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
2012
Open to Public
Inspection
Name of the organization
MERCY MEDICAL CENTER INC
 
Employer identification number
93-0386868
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) ROSEBURG CHAMBER FUTURE FIRST CITIZEN SCHOLARSHIP
PO BOX 1820
ROSEBURG,OR97470 		91-1852358 501(C)(3) 6,000       SCHOLARSHIP
(2) CCD BUSINESS DEVELOPMENT CORPORATION
744 SE ROSE
ROSEBURG,OR97470 		93-0594077 501(C)(3) 10,000       GENERAL SUPPORT
(3) THE LEAPFROG GROUP
1660 L STREET NW SUITE 308
WASHINGTON,DC20036 		52-2359517 501(C)(3) 5,000       GENERAL SUPPORT
(4) MERCY FOUNDATION INC
2700 STEWART PARKWAY
ROSEBURG,OR97471 		93-6088946 501(C)(3)   358,128 BOOK SUPPLIES GENERAL SUPPORT
















2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
4
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
0
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2012
Page 2

Schedule I (Form 990) 2012
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.
Part III can be duplicated 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, Part III, column (b), and any other additional information.
Identifier Return Reference Explanation
Procedures for monitoring use of grant funds Schedule I, Part I, Line 2 ALL DONATIONS ARE GIVEN TO NON-PROFIT ORGANIZATIONS TO BE USED IN ACCORDANCE WITH THEIR CHARITABLE PURPOSE; AND AS SUCH, USE OF THE FUNDS GIVEN TO THE GRANTEE IS NOT MONITORED BEYOND THEIR DISTRIBUTION. THE ORGANIZATION MAKES A RECORD OF ALL DONATIONS IN THE GENERAL LEDGER.
Schedule I (Form 990) 2012


Additional Data


Software ID: 12000266
Software Version: v2012.1.0