TY 2011 Form 990

(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)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) SCOTT ANDREWS MD DIRECTOR	1.0	X			0	0	0
(2) PEGGY BUFFINGTON PHD DIRECTOR	1.0	X			0	0	0
(3) LINDA BUZINEC MAYOR DIRECTOR	1.0	X			0	0	0
(4) LISA FIELD DIRECTOR	1.0	X			0	0	0
(5) MILTON GASPARIS MD DIRECTOR	1.0	X			770	0	0
(6) BILL JOINER DIRECTOR	1.0	X			0	0	0
(7) DONNA LAJIC DIRECTOR	1.0	X			0	0	0
(8) PETER MAVRELIS MD DIRECTOR	1.0	X			0	0	0
(9) JAMES MOODY JUDGE DIRECTOR	1.0	X			0	0	0
(10) MARK SIMAGA MD DIRECTOR	1.0	X			0	249,086	22,884
(11) WILLIAM SCHENCK PRESIDENT	1.0	X	X		0	40,042	0
(12) SR MICHELE DVORAK PHJC VICE PRESIDENT	1.0	X	X		0	0	0
(13) KEN KRUPINSKI CPA SECRETARY & TREASURER	1.0	X	X		0	0	0
(14) JANICE RYBA ADMINISTRATOR	41.0	X	X		0	459,539	48,414
(15) MARY ANN SHACKLETT SR VP & SYSTEM CFO	1.0		X		0	546,591	56,960
(16) MARY SUDICKY VICE PRESIDENT OF FINANCE/CFO	41.0		X		239,164	0	71,237
(17) TAMMIE JONES VP PATIENT CARE SERVICES/CNO	40.0			X	247,203	0	24,376

(A) Name and business address	(B) Description of services	(C) Compensation
Rehab Care Group Incorporated 7733 Forsyth Blvd Ste 1700 ST LOUIS,MO63105	Therapy Services	3,608,219
Lakeshore Anesthesia PC 1755 Fulton St ELKHART,IN46614	Anesthesia Services	1,959,804
Lake Porter Ambulartory LLC 7921 Grand Blvd HOBART,IN46342	Management Services	832,842
AXS IMAGING PO Box 637528 CINCINNATI,OH45263	RADIOLOGY SERVICES	811,195
Mayo Collaborative Services 200 SW First St ROCHESTER,MN55905	Laboratory Services	464,376
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 30

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	1,000,000	1,000,000
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 ....	579,492	770	578,722
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	76,238		76,238
7	Other salaries and wages	65,896,700	62,003,144	3,893,556
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	3,108,543	2,899,649	208,894
9	Other employee benefits .......	8,980,861	8,453,067	527,794
10	Payroll taxes ...........	4,515,785	4,212,325	303,460
11	Fees for services (non-employees):
a	Management ......	1,098,943		1,098,943
b	Legal .........	250,045	-2,482	252,527
c	Accounting ...........	0
d	Lobbying ...........	2,617		2,617
e	Professional fundraising. See Part IV, line 17..	0
f	Investment management fees ......	0
g	Other ..........	14,082,521	13,239,847	842,674
12	Advertising and promotion ....	760,799	749,655	11,144
13	Office expenses .......	2,481,576	1,890,667	590,909
14	Information technology ......	49,353	-13,506	62,859
15	Royalties ..	0
16	Occupancy ...........	3,860,287	1,992,015	1,868,272
17	Travel ............	151,084	127,273	23,811
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0
19	Conferences, conventions, and meetings ....	51,382	43,466	7,916
20	Interest ...........	2,653,541	2,653,541
21	Payments to affiliates .......	43,565	43,565
22	Depreciation, depletion, and amortization .....	8,940,061	8,339,289	600,772
23	Insurance ..............	1,623,201	1,514,122	109,079
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 SUPPLIES	38,986,768	38,813,178	173,590
b	CORPORATE ALLOCATION	20,340,387	18,973,513	1,366,874
c	MEDICAID ASSESSMENT FEE	11,914,204	11,914,204
d	LEASE AND RENTAL	1,965,104	1,938,487	26,617
e
f	All other expenses	5,676,065	3,584,665	2,091,400
25	Total functional expenses. Add lines 1 through 24f	199,089,122	184,370,454	14,718,668	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 if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet
	1	Cashnon-interest-bearing ..........	0	1	0
2	Savings and temporary cash investments .......	8,391,482	2	3,151,099
3	Pledges and grants receivable, net .........	0	3	0
4	Accounts receivable, net .........	28,275,318	4	29,550,155
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 ..............	4,768,093	8	5,215,530
9	Prepaid expenses and deferred charges ............	4,487,697	9	3,535,969
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	162,699,766
b	Less: accumulated depreciation. .....	10b	66,142,697	89,996,635	10c	96,557,069
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 ...........	65,615	15	6,240,030
16	Total assets. Add lines 1 through 15 (must equal line 34)...	135,984,840	16	144,249,852
	17	Accounts payable and accrued expenses .	25,564,853	17	17,536,740
18	Grants payable ..........	0	18	0
19	Deferred revenue ..........	258,727	19	228,813
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.....	744,324	25	14,526,307
26	Total liabilities. Add lines 17 through 25.....	26,567,903	26	32,291,860
		Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....	109,236,409	27	111,780,899
28	Temporarily restricted net assets .....	180,528	28	177,093
29	Permanently restricted net assets .....	0	29	0
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund .....		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances .....	109,416,937	33	111,957,992
34	Total liabilities and net assets/fund balances .....	135,984,840	34	144,249,852

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

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

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

See separate instructions.

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization

ST MARY MEDICAL CENTER INC

Employer identification number

35-2007327

Part I

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Type I

Type II

Type III - Functionally integrated

Type III - Other

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

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

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

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

Yes

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

11g(i)

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

11g(ii)

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

11g(iii)

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

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


Total

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 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).

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

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

Section C. Computation of Public Support Percentage

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

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

16a

33 1/3% support test—2011. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ...................... right arrow

33 1/3% support test—2010. If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2011. If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization .................................................. right arrow

10%-facts-and-circumstances test—2010. If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly
supported organization .............................................. right arrow

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

Schedule A (Form 990 or 990-EZ) 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.).

Section C. Computation of Public Support Percentage

Public Support Percentage for 2011 (line 8 column (f) divided by line 13 column (f)) .........

Public support percentage from 2010 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f)) ......

Investment income percentage from 2010 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2011. If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .......... right arrow

33 1/3% support tests—2010. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

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

Schedule A (Form 990 or 990-EZ) 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:

- TIN:

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

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

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

OMB No. 1545-0047

2011

Name of organization

ST MARY MEDICAL CENTER INC

Employer identification number

35-2007327

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

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

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

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

501(c)(3) taxable private foundation

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

General Rule

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

Special Rules

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

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

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

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

Name of organization ST MARY MEDICAL CENTER INC
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
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	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 3

Name of organization ST MARY MEDICAL CENTER INC
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
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
ST MARY MEDICAL CENTER INC

Employer identification number

35-2007327

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

(d)
Description of how gift is held

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

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

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

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

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

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

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

Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

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

Complete if the organization is described below.
SchCMd Bullet

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

See separate instructions.

OMB No. 1545-0047

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

ST MARY MEDICAL CENTER INC

Employer identification number

35-2007327

Part I-A

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

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

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

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

Part I-B

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

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

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

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

Yes No

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

Yes No

If "Yes," describe in Part IV.

Part I-C

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

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

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

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

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

Yes No

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

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

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 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 if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check if the filing organization checked box A and "limited control" provisions apply.

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

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

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

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

(b)

Amount

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

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

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

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

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

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

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

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

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

Other activities? ..........................

Yes

2,617

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

2,617

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

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

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

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

Part III-A

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

Yes

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

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

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

Part III-B

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

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

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

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

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

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

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

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

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

Part IV

Supplemental Information

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

Identifier	Return Reference	Explanation
IHA Dues		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:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 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

ST MARY MEDICAL CENTER INC

Employer identification number

35-2007327

Part I

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

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

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

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds 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? ...................................

Yes No

Part II

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

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

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

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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.


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

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

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

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

Yes No

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

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

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

Yes No

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

Part III

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

If the organization elected, as permitted under SFAS 116 (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.

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

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:

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

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

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

Cat. No. 52283D

Schedule D (Form 990) 2011

Page 2

Part III

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

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

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

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

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

Yes No

Part IV

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

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

Yes No

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


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

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

Yes No

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

Part V

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

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

Provide the estimated percentage of the year end balance (line 1g) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

The percentages in lines 2a, 2b, and 2c should equal 100%.

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

Yes

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

3a(i)

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

3a(ii)

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

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

Part VI

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

Description of property		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	8,100,855		8,100,855
b	Buildings ................	90,888,266	27,439,974	63,448,292
c	Leasehold improvements ............	756,442	131,125	625,317
d	Equipment ................	50,820,837	35,179,670	15,641,167
e	Other .................	12,133,366	3,391,928	8,741,438
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				96,557,069

Schedule D (Form 990) 2011

Page 3

Part VII

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

(a) Description of security or category (including name of security)		(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

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

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









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

Part IX

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

(a) Description				(b) Book value









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

Part X

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

1.(a) Description of Liability		(b) Book value
Federal Income Taxes		0
3RD PARTY SETTLEMENTS		6,874,270
DEVELOPER REIMBURSEMENT		3,647,146
LEGAL CLAIM LIABILITIES		1,842,627
CAPITAL LEASES-CURRENT		1,068,135
CAPITAL LEASES-LT		1,055,964
LT DEFERRED GAIN		38,165



Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		14,526,307
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

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		The adoption of ASC 740 did not materially impact the financial statements.

Schedule D (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H (Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

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

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

ST MARY MEDICAL CENTER INC

Employer identification number

35-2007327

Part I

Charity Care and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a....

Yes

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

Yes

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.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

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.

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:

Yes

100% 150% 200% Other

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: ............

Yes

200% 250% 300% 350% 400% Other

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.

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"? ..............

Yes

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

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount?......

Yes

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

Did the organization prepare a community benefit report during the tax year?...........

Yes

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

Yes

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

Financial Assistance and Certain Other Community Benefits at Cost

	(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) ..		4,659	4,540,884	141,584	4,399,300	2.200 %
b Medicaid (from Worksheet 3, column a) .....		17,910	29,689,721	20,851,541	8,838,180	4.430 %
c Costs of other means-tested government programs (from Worksheet 3, column b) .
dTotal Financial Assistance and Means-Tested Government Programs .....		22,569	34,230,605	20,993,125	13,237,480	6.630 %
Other Benefits e Community health improvement services and community benefit operations (from (Worksheet 4) ....	446	11,380	674,890		674,890	0.340 %
f Health professions education (from Worksheet 5) ..	23	558	781,413		781,413	0.390 %
g Subsidized health services (from Worksheet 6) ..		258	545,278	461,536	83,742	0.040 %
h Research (from Worksheet 7)
i Cash and in-kind contributions for community benefit (from Worksheet 8) ....	97		1,119,838		1,119,838	0.560 %
jTotal Other Benefits ...	566	12,196	3,121,419	461,536	2,659,883	1.330 %
kTotal. Add lines 7d and 7j. ..	566	34,765	37,352,024	21,454,661	15,897,363	7.960 %

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
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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

Yes

Enter the amount of the organization's bad debt expense........

3,404,032

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy .....

34,040

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

Section B. Medicare

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

86,509,792

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

100,583,142

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

-14,073,350

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

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

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.......................

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 %
1LAKE PARK SURGICARE	OUTPATIENT SURGICAL PROCEDURE	100.000 %
2
3
4
5
6
7
8
9
10
11
12
13

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		Other (Describe)
1	ST MARY MEDICAL CENTER 1500 SOUTH LAKE PARK AVENUE HOBART,IN46342	X	X	X	HOSPITAL

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)

ST MARY MEDICAL CENTER

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

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

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

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?24
Name and address		Type of Facility (describe)
1	Outpatient Surgery at Lake Park 7921 Grand Boulevard Hobart,IN46342	Outpatient Surgery
2	Center for Imaging and Radiation Oncolog 300 W 61st Avenue Hobart,IN46342	Radiology
3	OUTPATIENT REHABILITATION 320 W 61ST AVENUE HOBART,IN46342	REHABILITATION
4	WOMEN'S DIAGNOSTIC CENTER 320 W 61st Avenue Hobart,IN46342	DIAGNOSTIC CENTER
5	PORTAGE HEALTH CENTER II 3545 ARBORS STREET PORTAGE,IN46368	OUTPATIENT CENTER
6	WILLOWCREEK HEALTH CENTER 3170 WILLOWCREEK ROAD PORTAGE,IN46368	Outpatient Center
7	WINFIELD FAMILY HEALTH CENTER 10607 RANDOLPH STREET CROWN POINT,IN46307	Outpatient Center
8	Health & Rehabilitation Spectrum 1354 S Lake Park Avenue Hobart,IN46342	Outpatient Center
9	Home Health of St Mary Medical Center 1439 S Lake Park Avenue Hobart,IN46342	Home Health
10	INNOVATIVE WOMEN'S HEALTH 1400 SOUTH LAKE PARK AVE SUITE 20 HOBART,IN46342	PHYSICIAN PRACTICE
11	INNOVATIVE WOMEN'S HEALTH 3545 ARBORS STREET PORTAGE,IN46368	PHYSICIAN PRACTICE
12	INNOVATIVE WOMEN'S HEALTH 401 WALL STREET SUITE B VALPARAISO,IN46383	PHYSICIAN PRACTICE
13	INNOVATIVE WOMEN'S HEALTH 1551 SOUTH STURDY ROAD VALPARAISO,IN46383	PHYSICIAN PRACTICE
14	INNOVATIVE WOMEN'S HEALTH 10607 RANDOLPH ST SUITE C CROWN POINT,IN46307	PHYSICIAN PRACTICE
15	LAKE GEORGE MEDICAL CENTER 164 BRACKEN PARKWAY HOBART,IN46342	PHYSICIAN PRACTICE
16	PORTER COUNTY PRIMARY CARE 2000 ROOSEVELT ROAD SUITE 5 VALPARAISO,IN46383	PHYSICIAN PRACTICE
17	ST MARY CARE NETWORK 200 EAST 80TH PLACE SUITE 100E MERRILLVILLE,IN46410	PHYSICIAN PRACTICE
18	ST MARY CARE NETWORK 3170 WILLOWCREEK ROAD PORTAGE,IN46368	PHYSICIAN PRACTICE
19	ST MARY SURGICAL ASSOC 1400 SOUTH LAKE PARK AVE SUITE 20 HOBART,IN46342	PHYSICIAN PRACTICE
20	ST MARY CARE NETWORK 10607 RANDOLPH ST SUITE A CROWN POINT,IN46307	PHYSICIAN PRACTICE
21	ST MARY SURGICAL ASSOC 801 MACARTHUR BLVD SUITE 402 MUNSTER,IN46321	PHYSICIAN PRACTICE
22	ST MARY CARE NETWORK 1400 SOUTH LAKE PARK AVE SUITE 50 HOBART,IN46342	PHYSICIAN PRACTICE
23	ST MARY CARE NETWORK 1441 SOUTH LAKE PARK AVE HOBART,IN46342	PHYSICIAN PRACTICE
24	ST MARY CARE NETWORK 1400 SOUTH LAKE PARK AVE SUITE 10 HOBART,IN46342	PHYSICIAN PRACTICE

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
SUPPLEMENTAL INFORMATION - PART I	PART I, LINE 3C	N/A PART I, LINE 6A STATE FILING OF COMMUNITY BENEFIT REPORT (INDIANA).
SUPPLEMENTAL INFORMATION - PART I	PART I, LINE 7G	THE METHODOLOGY USED WAS THE COST TO CHARGE RATIO. IT IS FOR INPATIENT ONLY AND EXCLUDES MEDICAID, CHARITY AND BAD DEBT.
SUPPLEMENTAL INFORMATION - PART I	PART I, LINE 7, COLUMN F	BAD DEBT OF $11,432,057 IS EXCLUDED FROM THE CALCULATION. PART I, LINE 7 THE METHODOLOGY USED WAS THE COST TO CHARGE RATIO. IT IS FOR THE INPATIENTS ONLY AND EXCLUDES MEDICAID AND CHARITY.
SUPPLEMENTAL INFORMATION - PART III	PART III, LINE 4	ST. MARY MEDICAL CENTER EVALUATES THE COLLECTIBILITY OF ITS ACCOUNTS RECEVIABLE BASED ON THE LENGTH OF TIME THE RECEIVABLE IS OUTSTANDING AND THE ANTICIPATED FUTURE UNCOLLECTIBLE AMOUNTS BASED ON HISTORICAL EXPERIENCE. ACOUNTS RECEIVABLE ARE CHARGED TO THE ALLOWANCE FOR DOUBTFUL ACCOUNTS WHEN THEY ARE DEEMED UNCOLLECTIBLE. ST. MARY'S DOES NOT REQUIRE COLLATERAL. THE 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.
SUPPLEMENTAL INFORMATION - PART III	PART III - LINE 8	THE TOTAL REVENUE RECEIVED FROM MEDICARE WAS CALCULATED BY USING INFORMATION FROM THE COST ACCOUNTING SYSTEM. WE PROVIDE NECESSARY SERVICES REGARDLESS OF THE PATIENT'S ABILITY TO PAY FOR THE SERVICE PROVIDED OR THE REIMBUSEMENT RECEIVED FROM MEDICARE, QUALIFYING THE $14,073,350 OF MEDICARE SHORTFALL AS A COMMUNITY BENEFIT.
SUPPLEMENTAL INFORMATION - PART III	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 N/A PART V, LINE 20 N/A PART V, LINE 21 N/A NEEDS ASSESSMENT ST. MARY MEDICAL CENTER USED A THIRD-PARTY CONSULTING FIRM TO ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITY. ST. MARY MEDICAL CENTER SERVES AN OLDER POPULATION WITH AN EXPECTED LOSS OF POPULATION IN THE NEXT FIVE YEARS. ST. MARY'S CONTINUES TO SEE GROWTH IN AREAS SUCH AS ORTHOPEDICS AND GENERAL AND BARIATRIC SURGERY.
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE	PART VI, LINE 3	PATIENTS WHO ARE ADMITTED WITHOUT INSURANCE ARE DIRECTED TO THE HOSPITAL'S FINANCIAL COUNSELORS. THE FINANCIAL COUNSELORS PERFORM AN INTERVIEW WITH THE PATIENTS 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 POLICY IS POSTED IN THE EMERGENCY ROOM AREA AS WELL AS AT EACH INPATIENT WAITING DESK.
PROMOTION OF COMMUNITY HEALTH	PART VI, LINE 5	Alzheimer's Support Group - Alzheimer's Support Group meets the third Tuesday of each month at St. Mary Medical Center. This group is for patients, family and friends dealing with Alzheimer's. Participants in support groups receive emotional support, practical assistance in coping with the issues they face and the latest information about research. Alzheimer's Symposium - Support and resources are provided to help caregivers and those in very early stages of Alzheimer's learn about and navigate the medical and legal issues of this diagnosis. A physician and attorney give a speech and participants may also browse a consortium of vendors providing information about everything from assisted living to home monitoring. Bariatric Seminar - Using a team approach to achieving weight loss, Dr.'s Paul Stanish and Hung Dang discuss the etiology of obesity, its effect on an individual's physical, emotional and psychological health. The goal is to improve the medical complications of life-threatening obesity. Blood Profile Screening - These screenings offer a way for those concerned about heart health to monitor cholesterol, HDL, triglycerides or glucose. No physician order is necessary for the screening. Blood Pressure Screeing - These are blood pressure screenings free to the public at the Portage YMCA. Participants are given educational material regarding blood pressure and how it relates to their health. BMI/Body Fat Analysis - These are BMI and body fat screenings free to the public at the Portage YMCA. Participants are given educational material regarding BMI and body fat percentage and how it relates to their health. Cancer Survivors Day - The Cancer Resource Centre and St. Mary Medical Center provide a local celebration of this national event, honoring the strength and courage of those who have lived - and continue to live - with cancer. Prizes are raffled and each attendee receives a strength gift and food and entertainment are also provided. Cardiac Rehab: Ask the Pharmacist - Informational session for patients to ask a pharmacist questions regarding their cardiac medications. Handouts are provided to patients comparing certain blood pressure medications. Clinical Education for Ministry - Training college students for pastoral care. Consoling Hearts Grief Support - Support offered to those suffering from the loss of a loved one. Cooking Demonstrations - Chef Ryan C. Smith demonstrates delectable appetizers, salads, entrees, desserts and more in these fun and interactive demonstrations. Coronary Health Appraisal - This appraisal helps to determine risk for heart disease and other related medical conditions. Screening includes: cholesterol (total, HDL, LDL, triglycerides), blood sugar, metabolic syndrome, blood pressure, body mass index and a Heart Health Profile. Coumadin Class - A pharmacist and dietician discuss appropriate diet and medications to avoid while taking Coumadin. Diabetes Class - This is a class that discusses diabetes management, the proper use of medication, glucose monitoring, meal planning and diabetes complications. Guided Meditation - This is a class put on by the hospital's Same Day Surgery department that discusses meditation and the healing touch. Happy Hearts - Happy Hearts is a monthly educational support group designed to meet the learning needs of the Heart Failure (HF) patient/family or friends. Each month a program is developed to help answer questions and to teach the self-care need to the HF patient. The group meets at St. Mary Medical Center for two hours a month. There are on average 12-15 participants at each meeting. Some of the topics include: self management of heart failure, pacemakers, medications, recipe sharing, inspiration and coping skills. Healing Touch - Healing Touch is a complementary caregiving technique that uses a hands-on and energy-based approach to balance and align the human energy field. Body, mind, spirit and emotion are touched through this therapeutic process and each individual is empowered to participate fully in his or her own healing journey. Healing Touch sessions are held at St. Mary Medical Center on Wednesdays and there are also weekend workshops that provide techniques at Level 1 and 2. Hearts of Hope - Crimson lights on the Hearts of Hope trees outside St. Mary Medical Center shine brightly during the holiday season with the help and support of donations to cardiac research. The Hearts of Hope trees are decorated with lights that represent contributions made in honor of or in memory or someone who has been affected by heart disease. Monies raised through donations fund vitally needed research for heart disease. Donors and honorees are invited to a Hearts of Hope tree lighting ceremony that celebrates cardiac research success stories of St. Mary Medical Center. Hope Network Cancer Support Group - The last Wednesday of each month this group meets for informative sessions where they can share thoughts and feelings in a comfortable and confidential atmosphere. IUN - HIT Summer Clinical - 10 days of free clinical nursing education and training for IUN nursing students. Knox Suite - Knox Suite is similar to a hotel room that is located on the fourth floor of the hospital and accommodates families that need a place to stay. Lamaze - Six educational classes are offered each session for those in their last trimester of pregnancy. Classes include informative lectures about comfort measures and medication available for pain. The last session focuses on management of breast-feeding and newborn behavior patterns. Look Good-Feel Better - This class helps improve the physical appearance of cancer patients by helping them with make-up and wigs to aide in their mental and emotional well being in their struggle with cancer. This class is put on by the Women's Diagnostic Center. Maria Reiner Health Fair - Blood Glucose screenings. Medical Student Internships - Medical students interested in learning more about a clinical hospital setting can spend their summer in a volunteer program at St. Mary Medical Center. This innovative program allows pre-med students to shadow the many departments and units of a community-based hospital to assist them in making important decisions regarding their future medical careers. Vijay Dave, M.D. is the director of medical education at St. Mary Medical Center and heads up the summer program which partners with Indiana University School of Medicine - Northwest and the Northwest Indiana Area Health Education Center. Mended Hearts - Mended Hearts is a national organization with a local Northwest Indiana chapter that meets on the third Tuesday of each month. It is made up of men and women who have experienced first-hand or have a close family member who has undergone Open Heart Surgery of Valve Replacement Surgery. Some of the volunteers visit patients in the hospital after they have had surgery. They are available to reinforce what healthcare providers have prescribed and recommended. They also are there to listen and be supportive to the patients and their families. The volunteer shares informational packets and encourages patients during recovery. Moving Forward - Stroke Education - Stroke survivors and caregivers learn to prevent future strokes through risk detection and management. This is a five-part series that meets every other week Monday - Friday from 4-5 p.m. PAD - What's It All About? - The Cardiac Rehabilitation Medical Director discusses peripheral arterial disease (PAD). Attendees learn the signs, symptoms, causes and treatment of this serious disease. Pulmonary Function Screeings - Free PFT screenings for the community and blood pressure and oxygen concentration levels. Participants are given educational materials regarding pulmonary function and how it relates to their health. Scouting for Food - St. Mary Medical Center employees help replenish the shelves of the Hobart Food Pantry. St. Mary Medical Center partners with Boy Scouts of America - Calumet Council to participate in this annual food drive campaign. Food collection and delivery are organized under the auspices of St. Mary Medical Center's Christian Awareness Committee. Skin Cancer Screenings - Physician examines any questionable areas of the body to look for indications of cancer or pre-cancerous conditions. This screening takes place at a participating St. Mary Medical Center physician's office on a monthly basis. Smoking Cessation: "I Quit!"- This is a behavior modification program to help individuals in their attempt to quit smoking. Stroke Class- This is a 5 day class reviewing all aspects of stroke by Nursing, OT, PT, SP and SW. Teen Childbirth Education (Lamaze) - Our certified childbirth educator teaches how to give baby a healthy start. Participants learn about labor and delivery, nutrition, pain relief options, recovery and valuable resources for support. Classes are designed specifically for teenagers, ages 13-19. Based in Hobart and the surrounding communities, these pr
AFFILIATED HEALTH CARE SYSTEM		ST. MARY MEDICAL CENTER 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 (3,517,991) Physician practices (2,252,609) Medicare Managed Care (960,804) Fee-based Outpatient charges (3,366,231) Disallowed Medicare expenses (3,975,715) Total (Shortfall) (14,073,350)
PART V, LINE 19		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.

Schedule H (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

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

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

Attach to Form 990

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization
ST MARY MEDICAL CENTER INC

Employer identification number
35-2007327

Part I

General Information on Grants and Assistance

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

Yes No

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

Part II

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

(a) Name and address of organization or government	(b) EIN	(d) Amount of cash grant	(f) Method of valuation (book, FMV, appraisal, other)
(1) CITY OF HOBART414 MAIN STREET HOBART,IN46342	35-6001058	1,000,000	FMV

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

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

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

Schedule I (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

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

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

Attach to Form 990. SchJMediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

ST MARY MEDICAL CENTER INC

Employer identification number

35-2007327

Part I

Questions Regarding Compensation

Yes

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

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

Travel for companions Payments for business use of personal residence

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

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

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

Yes

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

Yes

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

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Cat. No. 50053T

Schedule J (Form 990) 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
(A) Name		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(1) MARK SIMAGA MD	(i) (ii)	0 246,764	0 0	0 2,322	0 7,350	0 15,534	0 271,970	0 0
(2) JANICE RYBA	(i) (ii)	0 348,336	0 95,618	0 15,585	0 34,787	0 13,627	0 507,953	0 0
(3) 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
(4) MARY SUDICKY	(i) (ii)	203,428 0	35,316 0	420 0	34,666 0	36,571 0	310,401 0	0 0
(5) TAMMIE JONES	(i) (ii)	181,662 0	64,685 0	856 0	8,735 0	15,641 0	271,579 0	0 0
(6) WALLACE SHERRITT DO	(i) (ii)	306,768 0	152,224 0	5,794 0	7,350 0	15,353 0	487,489 0	0 0
(7) IBRAHIM ZABANEH MD	(i) (ii)	234,091 0	50,096 0	1,754 0	7,350 0	21,507 0	314,798 0	0 0
(8) PAUL STANISH FACS	(i) (ii)	273,911 0	10,000 0	473 0	7,350 0	13,475 0	305,209 0	0 0
(9) ROBERT CHEN MD	(i) (ii)	242,663 0	0 0	426 0	7,350 0	17,751 0	268,190 0	0 0
(10) THOMAS DEVINE MD	(i) (ii)	240,211 0	0 0	426 0	7,350 0	19,952 0	267,939 0	0 0

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 I LINE 1A THE ORGANIZATION PAYS HEALTH/SOCIAL CLUB DUES ON BEHALF OF CERTAIN OFFICERS, KEY EMPLOYEES, AND FIVE HIGHEST PAID EMPLOYEES WHICH IS THEN TAXED AS A FRINGE BENEFIT TO THE INDIVIDUAL.

Schedule J (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

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

Attach to Form 990 or Form 990-EZ. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

ST MARY MEDICAL CENTER INC

Employer identification number

35-2007327

Part I

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

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

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

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

Part II

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

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






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

Part III

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

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

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

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 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?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) Carol Shingler	Fam Member-Linda Buzinec	76,328	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:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

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

Attach to Form 990 or 990-EZ.

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization

ST MARY MEDICAL CENTER INC

Employer identification number

35-2007327

Identifier	Return Reference	Explanation
FORM 990, PT VI-A LINE 7A	DESCRIPTION OF CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS	COMMUNITY FOUNDATION OF NORTHWEST INDIANA, INC IS THE PARENT COMPANY OF ST. MARY MEDICAL CENTER AND HAS CONTROL TO ELECT MEMBERS OF THEIR GOVERNING BODY.
FORM 990, PT VI-A LINE 7B	DESCR CLASSES OF PERSONS, DECISIONS REQUIRING APPR & TYPE OF VOTING RIGHTS	COMMUNITY FOUNDATION OF NORTHWEST INDIANA, INC IS THE PARENT COMPANY OF ST MARY MEDICAL CENTER AND HAS RIGHTS TO APPROVE DECISIONS MADE BY ST MARY MEDICAL CENTER.
FORM 990, PT VI-A LINE 11A	DESCRIBE THE PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990	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 FOR 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.
FORM 990, PT VI-B LINE 12C	DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST	AS PART OF THE ORGANIZATION'S ANNUAL MONITORING AND ENFORCEMENT PROCEDURES 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.
FORM 990, PT VI-B LINE 15	OFFICES & POSITIONS FOR WHICH PROCESS WAS USED, & YEAR PROCESS WAS BEGUN	SMMC FOLLOWS THE PARENT COMPANY (CFNI) POLICY. THE SALARY AND BENEFIT COMMITTEE OF THE BOARD REQUEST 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 IS ASSEMBLED FROM REPUTABLE, COMMERCIALLY-AVAILABLE SURVEYS.
FORM 990, PT VI-C LINE 19	AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMTS TO GEN PUBLIC	ST MARY MEDICAL CENTER DOES NOT MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. IN ACCORDANCE WITH BOND COVENANTS, ST MARY MEDICAL CENTER THROUGH COMMUNITY FOUNDATION OF NORTHWEST INDIANA MAKES ITS FINANCIAL STATEMENTS AND DISCLOSURES AVAILABLE TO THE PUBLIC THROUGH EMMA DATABASE. .
FORM 990, PT VII SECTION A	HOURS FOR RELATED ORGANIZATIONS	CFNI SCH SMMC CH CVI TATC CVPA CCRF Total Milton Gasparis, MD 1 1 Mark Simaga, MD 20 1 21 William Schenck 1 1 1 1 4 Janice Ryba 41 41 Mary Ann Shacklett 41 1 1 1 1 1 1 1 48 Milton Gasparis, MD - Compensation is for hours worked as a Utilization Management Consultant Mark Simaga, MD - Related organization compensation is for hours worked as the system Chief Medical Information Officer William Schenck - Related organization compensation is for attending CFNI monthly BOD and committee meetings Janice Ryba - Related organization compensation is for hours worked as the Hospital Administrator Mary Ann Shacklett - Related organization compensation is for hours worked as the system CFO .
FORM 990, PT XI LINE 5	RECONCILIATION OF NET ASSETS	TRANSFERS TO CFNI (PARENT) 12,839,609 Rounding 160 TOTAL CHANGE IN NET ASSETS 12,839,769

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

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

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

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

ST MARY MEDICAL CENTER INC

Employer identification number

35-2007327

Part I

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

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

Part II

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled organization
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1) COMMUNITY FOUNDATION OF NW INDIANA INC 10010 DONALD POWERS DR MUNSTER,IN46321 31-1128781	SUPPORT ORG	IN	501(c)(3)	11(c)	NA		No
(2) MUNSTER MEDICAL RESEARCH FOUNDATIONINC 800 MACARTHUR BLVD MUNSTER,IN46321 35-1107009	HOSPITAL	IN	501(c)(3)	3	CFNI	Yes
(3) ST CATHERINE HOSPITAL INC 4321 FIR STREET EAST CHICAGO,IN46312 35-1738708	HOSPITAL	IN	501(c)(3)	3	CFNI	Yes
(4) COMMUNITY CANCER RESEARCH FOUNDATION 901 MACARTHUR BLVD MUNSTER,IN46321 35-2146374	Cancer Funds	IN	501(c)(3)	7	MMRF	Yes
(5) COMMUNITY VILLAGE INC 10000 COLUMBIA AVE MUNSTER,IN46321 35-1956395	RETIRMT HOME	IN	501(c)(3)	9	CFNI	Yes
(6) CVPA HOLDING COMPANY 905 RIDGE RD MUNSTER,IN46321 35-1938136	SUPPORT ORG	IN	501(c)(2)	N/A	CFNI	Yes
(7) THEATRE AT THE CENTER 1040 RIDGE RD MUNSTER,IN46321 35-1939427	CONCERTS	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

Page 2

Part III

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) VALPARAISO MED DEV 3800 ST MARY DR VALPARAISO,IN46383 45-3194502	REAL ESTATE	IN	SMMC				No		Yes		50.000 %

Part IV

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)
(1) COMMUNITY RESOURCES INC 907 RIDGE RD MUNSTER,IN46321 35-1727711	MGMT SERVICES	IN	NA	C CORP

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

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

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

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

Yes

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

Yes

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

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

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

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

h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

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

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

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

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

m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .

n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

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

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

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) Munster Medical Research Foundation	n	813,207	FMV
(2) ST CATHERINE HOSPITAL INC	N	331,189	FMV
(3) ST CATHERINE HOSPITAL INC	o	128,639	FMV
(4) MUNSTER MEDICAL RESEARCH FOUNDATION	o	1,682,718	FMV
(5) MUNSTER MEDICAL RESEARCH FOUNDATION	p	7,405,722	FMV
(6) ST CATHERINE HOSPITAL INC	P	1,236,870	FMV

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

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

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: Community Healthcare System is committed to providing 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
3	Number of voting members of the governing body (Part VI, line 1a).....	3	14
4	Number of independent voting members of the governing body (Part VI, line 1b) ....	4	11
5	Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...	5	1,548
6	Total number of volunteers (estimate if necessary) ....	6	234
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ..	7a	648,643
b	Net unrelated business taxable income from Form 990-T, line 34 ..	7b	44,545

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	92,000	748,601
9	Program service revenue (Part VIII, line 2g) .........	195,333,629	212,440,787
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	28,193	-72,661
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	2,745,412	1,353,219
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	198,199,234	214,469,946
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	1,000,000
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)	86,011,968	83,157,619
16a	Professional fundraising fees (Part IX, column (A), line 11e).....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f)....	103,037,761	114,931,503
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	189,049,729	199,089,122
19	Revenue less expenses. Subtract line 18 from line 12.......	9,149,505	15,380,824
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	135,984,840	144,249,852
21	Total liabilities (Part X, line 26).............	26,567,903	32,291,860
22	Net assets or fund balances. Subtract line 21 from line 20.....	109,416,937	111,957,992

Sign Here

	Signature of officer	Date

	Type or print name and title.


4a	(Code: ) (Expenses $ 31,960,553 including grants of $ ) (Revenue $ 48,872,501 )
	Nursing: 63,131 Patient Days

4b	(Code: ) (Expenses $ 30,369,402 including grants of $ ) (Revenue $ 80,202,062 )
	IP/OP Surgeries: 46,682 Cases

4c	(Code: ) (Expenses $ 19,028,009 including grants of $ ) (Revenue $ 67,246,054 )
	Outpatient Services: 147,883 Patient Days

	(Code: ) (Expenses $ 15,897,622 including grants of $ ) (Revenue $ 58,517,473 )
	Pharmacy-4,448,518 Doses Administered

	(Code: ) (Expenses $ 14,039,504 including grants of $ ) (Revenue $ 18,987,769 )
	Physician-63,860 Visits

	(Code: ) (Expenses $ 12,629,356 including grants of $ ) (Revenue $ 47,560,065 )
	Cardio-28,075 Visits

	(Code: ) (Expenses $ 9,695,760 including grants of $ ) (Revenue $ 73,281,771 )
	Lab-762,717 Specimens Collected

	(Code: ) (Expenses $ 6,130,569 including grants of $ ) (Revenue $ 40,356,421 )
	ER-36,520 Visits & Admissions

	(Code: ) (Expenses $ 4,932,017 including grants of $ ) (Revenue $ 9,302 )
	Dietary-254,273 IP Meals

	(Code: ) (Expenses $ 4,872,845 including grants of $ ) (Revenue $ 65,403,194 )
	Radiology-103,707 Procedures

	(Code: ) (Expenses $ 4,448,001 including grants of $ ) (Revenue $ )
	Patient Services-59,039 Visits

	(Code: ) (Expenses $ 4,299,535 including grants of $ ) (Revenue $ 14,964,432 )
	PT OT Speech-140,673 Procedures

	(Code: ) (Expenses $ 3,958,348 including grants of $ ) (Revenue $ 5,625,396 )
	ICU-3,740 Patient Days

	(Code: ) (Expenses $ 3,578,189 including grants of $ ) (Revenue $ 6,548,144 )
	IMCU-6,450 Patient Days

	(Code: ) (Expenses $ 3,560,550 including grants of $ ) (Revenue $ )
	HIM-Medical Records Coded

	(Code: ) (Expenses $ 3,046,055 including grants of $ ) (Revenue $ 16,701,138 )
	Respiratory Therapy-96,781 Procedures

	(Code: ) (Expenses $ 2,774,198 including grants of $ ) (Revenue $ 3,248,093 )
	Home Health-26,700 Visits

	(Code: ) (Expenses $ 2,393,087 including grants of $ ) (Revenue $ )
	Admitting-12,037 IP Admission

	(Code: ) (Expenses $ 1,569,937 including grants of $ ) (Revenue $ )
	Medical Staff

	(Code: ) (Expenses $ 1,071,569 including grants of $ ) (Revenue $ 6,287,286 )
	Nuclear Med-2,602 Procedures

	(Code: ) (Expenses $ 980,791 including grants of $ ) (Revenue $ )
	Public Relations

	(Code: ) (Expenses $ 825,785 including grants of $ ) (Revenue $ )
	Security

	(Code: ) (Expenses $ 793,189 including grants of $ ) (Revenue $ )
	Central Sterilization-Provide Sterile Instruments

	(Code: ) (Expenses $ 782,273 including grants of $ ) (Revenue $ -47 )
	Central Supply

	(Code: ) (Expenses $ 416,813 including grants of $ ) (Revenue $ )
	Social Services

	(Code: ) (Expenses $ 253,839 including grants of $ ) (Revenue $ 2,398,427 )
	EEG-5,170 Procedures

	(Code: ) (Expenses $ 62,339 including grants of $ ) (Revenue $ )
	POB

	(Code: ) (Expenses $ 319 including grants of $ ) (Revenue $ )
	Misc

	(Code: ) (Expenses $ including grants of $ ) (Revenue $ -316,619,256 )
	Contractuals

	(Code: ) (Expenses $ including grants of $ ) (Revenue $ -15,135,724 )
	Charity

	(Code: ) (Expenses $ including grants of $ ) (Revenue $ -11,432,057 )
	Bad Debt

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 103,012,490 including grants of $ ) (Revenue $ 16,701,827 )
4e	Total program service expenses$ 184,370,454

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)		(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
(A) Name and Title
(18) WALLACE SHERRITT DO PHYSICIAN	40.0	X	464,786	0	22,703
(19) IBRAHIM ZABANEH MD PHYSICIAN	40.0	X	285,941	0	28,857
(20) PAUL STANISH FACS PHYSICIAN	40.0	X	284,384	0	20,825
(21) ROBERT CHEN MD PHYSICIAN	40.0	X	243,089	0	25,101
(22) THOMAS DEVINE MD PHYSICIAN	40.0	X	240,637	0	27,302

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	2,005,974	1,295,258	348,659

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512, 513, or 514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d
e	Government grants (contributions)1e		640,000

f	All other contributions, gifts, grants, and similar amounts not included above1f		108,601
g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			748,601
			Business Code
2a	NET PATIENT SERVICE REVENUE		900,099	212,440,787	211,792,144	648,643
b
c
d
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			212,440,787
3	Investment income (including dividends, interest
	and other similar amounts).....			179,508			179,508
4	Income from investment of tax-exempt bond proceeds..			0
5	Royalties............			0
		(i) Real	(ii) Personal
6a	Gross rents	634,243
b	Less: rental expenses	413,657
c	Rental income or (loss)	220,586
d	Net rental income or (loss).......			220,586	220,586
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory		45,533
b	Less: cost or other basis and sales expenses		297,702
c	Gain or (loss)		-252,169
d	Net gain or (loss)..........			-252,169			-252,169
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...			0
10a	Gross sales of inventory, less returns and allowances .
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..			0
Miscellaneous Revenue			Business Code
11a	CAFETERIA		721,000	750,689			750,689
b	EDUCATION AND TRAINING		611,430	201,613	201,613
c	MANAGED CARE AND OTHER REVENUE		900,099	159,458	159,458
d	All other revenue ....			20,873			20,873
e	Total. Add lines 11a–11d ......			1,132,633
12	Total revenue. See Instructions....			214,469,946	212,373,801	648,643	698,901


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing ..........			0	1	0
2	Savings and temporary cash investments .......			8,391,482	2	3,151,099
3	Pledges and grants receivable, net .........			0	3	0
4	Accounts receivable, net .........			28,275,318	4	29,550,155
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 ..............			4,768,093	8	5,215,530
9	Prepaid expenses and deferred charges ............			4,487,697	9	3,535,969
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	162,699,766
b	Less: accumulated depreciation. .....	10b	66,142,697	89,996,635	10c	96,557,069
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 ...........			65,615	15	6,240,030
16	Total assets. Add lines 1 through 15 (must equal line 34)...			135,984,840	16	144,249,852
17	Accounts payable and accrued expenses .			25,564,853	17	17,536,740
18	Grants payable ..........			0	18	0
19	Deferred revenue ..........			258,727	19	228,813
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.....			744,324	25	14,526,307
26	Total liabilities. Add lines 17 through 25.....			26,567,903	26	32,291,860
	Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....			109,236,409	27	111,780,899
28	Temporarily restricted net assets .....			180,528	28	177,093
29	Permanently restricted net assets .....			0	29	0
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances .....			109,416,937	33	111,957,992
34	Total liabilities and net assets/fund balances .....			135,984,840	34	144,249,852