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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," on Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990.
lBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2020
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 Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on 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 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
noncash assistance		 (h) Purpose of grant
or assistance
(1) MERCY FOUNDATION
2700 STEWART PARKWAY
ROSEBURG,OR97471 		93-6088946 501(C)3 643,385       GENERAL SUPPORT
(2) UMPQUA ECONOMIC DEVELOPMENT PARTNERSHIP
522 SE WASHINGTON AVE NO 107
ROSEBURG,OR97470 		45-2963767 501(C)6 8,000       GENERAL SUPPORT
(3) ST JOSEPH CHURCH
721 CHEMEKETA ST NE
SALEM,OR97301 		93-0399053 501(C)3 13,000       GENERAL SUPPORT
(4) DOUGLAS COUNTY CANCER SERVICES
2880 NW STEWART PARKWAY
ROSEBURG,OR97471 		94-3113835 501(C)3 5,650       GENERAL SUPPORT
(5) SLEEP IN HEAVENLY PEACE INC
1560 ELDRIDGE AVE
TWIN FALLS,ID83301 		46-4346568 501(C)3 7,200       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
1
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2020
Page 2

Schedule I (Form 990) 2020
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on 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
noncash assistance		 (e) Method of valuation (book,
FMV, appraisal, other)		 (f) Description of noncash assistance
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Part IV
Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.
Return Reference Explanation
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) 2020



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