TY 2010 Form 990

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(C) Position (check all that apply)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) MICHAEL A DORSEY PRESIDENT/CEO/ASST SECRETARY	9.5	X	X		428,871	41,097
(2) IRENE CAUDILLO BOARD MEMBER	0.0	X			0	0
(3) PETER CRISTIANO MD BOARD MEMBER	0.0	X			0	0
(4) SISTER MARY RACHEL FLYNN BOARD OF DIRECTORS	0.0	X			0	0
(5) SISTER PAM HINKLE BOARD MEMBER	0.0	X			0	0
(6) DR MICHAEL PARRA MD BOARD MEMBER	0.0	X			0	0
(7) WILLIAM D PETRIE CHAIRMAN	0.0	X	X		0	0
(8) ROY L ROBINSON VICE CHAIRMAN	0.0	X	X		0	0
(9) BERNICE COGBURN BOARD MEMBER	0.0	X			0	0
(10) PASTOR RICKY D TURNER SECRETARY/TREASURER	0.0	X	X		0	0
(11) MARY JO GREGORY BOARD MEMBER	0.0	X			0	0
(12) DANIEL CRABTREE BOARD MEMBER	0.0	X			0	0
(13) DIANE MARIE STEELE BOARD MEMBER	0.0	X			0	0
(14) CLAY PATTERSON BOARD MEMBER	0.0	X			0	0
(15) JOE JEANS REGION VICE PRESIDENT FINANCE	10.0		X		191,248	31,615
(16) DANIEL SHEEHAN CHIEF ADMIN OFFICER	40.0		X		159,145	20,547
(17) JUANITA ROY EXECUTIVE VP & COO	10.0			X	313,707	34,539

(A) Name and business address	(B) Description of services	(C) Compensation
HORIZON HEALTH 2941 SOUTH LAKE VISTA DR LEWISVILLE,TX75067	MGMT OF GERIO PSYCH	861,372
PROVIDENCE MEDICAL CENTER 8929 PARALLEL PARKWAY KANSAS CITY,KS66112	MGMT AND IT SVCS	1,226,000
ANESTHESIA CHARTERED 5600 W 95TH STREET SUITE 123 OVERLAND PARK,KS66207	ANESTHESIOLOGY SVCS	1,631,132
PHYSICIANS REFERENCE LAB PO BOX 7210 SHAWNEE MISSION,KS66207	LABORATORY SERVICES	187,984
COVENANT GROUP PA 14400 COLLEGE BLVD STE 100 OVERLAND PARK,KS66215	ER PHYSICIANS	732,449
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization 7

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.	(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to governments and organizations in the U.S. See Part IV, line 21	14,000	14,000
2	Grants and other assistance to individuals in the U.S. See Part IV, line 22	0
3	Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 15 and 16	0
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	0
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	0
7	Other salaries and wages	15,486,454	14,424,149	1,062,305
8	Pension plan contributions (include section 401(k) and section 403(b) employer contributions) ....	649,041	604,520	44,521
9	Other employee benefits .......	1,556,559	1,556,559
10	Payroll taxes ...........	951,117	925,220	25,897
11	Fees for services (non-employees):
a	Management ......	1,515,302	140,381	1,374,921
b	Legal .........	6,935		6,935
c	Accounting ...........	0
d	Lobbying ...........	0
e	Professional fundraising. See Part IV, line 17..	0
f	Investment management fees ......	0
g	Other ..........	6,785,934	5,048,450	1,737,484
12	Advertising and promotion ....	275,314	301	275,013
13	Office expenses .......	1,742,668	1,739,316	3,352
14	Information technology ......	245,455	218,781	26,674
15	Royalties ..	0
16	Occupancy ...........	39,995	39,995
17	Travel ............	16,719	6,458	10,261
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0
19	Conferences, conventions, and meetings ....	3,806	3,781	25
20	Interest ...........	67,325		67,325
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization .....	1,575,955		1,575,955
23	Insurance ..............	235,133	9,844	225,289
24	Other expenses. Itemize expenses not covered above. (Expenses grouped together and labeled miscellaneous may not exceed 5% of total expenses shown on line 25 below.)
a	BAD DEBTS	4,597,058	4,597,058
b	PHARMACEUTICALS	1,189,651	1,189,651
c	UTILITIES	580,429	401,111	179,318
d	NON-MEDICAL SUPPLIES	572,005	561,263	10,742
e	PROVIDER TAXES	199,544		199,544
f	All other expenses	298,662	164,817	133,845
25	Total functional expenses. Add lines 1 through 24f	38,605,061	31,645,655	6,959,406	0
26	Joint costs. Check here if following SOP 98-2 (ASC 958-720). Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation

Part X Balance Sheet
	1	Cashnon-interest-bearing ..........		1
2	Savings and temporary cash investments .......	472,173	2	-389,413
3	Pledges and grants receivable, net .........		3
4	Accounts receivable, net .........	4,510,185	4	5,738,568
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........		5
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........		6
7	Notes and loans receivable, net .............		7
8	Inventories for sale or use ..............	772,711	8	799,051
9	Prepaid expenses and deferred charges ............	108,105	9	207,488
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	35,754,230
b	Less: accumulated depreciation. .....	10b	25,298,276	9,011,376	10c	10,455,954
11	Investments—publicly traded securities ..........		11
12	Investments—other securities. See Part IV, line 11 ......	7,576,322	12	2,697,282
13	Investments—program-related. See Part IV, line 11 ..		13
14	Intangible assets .........		14
15	Other assets. See Part IV, line 11 ...........	27,506	15	62,281
16	Total assets. Add lines 1 through 15 (must equal line 34)...	22,478,378	16	19,571,211
	17	Accounts payable and accrued expenses .	2,332,014	17	2,683,233
18	Grants payable ..........		18
19	Deferred revenue ..........		19
20	Tax-exempt bond liabilities ..........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D..		21
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........		22
23	Secured mortgages and notes payable to unrelated third parties ..	1,732,988	23	1,605,816
24	Unsecured notes and loans payable to unrelated third parties ....		24
25	Other liabilities. Complete Part X of Schedule D.....	337,311	25	419,383
26	Total liabilities. Add lines 17 through 25.....	4,402,313	26	4,708,432
		Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....	18,076,065	27	14,862,779
28	Temporarily restricted net assets .....		28
29	Permanently restricted net assets .....		29
	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 .....	18,076,065	33	14,862,779
34	Total liabilities and net assets/fund balances .....	22,478,378	34	19,571,211

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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

2010

Open to Public
Inspection

Name of the organization

Saint John Hospital Inc

Employer identification number

48-0543768

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) 2010

Page 2

Part II

Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2006	(b) 2007	(c) 2008	(d) 2009	(e) 2010	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3..
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public Support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year(or fiscal year beginning in)		(a) 2006	(b) 2007	(c) 2008	(d) 2009	(e) 2010	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11	Total support (Add lines 7 through 10).

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—2010. 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—2009. 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—2010. 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—2009. 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) 2010

Page 3

Part III

Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2006	(b) 2007	(c) 2008	(d) 2009	(e) 2010	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513..
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public Support (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2006	(b) 2007	(c) 2008	(d) 2009	(e) 2010	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13	Total support (Add lines 9, 10c, 11 and 12.).

Section C. Computation of Public Support Percentage

Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f)) .........

Public support percentage from 2009 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f)) ......

Investment income percentage from 2009 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2010. 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—2009. 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) 2010

Page 4

Part IV

Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Explanation

Schedule A (Form 990 or 990-EZ) 2010

Additional Data

Software ID:
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

2010

Name of organization

Saint John Hospital Inc

Employer identification number

48-0543768

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, aggregate 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 aggregate 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 in the heading of its
Form 990-EZ, or on line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

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

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2010)

Name of organization Saint John Hospital Inc
Schedule B (Form 990, 990-EZ, or 990-PF) (2010) Page 1 of 1 of Part I
Part I	Contributors (see Instructions)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
RESTRICTED	RESTRICTED RESTRICTED RESTRICTED RESTRICTED, RESTRICTED RESTRICTED	$RESTRICTED	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate 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) Aggregate 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) Aggregate 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) Aggregate 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) Aggregate 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) (2010)

Name of organization Saint John Hospital Inc
Schedule B (Form 990, 990-EZ, or 990-PF) (2010) Page 1 of 1 of Part II
Part II	Noncash Property (see Instructions)
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Page 1 of 1 of Part III

Name of organization
Saint John Hospital Inc

Employer identification number

48-0543768

Part III

Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
aggregating more than $1,000 for the year. (Complete columns (a) through (e) and the following line entry.)
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet

(a) No.
from
Part I

(b)
Purpose of gift

(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) (2010)

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

2010

Open to Public
Inspection

If the organization answered “Yes,” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes,” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes,” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35a (Proxy Tax), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

Saint John Hospital Inc

Employer identification number

48-0543768

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 on behalf of or in opposition to candidates for public office 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 funtion 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) 2010

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check if the filing organization belongs to an affiliated group.
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) 2007	(b) 2008	(c) 2009	(d) 2010	(e) Total

2a	Lobbying non-taxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots non-taxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2010

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

(a)

Yes

(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? If "Yes," describe in Part IV ..........................

Yes

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

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 carryover 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) if BOTH Part III-A, lines 1 and 2 are answered “No” OR if Part III-A, line 3 is answered “Yes”.

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

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

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, line 5; and Part ll-B, line 1i.
Also, complete this part for any additional information.

Identifier	Return Reference	Explanation
OTHER ACTIVITIES	SCHEDULE C, PART11-B, LINE 1I	PROVIDENCE MEDICAL CENTER, THE SOLE CORPORATE MEMBER OF SAINT JOHN HOSPITAL, INCURRED LOBBYING RELATED EXPENSES AMOUNTING TO $12,567. NO LOBBYING RELATED EXPENSES WERE DIRECTLY INCURRED BY SAINT JOHN HOSPITAL.

Schedule C (Form 990 or 990EZ) 2010

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, 11, or 12.
SchDMd Bullet

Attach to Form 990. SchDMd Bullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

Saint John Hospital Inc

Employer identification number

48-0543768

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 may be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit. ...................................

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 pleasure) Preservation of an historically importantly land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a–2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06 ........	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the taxable 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, 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, 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 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) 2010

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
1a	Beginning of year balance ....	871,512	736,128	953,198
b	Contributions ........	3,900	1,250	1,850
c	Investment earnings or losses ...	88,300	138,884	-209,520
d	Grants or scholarships .....			9,400
e	Other expenditures for facilities and programs ........	37,105	4,750
f	Administrative expenses ....
g	End of year balance ......	926,607	871,512	736,128

Provide the estimated percentage of the year end balance held as:

Board designated or quasi-endowment: SchDMd Bullet

78.950 %

Permanent endowment: SchDMd Bullet

21.050 %

Term endowment: SchDMd Bullet

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)

Yes

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

Yes

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

Part VI

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

Description of investment		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	110,861		110,861
b	Buildings ................	18,444,597	11,823,214	6,621,383
c	Leasehold improvements ............
d	Equipment ................	16,815,834	13,132,316	3,683,518
e	Other .................	382,938	342,746	40,192
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........				10,455,954

Schedule D (Form 990) 2010

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
(3)Other (A) INVESTMENTS	2,697,282	F








Total. (Column (b) should equal Form 990, Part X, col.(B) line 12.)	2,697,282

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) should 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) should 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) Amount
Federal Income Taxes		0
EST 3RD PARTY SETTLEMENT		419,383








Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)		419,383
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).

Schedule D (Form 990) 2010

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 - 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 should 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 should 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
SCHEDULE D, PART V, LINE 4	ENDOWMENT FUNDS	Retained endowment funds are intended to support indigent care, provide nursing scholarships, and to be used for the general support of the hospital at the discretion of the board. Endowment funds are held by Providence/Saint John Foundation.

Schedule D (Form 990) 2010

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

2010

Open to Public Inspection

Name of the organization

Saint John Hospital Inc

Employer identification number

48-0543768

Part I

Charity Care and Certain Other Community Benefits at Cost

Yes

Does the organization have a charity care policy? If "No," skip to question 6a...........

Yes

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

Yes

If the organization has multiple hospitals, indicate which of the following best describes application of the charity care policy to the various hospitals.

Applied uniformly to all hospitals Applied uniformly to most hospitals Generally tailored to individual hospitals

Answer the following based on the charity care eligibility criteria that applies to the largest number of the organization's patients.

Does the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care to low

income individuals? If "Yes," indicate which of the following is the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other

Does the organization use FPG to determine eligibility for providing discounted care to low income individuals? If

"Yes," indicate which of the following is the family income limit for eligibility for discounted care: .....

Yes

200% 250% 300% 350% 400% Other

If the organization does not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization uses an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.

Does the organization's policy provide free or discounted care to the "medically indigent"? ......

Yes

Does the organization budget amounts for free or discounted care provided under its charity care policy? ...

Yes

If "Yes," did the organization's charity care expenses exceed the budgeted amount?.........

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

Does the organization prepare an annual community benefit report?.............

Yes

If "Yes," does 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.

Charity Care 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 Charity care at cost (from Worksheets 1 and 2) ..		3,243	1,495,409		1,495,409	4.400 %
b Unreimbursed Medicaid (from Worksheet 3, column a) .		3,394	4,074,012	3,952,778	121,234	0.360 %
c Unreimbursed costs—other means-tested government programs (from Worksheet 3, column b) ....
dTotal Charity Care and Means-Tested Government Programs .....		6,637	5,569,421	3,952,778	1,616,643	4.760 %
Other Benefits e Community health improvement services and community benefit operations (from (Worksheet 4) ....	7	652	5,640		5,640	0.020 %
f Health professions education (from Worksheet 5) ..
g Subsidized health services (from Worksheet 6) ..
h Research (from Worksheet 7)
i Cash and in-kind contributions to community groups (from Worksheet 8) ..	1	1	300		300
jTotal Other Benefits ...	8	653	5,940		5,940	0.020 %
kTotal. Add lines 7d and 7j. ..	8	7,290	5,575,361	3,952,778	1,622,583	4.780 %

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2010

Schedule H (Form 990) 2010

Page 2

Part II

Community Building Activities Complete this table if the organization conducted any community building activities.

		(a) Number of activities or programs (optional)	(c) Total community building expense	(e) Net community building expense
1	Physical improvements and housing	1	86	86
2	Economic development	2	1,740	1,740
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	3	1,826	1,826

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Does 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 (at cost).....

1,332,532

Enter the estimated amount of the organization's bad debt expense (at cost) attributable to patients eligible under the organization's charity care policy ..

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).....

6,640,220

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

6,759,079

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

-118,859

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

Does the organization have a written debt collection policy? ...............

Yes

If "Yes," does the organization's collection policy contain provisions on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance? Describe in Part VI......

Yes

Part IV

Management Companies and Joint Ventures

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership%	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2010

Page 3

Part VFacility Information

Section A. Hospital Facilities (list in order of size, measured by total revenue per facility, from largest to smallest) How many hospital facilities did the organization operate during the tax year?1 Name and address		Other (Describe)
1	SAINT JOHN HOSPITAL INC 3500 SOUTH FOURTH STREET LEAVENWORTH,KS66048	X	X	X

Schedule H (Form 990) 2010

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)

Name of Hospital Facility:SAINT JOHN HOSPITAL INC

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 2010)
1	During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. .....................		1
	If “Yes,” indicate what the Needs Assessment describes (check all that apply):
	a	A definition of the community served by the hospital facility
	b	Demographics of the community
	c	Existing health care facilities and resources within the community that are available to respond to the health needs of the community
	d	How data was obtained
	e	The health needs of the community
	f	Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
	g	The process for identifying and prioritizing community health needs and services to meet those needs
	h	The process for consulting with persons representing the community’s interests
	i	Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
	j	Other (describe in Part VI)
2	Indicate the tax year the hospital facility last conducted a Needs Assessment: 20
3	In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted.		3
4	Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................		4
5	Did the hospital facility make its Needs Assessment widely available to the public? ...........		5
	If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
	a	Hospital facility’s website
	b	Available upon request from the hospital facility
	c	Other (describe in Part VI)
6	If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
	a	Adoption of an implementation strategy to address the health needs of the hospital facility’s community
	b	Execution of the implementation strategy
	c	Development of a community benefit plan for the facility
	d	Participation in community-wide community benefit plan
	e	Inclusion of a community benefit section in operational plans
	f	Adoption of a budget for provision of services that address the needs identified in the CHNA
	g	Prioritization of health needs in the community
	h	Prioritization of services that the hospital facility will undertake to meet health needs in its community
	i	Other (describe in Part VI)
7	Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs.		7
Financial Assistance Policy
	Did the hospital facility have in place during the tax year a written financial assistance policy that:
8	Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?		8
9	Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?..		9
	If “Yes,” indicate the FPG family income limit for eligibility for free care: %

Schedule H (Form 990) 2010

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Part VFacility Information (continued)

				Yes	No
10	Used FPG to determine eligibility for providing discounted care to low income individuals?.........		10
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: %
11	Explained the basis for calculating amounts charged to patients?.................		11
	If “Yes,” indicate the factors used in determining such amounts (check all that apply):
	a	Income level
	b	Asset level
	c	Medical indigency
	d	Insurance status
	e	Uninsured discount
	f	Medicaid/Medicare
	g	State regulation
	h	Other (describe in Part VI)
12	Explained the method for applying for financial assistance?...................		12
13	Included measures to publicize the policy within the community served by the hospital facility?.......		13
	If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
	a	The policy was posted at all times on the hospital facility’s web site
	b	The policy was attached to all billing invoices
	c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
	d	The policy was posted in the hospital facility’s admissions offices
	e	The policy was provided, in writing, to patients upon admission to the hospital facility
	f	The policy was available upon request
	g	Other (describe in Part VI)
Billing and Collections
14	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........		14
15	Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments or arrests
	e	Other (describe in Part VI)
16	Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?...................................		16
	If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments
	e	Other (describe in Part VI)
17	Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
	a	Notified patients of the financial assistance policy upon admission
	b	Notified patients of the financial assistance policy prior to discharge
	c	Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
	d	Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
	e	Other (describe in Part VI)

Schedule H (Form 990) 2010

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Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
				Yes	No
18	Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..........		18
	If “No,” indicate the reasons why (check all that apply):
	a	The hospital facility did not provide care for any emergency medical conditions
	b	The hospital facility did not have a policy relating to emergency medical care
	c	The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
	d	Other (describe in Part VI)
Charges for Medical Care
19	Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
	a	The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
	b	The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
	c	The hospital facility used the Medicare rate for those services
	d	Other (describe in Part VI)
20	Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?.........		20
	If “Yes,” explain in Part VI.
21	Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?...................................		21
	If “Yes,” explain in Part VI.

Schedule H (Form 990) 2010

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Part VFacility Information (continued)

Section C. Other Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, measured by total revenue per facility, from largest to smallest) How many non-hospital facilities did the organization operate during the tax year?2
Name and address		Type of Facility (Describe)
1	SAINT JOHN MEDICAL OFFICE BUILDING 3550 SOUTH FOURTH STREET LEAVENWORTH,KS66048	MEDICAL OFFICE BUILDING
2	SAINT JOHN MEDICAL OFFICE BUILDING 3550 SOUTH FOURTH STREET LEAVENWORTH,KS66048	MEDICAL OFFICE BUILDING
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2010

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Part VI

Supplemental Information

Complete this part to provide the following information.

1	Required descriptions. Provide the description required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 2, 4c, 6i, 7, 11i, 13i, 17l, 18l, 19e, 21d, 25, and 26.
2	Community health needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any community health needs assessments reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Identifier	ReturnReference	Explanation
PART I, LINE 3C		N/A PART I, LINE 6A N/A PART I, LINE 7 METHODOLOGY FOR COMPUTING THE COST OF CHARITY AND UNREIMBURSED MEDICAID COST WAS BASED ON THE CATHOLIC HOSPITAL ASSOCIATION GUIDE FOR PLANNING AND REPORTING OF COMMUNITY BENEFITS, APPENDIX D, WORKSHEET 2. THIS METHODOLOGY COMPUTES A COST TO CHARGE RATIO USING TOTAL OPERATING EXPENSES INCLUDING BAD DEBT EXPENSE AND EXCLUDING MEDICAID PROVIDER TAXES. THIS AMOUNT IS REDUCED BY OTHER OPERATING REVENUE TO ARRIVE AT NET EXPENSE. NET EXPENSE AS A PERCENTAGE OF GROSS PATIENT REVENUE IS THE PERCENTAGE USED TO COMPUTE THE COST OF CHARITY AND UNREIMBURSED MEDICAID COST. OTHER BENEFITS (INCLUDING COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS ARE CALCULATED BASED ON THE ACTUAL COST TO DELIVER THESE SERVICES. FOR DONATIONS OTHER THAN MONETARY (IE STAFF TIME AND IN-KIND DONATIONS), THE COSTS ARE DETERMINED BASED ON FAIR MARKET VALUE OF THE DONATION. THIS INFORMATION IS TRACKED ON CBISA, A SOFTWARE DATABASE EXCLUSIVELY USED TO TRACK COMMUNITY BENEFIT REPORTING. NET COMMUNITY BENEFIT EXPENSE IS CALCULATED AS A PERCENTAGE OF TOTAL EXPENSES EXCLUDING BAD DEBT OF $4,597,058.
PART II		OUR COMMUNITY BUILDING EXPENSES ARE THOSE IDENTIFIED IN OUR COMMUNITY HEALTH ASSESSMENT AS CONTRIBUTING TO THE HEALTH OF THE COMMUNITY, BUT NOT DIRECTLY PROVIDING HEALTH SERVICES.
PART III, LINE 4		THE COSTING METHODOLOGY USED TO CALCULATE THE COST OF GROSS BAD DEBT EXPENSE WAS BASED ON THE COSTING METHODOLOGY IN THE INSTRUCTIONS TO SCHEDULE H, WORKSHEET 2, RATIO OF PATIENT CARE COST TO CHARGES. LINE 11 OF WORKSHEET 2 (RATIO OF PATIENT CARE COST TO CHARGES) WAS MULTIPLIED AGAINST THE GROSS BAD DEBT EXPENSE TO ARRIVE AT THE COST OF BAD DEBT EXPENSE. BAD DEBT EXPENSE REPRESENTS THE UNPAID PORTION OF THE GROSS CHARGES (AT ESTABLISHED RATES) LESS PAYMENTS FROM 3RD PARTY PAYORS AND THE PATIENT AND ANY CONTRACTUAL ADJUSTMENTS. THE HOSPITAL DOES NOT PROVIDE ANY PROMPT PAY DISCOUNTS FOR PAYING THE PATIENT PORTION OF THE BALANCE OF THEIR ACCOUNT WITHIN A SPECIFIED TIMEFRAME. SOME ACCOUNTS WRITTEN OFF TO BAD DEBTS WHICH ARE SENT TO THE HOSPITAL'S COLLECTION AGENCIES ARE SUBSEQUENTLY RECLASSIFIED TO CHARITY. ACCOUNTS THAT ARE CLOSED BY THE COLLECTION AGENCY BASED ON THE AGENCY'S ASSESSMENT OF THE PATIENT AND\OR GUARANTOR'S FINANCIAL POSITION (I.E. UNEMPLOYED, NO ASSETS, ETC.) ARE RECLASSIFIED TO CHARITY EXPENSE ONCE THAT DETERMINATION IS MADE. ACCOUNTS WRITTEN OFF TO BAD DEBT EXPENSE IN CY 2010 AND SUBSEQUENTLY RECLASSIFIED TO CHARITY IN CY 2011 WERE NOT QUANTIFIED AT DECEMBER 31, 2010. THE ORGANIZATION'S CONSOLIDATED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. WITHIN THE FINANCIAL STATEMENTS OF SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, BAD DEBT EXPENSE IS INCLUDED WITHIN OPERATING EXPENSES, AT THE VALUE OF UNCOLLECTED AND ESTIMATED UNCOLLECTIBLE CHARGES AFTER CONTRACTUAL ALLOWANCES AND SELF-PAY DISCOUNTS ARE APPLIED.
PART III, LINE 8		THE MEDICARE ALLOWABLE COSTS WERE ARRIVED AT FROM VARIOUS WORKSHEETS C, D AND E OF THE FILED MEDICARE COST REPORT FOR THE YEAR ENDED DECEMBER 31, 2010. THE MEDICARE SHORTFALL INDICATED IN PART III, LINE 7 WAS NOT INCLUDED IN PART I, LINE 7, COMMUNITY BENEFIT.
PART III, LINE 9B		AN INTEGRAL COMPONENT OF OUR MISSION IS TO BE GOOD FINANCIAL STEWARDS. THIS REQUIRES US TO DETERMINE WHICH PATIENTS ARE IN NEED OF CHARITY CARE AND WHICH ARE ABLE TO CONTRIBUTE SOME PAYMENT FOR CARE RECEIVED. WE MAINTAIN A BALANCE THAT ENABLES US TO CONTINUE TO PROVIDE CHARITY CARE TO THOSE WHO NEED IT MOST, AND TO ENSURE THAT WE MANAGE OUR RESOURCES SO THAT WE CAN CONTINUE TO BE HERE WHEN PEOPLE NEED US MOST. SAINT JOHN HOSPITAL NOTIFIES PATIENTS OF FINANCIAL ASSISTANCE POLICY UPON ADMISSION, DISCHARGE AND IN COMMUNICATION REGARDING PATIENT BILLS. PATIENTS ARE CONTACTED MULTIPLE TIMES ABOUT UNPAID BALANCES PRIOR TO INITIATING ANY COLLECTION ACTION. IF A PATIENT IS DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE AT ANY TIME DURING THE COLLECTION PROCESS, THE ACCOUNT IS RECLASSIFIED AS FINANCIAL ASSISTANCE AND DEBT COLLECTION EFFORTS ARE CEASED.
NEEDS ASSESSMENT		AS PART OF OUR CORE VALUE OF RESPONSE TO NEED, WE TAKE STEPS TO DETERMINE WHERE THERE IS THE MOST NEED IN ORDER TO PROVIDE THE GREATEST GOOD. SAINT JOHN HAS REGULARLY PARTICIPATED IN NEEDS ASSESSMENT SURVEYS TO IDENTIFY THE ONGOING AND CHANGING NEEDS OF THE COMMUNITY. THE MOST RECENT SURVEY WAS CONDUCTED IN 2009, AND ONE IS SCHEDULED TO BE COMPLETED IN 2012. THIS ASSESSMENT STUDIES A DEFINED COMMUNITY SERVED BY SAINT JOHN, AND IS DONE BY PARTNERING WITH LOCAL GOVERNMENT AND SOCIAL AGENCIES; COMBINING EFFORTS WITH OTHER LOCAL HOSPITALS AND HEALTH CARE ORGANIZATIONS; AND CONDUCTING SURVEYS AND ASSESSMENTS WITH THE ASSISTANCE OF OUTSIDE CONSULTANTS. WE ALSO CONTINUOUSLY ASSESS THE NEEDS OF THE COMMUNITY THROUGH CLOSE WORKING RELATIONSHIPS AND PARTNERSHIPS WITH SERVICE AGENCIES IN THE COMMUNITY, AND BY EVALUATING STATE AND COUNTY HEATLH STATISTICS. EVERY YEAR AS A COMPONENT OF THE ANNUAL STRATEGIC PLANNING PROCESS, SAINT JOHN PARTNERS WITH COMMUNITY ORGANIZATIONS INCLUDING THE AMERICAN CANCER SOCIETY, THE AMERICAN HEART ASSOCIATION, THE LEAVENWORTH ECONOMIC DEVELOPMENT COUNCIL AND THE UNITED WAY TO REVIEW STATISTICS REGARDING THE POPULATION AND HEALTH-RELATED TRENDS. THE MOST RECENT SURVEY WAS CONDUCTED IN 2010 AND WILL BE UPDATED AS A PART OF THE 2011 PLANNING PROCESS. IN ADDITION, SAINT JOHN CONDUCTED A PHYSICIAN NEEDS ASSESSMENT OF LEAVENWORTH COUNTY UTILIZING QUANTITATIVE RESEARCH METHODS TO DETERMINE GAPS IN PHYSICIAN SPECIALTY COVERAGE IN THE MARKET. WE ALSO CONTINUOUSLY ASSESS THE NEEDS OF THE COMMUNITY THROUGH CLOSE WORKING RELATIONSHIPS AND PARTNERSHIPS WITH SERVICE AGENCIES IN THE COMMUNITY AND BY EVALUATING STATE AND COUNTY HEALTH STATISTICS.
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE	SCHEDULE H, PART VI, LINE 3	SAINT JOHN HOSPITAL TREATS PATIENTS WITH RESPECT AND DIGNITY REGARDLESS OF THEIR ABILITY TO PAY. SAINT JOHN HOSPITAL HAS A WRITTEN FINANCIAL ASSISTANCE POLICY THAT EXPLAINS ELIGIBILITY CRITERIA FOR FINANCIAL ASSISTANCE AT VARIOUS LEVELS, INCLUDING A 100% DISCOUNT, AND IS BASED ON FEDERAL POVERTY GUIDELINES. WE WORK WITH PATIENTS TO HELP THEM UNDERSTAND THEIR FINANCIAL RESPONSIBILITY FOR CARE RECEIVED, FINANCIAL ASSISTANCE AVAILABLE TO THEM, AND TO ESTABLISH PAYMENT PROGRAMS IN DEMONSTRATION OF OUR CORE VALUE OF RESPECT. AS PART OF OUR RESPONSIBILITY TO EDUCATE, WE INFORM OUR PATIENTS AND THEIR FAMILIES OF THE AVAILABILITY OF ASSISTANCE, INCLUDING GOVERNMENT PROGRAMS. WE COMMUNICATE THIS IN A VARIETY OF WAYS TO ENSURE THAT MESSAGES REACH MULTIPLE AUDIENCES. BEFORE, DURING AND/OR AFTER ADMISSION, WE ENCOURAGE OUR SELF PAY PATIENTS TO VISIT WITH A FINANCIAL COUNSELOR TO DISCUSS QUALIFICATIONS FOR FINANCIAL ASSISTANCE. THE FINANCIAL COUNSELOR WORKS WITH THE PATIENT TO COMPLETE A FINANCIAL ASSISTANCE FORM TO DETERMINE THE LEVEL OF DISCOUNT FOR WHICH THE PATIENT MAY BE ELIGIBLE. WE POST FINANCIAL ASSISTANCE INFORMATION IN EMERGENCY AND ADMISSIONS AREAS, ON BILLINGS INVOICES, IN VARIOUS AREAS AROUND THE HOSPITAL AND CLINIC SITES AND ON THE HOSPITAL WEBSITE. WE PROVIDE WRITTEN MATERIALS TO PATIENTS THAT DETAIL OUR FINANCIAL ASSISTANCE POLICY AND HOW IT IS ADMINISTERED. THIS COVERS ELIGIBILITY, STEPS TO FOLLOW TO DETERMINE IF A PATIENT QUALIFIES FOR ASSISTANCE, TYPICAL CHARGES A PATIENT MAY EXPECT FOR ROUTINE PROCEDURES, AND ASSISTANCE AVAILABLE BASED ON A PATIENT'S INCOME LEVEL. WE PROVIDE MATERIALS AND EDUCATION WHEN PATIENTS ARE DISCHARGED, AND INCLUDE INFORMATION IN BILLING STATEMENTS, INCLUDING PHONE NUMBERS AND OTHER METHODS TO CONTACT US WITH QUESTIONS. WE ENSURE THAT OUR FINANCIAL COUNSELORS, ADMISSION EMPLOYEES, SOCIAL WORKERS AND OTHER EMPLOYEES UNDERSTAND OUR POLICIES TO BE ABLE TO ASSIST PATIENTS IN THE MOST APPROPRIATE WAY. WE HAVE A PARTNERSHIP WITH THE MIDLAND GROUP TO PROVIDE EXTENDED PAYMENT PLANS. THIS HELPS PATIENTS MEET THEIR FINANCIAL OBLIGATIONS IN A REASONABLE AND DIGNIFIED MANNER BASED ON THEIR ABILITY TO PAY, AND ALLOWS THEM TO CONTINUE TO ENSURE THE ONGOING WELFARE OF THEIR FAMILIES. THIS IS DONE IN ACCORDANCE WITH OUR CORE VALUE OF RESPECT.
COMMUNITY INFORMATION	SCHEDULE H, PART VI, LINE 4	SAINT JOHN IS PART OF A NATIONAL SYSTEM OF FAITH-BASED HOSPITALS SPONSORED BY THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM LOCATED IN LENEXA, KANSAS. THE HOSPITAL IS COMMITTED TO IMPROVING THE HEALTH OF THE RESIDENTS IN ITS SERVICE AREAS INCLUDING LEAVENWORTH AND WYANDOTTE COUNTIES IN KANSAS. BASED ON RESEARCH FROM CLARITAS, INC., SAINT JOHN'S PRIMARY SERVICE AND SECONDARY SERVICE AREAS ARE EXPECTED TO INCREASE RAPIDLY OVER THE NEXT FIVE YEARS, INCREASING THE NEED FOR SERVICES THESE INDIVIDUALS HISTORICALLY NEED, SUCH AS CARDIOLOGY, NEUROLOGY, ONCOLOGY, ORTHOPAEDIC AND PULMONARY CARE. IN THE HOSPITAL'S PRIMARY SERVICE AREA, 78.1 PERCENT OF THE ETHNIC POPULATION IS WHITE; 12.5 PERCENT IS AFRICAN-AMERICAN; AND 4.2 PERCENT IS HISPANIC. THE HOSPITAL'S SECONDARY SERVICE AREA IS 92.5 PERCENT WHITE. ADDITIONALLY, IN LEAVENWORTH COUNTY, 10.6 PERCENT OF THE POPULATION IS UNINSURED, WITH 42 PERCENT OF THE UNINSURED FALLING UNDER 200 PERCENT OF THE FEDERAL POVERTY LINE.
PROMOTION OF COMMUNITY HEALTH	SCHEDULE H, PART VI, LINE 5	WE ARE AN IMPORTANT PART OF OUR COMMUNITY AND SERVE IN MANY WAYS FROM DELIVERING CORE HEALTH CARE TO PREVENTIVE CARE TO SUPPORT OF OTHER CIVIC GROUPS. IN 2010, WE PROVIDED COMMUNITY BENEFIT TOTALING $1,622,583.00, INCLUDING TRADITIONAL CHARITY CARE AND THE UNPAID COST OF MEDICAID. OUR BOARD OF DIRECTORS REPRESENTS MEDICAL AND BUSINESS PROFESSIONALS AND ALL PROVIDE HOURS OF SERVICE IN SUPPORT OF OUR HOSPITAL. THEY ARE DEEPLY INVOLVED IN OUR NEEDS ASSESSMENT PROCESS, BUILDING PROGRAMS AND SERVICES, AND COMMUNITY OUTREACH TO ENSURE THAT PEOPLE KNOW ABOUT SERVICES AVAILABLE TO THEM THROUGH OUR HOSPITAL. WHEN SAINT JOHN HAS EXCESS REVENUE OVER OPERATING EXPENSES, WE USE THOSE FUNDS TO OBTAIN CURRENT HEALTH CARE TECHNOLOGIES AND EQUIPMENT, IMPROVE PATIENT CARE, PROVIDE MEDICAL TRAINING, EDUCATION AND RESEARCH, AND TO EXPAND ACCESS TO POINTS OF CARE. THESE INVESTMENTS ENSURE WE'LL BE HERE TO CARE FOR FUTURE GENERATIONS. WE EXTEND OUR CARE BEYOND OUR HOSPITAL'S WALLS IN ORDER TO IMPROVE THE HEALTH OF OUR COMMUNITY. OUR COMMUNITY ACTIVITIES DEMONSTRATE THIS COMMITMENT. DURING THIS YEAR, OUR COMMUNITY ACTIVITIES INCLUDED: " ATHLETIC TRAINERS-TEAM WORKS IS A SAINT JOHN-SPONSORED PROGRAM THAT WORKS WITH THE LEAVENWORTH AND LANSING AREA HIGH SCHOOLS TO PROVIDE CERTIFIED ATHLETIC TRAINERS TO THE SCHOOLS AT LITTLE COST. TEAM WORKS PROVIDES GAME EVENT COVERAGE, INJURY PREVENTION COUNSELING, EFFICIENT RUNNING ASSESSMENT PROGRAMS, PRE-GAME WORKOUTS, WELLNESS PROGRAMS, MANAGEMENT AND TREATMENT OF INJURIES ON THE FIELD, ATHLETIC TRAINING PROGRAMS, A COMPREHENSIVE REHABILITATION/RECONDITIONING PROGRAM FOR INJURIES, HEALTH INFORMATION AND COUNSELING, SPORTS PERFORMANCE/CONDITIONING AND INJURY TRACKING CAPABILITIES. THE PROGRAM'S GOALS INCLUDE EARLY DIAGNOSIS OF CONCUSSIONS ON THE FIELD TO PREVENT LONG-TERM AFFECTS, OR EVEN DEATH; AND TO PREVENT OR REHABILITATE INJURIES EARLY ON IN THESE STUDENTS SO THAT THESE INJURIES DO NOT BECOME LIFETIME HEALTH ISSUES. " CANCER SUPPORT GROUP-SAINT JOHN SPONSORS A CANCER SUPPORT GROUP THAT MEETS ON A REGULAR BASIS TO ASSIST PATIENTS AS THEY ARE UNDERGOING CANCER TREATMENT AND RECOVERY. ISSUES COVERED INCLUDE NUTRITION, CANCER-RELATED FATIGUE AND DISEASE RECURRENCE. " CHILDBIRTH PREPARATION COURSES-TO PROVIDE THE COMMUNITY'S NEWEST RESIDENTS WITH THE BEST STARTS POSSIBLE IN LIFE, SAINT JOHN OFFERS A WIDE RANGE OF CHILDBIRTH PREPARATION COURSES, INCLUDING BREASTFEEDING, PREPARED CHILDBIRTH, AND SIBLING PREPARATION. THE GOAL IS TO PROMOTE A HEALTHY FAMILY ENVIRONMENT, REDUCE THE RISK OF LOW-BIRTH WEIGHT BABIES AND IMPROVE THE SUCCESS OF BREASTFEEDING FOR NEW MOTHERS AND THEIR INFANTS. THESE INITIATIVES HAVE BEEN PROVEN TO LOWER HEALTH-RELATED COSTS ASSOCIATED WITH CHILDBIRTH, AND RELATED COMPLICATIONS. " DIABETES EDUCATION COURSES-SAINT JOHN OFFERS COURSES TO REDUCE COMPLICATIONS AND COSTS ASSOCIATED WITH DIABETES, INCLUDING A DIABETES DINING CLUB, DIABETES OUTPATIENT CLASSES AND DIABETES SUPPORT GROUP. THESE OFFERINGS ASSIST PATIENTS WITH SUCCESSFULLY MANAGING THEIR DISEASE, IMPROVING LONG-TERM HEALTH FOR THESE PATIENTS AND THE COMMUNITY. " HEART HEALTH EDUCATION-BY ENCOURAGING COMMUNITY PARTICIPATION IN ACTIVITIES SUCH AS BLOOD PRESSURE SCREENINGS, HEART HEALTH FAIRS, AND WALKS, SAINT JOHN ASSISTS INDIVIDUALS IN MAKING HEALTHIER LIFESTYLE CHOICES (EXERCISE AND SMOKING CESSATION) THAT CAN IMPROVE THEIR INDIVIDUAL HEALTH, AS WELL AS THE COMMUNITY'S HEALTH IN GENERAL. THE HOSPITAL ALSO HAS PARTNERED WITH THE AMERICAN HEART ASSOCIATION TO IMPLEMENT THE SEARCH YOUR HEART PROGRAM IN THE LEAVENWORTH COMMUNITY. SEARCH YOUR HEART IS AN EFFORT TO EDUCATE AREA CONGREGATIONS ON ISSUES RELATED TO HEART DISEASE AND STROKE. THE HOSPITAL ALSO SPONSORS HEALTH SCREENINGS, COOKING DEMONSTRATIONS AND OTHER AWARENESS ACTIVITIES FOR PARTICIPATING CHURCHES. OTHER COMMUNITY EVENTS SAINT JOHN PARTICIPATED IN DURING 2010 INCLUDE: " BREASTFEEDING CLASSES " CANCER SUPPORT GROUP " CITY OF LEAVENWORTH HEALTH FAIR " CHILDBIRTH PREPARATION CLASSES " COVER THE UNINSURED WEEK " DIABETES DINING CLUB " DIABETES OUTPATIENT CLASSES " DIABETES SUPPORT GROUP " FT. LEAVENWORTH PAIR DAY " HALLMARK EMPLOYEE HEALTH FAIR " LEAVENWORTH COUNTY EMPLOYEES SAFETY DAY " LEAVENWORTH COUNTY HEALTH FAIR " LEAVENWORTH FIRST CITY FESTIVAL " LEAVENWORTH HEART WALK " NATIONAL HEALTH CARE DECISIONS DAY " RELAY FOR LIFE " SIBLING PREPARATION CLASSES " UNIVERSITY OF SAINT MARY HEALTH FAIR WE ALSO SUPPORT OUR EMPLOYEES IN VOLUNTEERING FOR COMMUNITY ORGANIZATIONS, INCLUDING SERVING ON COMMUNITY BOARDS AND PROVIDE OPPORTUNITIES FOR THEM TO SUPPORT CAUSES THROUGH HOSPITAL EVENTS SUCH AS: " CATHOLIC CHARITIES FOOD SUPPLIES DRIVE " CHRISTMAS IN OCTOBER " COMMUNITY BLOOD CENTER BLOOD DRIVE " CRISTO REY SCHOOL SUPPLIES DRIVE " HAITI RELIEF EFFORTS " HARVESTERS FOOD DRIVE " LENTEN FOOD FOR THOUGHT " UNITED WAY CAMPAIGN WE ARE GOOD CITIZENS AND PARTNER WITH OTHER ORGANIZATIONS AND AGENCIES TO SUPPORT A THRIVING COMMUNITY: " ALLIANCE AGAINST FAMILY VIOLENCE " AMERICAN CANCER SOCIETY " AMERICAN HEART ASSOCIATION " CARITAS CLINICS, INC. " FRIENDS OF LEAVENWORTH HIGH SCHOOL " GREATER KANSAS CITY MEDICAL SOCIETY " IMMACULATA HIGH SCHOOL " KANSAS CITY WIZARDS " LANSING BASKETBALL COMMITTEE " LANSING EDUCATIONAL FOUNDATION " LANSING HIGH SCHOOL OPERATION GRADUATION " LEAVENWORTH COUNTY CHILD ABUSE PREVENTION COUNCIL " LEAVENWORTH HIGH SCHOOL PIONEER FOOTBALL " LEAVENWORTH PARK AND COMMUNITY ACTIVITIES DEPARTMENT " LEAVENWORTH REGIONAL CATHOLIC SCHOOLS " LEAVENWORTH YAC " LEAVENWORTH-LANSING AREA CHAMBER OF COMMERCE " LEGENDS OF KANSAS CITY " MAKE-A-WISH FOUNDATION " METROPOLITAN MEDICAL SOCIETY " MOUNT SCHOLASTICA BENEDICTINE SISTERS " OLDER AMERICAN MONTH CELEBRATIONS " SAINT FRANCIS DE SALES " SAINT VINCENT CLINIC " T-BONES BASEBALL CLUB " UNIVERSITY OF SAINT MARY " USD 453 LEAVENWORTH SCHOOL DISTRICT " USD 469 LANSING SCHOOL DISTRICT " WOMEN'S FOUNDATION OF GREATER KANSAS CITY WE PROVIDE FOCUSED SUPPORT FOR CARITAS CLINICS, INC., (DUSCHENE AND SAINT VINCENT CLINICS) THE COMMUNITY'S HEALTH CLINICS FOR THE UNINSURED. WE WORK CLOSELY TOGETHER TO PROVIDE INTEGRATED CARE FOR THOSE WHO COME TO EITHER THE HOSPITAL OR THE CLINICS FOR THEIR HEALTH NEEDS. CARITAS CLINICS PROVIDE QUALITY PRIMARY HEALTH CARE SERVICES FOR UNINSURED, LOW-INCOME PATIENTS REGARDLESS OF ABILITY TO PAY. THE CLINICS ARE COMMITTED TO PROVIDING ACCESS TO COMPASSIONATE AND TRUSTWORTHY CARE FOR THE UNINSURED POOR. SERVICES THE CLINICS PROVIDE INCLUDE PRIMARY CARE, ONGOING MANAGEMENT OF CHRONIC DISEASES AND MEDICATION ASSISTANCE. IN ADDITION TO FINANCIAL SUPPORT, SAINT JOHN ASSISTS THE CLINICS IN MANY OTHER WAYS INCLUDING STRATEGY AND OPERATIONS GUIDANCE, DONATING SUPPLIES AND PROVIDING IT AND FINANCIAL SYSTEMS MANAGEMENT. COMMUNITY BENEFITS PROVIDED IN 2010 THROUGHOUT SCLHS TOTALED $204.8 MILLION. AS PART OF SCLHS, WE PROMOTE THE SHARED MISSION THAT "WE WILL, IN THE SPIRIT OF THE SISTERS OF CHARITY, REVEAL GOD'S HEALING LOVE BY IMPROVING THE HEALTH OF THE INDIVIDUALS AND COMMUNITIES WE SERVE, ESPECIALLY THOSE WHO ARE POOR OR VULNERABLE." WE ARE COMMITTED TO LIVING AND DEMONSTRATING OUR CORE VALUES OF EXCELLENCE, RESPECT, RESPONSE TO NEED, STEWARDSHIP AND WHOLENESS. SCLHS SUPPORTS ITS HOSPITALS BY PROVIDING GUIDANCE, OVERSIGHT, AND RESOURCES TO HELP THEM ACCOMPLISH INITIATIVES THAT IMPROVE HEALTH IN ALL OUR COMMUNITIES. THIS INCLUDES COORDINATING COMMUNITY BENEFIT PROCESSES, PROVIDING GUIDANCE WITH COMMUNITY NEEDS ASSESSMENTS, AND ESTABLISHING CONSISTENT FINANCIAL ASSISTANCE AND CHARITY CARE POLICIES AND PROCEDURES. OTHER WAYS SCLHS BENEFITS ITS HOSPITALS INCLUDE QUALITY IMPROVEMENT AND PERFORMANCE EXCELLENCE INITIATIVES; SYSTEM-WIDE IT IMPLEMENTATION AND INFRASTRUCTURE; STRATEGIC AND OPERATIONS DIRECTION AND OVERSIGHT; SUPPLY CHAIN MANAGEMENT AND PURCHASING; BENEFITS ADMINISTRATION (INCLUDING A WELLNESS PROGRAM FREE TO EMPLOYEES THAT PROMOTES THEIR HEALTH AND WELL-BEING); RISK MANAGEMENT; DISASTER PLANNING AND CRISIS ASSISTANCE. BY SHARING THE WORK ACROSS OUR SYSTEM WE ARE ABLE TO LIGHTEN THE BURDEN FOR ALL IN ORDER TO FULFILL OUR MISSION OF IMPROVING HEALTH IN OUR COMMUNITIES. SCLHS IMPROVES OVERALL HEALTH IN OUR COMMUNITIES BY PROVIDING INFRASTRUCTURE TO SUPPORT AND SUSTAIN FOUR CLINICS FOR THE UNINSURED IN KANSAS AND COLORADO. THE SCLHS CLINICS FOR THE UNINSURED ARE OFTEN THE ONLY SAFETY NET CLINIC IN THEIR COMMUNITY AND PROVIDE VALUABLE SERVICES FOR THOSE WHO ARE MOST VULNERABLE. EACH HOSPITAL IS SUPPORTED BY A FOUNDATION TO ACCESS AND OPTIMIZE LOCAL PHILANTHROPIC ORGANIZATIONS AND INDIVIDUALS. THESE FOUNDATIONS RAISE FUNDS THROUGH OUTREACH, SPECIAL EVENTS, AND BUILDING DONOR RELATIONS THROUGHOUT THEIR COMMUNITY TO SUPPORT THE NEEDS OF THE HOSPITAL.
AFFILIATED HEALTH CARE SYSTEM	SCHEDULE H, PART VI, LINE 6	SAINT JOHN HOSPITAL IS A CONTROLLED ENTITY OF THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. (SCLHS). SCLHS AND ITS AFFILIATED ENTITIES HAVE A COMMON CALLING AND MISSION "TO REVEAL GOD'S HEALING LOVE BY IMPROVING THE HEALTH OF THE INDIVIDUALS AND COMMUNITIES IT SERVES, ESPECIALLY THOSE WHO ARE POOR OR VULNERABLE." SAINT JOHN HOSPITAL PROMOTES THE HEALTH OF THE COMMUNITY BY DELIVERING DIRECT HIGH QUALITY HEALTHCARE SERVICES THAT ARE RESPONSIVE TO THE NEEDS OF ITS PATIENTS AND THEIR FAMILIES. SCLHS SUPPORTS THE EFFORTS OF THE HOSPITAL THROUGH STRATEGIC DIRECTION AND OPERATING OVERSIGHT. SCLHS SUPPLIES OVERHEAD SUPPORT SERVICES TO SAINT JOHN HOSPITAL, INCLUDING INFORMATION TECHNOLOGY SERVICES, CENTRAL CASH MANAGEMENT AND INVESTMENT, INTERNAL AUDIT, SUPPLY CHAIN MANAGEMENT, BENEFITS ADMINISTRATION, RISK MANAGEMENT AND INSURANCE AND QUALITY IMPROVEMENT LEADERSHIP.
STATE FILING OF COMMUNITY BENEFIT REPORT	SCHEDULE H, PART VI, LINE 7	THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM FILES A COMMUNITY BENEFIT REPORT IN THREE STATES: CALIFORNIA, KANSAS AND MONTANA.

Schedule H (Form 990) 2010

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

2010

Open to Public
Inspection

Name of the organization
Saint John Hospital Inc

Employer identification number
48-0543768

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	(c) IRC Code section if applicable	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) PROVIDENCESAINT JOHN FOUNDATION8929 PARALLEL PARKWAY KANSAS CITY,KS66112	48-0925688	501(C)(3)	14,000	OFFSET OPERATING COSTS AND GENERAL SUPPORT OF FOUNDATION'S MISSION

Enter total number of section 501(c)(3) and government organizations ......................... Bullet Image

Enter total number of other organizations ................................ . Bullet Image

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

Cat. No. 50055P

Schedule I (Form 990) 2010

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) 2010

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

2010

Open to Public Inspection

Name of the organization

Saint John Hospital Inc

Employer identification number

48-0543768

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 orprovision of all the expenses described above? If "No," complete Part III to explain....

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? ....

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.

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? ........

Yes

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 Regs. 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) 2010

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use Schedule J-1 if additional space needed.

For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) must equal the applicable column (D) or column (E) amounts on Form 990, Part VII, line 1a.

(A) Name		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported in prior Form 990 or Form 990-EZ
(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)
(1) MICHAEL A DORSEY	(i) (ii)	0 314,954	0 48,554	0 65,363	0 26,077	0 15,020	0 469,968	0 0
(2) JUANITA ROY	(i) (ii)	0 254,740	0 27,230	0 31,737	0 19,600	0 14,939	0 348,246	0 0
(3) CAROLYN BOWMER	(i) (ii)	0 161,911	0 13,921	0 20,466	0 13,709	0 6,065	0 216,072	0 0
(4) JAN YERGAN	(i) (ii)	0 189,129	0 16,413	0 5,593	0 32,015	0 5,965	0 249,115	0 0
(5) JAMES PAQUETTE	(i) (ii)	0 416,920	0 66,462	0 285,527	0 87,072	0 10,868	0 866,849	0 0
(6) JOE JEANS	(i) (ii)	0 177,416	0 2,587	0 11,245	0 20,933	0 10,682	0 222,863	0 0
(7) BAIN FARRIS	(i) (ii)	0 425,155	0 83,164	0 17,597	0 63,105	0 10,699	0 599,720	0 0
(8) DANIEL SHEEHAN	(i) (ii)	0 143,382	0 1,042	0 14,721	0 14,592	0 5,955	0 179,692	0 0
(9) BARRY SOLOMON	(i) (ii)	0 280,473	0 23,715	0 3,337	0 48,642	0 6,324	0 362,491	0 0
(10) GEORGE NOONAN	(i) (ii)	0 146,983	0 10,544	0 63,993	0 12,732	0 13,728	0 247,980	0 42,514
(11) DR MARC LUCKETT	(i) (ii)	191,752 0	0 0	0 0	0 0	0 0	191,752 0	0 0

Schedule J (Form 990) 2010

Page 3

Part III

Supplemental Information

Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.

Identifier	Return Reference	Explanation
SCHEDULE J, PART I, LINE 3	PROCESS FOR DETERMINING COMPENSATION	SCLHS EMPLOYS THE EXECUTIVE TEAM AT EACH OF ITS HOSPITAL AFFILIATES. AS PART OF ITS ANNUAL REVIEW PROCESS, SCLHS USES THE FOLLOWING IN ESTABLISHING THE COMPENSATION OF THOSE IN THESE POSITIONS: -COMPENSATION COMMITTEE -INDEPENDENT COMPENSATION CONSULTANT -FORM 990 OF OTHER ORGANIZATIONS -WRITTEN EMPLOYMENT CONTRACTS -COMPENSATION SURVEYS AND STUDIES -APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE THE ABOVE SUPPORT THE COMPENSATION COMMITTEE'S EFFORTS TO ENSURE THAT THE LEVEL OF COMPENSATION PROVIDED TO ITS EXECUTIVES (OFFICERS, KEY EMPLOYEES, ETC.) IS CONSISTENT WITH MARKET VALUE AND THE PAY PHILOSOPHY SET BY THE BOARD. THE PAY PHILOSOPHY SET BY THE BOARD IS TO PAY THE MIDDLE OF THE MARKET FOR EXECUTIVES OF SIMILAR SIZED ORGANIZATIONS OVERALL. SCLHS' EXECUTIVE COMPENSATION IS COMPARABLE TO THAT PROVIDED IN SIMILAR, NOT-FOR-PROFIT HEALTHARE SYSTEMS AND HOSPITALS. SIMILAR, NOT-FOR-PROFIT HEALTHARE SYSTEMS AND HOSPITALS.
SCHEDULE J, PART I, LINE 4B	SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN	OTHER REPORTABLE COMPENSATION SHOWN IN SCHEDULE J PART II COLUMN (B) (III) CONTAINS AN ANNUAL REPORTING ADJUSTMENT FOR CERTAIN EMPLOYEES WHO PARTICIPATE IN THE SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS. SCLHS PROVIDES NONQUALIFIED RETIREMENT PLANS FOR EXECUTIVES TO COMPENSATE FOR IRS IMPOSED LIMITATIONS IN QUALIFIED RETIREMENT PLANS AND TO PROVIDE A BENEFIT CONSISTENT WITH OTHER NOT FOR PROFIT HEALTH SYSTEMS. THESE PLANS ENABLE THE EXECUTIVE TO EARN BENEFITS DURING EACH YEAR THAT THEY PARTICIPATE. ON THE ADVICE OF COUNSEL, SCLHS HAS DETERMINED THAT THESE BENEFITS SHOULD BE SUBJECT TO TAXATION AS THEY ARE EARNED AND VESTED RATHER THAN WHEN THEY ARE RECEIVED. AS A RESULT, THE TOTAL NONQUALIFIED RETIREMENT PLAN BENEFITS, WHICH WERE ACCRUED AND VESTED IN THE CURRENT YEAR, ARE NOW CONSIDERED TAXABLE AND THUS WERE TAXED TO THE PARTICIPANTS. AN AMOUNT EQUAL TO THE PARTICIPANT'S EXPECTED INCOME TAX LIABILITY WAS WITHDRAWN FROM THE PARTICIPANT'S ACCOUNT AND REMITTED TO THE IRS AS WITHHOLDING ON THE TAXABLE BENEFIT. THE AMOUNTS WITHDRAWN FROM THE PLAN FOR TAXES IN 2010 WERE: MICHAEL A. DORSEY-$14,220 JUANITA D. ROY-$10,720 GEORGE M. NOONAN-$21,154 CAROLYN S. BOWMER-$5,969 JAMES T. PAQUETTE-$108,797
SCHEDULE J, PART II		THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. (SCLHS) CONSISTS OF ELEVEN HOSPITALS AND FOUR CLINICS (AFFILIATES) IN FOUR STATES INCLUDING SAINT JOHN HOSPITAL (SAINT JOHN) IN LEAVENWORTH, KANSAS. SCLHS AND ITS AFFILIATES ADHERE TO GOVERNANCE EXCELLENCE STANDARDS INCLUDING TRANSPARENCY AND ACCOUNTABILITY. BAIN J. FARRIS IS PRESIDENT & CHIEF EXECUTIVE OFFICER OF EXEMPLA SAINT JOSEPH HOSPITAL (ESJH) IN DENVER, COLORADO WHICH IS AN SCLHS AFFILIATE. AS A FORMER OFFICER OF SAINT JOHN'S, THIS DISCLOSURE IS REQUIRED FOR 990 REPORTING PURPOSES ONLY. THE COMPENSATION REFLECTED IS THAT OF MR. FARRIS' POSITION AS AN ESJH EXECUTIVE AND IS NOT RELATED TO SAINT JOHN'S. JAMES T. PAQUETTE IS PRESIDENT & CHIEF EXECUTIVE OFFICER OF ST. VINCENT HEALTHCARE (ST. VINCENT) IN BILLINGS, MONTANA WHICH IS AN SCLHS AFFILIATE. AS A FORMER OFFICER OF SAINT JOHN'S, THIS DISCLOSURE IS REQUIRED FOR 990 REPORTING PURPOSES ONLY. THE COMPENSATION REFLECTED IS THAT OF MR. PAQUETTE'S POSITION AS A ST. VINCENT EXECUTIVE AND IS NOT RELATED TO SAINT JOHN'S. IN KEEPING WITH SCLHS' CORE VALUE OF STEWARDSHIP, NO BOARD MEMBER SERVING ON SCLHS OR AFFILIATE BOARDS IS COMPENSATED FOR THAT SERVICE.

Schedule J (Form 990) 2010

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

2010

Open to Public
Inspection

Name of the organization

Saint John Hospital Inc

Employer identification number

48-0543768

Identifier	Return Reference	Explanation
FORM 990, PART VI, SECTION A, LINE 3	DELEGATE CONTROL OVER MANAGEMENT DUTIES	ALTHOUGH THESE SERVICES MAY NOT ALL RISE TO THE LEVEL OF MANAGEMENT CONTROL AS DEFINED IN THE 990 INSTRUCTION, WE HAVE IN THE SPIRIT OF FULL TRANSPARENCY PROVIDED THE FOLLOWING DISCLOSURE. AS A MEMBER OF SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, THIS PROVIDER MAY HAVE INDIVIDUAL AND/OR SYSTEM CONTRACT(S) THAT HAS DELEGATED CONTROL OVER MANAGEMENT DUTIES IN SOME OR ALL OF THE FOLLOWING AREAS: DIETARY AND FOOD SERVICE HOUSEKEEPING SUPPLY CHAIN REVENUE CYCLE SECURITY FORM 990, PART VI, SECTION A, LINE 6, 7A & 7B MEMBERS OF THE ORGANIZATION PROVIDENCE MEDICAL CENTER, INC. IS THE SOLE MEMBER OF SAINT JOHN HOSPITAL, INC.
FORM 990, PART VI, SECTION B, LINE 11B		ON OCTOBER 25, 2011 COPIES OF THE 990 WERE DISTRIBUTED TO ALL BOARD MEMBERS FOR THEIR REVIEW PRIOR TO FILING THE RETURN. THE FORM 990 IS ALSO REVIEWED BY FINANCE PERSONNEL AT SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM AND AN INDEPENDENT ACCOUNTING FIRM.
FORM 990, PART VI, SECTION B, LINE 12C		CONFLICT OF INTEREST FORMS ARE SENT OUT ANNUALLY TO ALL BOARD MEMBERS AND KEY EMPLOYEES. THESE STATEMENTS ARE CAREFULLY REVIEWED AND A REPORT PROVIDED TO THE CEO AND COO REGARDING EMPLOYEES AND OFFICERS, AND TO THE CHAIR OF THE BOARD AND CHAIR OF THE GOVERNANCE COMMITTEE REGARDING BOARD MEMBERS. IF A CONFLICT OF INTEREST ARISES, THE CEO DETERMINES ANY ACTION TO BE TAKEN AT THAT TIME.
FORM 990, PART VI, SECTION C, LINE 19	PUBLIC AVAILABILITY OF FINANCIALS, GOVERNING DOCUMENTS, AND COI POLICIES	SCLHS' GOVERNANCE MANUAL FOR BOARD MEMBERS AND ITS AFFILIATE BOARD MEMBERS IS AVAILABLE TO THE PUBLIC ON THE WEBSITE, WWW.GREATBOARDS.ORG. THE MANUAL SETS FORTH THE STANDARDS AND EXPECTATIONS OF EACH BOARD MEMBER INCLUDING THE FIDUCIARY DUTY OF LOYALTY WHICH REQUIRES THAT EACH MEMBER ABIDE BY SCLHS' CONFLICT OF INTEREST POLICY, DISCLOSE ANY ISSUES WHICH MAY PRESENT A CONFLICT, COMPLETE THE ANNUAL DISCLOSURE STATEMENT, REVIEW POLICIES AND PROCEDURES PERTAINING TO CONFLICTS OF INTEREST, AND PROVIDE OVERSIGHT OF SCLHS' RESPONSIBILITY PROGRAM. SAINT JOHN HOSPITAL'S UNAUDITED FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE PUBLIC. SAINT JOHN HOSPITAL IS A MEMBER OF THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM. THE AUDITED FINANCIAL STATEMENTS FOR THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM ARE AVAILABLE TO THE PUBLIC AT THEIR WEBSITE.
FORM 990, PART XI, LINE 5	OTHER CHANGES IN NET ASSETS OR FUND BALANCES	RECONCILING AMOUNTS INCLUDE EQUITY TRANSFERS AND CONTRIBUTIONS TO/FROM RELATED ORGANIZATIONS OF $65,814, CONTRIBUTIONS TO LONG LIVED ASSETS TOTALING $8,886, MEDICAL STAFF EQUITY ADJUSTMENT OF $17,607, AND UNREALIZED GAINS & LOSSES NETTING $382,747.
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:MICHAEL A DORSEY TITLE:PRESIDENT/CEO/ASST SECRETARY HOURS:31
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:MARY JO GREGORY TITLE:BOARD MEMBER HOURS:40
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:JOE JEANS TITLE:REGION VICE PRESIDENT FINANCE HOURS:30
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:JUANITA ROY TITLE:EXECUTIVE VP & COO HOURS:30
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:CAROLYN BOWMER TITLE:Vice President- Human Resource HOURS:30
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:JAN YERGAN TITLE:Vice President Strategy & Bus HOURS:30
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:BARRY SOLOMON TITLE:CHIEF MEDICAL OFFICER HOURS:30
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:GEORGE NOONAN TITLE:VP MISSION INTEGRATION HOURS:30
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:JAMES PAQUETTE TITLE:FORMER CEO HOURS:40
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:BAIN FARRIS TITLE:INTERIM CHIEF ADMIN OFFICER HOURS:40

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2010

Additional Data

Software ID:
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

2010

Open to Public Inspection

Name of the organization

Saint John Hospital Inc

Employer identification number

48-0543768

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) SISTERS OF CHARITY LEAVENWORTH HLTH SYST 9801 RENNER BLVD STE 100 LENEXA,KS66219 23-7379161	SUPPORT MMBRS	KS	501(C)(3)	11B-TYPE II	NA
(2) CARITAS CLINICS INC 818 NORTH 7TH STREET LEAVENWORTH,KS66048 48-1009910	CLINIC SVCS	KS	501(C)(3)	3	NA
(3) MARIAN CLINIC INC 1001 SW GARFIELD TOPEKA,KS66604 48-1046905	CLINIC SVCS	KS	501(C)(3)	3	NA
(4) MARILLAC CLINIC INC 2333 N 6TH STREET GRAND JUNCTION,CO81501 84-1085822	CLINIC SVCS	CO	501(C)(3)	3	NA
(5) PROVIDENCE MEDICAL CENTER 8929 PARALLEL PARKWAY KANSAS CITY,KS66112 48-0784446	HEALTHCARE	KS	501(C)(3)	3	NA
(6) BETHANY COMMUNITY PLAZA INC 15 NORTH 12TH STREET KANSAS CITY,KS66102 48-1207407	HEALTHCARE	KS	501(C)(3)	3	NA
(7) PROVIDENCEST JOHN FOUNDATION INC 8929 PARALLEL PARKWAY KANSAS CITY,KS661121689 48-0925688	SUPPORT 501C3	KS	501(C)(3)	7	NA
(8) ST FRANCIS HEALTH CENTER INC 1700 SW 7TH STREET TOPEKA,KS66606 48-0547719	HEALTHCARE	KS	501(C)(3)	3	NA
(9) ST FRANCIS HEALTH CENTER FOUNDATION 1700 SW 7TH STREET TOPEKA,KS66606 48-1092520	SUPPORT 501C3	KS	501(C)(3)	11A-TYPE I	NA
(10) ST MARYS HOSPITAL & MEDICAL CENTER INC 2635 N 7TH STREET GRAND JUNCTION,CO81502 84-0425720	HEALTHCARE	CO	501(C)(3)	3	NA
(11) ST MARYS HOSPITAL FOUNDATION 2635 N 7TH STREET GRAND JUNCTION,CO81502 23-7001007	SUPPORT 501C3	CO	501(C)(3)	11A-TYPE I	NA
(12) SAINT JOSEPH HOSPITAL FOUNDATION 1835 FRANKLIN STREET DENVER,CO80218 84-0735096	SUPPORT 501C3	CO	501(C)(3)	11A-TYPE I	NA
(13) HOLY ROSARY HEALTHCARE 2600 WILSON MILES CITY,MT59301 81-0231792	HEALTHCARE	MT	501(C)(3)	3	NA
(14) HOLY ROSARY HEALTHCARE FOUNDATION INC 2600 WILSON MILES CITY,MT59301 20-2270238	SUPPORT 501C3	MT	501(C)(3)	11A-TYPE I	NA
(15) ST VINCENT HEALTHCARE 1233 NORTH 30TH BILLINGS,MT59101 81-0232124	HEALTHCARE	MT	501(C)(3)	3	NA
(16) ST VINCENT HEALTHCARE FOUNDATION PO BOX 35200 BILLINGS,MT591075200 81-0468034	SUPPORT 501C3	MT	501(C)(3)	7	NA
(17) NORTHWEST RESEARCH & EDUCATION INSTITUTE 315 NORTH 25TH STREET BILLINGS,MT59101 20-1343024	COMM HLTH RES	MT	501(C)(3)	9	NA
(18) ST JAMES HEALTHCARE 400 SOUTH CLARK STREET BUTTE,MT597012328 81-0231785	HEALTHCARE	MT	501(C)(3)	3	NA
(19) ST JAMES HEALTHCARE FOUNDATION 400 SOUTH CLARK STREET BUTTE,MT59701 65-1202190	SUPPORT 501C3	MT	501(C)(3)	11A-TYPE I	NA
(20) SAINT JOHNS HEALTH CENTER 1328 22ND STREET SANTA MONICA,CA90404 95-1684082	HEALTHCARE	CA	501(C)(3)	3	NA
(21) JOHN WAYNE CANCER INSTITUTE 2000 SANTA MONICA BLVD SANTA MONICA,CA90404 95-4291515	CANCER R&D	CA	501(C)(3)	4	NA
(22) SAINT JOHNS HOSPITAL & HLTH CENTER FNDTN 1328 22ND STREET SANTA MONICA,CA904042091 95-6100079	SUPPORT 501C3	CA	501(C)(3)	11A-TYPE I	NA
(23) EXEMPLA INC FKA LUTHERAN HOSPITAL 2420 W 26TH AVE SUITE 100D DENVER,CO80211 84-1103606	HEALTHCARE	CO	501(C)(3)	3	NA
(24) EXEMPLA LUTHERAN MEDICAL CENTER FNDTN 2480 W 26TH AVESUITE 360B DENVER,CO80211 20-8846152	SUPPORT 501C3	CO	501(C)(3)	7	NA
(25) EXEMPLA GOOD SAMARITAN MEDICAL CTR FNDTN 200 EXEMPLA CIRCLE LAFAYETTE,CO80026 84-1649162	SUPPORT 501C3	CO	501(C)(3)	7	NA
(26) LUTH MED CNTR PRO&GEN LIAB SELF-INS TRST 2480 W 26TH AVESUITE 360B DENVER,CO80211 74-2571584	INSURANCE	CO	501(C)(3)	11A-TYPE I	NA
(27) MEDPARK INC 2480 W 26TH AVESUITE 360B DENVER,CO80211 84-1490379	PARKING	CO	501(C)(3)	7	NA
(28) SAINT JOSEPH HOSPITAL 1835 FRANKLIN STREET DENVER,CO80218 84-0417134	HEALTHCARE	CO	501(C)(3)	3	NA

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

Cat. No. 50135Y

Schedule R (Form 990) 2010

Page 2

Part III

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(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) PAVILION IMAGING LLC 750 WELLINGTON GRAND JUNCTION,CO81501 03-0516198	RADIOLOGY	CO	NA	N/A
(2) GRAND VALLEY SURGICAL CENTER LLC 710 WELLINGTON GRAND JUNCTION,CO81501 84-1505075	OP SURGERY	CO	NA	N/A
(3) SAN JUAN CANCER CENTER LLC 600 SOUTH 5TH STREET MONTROSE,CO81401 20-2856331	OP CANCER	CO	NA	N/A
(4) BILLINGS MRI CENTER LLC 1041 NORTH 29TH STREET BILLINGS,MT59101 81-0450943	MRI-PET SCAN	MT	NA	N/A
(5) LUTHERAN CAMPUS ASC LLC 3455 LUTHRN PKW SUITE 150 WHEATRIDGE,CO800336028 02-0749532	OP SURGERY	CO	NA	N/A
(6) COLORADO SURGICAL VENTURES LLC 30 S WACKER DR SUITE 2302 CHICAGO,IL60605 20-8038915	OP SURGERY	CO	NA	N/A
(7) COLORADO SURGICAL HOSPITAL LLC 30 S WACKER DR SUITE 2302 CHICAGO,IL60605 20-8038977	OP SURGERY	CO	NA	N/A

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) CARITAS INC AND SUBSIDIARIES 9801 RENNER BOULEVARD SUITE 100 LENEXA,KS66219 48-0941069	OTHER MEDICAL	KS	N/A	C CORP
(2) LEAVEN INSURANCE COMPANY LTD 23 LIME TREE BAY AVE PO BOX 1051 GEORGETOWN,GRAND CAYMANKY1-1102 CJ 98-0370522	INSURANCE	CJ	N/A

Schedule R (Form 990) 2010

Page 3

Part V

Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)

Note. Complete line 1 if any entity is listed in Parts II, III or IV.

Yes

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 other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

h Exchange of assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Yes

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

Yes

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

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

Yes

m Sharing of facilities, equipment, mailing lists, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

n Sharing of paid employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

o Reimbursement paid to other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

p Reimbursement paid by other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

r Other transfer of cash or property from other 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
(1) PROVIDENCE MEDICAL CENTER	L	1,226,000
(2) CARITAS INC AND SUBSIDIARIES	O	408,738
(3) CARITAS INC AND SUBSIDIARIES	I	275,796
(4) PROVIDENCE MEDICAL CENTER	N	91,690
(5) PROVIDENCE MEDICAL CENTER	M	114,679
(6)

Schedule R (Form 990) 2010

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Are all partners section 501(c)(3) organizations?		(e) Share of end-of-year assets	(f) Disproprtionate allocations?		(g) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(h) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(e) Share of end-of-year assets	Yes	No	(g) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2010

Page 5

Part VII

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule R (see instructions).

Identifier	Return Reference	Explanation

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: WE WILL, IN THE SPIRIT OF THE SISTERS OF CHARITY, REVEAL GOD'S HEALING LOVE BY IMPROVING THE HEALTH OF THE INDIVIDUALS AND COMMUNITIES WE SERVE, ESPECIALLY THOSE WHO ARE POOR OR VULNERABLE.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ....	3	13
4	Number of independent voting members of the governing body (Part VI, line 1b) ....	4	12
5	Total number of individuals employed in calendar year 2010 (Part V, line 2a) ...	5	358
6	Total number of volunteers (estimate if necessary) ....	6	35
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ..	7a	0
b	Net unrelated business taxable income from Form 990-T, line 34 ..	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	0	9,648
9	Program service revenue (Part VIII, line 2g) .........	31,882,007	34,852,121
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	76,448	23,320
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	31,509	31,632
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	31,989,964	34,916,721
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	27,299	14,000
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)	17,789,283	18,643,171
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)....	13,681,476	19,947,890
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	31,498,058	38,605,061
19	Revenue less expenses. Subtract line 18 from line 12......	491,906	-3,688,340
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16)............	22,478,378	19,571,211
21	Total liabilities (Part X, line 26)............	4,402,313	4,708,432
22	Net assets or fund balances. Subtract line 21 from line 20 .....	18,076,065	14,862,779

Sign Here

	Signature of officer	Date

	Type or print name and title.

Paid Preparer's Use Only	Preparer's signature	Date	Check if self- employed	Preparer’s taxpayer identification number (see instructions)
	Firm’s name (or yours if self-employed), address, and ZIP + 4			EIN
				Phone no.


4a	(Code: ) (Expenses $ 31,645,655 including grants of $ ) (Revenue $ 34,515,325 )
	AS PART OF THE HEALING MISSION OF THE CATHOLIC CHURCH, THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. AND ITS AFFILIATES WITNESS TO THE GOSPEL OF JESUS BY STRIVING TO PROVIDE QUALITY HEALTH CARE IN A SPIRIT OF JUSTICE AND CHARITY. 1. IT IS THE PHILOSOPHY OF THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEMS, INC. AND AFFILIATED HOSPITALS TO TREAT PATIENTS IN A NON-DISCRIMINATORY MANNER, MINIMIZE HUMAN SUFFERING AS MUCH AS POSSIBLE; CREATE A PREFERENTIAL OPTION FOR THE POOR; AND PROVIDE ASSISTANCE TO THOSE PATIENTS WHO HAVE LIMITED FINANCIAL RESOURCES. THE HOSPITAL PARTICIPATES IN THE MEDICARE AND MEDICAID PROGRAMS AND AS SUCH PROVIDES CARE AT REIMBURSEMENT LEVELS LOWER THAN CHARGES. THE DIFFERENCE BETWEEN REIMBURSEMENT FROM THESE PROGRAMS AND CHARGES AT ESTABLISHED RATES AMOUNTED TO $39,002,988 2. INCLUDED IN THE HOSPITAL MISSION IS SERVICE TO THE COMMUNITY IN WHICH IT OPERATES. TO THAT END, THE HOSPITAL PARTICIPATES IN THE FOLLOWING COMMUNITY BENEFIT ACTIVITIES: COMMUNITY HEALTH SERVICES PROVIDED AT MINIMAL OR NO CHARGE. CHOLESTEROL SCREENING, SIBLING PREPARATION, CANCER SUPPORT GROUP, BREAST FEEDING SUPPORT, CESAREAN BIRTH CLASSES, BLOOD SUGAR SCREENING, LAMAZE CHILDBIRTH CLASSES, HEARING SCREENING, NUTRITIONAL COUNSELING, & HOSPITAL CARE: INPATIENT DAYS OF CARE 11,595 INPATIENT ADMISSIONS 2,172 NEWBORN DELIVERIES 84 OUTPATIENT REGISTRATIONS 28,931 EMERGENCY ROOM VISITS 10,624 CLINIC VISITS 6,598

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services. (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses$ 31,645,655

(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) CAROLYN BOWMER Vice President- Human Resource	10.0	X		0	196,298	19,774
(19) JAN YERGAN Vice President Strategy & Bus	10.0	X		0	211,135	37,980
(20) BARRY SOLOMON CHIEF MEDICAL OFFICER	10.0	X		0	307,525	54,966
(21) GEORGE NOONAN VP MISSION INTEGRATION	10.0	X		0	221,520	26,460
(22) DR MARC LUCKETT PHYSICIAN	40.0	X		191,752	0	2,780
(23) JAMES PAQUETTE FORMER CEO	0.0		X	0	768,909	97,940
(24) BAIN FARRIS INTERIM CHIEF ADMIN OFFICER	0.0		X	0	525,916	73,804

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	191,752	3,324,274	441,502

				(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		9,648
e	Government grants (contributions)1e

f	All other contributions, gifts, grants, and similar amounts not included above1f
g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			9,648
			Business Code
2a	PATIENT CARE REVENUE		621,500	34,483,693	34,483,693
b	CAFETERIA/VEND		722,210	60,044			60,044
c	MOB RENTAL INCOME		531,120	301,714			301,714
d	OTHER		900,099	6,670			6,670
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			34,852,121
3	Investment income (including dividends, interest
	and other similar amounts).....			23,320			23,320
4	Income from investment of tax-exempt bond proceeds..			0
5	Royalties............			0
		(i) Real	(ii) Personal
6a	Gross Rents
b	Less: rental expenses
c	Rental income or (loss)
d	Net rental income or (loss).......
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory
b	Less: cost or other basis and sales expenses
c	Gain or (loss)
d	Net gain or (loss)..........			0
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	MEDICAL STAFF		541,900	31,632	31,632
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			31,632
12	Total revenue. See Instructions....			34,916,721	34,515,325		391,748


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing ..........				1
2	Savings and temporary cash investments .......			472,173	2	-389,413
3	Pledges and grants receivable, net .........				3
4	Accounts receivable, net .........			4,510,185	4	5,738,568
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........				5
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........				6
7	Notes and loans receivable, net .............				7
8	Inventories for sale or use ..............			772,711	8	799,051
9	Prepaid expenses and deferred charges ............			108,105	9	207,488
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	35,754,230
b	Less: accumulated depreciation. .....	10b	25,298,276	9,011,376	10c	10,455,954
11	Investments—publicly traded securities ..........				11
12	Investments—other securities. See Part IV, line 11 ......			7,576,322	12	2,697,282
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets .........				14
15	Other assets. See Part IV, line 11 ...........			27,506	15	62,281
16	Total assets. Add lines 1 through 15 (must equal line 34)...			22,478,378	16	19,571,211
17	Accounts payable and accrued expenses .			2,332,014	17	2,683,233
18	Grants payable ..........				18
19	Deferred revenue ..........				19
20	Tax-exempt bond liabilities ..........				20
21	Escrow or custodial account liability. Complete Part IV of Schedule D..				21
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........				22
23	Secured mortgages and notes payable to unrelated third parties ..			1,732,988	23	1,605,816
24	Unsecured notes and loans payable to unrelated third parties ....				24
25	Other liabilities. Complete Part X of Schedule D.....			337,311	25	419,383
26	Total liabilities. Add lines 17 through 25.....			4,402,313	26	4,708,432
	Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....			18,076,065	27	14,862,779
28	Temporarily restricted net assets .....				28
29	Permanently restricted net assets .....				29
	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 .....			18,076,065	33	14,862,779
34	Total liabilities and net assets/fund balances .....			22,478,378	34	19,571,211