data


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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
2011
Open to Public Inspection
Name of the organization
MUNSTER MEDICAL RESEARCH FOUNDATION INC
 
Employer identification number

35-1107009
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) COMMUNITY FOUNDATION OF NW INDIANA INC

10010 DONALD POWERS DRIVE

MUNSTER,IN46321
31-1128781 		SUPPORTNG ORG IN 501(C)(3) 11(c) NA
 
 
No
(2) ST CATHERINE HOSPITAL INC

4321 FIR STREET

EAST CHICAGO,IN46312
35-1738708 		HOSPITAL IN 501(C)(3) 3 CFNI
 
Yes
 
(3) ST MARY MEDICAL CENTER

1500 S LAKE PARK AVE

HOBART,IN46342
35-2007327 		HOSPITAL IN 501(C)(3) 3 CFNI
 
Yes
 
(4) COMMUNITY CANCER RESEARCH FOUNDATION

901 MACARTHUR BLVD

MUNSTER,IN46321
35-2146374 		CANCER FUNDRA IN 501(C)(3) 7 MMRF
 
Yes
 
(5) COMMUNITY VILLAGE INC

10000 COLUMBIA AVE

MUNSTER,IN46321
35-1956395 		RETRMT HOME IN 501(C)(3) 9 CFNI
 
Yes
 
(6) CVPA HOLDING COMPANY

905 RIDGE RD

MUNSTER,IN46321
35-1938136 		TITLE HOLDING IN 501(C)(2) N/A CFNI
 
Yes
 
(7) THEATRE AT THE CENTER

905 RIDGE RD

MUNSTER,IN46321
35-1939427 		PLAYS & ARTS IN 501(C)(3) 9 CFNI
 
Yes
 
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



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

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




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



 		(k)
Percentage
ownership
Yes No Yes No












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



 		(b)
Primary activity



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


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

 		(f)
Share of total income



 		(g)
Share of
end-of-year
assets

 		(h)
Percentage
ownership
(1) COMMUNITY RESOURCES INC
907 RIDGE ROAD
MUNSTER,IN46321
35-1727711 		MGMT SERVICES IN NA
  		C CORP      












Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III or IV.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
 
No
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property from related 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) THEATRE AT THE CENTER

 B 80,000 FMV
(2) ST CATHERINE HOSPITAL INC

 N 2,089,978 FMV
(3) ST MARY MEDICAL CENTER

 N 813,207 FMV
(4) ST CATHERINE HOSPITAL INC

 O 2,541,255 FMV
(5) ST MARY MEDICAL CENTER

 O 7,405,722 FMV
(6) COMMUNITY CANCER RESEARCH FOUNDATION INC

 O 58,062 FMV
(7) ST CATHERINE HOSPITAL INC

 P 5,960,158 FMV
(8) ST MARY MEDICAL CENTER

 P 1,682,718 FMV
(9) COMMUNITY CANCER RESEARCH FOUNDATION INC

 P 251,083 FMV
(10) COMMUNITY CANCER RESEARCH FOUNDATION INC

 Q 248,758 FMV
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
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)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(e)
Are all
partners
section
501(c)(3)
organizations? 		(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 Yes No






























Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
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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