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)
(1) MARK WARGO MD SECRETARY, B.O.D.	1.0	X	X	0	0	0
(2) STEVEN BROADUS CHAIRPERSON, B.O.D.	1.0	X	X	0	0	0
(3) WILLIAM E EHLING MD MBR. BOARD OF DIRECTORS	1.0	X		0	0	0
(4) PATRICK GIBBONS MBR. BOARD OF DIRECTORS	1.0	X		0	0	0
(5) SR MARYbeth CULNAN OSF MBR. BOARD OF DIRECTORS	1.0	X		0	0	0
(6) SHERYL KUZMA MBR. BOARD OF DIRECTORS	1.0	X		0	0	0
(7) JIMMIE LANSFORD secretary, B.O.D.	1.0	X	X	0	0	0
(8) SR Josepha SCHAEFFER OSF MBR. BOARD OF DIRECTORS	1.0	X		0	0	0
(9) WILLIAM SIMMONS MBR. BOARD OF DIRECTORS	1.0	X		0	0	0
(10) EVERETT J SOLON vice chair, B.O.D.	1.0	X		0	0	0
(11) JOANNE FENTON PRESIDENT/CEO	40.0	X	X	0	246,173	98,866
(12) Sr Maureen Fagan OSF MBR. Board of Directors	1.0	X		0	0	0
(13) William Franklin Mbr. board of directors	1.0	X		0	0	0
(14) ANN CARR TREASURER	.25		X	0	191,336	109,542
(15) KEVIN KAST Division CEO	1.0		X	0	418,200	149,987
(16) KAREN CLARK CHIEF FINANCIAL OFFICER	40.0		X	150,530	0	8,750
(17) KIMBERLY LANDERS DIR. PAT. CARE SERVICES	40.0		X	140,497	0	21,715

(A) Name and business address	(B) Description of services	(C) Compensation
Emergency Medical Experts LTD 1401 South Prairie Avenue CHICAGO,IL60605	Emergency MD	1,647,914
Anesthesia Pain Services LLC 1800 E Lake Shore Dr DECATUR,IL62521	Anesthesia MD	1,237,651
Immediate Care Experts LLC 1401 South Prairie Avenue Chicago,IL60605	Immediate Care MD	1,103,571
Delta Flex Travelers PO Box 202940 Dallas,TX753202056	Agency Personnel	188,394
Mayo Medical Lab Mayo Collaborative PO Box 9146 Minneapolis,MN554809148	Referral Lab	153,070
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 40

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	0
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 ....	744,151		744,151
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	20,081,515	16,163,455	3,918,060
8	Pension plan contributions (include section 401(k) and section 403(b) employer contributions) ....	1,503,728	1,503,728
9	Other employee benefits .......	4,904,692	4,904,692
10	Payroll taxes ...........	1,512,364	1,512,364
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	285,091		285,091
c	Accounting ...........	0
d	Lobbying ...........	0
e	Professional fundraising. See Part IV, line 17..	0
f	Investment management fees ......	0
g	Other ..........	10,429,590	7,549,074	2,880,516
12	Advertising and promotion ....	356,254	173,292	182,962
13	Office expenses .......	8,983,835	8,163,605	820,230
14	Information technology ......	320,892	71,956	248,936
15	Royalties ..	0
16	Occupancy ...........	1,297,834	1,200,324	97,510
17	Travel ............	76,894	65,625	11,269
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	68,511	5,587	62,924
19	Conferences, conventions, and meetings ....	0
20	Interest ...........	211,079		211,079
21	Payments to affiliates .......	3,312,000		3,312,000
22	Depreciation, depletion, and amortization .....	3,901,693	3,901,693
23	Insurance ..............	288,218	288,218
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 DEBT EXPENSE	1,970,786	1,970,786
b	VARIOUS	1,527,076	363,005	1,164,071
c	REFERRAL LAB	659,059	659,059
d	PHYSICIAN AUDIT SETTLEMENT	658,543		658,543
e	DUES AND SUBSCRIPTIONS	19,812		19,812
f	All other expenses
25	Total functional expenses. Add lines 1 through 24f	63,113,617	48,496,463	14,617,154	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 ..........	1,574	1	1,424
2	Savings and temporary cash investments .......	2,485,574	2	499,962
3	Pledges and grants receivable, net .........		3
4	Accounts receivable, net .........	7,712,400	4	7,544,058
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 ..............	1,495,993	8	1,440,093
9	Prepaid expenses and deferred charges ............	408,712	9	518,462
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	79,686,561
b	Less: accumulated depreciation. .....	10b	36,894,129	44,045,542	10c	42,792,432
11	Investments—publicly traded securities ..........	23,970,083	11	28,971,877
12	Investments—other securities. See Part IV, line 11 ......		12
13	Investments—program-related. See Part IV, line 11 ..	63,500	13	76,000
14	Intangible assets .........		14
15	Other assets. See Part IV, line 11 ...........	9,086,764	15	7,217,918
16	Total assets. Add lines 1 through 15 (must equal line 34)...	89,270,142	16	89,062,226
	17	Accounts payable and accrued expenses .	6,601,239	17	10,793,726
18	Grants payable ..........		18
19	Deferred revenue ..........		19
20	Tax-exempt bond liabilities ..........	13,207,783	20	12,917,783
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 ..		23
24	Unsecured notes and loans payable to unrelated third parties ....		24
25	Other liabilities. Complete Part X of Schedule D.....	17,845,432	25	11,405,489
26	Total liabilities. Add lines 17 through 25.....	37,654,454	26	35,116,998
		Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....	49,712,818	27	51,726,068
28	Temporarily restricted net assets .....	1,882,780	28	2,152,138
29	Permanently restricted net assets .....	20,090	29	67,022
	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 .....	51,615,688	33	53,945,228
34	Total liabilities and net assets/fund balances .....	89,270,142	34	89,062,226

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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

ST MARY'S HOSPITAL STREATOR HOSPITAL SISTERS
OF THE 3RD ORDER ST FRANCIS

Employer identification number

36-2169181

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

ST MARY'S HOSPITAL STREATOR HOSPITAL SISTERS
OF THE 3RD ORDER ST FRANCIS

Employer identification number

36-2169181

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 ST MARY'S HOSPITAL STREATOR HOSPITAL SISTERS OF THE 3RD ORDER ST FRANCIS
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 ST MARY'S HOSPITAL STREATOR HOSPITAL SISTERS OF THE 3RD ORDER ST FRANCIS
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
ST MARY'S HOSPITAL STREATOR HOSPITAL SISTERS
OF THE 3RD ORDER ST FRANCIS

Employer identification number

36-2169181

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

ST MARY'S HOSPITAL STREATOR HOSPITAL SISTERS
OF THE 3RD ORDER ST FRANCIS

Employer identification number

36-2169181

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

19,812

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

19,812

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
DESCRIPTION OF OTHER LOBBYING ACTIVITIES	Schedule C, Part II, Question 1i	St. Mary's Hospital ("The Hospital") is a member of the Catholic Health Association ("CHA"), The Illinois Hospital Association ("IHA"), The National Association for Home Care and Hospice, and the American Hospital Association ("AHA"). As a member of these organizations, the hospital pays dues and part of these dues are attributable to lobbying fees paid by the organizations. The amount listed above is the amount attributable to the hospital for its dues paid.

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

ST MARY'S HOSPITAL STREATOR HOSPITAL SISTERS
OF THE 3RD ORDER ST FRANCIS

Employer identification number

36-2169181

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	(d)Three Years Back	(e)Four Years Back
1a	Beginning of year balance ....
b	Contributions ........
c	Investment earnings or losses ...
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........
f	Administrative expenses ....
g	End of year balance ......

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

Board designated or quasi-endowment: SchDMd Bullet

Permanent endowment: SchDMd Bullet

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)

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

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

Part VI

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 .................	1,234,900		1,234,900
b	Buildings ................	51,394,088	18,986,108	32,407,980
c	Leasehold improvements ............	979,977	636,606	343,371
d	Equipment ................	25,258,325	17,271,415	7,986,910
e	Other .................	819,271	0	819,271
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........				42,792,432

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
Other








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

Part VIII

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

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









Total. (Column (b) 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
(1) VALUATION RESERVE				2,880,000
(2) ASSETS WHOSE USE IS LIMITED				2,219,161
(3) WORKERS COMP HS				1,022,581
(4) GOODWILL				548,000
(5) A/R NON-PATIENT				524,884
(6) A/R FOUNDATION				21,327
(7) PAY ADJUSTMENT				1,965


Total. (Column (b) should equal Form 990, Part X, col.(B) line 15.)...........				7,217,918

Part X

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

1.(a) Description of Liability		(b) Amount
Federal Income Taxes		0
ACCRUED BENEFIT LIABILITY		9,625,424
RETIRE OBLIGATION - ASBESTOS		1,778,298
A/R SELF INSURANCE		1,767






Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)		11,405,489
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
ASC SUBTOPIC 740-10		On July 1, 2007, the Obligated Group adopted ASC Subtopic 740-10, Accounting for Uncertainty in Income Taxes - an Interpretation of FASB Statement No. 109. ASC Subtopic 740-10 addresses the determination of how tax benefits claimed or expected to be claimed on a tax return should be recorded in the consolidated financial statements. Under ASC Subtopic 740-10, the Obligated Group must recognize the tax benefit from an uncertain tax position only if it is more likely than not that the tax position will be sustained on examination by the taxing authorities, based on the technical merits of the position. The tax benefits recognized in the consolidated financial statements from such a position are measured based on the largest benefit that has a greater than 50% likelihood of being realized upon ultimate settlement. ASC Subtopic 740-10 also provides guidance on derecognition, classification, interest and penalties on income taxes, and accounting in interim periods, and requires increased disclosures. As of June 30, 2011 and 2010, the Obligated Group does not have a liability for unrecognized tax benefits.

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

ST MARY'S HOSPITAL STREATOR HOSPITAL SISTERS
OF THE 3RD ORDER ST FRANCIS

Employer identification number

36-2169181

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 135 %

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 215 %

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?.........

Yes

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) ..		3,866	2,979,111		2,979,111	4.870 %
b Unreimbursed Medicaid (from Worksheet 3, column a) .		8,902	7,509,674	3,988,990	3,520,684	5.760 %
c Unreimbursed costs—other means-tested government programs (from Worksheet 3, column b) ....
dTotal Charity Care and Means-Tested Government Programs .....		12,768	10,488,785	3,988,990	6,499,795	10.630 %
Other Benefits e Community health improvement services and community benefit operations (from (Worksheet 4) ....	25	28,250	240,012	1,995	238,017	0.390 %
f Health professions education (from Worksheet 5) ..	3	35	23,161		23,161	0.040 %
g Subsidized health services (from Worksheet 6) ..	2	130	315,885	237,859	78,026	0.130 %
h Research (from Worksheet 7)
i Cash and in-kind contributions to community groups (from Worksheet 8) ..	20	18,623	156,857		156,857	0.260 %
jTotal Other Benefits ...	50	47,038	735,915	239,854	496,061	0.820 %
kTotal. Add lines 7d and 7j. ..	50	59,806	11,224,700	4,228,844	6,995,856	11.450 %

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)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy	16	3,136	21,378	4,280	17,098	0.030 %
8	Workforce development
9	Other
10	Total	16	5,948	21,378	4,280	19,910	0.030 %

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).....

721,702

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).....

22,068,372

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

30,423,804

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

-8,355,432

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	St Mary's Hospital 111 Spring Street Streator,IL61364	X	X	X

Schedule H (Form 990) 2010

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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:St Mary's Hospital

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

Page 5

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

Page 6

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

Page 7

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?
Name and address		Type of Facility (Describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2010

Page 8

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		Not applicable as the organization does follow federal poverty guidelines to determine eligibility for providing charity and discounted care to low-income uninsured and underinsured individuals. Charity Care Guidelines and Medical assistance program determination forms are available on the Hospital website.
Part I, line 6a		SMS does prepare an annual community benefit report in booklet form distributed to the public via mail and available at St. Mary's Hospital, 111 Spring Street, Streator, IL.
Part I, line 7g		The Adult Day program and Supportive Care program are subsidized services offered at St. Mary's Hospital. The hospital uses Lyons Software ("CBISA") to determine subsidized services. Physician clinics were not included in the subsidized health services.
Part I, line 7, column (f)		The percent of charity care and certain other benefits at cost as a percent of total expenses less bad debt is 4.87%. The amount of bad debt removed when calculating the percentages in Part I, Line 7, column (F) was $1,970,786.
Part I, line 7		SMS uses the Lyons Software ("CBISA") which follows the catholic health association ("CHA") guidelines on reporting charity care and certain other community benefits at cost. Lyons Software uses the hospitals audited financials for total expenses, bad debt, and gross patient charges to calculate the appropriate cost to charge ratio in determining charity care and other community benefits at cost.
Part II		Community building through community support, health improvement advocacy, and workforce development is an important part of St. Mary's commitment to enhancing community-wide health and well-being. St. Mary's is engaged in the community by developing support groups and through coalition building with community outreach events. An example of this includes a collaborative approach with the Streator Substance Abuse Coalition. St. Mary's has taken steps to inform the community of potential health risks of substance abuse, and has placed a focus on prevention. According the EMS Data Reporting System, the highest cause for hospitalization in the SMS primary service area is heart disease. In an effort to inform and educate the population, St. Mary's Hospital hosted a healthy heart presentation given by Dr. Riyaz Nomani and Dr. Forrest Rubenstein on heart and vascular disease, and another hosted by cardiologist Dr. Holly Novak on the topic of women and heart disease. In a service area where an alarming 1 out of 5 children under the age of 17 are living in poverty, St. Mary's Lean to Green weight loss/healthy living program started a food drive called "one person's loss is another's gain" to benefit the Streator food pantry. On behalf of the Lean to Green food drive, St. Mary's donated 368 pounds of food to the Streatorland Community Pantry. St. Mary's also hosted a three-part diabetes education series incorporating fun and interactive discussions to help educate those suffering from the condition on how to take better care of themselves. St. Mary's Hospital is a proud supporter of the American Cancer Society's relay for life. This year the hospital was a $3,000 gold sponsor of Relay for Life. This event represents the hope that those lost to cancer will never be forgotten, that those who face cancer will be supported, and that one day, cancer will be eliminated. In addition to being a gold sponsor, the hospital was able to assist Relay for Life by printing the event programs in-house, free of charge, as well as supplying the bottles of water for the night of the event. Beyond our hospital efforts, St. Mary's Hospital had several colleagues that supported the fight against cancer. Nearly thirty colleagues joined a relay team and raised thousands of dollars for the cause. In addition to those thirty colleagues that participated on a team, we also had a group of St. Mary's colleagues who volunteered at the event and distributed health care information and water to the walkers. St. Mary's Hospital is proud to be a sponsor of this great event - one that educates the public about the importance of cancer research and celebrates those whose lives have been affected by cancer. Recruitment and retention of health professionals and physicians is essential to provide access to care. St. Mary's Hospital is located in a health professional shortage area designated by the U.S. Department of Health and Human Services, Health Resources and Services Administration ("HRS"). Health professional shortage areas ("HPSAS") are designated by HRSA as having shortages of primary medical care, dental or mental health providers, and may be geographic (a county or service area), demographic (low income population) or institutional (comprehensive health center, federally qualified health center, or other public facility). Medically underserved areas/populations are areas or populations designated by HRSA as having: too few primary care providers, high infant mortality, high poverty, and/or high elderly population. The hospital is also situated within the Illinois physician shortage area designated by the Illinois Department of Public Health, Center for Rural Health. Located in a geographically challenged area, resources are committed to attracting new physicians, in both primary care-increasing vital access to initial care providers-and specialty areas. These efforts have resulted in adding the needed resources and capability to care for an aging population with increased individual needs. Physicians for urology, surgery, internal medicine, and nurse practitioner were added to the core medical staff. The population-to-practitioner ratio of 2,000:1 goal set by HRSA was achieved to meet the federal shortage area need for primary care providers. Filling professional skilled, technical clinical positions and specialty nursing positions have included searches to outlying populous areas. In response to the added physician base, additional colleagues were needed to assist in fulfilling our patients' needs. St. Mary's has helped to create employment opportunities within LaSalle County, an area with a high rate of joblessness reaching 12.7% in October 2009.
Part III, Line 4		Since the hospital implemented the Search America process, a much closer representation of the true community benefit is reflected. Prior to implementation of Search America software, patients previously designated as "no response" were written off to bad debt. "No response" is defined as no response for at least sixty days, during which at least three contact attempts have been made including mailing application, sending patient statements, and/or making telephone calls. "No response" patients are now processed through Search America, and if the result of the payment predictability comes back as low or undetermined, the Search America results will be printed and the account written off to charity. The new processes more effectively determine charity care and further reduce a patient's documentation requirements easing the patient's emotional burden in applying for charity care. Worksheet A was used multiplying bad debt expense by the cost to charge ratio as determined by completing Worksheet 2 (line 11). The hospital bad debt expense at cost for fiscal year 2011 was $721,702. Established guidelines will determine those uninsured guarantors not eligible for Charity, and who are uninsured. Discounts will be based on whether a family income is less than 300% of the federal poverty level or greater than 300% of the federal poverty level. Self pay patients will be screened for verification of no insurance coverage. Once verification of no coverage has been completed, the guarantors will be screened for charity or uninsured discounts based on income levels. Those guarantors that do not qualify for charity through the screening process will be asked to provide proof of income in the form of a recent pay stub and/or recent tax return to determine the level of uninsured discounting. If no proof of income is provided or a guarantor's income is greater than 301% of the federal poverty level, the appropriate discount according to the established criteria will be applied. The same process is followed for those guarantors' providing proof of income whose income is less than 300% of the federal poverty level. The discounting methodology of 135% of cost is based on the most current Worksheet C of the Medicare Cost Report. In any given year, the maximum that can be collected from a family cannot exceed 25% of the family's annual income. The patient is responsible to inform the facility of subsequent services in which they request the discount be applied. Annual income is documented on the patient accounting system at the time the person qualifies for the discount. It is updated based on new information received from the patient. Based on their family income, uninsured discounts will be applied uniformly to all uninsured patients. The discount rates will only be updated annually each October 1, based on the prior fiscal year's allowances, and shall remain in effect until the following October 1. Before granting a discount under this policy, the hospital will continue to take appropriate action to help patients qualify for any government assistance programs providing hospital benefits.
Part III, Line 8		The hospital continually strives to provide excellent patient care in the most cost effective fashion. Nonetheless, the Medicare program, in many cases, does not provide payment that covers the full cost of the care provided. Since it is the mission of the hospital to respond to community need, hospital management continually advocates for improved Medicare payment so that the cost of quality care to those patients that are not able to afford it is not compromised and is fairly subsidized by all payers. While this shortfall in Medicare payments is not classified as community benefit by the IRS, we nonetheless believe it is an important contribution made by the hospital to the health and well being of the community. The hospital Medicare shortfall at cost for fiscal year 2011 was $8,355,432. Our mission calls us to serve all patients with the highest possible quality and efficiency, even if we are not paid fully for doing so.
Part III, line 9b		If an indication of the inability to pay is apparent, the patient will be given the option to complete Illinois Public Aid - Form 450, if appropriate. The final option would then be to ask the patient to cooperate with the Christian Care determination process to determine the patient's ability to pay.
Needs Assessment		St. Mary's Hospital ("SMS") continually evaluates the needs of the community. The historic encounters are reviewed for trends, and demographic information is reviewed annually during our strategic planning process. Indigent levels, educational level, housing costs, unemployment, and uninsured children are all considered in the planning process. Physician demand analysis is ongoing. SMS engages in conversations with the community to ascertain those services that are in demand, and which ones are out migrating. Those conversations are held informally and sometimes formally. As areas are identified a business plan and proforma are done to validate the need. A formal community needs assessment is planned for the upcoming fiscal year.
Patient education of eligibility for assistance		Brochures giving notice of the hospital's Charity Assistance Policy are available to the public in the Emergency Department, Collection, and Registration areas. Information outlining the program is also available on patient statements and upon request. St. Mary's Hospital has multiple processes to inform and educate our patients about their patient eligibility for assistance under federal, state, or local programs, or charity care as defined below. These practices are handled with the utmost dignity and privacy. As part of the Registration process for all Self Pay patients, a Medicaid screening questionnaire is completed and a financial assistance pamphlet is handed out. The Medicaid screening questionnaires are reviewed by Patient Financial Services ("PFS") staff to determine potential Medicaid eligibility. After review, internal staff works with the patients to refer them to the local Medicaid office or assist the patient in completing an application. If it is felt that the patient may need additional help to qualify, we do refer the case to an outside agency that will assist the patient as necessary to qualify for Medicaid for a fee covered by St. Mary's Hospital. The Patient and Visitor guides in each patient room and waiting areas include a Financial Information sheet that outlines St. Mary's Hospital financial policy as well as information about the financial assistance and uninsured discount programs. The Case Managers and Social Workers also screen hospital inpatients for the potential need of assistance programs, and refer patients to work with the PFS staff as needed. Patient Financial Representatives conduct telephone interviews and in person counseling sessions with patients as to program availability and potential qualification based on discussion results. Once a patient completes the self-pay questionnaire, a determination is made based on policy guidelines through an internet-based tool. If a patient fails to comply with the questions, prior to an account being sent to collection, the patient payment predictability from an outside vendor is reviewed and based on the information an account may be written off to charity. As directed by Illinois State Law, the hospital internet site lists the information regarding income guidelines for financial assistance as well as the process to apply. These guidelines are updated annually based on changes in the federal poverty guidelines. All billing statements list various payment options including a statement that reads, "Financial Assistance is available to eligible persons who meet requirements." Self pay patient statements also include the following statement "Please contact our office to see if you qualify for the level of Uninsured Discounts or Financial Assistance."
community information		Streator is located in LaSalle and part of Livingston County Illinois. The city is situated on the Vermilion River approximately 81 miles southwest of Chicago, Illinois in the prairie and farm land of north-central Illinois. According to the 2010 census, the population of Streator was 13,710 people. Population and Demographics The census also indicated that Streator is made up of 5,621 households and 3,481 families residing in the city. The racial makeup of the city was 93.3% White, 10.4 Latino 3.5% African American, 1.5% from other races, and 1.47% from two or more races. Out of 5,621 households, 26.7% had children under the age of 18, 41.8% were married couples living together, 14.3% had a female householder with no husband present, and 38.13% were non-families. 32.6% of all households were made up of individuals and 31.6% had someone living alone who was 65 years of age or older. The average household size was 2.41, and the average family size was 3.04. In the city, the population was spread out with 25.9% under the age of 18, 8.3% from 18 to 24, 25.9% from 25 to 44, 21.0% from 45 to 64, and 19.0% who were 65 years of age or older. The median age was 39 years. For every 100 females there were 91.7 males. For every 100 females age 18 and over, there were 87.3 males. The median income for a household in the city was $33,868, and the median income for a family was $43,774. Males had a median income of $34,932 versus $20,994 for females. The per capita income for the city was $16,650. Poverty in Illinois and LaSalle County In September 2011, the Sun Times reported that Illinois had more poor people in 2010 than it has had in nearly two decades, according to data released recently by the U.S. Census Bureau that also showed the number of impoverished nationally at a new high. More than 1.82 million people lived in poverty in Illinois last year, up from 1.69 million. That was the biggest number of poor since 1992 when there were 1.86 million people who were impoverished. The poverty rate last year rose to 14.1 percent from 13.2 percent in 2009. Nationally, the overall poverty rate climbed to 15.1 percent, or 46.2 million Americans - the largest number since the Census Bureau began tracking poverty in 1959 - and up from 14.3 percent, or 43.6 million in 2009. The data also reflects the high number of long-term unemployed, those unemployed for 27 weeks or more, a group that's more likely to fall into poverty. That group encompassed more than 6 million people nationally in August - 42.9 percent of the 14 million unemployed. In Illinois, nearly half of the 675,000 unemployed in the state last year were long-term unemployed. The economic data suggests that these (poverty) trends aren't likely to change in the near future, and reflects the importance of safety net programs like hospitals that provide charity care. The census report also revealed the percent of uninsured in Illinois rose to 14.8 from 14.2 in 2009. There were 1.91 million people uninsured in the state last year, up from 1.81 million. Nationally, 49.9 million Americans had no health insurance, or 16.3 percent, up from 16.1 percent, or 49 million. Median household income in Illinois fell 5.5 percent to $50,761 last year from $53,743, the report showed. Nationally, it dropped 2.3 percent to $49,445, from $50,599. Since 2007, median household income has declined 6.4 percent. The latest data available for LaSalle County was published in September 2010 by the Social Impact Research Center in Chicago. In 2009, the poverty rate was 12.7% in LaSalle County which was a 3.3% increase over the poverty level in 2008. During the year, the number of people in poverty rose by over 4,000 people in the county and it affected children the most. In 2008, the poverty rate among children in LaSalle County was 12.9%. In 2009, that number nearly doubled to 25.2%. Over one quarter of the children living in LaSalle County, live in poverty. Local Economy Streator's economic history has been tied with its natural resources. Coal was the initial catalyst of the city's economy from 1866 until the late 1920s. As the community matured, silica deposits provided the resource for Streator's next industry leader: glass-container manufacturing. While the coal industry eventually died, glass manufacturing remains a presence in Streator. Agriculture and related agri-business in the farmlands of LaSalle County and nearby Livingston County are also a strong influence in Streator's economic engine. Though manufacturing provides the greatest share of earnings, the service industry now accounts for the largest share of jobs. Three of Streator's largest companies are some of its longest lasting companies. Vactor Manufacturing began in 1911 as the Myers-Sherman Company, manufacturing milking machines and conveyors for the agricultural industry. In the 1960s Myers-Sherman patented a sewer cleaning vehicle for the municipal public works market. The company was renamed Vactor when it became a subsidiary of the Federal Signal Corporation They are the world's leading producer of heavy-duty sewer cleaning equipment. They are the second largest employer in Streator with 530 employees. Owens-Illinois' Streator plant produces Duraglas XL(TM) bottles; a lightweight, stronger beer bottle for the Miller Brewing Company. Owens Bottle Company opened in Streator in 1916. Production peaked in the 1960s with 3,500 employees working in its 68-acre (280,000 m2) facility. Today it is Streator's fifth-largest employer, with 210 employees. In 2006, the plant was honored by the Miller Brewing Company for producing 650 million bottles for the brewer. St. Mary's Hospital is the city's largest employer with 550 employees. Founded in 1887 by the Hospital Sisters of the Third Order of St. Francis, this 127 certificate of need licensed bed hospital serves Streator and its outlying areas. The hospital serves a primary service area of approximately 113,921 residents in LaSalle County with a secondary service area of approximately 90,254 in Marshall, Woodford and Livingston counties. Health and Safety Statistics According to the Illinois Department of Public Health, the top six combined average causes for hospitalization in our four county primary/secondary service area for 2007 and 2008 include: * 10% - diseases of the heart * 7% - pneumonia * 6% - injury * 5% - mental issues * 4% - cancer * 3% - stroke The department also reported that the top five combined average causes of death in the four county service area included: * 25% - all other causes combined * 24% - diseases of the heart * 22% - cancer * 3% - vascular * 1% - respiratory
Promotion of community health		Expanding Access for vulnerable populations St. Mary's Hospital strives to promote and improve the health of the communities it serves by providing a teaching environment for nursing and technical clinical expertise for the regional workforce, recruiting and retaining the professional medical staff to meet the area need, and by providing care through a collaborative approach. Sustainability St. Mary's hosted an electronic recycling and used medical equipment drive open to all colleagues and the community in honor of earth day. Vintage Tech Recyclers, Inc. were on site with a truck collecting various electronic items to be recycled, and the used medical equipment was donated to HSHS Mission Outreach in Springfield, Illinois. Protecting the earth and being sustainable is an everyday goal at St. Mary's. St. Mary's Hospital supports those students who wish to make a difference in the lives of others by going into the field of health care. Friends of St. Mary's Hospital awarded two $1,000 scholarships for the 2011 Chad Scoles memorial scholarship. The scholarship was established in memory of Chad Scoles, son of Dick Scoles, a long-term St. Mary's Hospital employee, and his wife Sally. Chad passed away in 2004 at the age of 21. The scholarship fund was created by two emergency room physicians, Dr. William Sullivan and Dr. Ted Patras. Affordable health care for uninsured and underinsured patients St. Mary's devotes significant resources to access for patients who cannot afford care, along with other community benefits. In fiscal year 2011, St. Mary's provided nearly $5.3 million in community benefit services, including charity care at cost, unpaid costs of Medicaid and other public programs, and a range of programs designed to enhance access and improve community health. Additionally, during this period, St. Mary's provided $1.2 million (at cost) in uncompensated care to patients that did not qualify for charity care or public assistance and $5.4 million (at cost) in excess of Medicare payment for health care services. St. Mary's Hospital participates in multiple government-sponsored health care programs, including Medicaid, Medicare, Champus, and Tricare. Community benefits at St. Mary's include programs aimed at access and health promotion, especially for persons with special needs. For example, St. Mary's Hospital operates an adult day program that provides meals, transportation, and social stimulation for seniors who live at home but do not have a caretaker available during the day. The adult day center is for adults who are minimally physically impaired, socially isolated, or disabled. The program provides daily activities that may include music, art, crafts, and exercise provided by professionally trained and qualified individuals. No participant is refused service because of an inability to pay. Facilitating access for populations with special needs Transportation options in Streator are severely limited. Not only is there no public transportation system, there is not even a taxi company. This leaves many people, especially the elderly or disabled, at the mercy of others' kindness. St. Mary's Hospital recognized this as a very serious problem and responded with the medical transportation program. The program, established in 1994, provides free transportation to needy patients, particularly those with disabilities, who had no other way of getting to and from their medical appointments. The program provides transportation to seniors, children, expectant mothers, and individuals with special needs. Transportation is made with the participant's safety in mind with a qualified staff to assist individuals with boarding and disembarking in vans maintained to Illinois Department of Transportation Standards. A frequent user of the medical transportation van says, "I am so grateful for the hospital van. Since I can no longer see well enough to drive, I would be in real trouble." Another client wrote, "I appreciate the service of the van. I do not know how I would get to my appointments if it were not available. I have been using the service for some time now and usually three times per week." St. Mary's Hospital has recognized the need for comprehensive management of the physical, psychosocial, and spiritual needs of patients with complicated or serious illnesses. In response to this need, the hospital offers the services of the supportive care team. This team utilizes a team of professionals as a consult with the primary physician. A physician, nurse, social worker, and chaplain aim to relieve suffering, and improve quality of life, regardless of the prognosis and treatment. The primary focus of care is to identify patient and family goals, and manage symptoms for a better quality of life. This service is offered free of charge, and offers coordination of care based on patient and family goals. The service includes time intensive patient-family communication including difficult decision making, expertise in symptom management such as pain, anxiety, nausea, difficulty breathing, appetite loss, bowel patterns, emotional distress, and sleep disturbances. Enhancing the health of our community As part of our commitment to provide our community with the highest quality of care, St. Mary's Hospital participated in a number of health fairs providing free health screenings and educational information. This year, St. Mary's colleagues donated their time to travel to several health fairs throughout the Illinois Valley, offering health education and free screenings such as bone density tests, ankle brachial index screenings, blood pressure checks, and pulse ox screenings. These health fairs are just one way that our hospital can educate the community and promote early detection and disease prevention, as well as encouraging a healthy lifestyle. Helping patients and their families steer through the vast amount of cancer information and patient services has been made easier through a partnership between St. Mary's Hospital and the American Cancer Society ("ACS"). The partnership will allow cancer patients and their families to receive a variety of free support services and educational information during visits to the new ACS patient resource center on St. Mary's Hospital campus in the medical office building. St. Mary's Hospital offers hope to our community in the tradition of The Hospital Sisters of St. Francis. As a healing ministry of the Catholic Church and an affiliate of the Hospital Sisters Health System ("HSHS"), St. Mary's is committed to delivering high quality, compassionate, and cost-effective health care services to all. The hospital was founded over 125 years ago to bring a healing presence and improve the health of our community, especially for people who are sick, poor, and disadvantaged. Because of the hospital's purpose and tradition, it is organized to promote the health of Streator and surrounding areas. The hospital is governed by a board of directors, the majority of which is comprised of persons who reside in the organization's primary service area and who are neither employees nor contractors of the hospital. The board ensures that St. Mary's is responding to community need. Colleague participation in community organizations such as Streator area Chamber of Commerce and Industry, Streator Unlimited, Red Cross, Streator Day Care, United Way, ADV/SAS as well as Friends of St. Mary's Foundation help the hospital connect with the community. Also consistent with its exempt purpose, St. Mary's has an open medical staff with privileges available to all qualified physicians in the area who met criteria and are approved by the board. In addition, the hospital operates an emergency department that is open 24 hours to all persons regardless of their ability to pay. As a non-profit hospital, St. Mary's reinvests surplus funds into the Mission of the organization and health of the community rather than distributing them as profits to shareholders or individuals. Funds not committed to ongoing operations are generally used to upgrade facilities, secure new technologies, improve patient care, and support initiatives designed to promote health and ensure access for all. St. Mary's Hospital exists to provide quality health care to the communities we serve. Our mission compels us to continue Christ's healing ministry through service to the sick, the aged, the poor, and the terminally ill, regardless of race, creed, sex, handicaps, religion, age, sexual orientation, marital, military discharge, or financial status. Our values of compassion, justice, reverence for life, and individual dignity are an integral part of the health services that improve the quality of life and health status of the entire region. But we are not satisfied simply providing care for patients at our facility every day of the year. Our dedicated employees, volunteers, and extended hospital family go above and beyond to provide health education health services and contribute
AFFILIATED HEALTH CARE SYSTEM		St. Mary's Hospital Streator is an affiliate of Hospital Sisters Health System. The mission of Hospital Sisters Health System ("HSHS") is to serve those in need through a health care ministry that values compassion, respect and reverence for life. The nearly 14,000 colleagues who make up HSHS are dedicated to this mission and to providing high quality health care to whoever seeks our services. By living our mission each day, HSHS colleagues constantly strive to provide the highest quality and most cost-effective and compassionate health care to those we are privileged to serve. Our health care ministry extends across 12 communities in Wisconsin and Illinois and includes 13 hospitals, dozens of community-based health centers and clinics, and more than 2,000 physician partners. As part of our mission to provide healing and hope to the three million people we serve, we have developed Community Benefit initiatives that 1) expand access to health care, 2) enhance overall health status and 3) promote medical education. In the Fiscal Year that ended June 30, 2011, HSHS hospitals provided $166.1 million in Community Benefits (or 8.7% of total expenses), an increase of $15.7 million from FY 2010. Of this amount, $37.1 million was provided for charity care and $99.8 million was the amount of unreimbursed care provided under the Medicaid program. In addition, HSHS hospitals committed significant resources in serving the Medicare population. The cost of providing services to primarily elderly beneficiaries of the Medicare program, in excess of governmental and managed care contract payments, was $183.8 million during Fiscal Year 2011. HSHS hospitals also recorded $103.9 million in uncollectible accounts. HSHS strengthens the health of our communities by continually reinvesting any surplus revenue from operations and investments into new medical technology, facility infrastructure and health care services. These investments ensure that our hospitals can continue to provide high quality, compassionate care to our patients. During Fiscal Year 2011, HSHS also continued to invest in our Care Integration strategy that places the patient at the center of our work while allowing us to deliver care in a more cost-effective and efficient manner. These investments are designed to better coordinate care, improve health outcomes, create new efficiencies, and help ensure that patients (especially those with chronic conditions) get well and stay well. Our Care Integration strategy is delivering promising results. An example is our three Medical Home pilot projects. Diabetic Patients enrolled in Medical Homes in rural Illinois experienced an average 42 percent decrease in their blood glucose levels while their unplanned readmissions to the hospital dropped to zero. HSHS is making significant progress implementing interoperable health information technologies and robust health information exchanges. In central Illinois, HSHS is joining with other health care providers to develop a statewide Health Information Exchange ("HIE") that will allow health care providers to exchange clinical information, such as medication histories and test results, access that information at the point of care and make better informed decisions with their patients. HSHS understands that our investments in information technology will have a positive impact on the quality, safety and efficiency of health care. 1. Expanding access to health care An integral component of our Community Benefit initiatives is to provide care to every patient who seeks our services without exception. To that end, HSHS hospitals have established Charity Care program guidelines that cover 100% of hospital charges for individuals and families who earn 125% to 250% of the federal poverty level. HSHS hospital's Charity Care guidelines have sliding scales, in some instances providing up to a 50% discount on charges for those earning up to 600% of the federal poverty level. HSHS hospitals have created simple forms for those wishing to apply for Charity Care and assign counselors to visit with inpatients who are uninsured to let them know about our charity care policies and provide assistance filling out applications for financial assistance or enrollment in publicly funded health care programs. HSHS hospitals also work collaboratively with others to enhance access to health care services for those in need. St. John's Hospital in Springfield, IL has partnered with Memorial Medical Center, Southern Illinois University School and Medicine and other community partners to support the Coordinated Access to Community Health ("CATCH") initiative. The free program is being made available to uninsured adults in Sangamon County to help them access routine medical care, specialty doctors and affordable medicine. Launched in May 2011, CATCH enrolls patients as they visit social service agencies or when they leave hospital emergency rooms. Enrollees are then referred to Springfield's federally funded primary care clinic, Capitol Community Health Center, or participating doctors' private offices. Grants from St. John's Hospital, Memorial Medical Center, United Way of Central Illinois and the Dominican Sisters offset CATCH's first year of expenses. Patient advocates at St. John's Hospital and Memorial Medical Center help uninsured patients find primary or specialty doctors and make appointments, and arrange for financial assistance from participating social service agencies for prescription drugs. In the first three months since the program was launched, CATCH signed up more than 250 physicians in the community who agreed to see patients at no charge. The program endeavors to enroll up to 6,000 uninsured patients within the next few years. By making it easier for uninsured residents to get preventive health care services, CATCH organizers believe uninsured patients' medical problems will be addressed early, helping improve their quality of life. St. Mary's Hospital Medical Center in Green Bay, WI supports the NEW Community Clinic, a 38-year-old free health center for the uninsured and underinsured. St. Mary's provides free and discounted laboratory and radiology services to the clinic. More than 70 percent of patients say the clinic's care allowed them to avoid having to seek care in a local Emergency Room. For the past decade, St. Anthony's Memorial Hospital in Effingham, IL has teamed up with Effingham Catholic Charities to co-sponsor the Prescription Assistance Program. Catholic Charities' staff members work with clients who need prescription medication but may not be able to afford them because they are uninsured or underinsured. Due to the financial support of St. Anthony's, the program is able to provide needed prescriptions to dozens of residents each month. St. Francis Hospital in Litchfield, IL collaborated with local dental care providers to coordinate and provide a free day of dental care to uninsured individuals. The collaboration was the result of a community needs assessment that determined access to dental care was a priority in the community. The "Community Day of Dental Care" provided free dental cleanings, X-Rays, and extractions to 90 uninsured individuals. Among those 90 people served included a military veteran who has been unable to obtain dental care after a St. Louis facility closed. He was able to have five teeth extracted. Another person served was a young woman who needed some minor restorative care which greatly improved her appearance. She was very grateful because she had a job interview coming up and would be able to attend the interview feeling better about her appearance. 2. Enhancing the health status of the community Another component of our Community Benefit initiatives is to improve the quality of life in our communities. Our hospitals work closely with a wide array of public and private organizations that share our commitment to enhancing health and wellness. We know that by working together, we can maximize our efforts by sharing resources, reduce duplication of services, and make it easier for residents to get the services and knowledge they need to live healthier lives. HSHS hospitals also understand they need to listen closely to the residents of the communities they serve to ensure the health care needs of all are being met. Sacred Heart Hospital in Eau Claire, WI invited more than 1,400 area residents to share their vision for health care during a series of focus groups. Participants included constituents that are often overlooked: low-income, vulnerable populations and minority groups. The visioning sessions captured the voices of special populations, Among Mutual Assistance Association members, Amish farmers, seniors, young children and other diverse groups. The feedback provided led to more than 100 actionable items that were assessed and/or implemented over the first six months since the sessions concluded. One action taken by Sacred Heart Hospital and St. Joseph's Hospital in Ch
STATE FILING OF COMMUNITY BENEFIT REPORT	990 SCHEDULE H, PART VI	IL,

Schedule H (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

ST MARY'S HOSPITAL STREATOR HOSPITAL SISTERS
OF THE 3RD ORDER ST FRANCIS

Employer identification number

36-2169181

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....

Yes

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

Yes

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

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? ...............

Yes

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

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

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

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

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

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

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

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

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

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

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

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

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

Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in 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) JOANNE FENTON	(i) (ii)	0 216,681	0 16,000	0 13,492	0 80,893	0 18,793	0 345,859	0 0
(2) ANN CARR	(i) (ii)	0 152,228	0 11,100	0 28,008	0 92,165	0 18,090	0 301,591	0 0
(3) KEVIN KAST	(i) (ii)	0 359,829	0 24,600	0 33,771	0 126,681	0 24,126	0 569,007	0 0
(4) KAREN CLARK	(i) (ii)	144,029 0	6,400 0	101 0	0 0	9,363 0	159,893 0	0 0
(5) KIMBERLY LANDERS	(i) (ii)	140,396 0	0 0	101 0	0 0	22,333 0	162,830 0	0 0
(6) LARRY JONES	(i) (ii)	227,473 0	0 0	33,029 0	0 0	13,688 0	274,190 0	0 0
(7) PARVEEN CHAND	(i) (ii)	151,495 0	6,200 0	371 0	0 0	20,284 0	178,350 0	0 0
(8) John M Speca MD	(i) (ii)	282,472 0	0 0	969 0	0 0	10,759 0	294,200 0	0 0
(9) Forrest S Rubenstein MD	(i) (ii)	232,204 0	5,500 0	298 0	0 0	7,057 0	245,059 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
Health or Social Club Dues	Schedule J, Part I, Line 1a	St. Mary's Streator paid for Joanne Fenton's country club dues during the year. The amount was included in her annual reportable compensation.
severance payment	Schedule J, Part I, Line 4a	Larry Jones received a severance payment in the amount of $19,232 during the tax year. This amount has been included in Larry's reportable compensation on Schedule J and Form 990, Part VII.

Schedule J (Form 990) 2010

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

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

Attach to Form 990 or Form 990-EZ. MediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

ST MARY'S HOSPITAL STREATOR HOSPITAL SISTERS
OF THE 3RD ORDER ST FRANCIS

Employer identification number

36-2169181

Part I

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

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

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

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

Part II

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

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






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

Part III

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

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

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

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2010

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) Georgene Lansford	Spouse of Director	92,056	Employment		No
(2) Kara Hughes	Sister of Officer	76,402	Employment		No
(3) Jeannine Solon	Spouse of Director	62,376	Employment		No
(4) Paulette Simmons	Sister-in-law of Director	77,108	Employment		No
(5) Brooke VanCoppenolle	Daughter of Director	55,214	Employment		No

Part V

Supplemental Information

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

Identifier	Return Reference	Explanation
BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS	FORM 990 SCHEDULE L, PART IV	There are three St. Mary's Hospital colleagues who are spouses of either Directors or Officers. Two employees are sister and sister-in-law of Director and Officer. One employee is the daughter of a Director. All persons listed on Schedule L, Part IV were hired in accordance with the hospital hiring policy at comparative industry market compensation. Four persons were hired prior to the business transaction (member of hospital board); the remaining person was hired in accordance with hospital hiring policy as stated above in compliance with the conflict of interest policy.

Schedule L (Form 990 or 990-EZ) 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

ST MARY'S HOSPITAL STREATOR HOSPITAL SISTERS
OF THE 3RD ORDER ST FRANCIS

Employer identification number

36-2169181

Identifier	Return Reference	Explanation
Organization's mission	FORM 990 PART III, Line 1	To continue Christ's healing ministry through service to the sick, THE AGED, THE POOR AND THE TERMINALLY ILL, REGARDLESS OF RACE, CREED, SEX, HANDICAPS, RELIGION, AGE, SEXUAL ORIENTATION, MARITAL, MILITARY DISCHARGE, OR FINANCIAL STATUS. THE VALUES OF COMPASSION, JUSTICE, REVERENCE FOR LIFE, AND INDIVIDUAL DIGNITY ARE FOSTERD. HEALTH SERVICES THAT IMPROVE OR MAINTAIN THE QUALITY OF LIFE ARE SUPPORTED. THE SISTERS, ADMINISTRATION, MEDICAL STAFF AND EMPLOYEES PRACTICE THIS MISSION BY IDENTIFYING WITH THE CORE VALUES OF THE HOSPITAL SISTERS HEALTH SYSTEM - RESPECT, CARE, COMPETENCE AND JOY. STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS FORM 990 PART III Three largest programs Inpatient and Outpatient care services with direct expenses of $4,188,059 includes Medical Surgical, Women's Health, and Intensive Care acute inpatient and observation patient services as well as nursery inpatient care. These services provided 10124 Acute patient days, provided services for 840 observation patients and 519 nursery days. Imaging services with direct expenses of $4,166,396 include routine diagnostic, angiography, ultrasound, MRI, CT, and Nuclear Medicine services. Diagnostic imaging conducted 21,363 IP/OP procedures; angiography conducted 2,357 IP/OP procedures; ultrasound conducted 8,000 IP/OP procedures; MRI conducted 1490 IP/OP procedures; CT 4,001 IP/OP procedures and Nuclear Medicine conducted 1,647 IP/OP procedures. The imaging departments provide necessary inpatient and outpatient services to the community we serve. Surgical Services with direct expenses of $4,132,693 included both Inpatient and Outpatient Services. Surgery performed a total of 3,452 Surgical Procedures. 721 of those services were provided for inpatients and 2731 for outpatients. The surgery department meets the needs of the community by providing both emergent and elective surgery on an inpatient and outpatient basis. community benefit contribution The community benefit contribution of St. Mary's Hospital includes programs and activities that improve access to health care, and improve health in our communities. In order to portray the full breadth of our contribution, our community benefit information is described below: Section 1: Qualitative Description of Community Benefit - describes the hospital's community benefit mission, how the mission is translated into a proactive approach designed to meet community health needs, how the hospital meets tax-exempt requirements, and a description of community benefit programs and services that highlight the hospital's impact on community health. Section 2: Quantitative Description of Community Benefit - describes the hospital's community benefit contribution in financial terms presenting the amount of charity care, the unpaid shortfall from government health care for the indigent, and the net expense of community benefit services. SECTION 1 - QUALITATIVE DESCRIPTION OF COMMUNITY BENEFIT 1.Organizational Commitment to Providing Community Benefit- St. Mary's Hospital mission is to continue Christ's healing ministry through service to the sick, the aged, the poor, and the terminally ill regardless of race, creed, sex, handicaps, age, religion, sexual orientation, marital, military-discharge, or financial status. Although reimbursement for services rendered is critical to the operation and stability of St. Mary's Hospital, it is recognized that not all individuals possess the ability to purchase essential medical services, and further that our mission is to serve the community with respect to providing healthcare services and healthcare education. A. St. Mary's Hospital is located in Streator Illinois, and serves a primary service area of approximately 112,500 residents; with a secondary service area of approximately 89,300 residents. St. Mary's Hospital has been designated as a Medicare Dependent Hospital meeting the criteria of at least 60 percent of inpatient days or discharges covered by Medicare. This greater dependence on Medicare makes the Hospital more financially vulnerable to prospective payment. St. Mary's Hospital has identified transportation as a need of our service area. The increase in the elderly population who are still in their homes and do not have transportation to obtain medical needs has increased in this service area. The Hospital has provided transportation, and is working in conjunction with the Interagency Coordinating Committee on Transportation for LaSalle County to address this growing need. A shortage of physician specialties has been identified as an additional need of the community. St. Mary's is working with existing physicians and community leaders in recruitment efforts to meet this need. Additionally, the Hospital is the provider for continuing education for the EMS system. The Hospital encourages employee participation with community organizations to improve and inform community members of health related issues and needs. St. Mary's sponsors teams in the community youth sports programs, and provides certified athletic trainer services for the local school athletic programs as well as the community sports leagues. B. St. Mary's Hospital has a charity program in place to offer financial assistance to persons without the ability to pay for necessary medical treatment. St. Mary's provides brochures in the emergency department, patient registration department and from the patient financial representatives giving notice of the hospital's charity assistance policy. Information outlining the program is also available on patient statements and upon request. 2. Organizational Description for Tax Exemption - St. Mary's Hospital operates an emergency department that is open 24 hours to all persons regardless of their ability to pay. The Hospital has an open medical staff with privileges available to all qualified physicians in the area. St. Mary's Hospital serves as a clinical site for students in the fields of nursing, laboratory, diagnostic imaging, physical therapy, speech, and pharmacy. St. Mary's Hospital participates in the government-sponsored health care programs for Medicaid, Medicare, CHAMPUS, and Tricare. 3. Description of Community Benefit Programs - St. Mary's Hospital operates an Adult Day program which provides meals, transportation, and social stimulation for seniors who live at home but do not have a caretaker available during the day. The Adult Day Center is for adults who are minimally physically impaired, socially isolated, or disabled. The program provides daily activities which may include music, art, crafts, and exercise provided by professionally trained and qualified individuals. No participant is refused service because of an inability to pay. St. Mary's Hospital is aware of the need in the community for transportation to and from medical services. In an effort to alleviate this need, the Hospital provides a Medical Transportation Program which includes free van service to medical appointments for patients with special needs and no means of transportation. This service includes transportation to physician office and all outpatient services affiliated with St. Mary's Hospital. Transportation is made with the participants safety in mind with a qualified staff to assist individuals with boarding and disembarking in vans maintained to Illinois Department of Transportation standards. St. Mary's Hospital has recognized the need for comprehensive management of the physical, psychosocial, and spiritual needs of patients with complicated or serious illnesses. In response to this need, the Hospital offers the services of the Supportive Care team. This team utilizes a team of professionals as a consult with the primary physician. A physician, nurse, social worker, and chaplain aim to relieve suffering, and improve quality of life, regardless of the prognosis and treatment. The primary focus of care is to identify patient and family goals, and manage symptoms for a better quality of life. This service is offered free of charge, and offers coordination of care based on patient and family goals, time intensive patient-family communication including difficult decision making, expertise in symptom management such as pain, anxiety, nausea, difficulty breathing, appetite loss, bowel patterns, emotional distress, and sleep disturbances and a high level patient and family satisfaction with their physician, health care team and hospital. 4. Links to Additional Community Benefit Information - St. Mary's Hospital Charity Policy, Request for Financial Assistance, Financial Eligibility Criteria Table, and Community Benefits report is attached.
STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS CONTINUED	FORM 990 PART III,	SECTION 2 - QUANTIFIABLE COMMUNITY BENEFIT THE FINANCIAL INFORMATION IN THIS REPORT WAS PREPARED IN ACCORDANCE WITH THE CATHOLIC HEALTH ASSOCIATION'S ("CHA") COMMUNITY BENEFIT REPORTING GUIDELINES. THESE GUIDELINES RECOMMEND THE FOLLOWING: "REPORT CHARITY CARE AT COST, NOT CHARGES. "DO NOT INCLUDE BAD DEBT, CONTRACTUAL ALLOWANCES, AND QUICK PAY DISCOUNTS AS PART OF CHARITY CARE EXPENSE. "DO NOT COUNT MEDICARE SHORTFALL AS A COMMUNITY BENEFIT. "REPORT THE NET EXPENSE FOR COMMUNITY BENEFIT SERVICES, I.E., THE TOTAL COMMUNITY BENEFIT EXPENSE MINUS ANY ASSOCIATED REVENUE FROM PATIENTS, PAYERS, AND OTHER EXTERNAL SOURCES. THE CHA REPORTING GUIDELINES REFLECT A CONSERVATIVE APPROACH TO REPORTING QUANTIFIABLE COMMUNITY BENEFIT. THE GOAL OF THE REPORTING GUIDELINES IS TO PRODUCE COMMUNITY BENEFIT FINANCIAL REPORTS THAT REFLECT TRUE COSTS AND THAT DESCRIBE COMMUNITY BENEFIT ACTIVITIES THAT INCREASE ACCESS TO HEALTH CARE AND IMPROVE COMMUNITY HEALTH. CATEGORY A, COMMUNTIY HEALTH IMPROVEMENT SERVICES - EDUCATION, CLINICAL, AND SUPPORT SERVICES WERE PROVIDED TO 15,455 PEOPLE, AT A COST OF 155,055, FOR A TOTAL BENEFIT AMOUNT OF 153,360. A1 - COMMUNITY HEALTH EDUCATION: COMMUNITY HEALTH EDUCATION BENEFIT PROGRAMS, SERVED 15,141 PERSONS AT A COST OF 76,045. THERE WERE NO OFFSETTING REVENUES FOR A TOTAL BENEFIT AMOUNT OF 76,045. A2 - COMMUNITY BASED CLINICAL SERVICES: COMMUNITY HEALTH EDUCATION BENEFIT PROGRAMS SERVED 34 PERSONS AT A COST OF 196, WITH NO OFFSETTING REVENUES FOR A TOTAL BENEFIT AMOUNT OF 196. A3 - HEALTH CARE SUPPORT SERVICES: COMMUNITY HEALTH EDUCATION BENEFIT PROGRAMS SERVED 280 PERSONS AT A COST OF 78,814, WITH OFFSETTING REVENUES OF 1,695 FOR A TOTAL BENEFIT AMOUNT OF 77,119. CATEGORY B, COMMUNTIY HEALTH IMPROVEMENT SERVICES- 27,443 IN SCHOLARSHIPS AND FUNDING FOR EDUCATION WAS PROVIDED. CATEGORY C, LOW OR NEGATIVE MARGIN PROGRAMS SERVED 143 PEOPLE AT A COST OF 266,860, WITH OFFSETTING REVENUES OF 209,592 FOR A TOTAL BENEFIT AMOUNT OF 57,268. CATEGORY E, FINANCIAL AND IN-KIND CONTRIBUTIONS TOTALED 164,143 SERVING 6,697 PEOPLE. E1 - CASH DONATIONS TOTALED 2,402. E3 - IN-KIND DONANTIONS: IN-KIND DONATIONS SERVED 7,697 PERSONS AT A COST OF 161,741 WITH NO OFFSETTING REVENUES FOR A TOTAL BENEFIT AMOUNT OF 161,741 CATEGORY F - COMMUNITY BUILDING ACTIVITIES, INCLUDED SUPPORT SYSTEM ENHANCEMENTS AT A COST OF 6,156. A TOTAL OF 53 COMMUNITY BENEFIT ACTIVITIES WERE COMPLETED, AT A COST OF 613,501 WITH OFFSETTING REVENUES OF 211,287 FOR A TOTAL BENEFIT AMOUNT OF 402,214. TAX EXEMPT BONDS FORM 990, PART IV, QUESTION 4 St. Mary's - Streator HOLDS A LIABILITY ON ITS BOOKS FOR TAX-EXEMPT BONDS, WHICH IS AN ALLOCATION FROM ITS SOLE CORPORATE MEMBER, HOSPITAL SISTERS SERVICES, INC. AS A RESULT, THIS QUESTION WAS ANSWERED NO, AND SCHEDULE K WILL BE COMPLETED ON THE HOSPITAL SISTERS SERVICES, INC. FORM 990.
CHANGES TO BY-LAWS	FORM 990 PART VI, LINE 4	SEVEN key changes WERE MADE to the St. Mary's Hospital by-laws. Section 2.3(g) - this is a new section giving the members authority over the incurrence of debt above a limit set by the members. this section makes explicit what was implied in section 2.3(f) and clarifies that the authority extends also to debt secured by other than real estate. section 3.2 - the added language to this section clarifies the position of the president as a board member. section 4.8 - this revision gives the board the ability to use electronic voting technology. the board members are not likely to use this ability frequently. section 4.9 - this revision broadens the use of telecommunications to any board committees. section 5.5 - this revision clarifies the role of the executive committee in financial stansactions with physicians (as per hshs policy). section 5.7 - the underlined is an addition to the quality care committee. most local systems will not be using a combined quality care committee, but is available to them should they desire to do so. article 7 medical staff - revisions are made to address recent joint commission changes to medical staff accredidation standards.
RIGHTS OF MEMBERS TO ELECT GOVERNING BODY	FORM 990 PART VI, LINES 6 & 7A	THE SENIOR GOVERNING BODY OF ST. Mary's HOSPITAL (THE "CORPORATION") IS THE MEMBER OF THE CORPORATION, WHICH IS HOSPITAL SISTERS SERVICES, INC. ("HSSI"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. PURSUANT TO SECTION 2.3 OF THE CORPORATION'S BYLAWS, HSSI HAS THE RIGHT TO APPOINT AND REMOVE THE CORPORATION'S BOARD OF DIRECTORS, CHAIRPERSON OF THE BOARD AND PRESIDENT.
MEMBER RESERVED POWERS	FORM 990 PART VI, LINE 7B	Responsibility for the policy and operations of St. Mary's Hospital (the "Corporation") is vested in its Board of Directors, except with respect to specific powers reserved in the Corporation's Bylaws to the Corporation's Member, Hospital Sisters Services, Inc. ("HSSI"), an Illinois not for profit corporation exempt from federal taxation under Section 501(c)(3) of the Internal Revenue Code. The member of HSSI is Hospital Sisters Health System ("HSHS"), an Illinois not for profit corporation exempt from federal taxation under Section 501(c)(3) of the Internal Revenue Code. The members of HSHS are the individual sisters who, from time to time, are the duly elected Provincial Superior and Provincial Councilors, respectively of the American Province of the Hospital Sisters of St. Francis ("American Province"). The American Province is the United States organization of the Congregation of the Hospital Sisters of the Third Order Regular of St. Francis, a religious institute of the Roman Catholic Church. The governance and operations of the Corporation are subject to HSSI's right to exercise these reserved powers with respect to the Corporation and organizations of which the Corporation is either, directly or indirectly, a controlling member or a controlling shareholder ("Affiliates"). HSSI's right to exercise certain of these reserved powers is, in turn, subject to the approval of HSHS and HSHS' members. The reserved powers include all rights granted to HSSI by law and the right to: (a) Adopt, approve amendments to, or amend any statement of philosophy, mission, mission integration or values, or any name, logo, or mark of the Corporation or of any Affiliate; (b) Adopt, approve amendments to, or amend the Articles of Incorporation of the Corporation or of any Affiliate; (c) Adopt, approve amendments to, or amend the Bylaws of the Corporation or of any Affiliate; (d) Appoint and remove the Board of Directors, any one or more of the Directors of the Corporation or of any Affiliate, and the Chairperson and President of the Corporation or of any Affiliate; (e) Approve the recommendation of the Board of Directors to appoint or remove the Board of Directors, any one or more Directors of the Corporation or of any Affiliate, or the Chairperson and President of the Corporation or of any Affiliate. (f) With respect to the Corporation or any Affiliate, approve the purchase, sale, alienation, exchange, lease, or encumbrance of any real property of the Corporation or of any Affiliate, which property has a value in excess of limits set from time to time by HSSI; (g) Approve the operating and capital budgets of the Corporation or of any Affiliate, and any deviations by the Corporation or of any Affiliate from such budgets in an amount or percentage specified by HSSI from time to time; (h) Approve the strategic plan and goals of the Corporation or of any Affiliate; (i) Approve the sale of substantially all of the assets of the Corporation or of any Affiliate; (j) Approve the merger or dissolution of the Corporation or of any Affiliate; (k) Adopt or amend the plan for ministry education and governance for the Corporation and its Affiliates; (l) Approve the Corporation's Mission Accountability Reports and those of any Affiliate; (m) Approve the financial policies and procedures of the Corporation or of any Affiliate, and approve any deviations from such policies and procedures by the Corporation or any Affiliate; and (n) Adopt policies to implement the Reserved Powers of HSSI.
FORM 990 REVIEW PROCESS	FORM 990 PART VI, LINE 11b	The hospital employs KPMG to assist in the overall review and electronic submission of its Form 990. KPMG provides guidance in identifying critical errors in the return submission and feedback on quantitative and qualitative responses. Additionally, the hospital CFO performs a thorough review of the return, and reviews it with the hospital CEO and/or senior leaders before presenting it in its entirety to the hospital Board for questioning and review prior to the return's signing and submission to the IRS.
CONFLICT OF INTEREST POLICY	FORM 990 PART VI, LINE 12C	The organization is subject to the corporate compliance program and conflict of interest policy ("policy") of Hospital Sisters Health System, an Illinois not for profit corporation exempt from federal taxation under section 501(c)(3) of the internal revenue code. A REVISED CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY HAVE BEEN IMPLEMENTED SINCE JANUARY, 2009 TO MANAGE CONFLICTS OF INTEREST USING A SYSTEM-WIDE PROTOCOL FOR DISCLOSURE STATEMENTS. IN ACCORDANCE WITH the organizaton's CONFLICT OF INTEREST POLICY, ALL COVERED PERSONS HAVE A DUTY TO COMPLY WITH THE CONFLICT OF INTEREST POLICY FOR ANY CONTRACT, TRANSACTION, RELATIONSHIP, OR ACTIVITY CONTEMPLATED, ENTERED INTO, OR CONDUCTED AT HSHS OR ITS AFFILIATES. THE POLICY DEFINES COVERED PERSONS AS BOARD MEMBERS, BOARD COMMITTEE MEMBERS, OFFICERS, BOARD DESIGNEES, SENIOR MANAGEMENT, MEMBERS OF ANY COMMITTEE THAT OVERSEES THE APPROVAL OF PHARMACEUTICALS AND MEDICAL DEVICES, and ANY OTHER INDIVIDUAL WHO HOLDS A POSITION OF TRUST. ON AN ANNUAL BASIS, HSHS DISCLOSES A COPY OF THE CONFLICT OF INTEREST POLICY (AND ALL CORRESPONDING PROCEDURES, GUIDELINES, FORMS, AND TOOLS) TO ALL COVERED PERSONS, AND ADVISES ALL COVERED PERSONS IN WRITING OF ANY SUBSTANTIVE CHANGES TO THIS POLICY AND SUCH RELATED MATERIALS. COVERED PERSONS ARE REQUIRED TO REVIEW AND COMPLETE THE CORRESPONDING CONFLICT OF INTEREST STATEMENT. THE SYSTEM OFFICE VICE PRESIDENT - SYSTEM RESPONSIBILITY, VICE PRESIDENT - RISK & COMPLIANCE, OR MEMBERS OF THE AUDIT AND INTEGRITY COMMITTEE ("COMMITTEE") ARE AVAILABLE TO ANSWER ANY QUESTIONS A COVERED PERSON MAY HAVE. IN ADDITION, IF AT ANY TIME AFTER SUBMITTING AN ANNUAL CONFLICT OF INTEREST STATEMENT, A COVERED PERSON BECOMES AWARE OF AN INTEREST THAT HE OR SHE WOULD HAVE HAD TO DISCLOSE AT THE ANNUAL INTERVAL, THE COVERED PERSON IS REQUIRED PROMPTLY TO DISCLOSE THE INTEREST TO THE COMMITTEE USING THE HSHS CONFLICT OF INTEREST DISCLOSURE STATEMENT. COMPLETED CONFLICT OF INTEREST STATEMENTS ARE SUBMITTED TO THE COMMITTEE, WHICH IS RESPONSIBLE FOR IDENTIFYING, ASSESSING, AND MANAGING CONFLICTS OF INTEREST THAT ARISE IN THE COURSE OF CONDUCTING THE AFFAIRS OF HSHS AND ITS AFFILIATES. IF THE COMMITTEE DETERMINES THAT A CONFLICT OF INTEREST EXISTS, THE CONFLICT OF INTEREST POLICY REQUIRES HSHS NOT TO ENGAGE IN, OR ENTER INTO, A PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY UNLESS THE COMMITTEE OR, WHERE NECESSARY, THE BOARD OF DIRECTORS (ACTING THROUGH ITS DISINTERESTED MEMBERS), HAS INVESTIGATED ALTERNATIVES TO THE PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY AND, IN THE ABSENCE OF ALTERNATIVES THAT ARE IN THE BEST INTERESTS OF HSHS, HAS DETERMINED: 1. THAT, REGARDLESS OF WHETHER THE COVERED PERSON PARTICIPATES IN THE IMPLEMENTATION OF THE PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY; 2. THE CONTRACT, TRANSACTION, ARRANGEMENT, OR ACTIVITY IS IN THE BEST INTERESTS OF HSHS; 3. THE CONTRACT, TRANSACTION, ARRANGEMENT, OR ACTIVITY IS FAIR AND REASONABLE FROM THE PERSPECTIVE OF HSHS; AND 4. HSHS CANNOT OBTAIN A MORE ADVANTAGEOUS CONTRACT, TRANSACTION, ARRANGEMENT, OR ACTIVITY WITH REASONABLE EFFORTS UNDER THE CIRCUMSTANCES. IN DETERMINING WHETHER A CONTRACT, TRANSACTION, OR ARRANGEMENT IS FAIR AND REASONABLE TO HSHS, THE COMMITTEE SHALL CONSIDER, WHERE APPLICABLE: 1. APPRAISALS OR OTHER INDEPENDENT VALUATIONS OF THE FAIR MARKET VALUE OF THE CONTRACT, TRANSACTION, OR ARRANGEMENT; 2. INFORMATION REGARDING COMPARABLE CONTRACTS, TRANSACTIONS, OR ARRANGEMENTS BETWEEN UNRELATED PARTIES; 3. OFFERS FROM COMPARABLE COMPETING ENTITIES; AND/OR 4. STUDIES OF COMPARABLE COMPENSATION ARRANGEMENTS. IN ANY CASE IN WHICH THE COMMITTEE FINDS, AFTER TAKING THE STEPS DESCRIBED ABOVE, THAT HSHS SHOULD PARTICIPATE IN A PROPOSED TRANSACTION OR ARRANGEMENT DESPITE THE EXISTENCE OF A CONFLICT OF INTEREST, THE COMMITTEE SHALL DEVELOP, IMPLEMENT, MONITOR, AND ENFORCE COMPLIANCE WITH, A CONFLICT MANAGEMENT PLAN FOR MANAGING THE CONFLICT OF INTEREST AS IT CONSIDERS NECESSARY FOR SUCH FINDINGS TO REMAIN VALID THROUGHOUT THE LIFE OF THE CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY. ALL CONFLICT MANAGEMENT PLANS SHALL: 1. STATE THAT THE COMMITTEE WILL OVERSEE, MONITOR, AND ENFORCE COMPLIANCE WITH THE PLAN THROUGHOUT THE COURSE OF THE STUDY, AND SPECIFY MEANS FOR DOING SO, INCLUDING, WITHOUT LIMITATION, THAT THE APPROPRIATE INDIVIDUALS MUST PROVIDE THE COMMITTEE WITH WRITTEN REPORTS PERTAINING TO COMPLIANCE WITH THE CONFLICT MANAGEMENT PLAN, THAT THE COMMITTEE SHALL HAVE THE RIGHT TO AUDIT THE STUDY FOR SUCH COMPLIANCE, AND THE RIGHT TO IMPOSE SANCTIONS FOR NON-COMPLIANCE; 2. STATE THAT THE PLAN MUST BE SHARED WITH COVERED PERSON WHOSE INTERESTS IT WAS DEVELOPED TO MANAGE; 3. STATE THAT THE PLAN MUST BE SHARED WITH, AND PERIODIC REPORTS ON COMPLIANCE WITH THE PLAN MUST BE PROVIDED TO, THE BOARD, SENIOR MANAGEMENT, AND/OR GOVERNMENT AGENCIES; AND 4. PROVIDE FOR SUCH OTHER MANAGEMENT STEPS AND MECHANISMS THE COMMITTEE CONSIDERS NECESSARY AND APPROPRIATE. IN ADDITION TO THE COMMITTEE, THE SYSTEM OFFICE VICE PRESIDENTS OF SYSTEM RESPONSIBILITY AND RISK & COMPLIANCE MAY RETAIN SUCH INDEPENDENT ADVISORS OR EXPERTS AS DEEMED NECESSARY TO ASSIST IN MAKING ITS DETERMINATIONS AND DECISIONS. IF THE COMMITTEE DETERMINES THAT THE CONTEMPLATED TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY CANNOT PROCEED DUE TO A CONFLICT OF INTEREST, THE COMMITTEE SHALL INFORM THE APPLICABLE COVERED PERSON OR DECISION-MAKING BODY OF SUCH DETERMINATION WITHIN ONE WEEK OF THE COMMITTEE MEETING AT WHICH THE CONTEMPLATED TRANSACTION WAS DISCUSSED. THE COMMITTEE SHALL DOCUMENT ITS REJECTION OF THE CONTEMPLATED TRANSACTION IN THE COMMITTEE'S MEETING MINUTES.
WHISTLEBLOWER POLICY	FORM 990 PART VI, LINE 13	Provisions within the Corporate Compliance Program and Conflict of Interest Policy provide protections for whistleblower type activities.
COMPENSATION PROCESS	FORM 990 PART VI, LINE 15	The Compensation Committee ("Committee") is comprised of independent members of the Board of Directors. The Committee develops a compensation philosophy for the System and all affiliates. The Committee selects and hires the independent compensation consultant to develop comparability data and advise the Committee during its deliberations regarding all elements of total compensation for all disqualified individuals. Integrated Healthcare Strategies ("IHS"), the consultants utilized by the Committee, use data from multiple tax-exempt peer group sources to determine salary ranges, incentive opportunity ranges, and benefits for the disqualified individuals. IHS then assists the Committee in preparing contemporaneous documentation of all actions. Each Committee meeting is conducted with the intent to create a rebuttable presumption of reasonableness for all elements of executive total compensation for the disqualified individuals. The Chairman makes this declaration and also inquires if there are any conflicts of interest by any attendees. Any conflicts are disclosed and the Committee then acts in a manner to avoid any conflicted individual participating in any manner where a conflict might exist. At the end of the meeting, the Committee prepares contemporaneous minutes that record all actions taken during the meeting.
DOCUMENTS AVAILABLE TO THE PUBLIC	FORM 990 PART VI, LINE 19	Board-approved financial statements are made available to the public upon request. The governing documents and conflict of interest policy are not made available to the general public at this time
POOLED INVESTMENT ACCOUNT	FORM 990 PART X, LINE 11	St. Mary's Hospital's cash reserves are invested in a pooled investment account. Participation in the pooled fund is limited to the 501(C)(3) Hospitals and related health services organizations sponsored by the Hospital Sisters Health System. The pooled account consists of cash, and equity and debt securities that are publicly traded. In accordance with the provisions of SFAS No. 124 "Accounting for certain investments held by Not-For-Profit Organizations," investments in equity securities with readily determinable values, and all investments in debt securities, are reported at fair value on the Balance Sheet. Income, realized and unrealized gains and losses are pooled and allocated to the participants. Individual components of assets and revenue are not identified to the participants.
Other changes in net assets	Form 990, Part XI, Line 5	unrealized gains 2,624,534 net assets released from restriction - pp&E 68,723 net assets released from restriction - general 9,167 temporarily restricted net income 173,617 permanently restricted net income 46,932 Recognition of changes in pension funded status 5,324,664 writeoff of goodwill impairment (458,895) transfer to/from affiliates (1,757,335) ------------- total 6,031,407 =============
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:ANN CARR TITLE:TREASURER HOURS:75

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

ST MARY'S HOSPITAL STREATOR HOSPITAL SISTERS
OF THE 3RD ORDER ST FRANCIS

Employer identification number

36-2169181

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
(1) Springfield Health Partners LLC 4936 Laverna Road Springfield,IL62707 37-1364419	Healthcare	IL	0	0	hshs mg
(2) Kiara Clinical Integration Network LLC 4936 Laverna Road Springfield,IL62707 26-1417684	Healthcare	IL	0	0	Kiara Inc

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) HOSPITAL SISTERS HEALTH SYSTEM 4936 LAVERNA ROAD SPRINGFIELD,IL62707 37-1058692	HEALTHCARE	IL	501(c)(3)	11A	NA
(2) HOSPITAL SISTERS SERVICES INC 4936 LAVERNA ROAD SPRINGFIELD,IL62707 37-1163402	HEALTHCARE	IL	501(c)(3)	11A	NA
(3) HOSPITAL SISTERS OF ST FRANCIS FDTN 4936 LAVERNA ROAD SPRINGFIELD,IL62707 37-1186514	HEALTHCARE	IL	501(c)(3)	11A	NA
(4) HSHS HEALTH CARE TRUST FUND 4936 LAVERNA ROAD SPRINGFIELD,IL62707 37-1137724	HEALTHCARE	IL	501(c)(9)	N/A	NA
(5) ST ANTHONY'S HOSPITAL 503 N MAPLE STREET EFFINGHAM,IL62401 37-0661233	HEALTHCARE	IL	501(c)(3)	3	NA
(6) ST ELIZABTH'S HOSPITAL 211 SOUTH THIRD STREET BELLEVILLE,IL62220 37-0663567	HEALTHCARE	IL	501(c)(3)	3	NA
(7) ST FRANCIS HOSPITAL 1215 FRANCISCAN DRIVE LITCHFIELD,IL62056 37-0661236	HEALTHCARE	IL	501(c)(3)	3	NA
(8) ST JOHN'S HOSPITAL 800 EAST CARPENTER STREET SPRINGFIELD,IL62769 37-0661238	HEALTHCARE	IL	501(c)(3)	3	NA
(9) ST JOSEPH'S HOSPITAL 9515 HOLY CROSS LANE BREESE,IL62230 37-1208459	HEALTHCARE	IL	501(c)(3)	3	NA
(10) ST JOSEPH'S HOSPITAL 1515 MAIN STREET HIGHLAND,IL62249 37-0663568	HEALTHCARE	IL	501(c)(3)	3	NA
(11) ST JOSEPH'S HOSPITAL 2661 COUNTY HIGHWAY 1 CHIPPEWA FALLS,WI54729 39-0810545	HEALTHCARE	WI	501(c)(3)	3	NA
(12) ST MARY'S HOSPITAL 1800 E LAKE SHORE DRIVE DECATUR,IL62521 37-0661244	HEALTHCARE	IL	501(c)(3)	3	NA
(13) SACRED HEART HOSPITAL 900 WEST CLAIREMONT AVE EAU CLAIRE,WI54701 39-0807060	HEALTHCARE	WI	501(c)(3)	3	NA
(14) ST MARY'S MEDICAL CENTER 1726 SHAWANO AVENUE GREEN BAY,WI54303 39-0818682	HEALTHCARE	WI	501(c)(3)	3	NA
(15) ST NICHOLAS HOSPITAL 3100 SUPERIOR AVENUE SHEBOYGAN,WI53081 39-0808480	HEALTHCARE	WI	501(c)(3)	3	NA
(16) ST VINCENT HOSPITAL 835 S VAN BUREN GREEN BAY,WI54301 39-0817529	HEALTHCARE	WI	501(c)(3)	3	NA
(17) Hospital Sisters Healthcare West Inc 2661 COUNTY HIGHWAY I CHIPPEWA FALLS,WI54729 51-0157933	HEALTHCARE	WI	501(c)(3)	11A	NA
(18) HSHS SELF INSURANCE TRUST FUND 4936 LAVERNA ROAD SPRINGFIELD,IL62707 37-1120626	INSURANCE	IL	501(c)(3)	11A	NA
(19) HSHS Medical Group Inc 4936 LAVERNA ROAD SPRINGFIELD,IL62707 26-3956318	HEALTHCARE	IL	501(c)(3)	11A	NA
(20) HSHS Wisconsin Medical Group Inc 8040 Excelsior Drive STE 200 MADISON,WI53717 26-4515959	HEALTHCARE	WI	501(c)(3)	11A	NA
(21) Orange Cross Ambulance Inc 919 ASHLAND AVENUE SHEBOYGAN,WI53081 39-1860942	HEALTHCARE	WI	501(c)(3)	9	ST NICHOLAS
(22) WISCONSIN UPPER PENINSULA ONCOLOGY MGMT 835 S VAN BUREN GREEN BAY,WI54301 39-1677100	HEALTHCARE	WI	501(c)(3)	3	ST VINCENT
(23) UNITY LIMITED PARTNERSHIP 2366 OAK RIDGE CIRCLE DE PERE,WI54115 39-1750729	HEALTHCARE	WI	501(c)(3)	9	HSSI

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?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) Memorial and St Elizabeth's Healthcare 4000 North Illinois Street Swansea,IL62226 37-1312961	HealthCare	IL	St Elizabeth's	related	0	0		No	0		No	0 %
(2) Prairie Heart Institute - Carbondale 800 East Carpenter Street Springfield,IL62769 37-1321197	HealthCare	IL	St John's	related	0	0		No	0		No	0 %
(3) Northeast Wisconsin Radiation Therapy Se 1821 S Webster Avenue STE 300 Green Bay,WI543079047 26-3749065	HealthCare	WI	HSSI	related	0	0		No	0		No	0 %
(4) Pain Center of Wisconsin 4131 W Loomis Road STE 300 Greenfield,WI53221 26-3155343	HealthCare	WI	St Vincent	related	0	0		No	0		No	0 %
(5) Prevea Ventures LLC 2710 EXECUTIVE DRIVE Green Bay,WI54304 20-3775127	HealthCare	WI	HSSI	related	0	0		No	0		No	0 %
(6) Surgery Center of Sheboygan LLC 3141 Saemann Avenue Sheboygan,WI53081 26-0822209	Healthcare	WI	St Nicholas	related	0	0		No	0		No	0 %
(7) Carpenter Street Hotel LLC 525 North Sixth Street Springfield,IL62702 36-4128127	Hotel	IL	LaSante Inc	related	0	0		No	0		No	0 %
(8) Springfield Urgent Care Real Estate LLC PO Box 19456 Springfield,IL627949456 03-0413258	Rent. Real Es	IL	LaSante Inc	related	0	0		No	0		No	0 %

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) Kiara Inc 4936 Laverna ROAd Springfield,IL62707 37-1163401	HealthCare	IL	HSHS	C Corp
(2) LaSante Wisconsin Inc 4936 Laverna ROAd Springfield,IL62707 39-1572196	HealthCare	IL	Kiara Inc	C Corp
(3) LaSante Inc 4936 Laverna ROAd Springfield,IL62707 37-1163400	HealthCare	IL	Kiara Inc	C Corp
(4) Prairie Cardiovascular 619 East Mason STE 4P57 Springfield,IL62701 37-1071858	HealthCare	IL	Kiara Inc	C Corp
(5) Prevea Health Services 2710 EXECUTIVE DRIVE Green Bay,WI54304 39-1839351	HealthCare	WI	HSSI	C Corp
(6) Prevea Clinic Inc 2710 EXECUTIVE DRIVE Green Bay,WI54304 39-1839349	HealthCare	WI	HSSI	C Corp
(7) Prevea Health Network 2710 EXECUTIVE DRIVE Green Bay,WI54304 39-2000537	HealthCare	WI	HSSI	C Corp
(8) RENAISSANCE QUALITY INSURANCE PO Box 1159 Grand Caymans KY1-1102 CJ 98-0669953	Insurance	CJ	HSSI	C Corp

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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

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) . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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) PRARIE CARDIOVASCULAR	I	19,092
(1)
(2)
(3)
(4)
(5)
(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
transactions with related organizations	schedule r, part v, line 2	The transactions reported on line 1 and not specifically identified on line 2 are between related 501(c)(3) public charities. accordingly they are not reported in this section.

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: TO CONTINUE CHRIST'S HEALING MINISTRY THROUGH SERVICE TO THE SICK, THE AGED, THE POOR, AND THE TERMINALLY ILL.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ....	3	11
4	Number of independent voting members of the governing body (Part VI, line 1b) ....	4	6
5	Total number of individuals employed in calendar year 2010 (Part V, line 2a) ...	5	639
6	Total number of volunteers (estimate if necessary) ....	6	116
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ..	7a	743
b	Net unrelated business taxable income from Form 990-T, line 34 ..	7b

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	120,732	95,740
9	Program service revenue (Part VIII, line 2g) .........	59,660,748	56,252,478
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	858,803	2,288,999
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	758,457	774,533
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	61,398,740	59,411,750
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
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)	27,688,611	28,746,450
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)....	32,730,374	34,367,167
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	60,418,985	63,113,617
19	Revenue less expenses. Subtract line 18 from line 12......	979,755	-3,701,867
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16)............	89,270,142	89,062,226
21	Total liabilities (Part X, line 26)............	37,654,454	35,116,998
22	Net assets or fund balances. Subtract line 21 from line 20 .....	51,615,688	53,945,228

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 $ 48,496,463 including grants of $ ) (Revenue $ 56,251,735 )
	See Schedule O - Community Benefit Report

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$ 48,496,463

(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) LARRY JONES CHIEF MEDICAL OFFICER	40.0	X		260,502	0	12,963
(19) PARVEEN CHAND CHIEF OPERATING OFFICER	40.0	X		158,066	0	19,635
(20) John M Speca MD Physician	40.0		X	283,441	0	10,317
(21) CATHERINE CHAPMAN Director Pharmacy	40.0		X	123,636	0	0
(22) Jeanne A Washko Pharmacist	40.0		X	116,733	0	1,084
(23) Forrest S Rubenstein MD Physician	40.0		X	238,002	0	6,616
(24) RENA A MATHESIUS PHARMACIST	40.0		X	122,875	0	8,320

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	1,594,282	855,709	447,795

				(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		95,740
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.......			95,740
			Business Code
2a	NET PATIENT SERVICE REVENUE		900,099	56,252,478	56,251,735	743
b
c
d
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			56,252,478
3	Investment income (including dividends, interest
	and other similar amounts).....			902,520			902,520
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	1,412,568	21,818
b	Less: cost or other basis and sales expenses		47,907
c	Gain or (loss)	1,412,568	-26,089
d	Net gain or (loss)..........			1,386,479			1,386,479
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	MISC. HEALTHCARE REVENUE		532,000	558,499			558,499
b	CAFETERIA		722,210	156,413			156,413
c	GIFT SHOP		453,220	59,621			59,621
d	All other revenue ....
e	Total. Add lines 11a–11d ......			774,533
12	Total revenue. See Instructions....			59,411,750	56,251,735	743	3,063,532


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing ..........			1,574	1	1,424
2	Savings and temporary cash investments .......			2,485,574	2	499,962
3	Pledges and grants receivable, net .........				3
4	Accounts receivable, net .........			7,712,400	4	7,544,058
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 ..............			1,495,993	8	1,440,093
9	Prepaid expenses and deferred charges ............			408,712	9	518,462
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	79,686,561
b	Less: accumulated depreciation. .....	10b	36,894,129	44,045,542	10c	42,792,432
11	Investments—publicly traded securities ..........			23,970,083	11	28,971,877
12	Investments—other securities. See Part IV, line 11 ......				12
13	Investments—program-related. See Part IV, line 11 ..			63,500	13	76,000
14	Intangible assets .........				14
15	Other assets. See Part IV, line 11 ...........			9,086,764	15	7,217,918
16	Total assets. Add lines 1 through 15 (must equal line 34)...			89,270,142	16	89,062,226
17	Accounts payable and accrued expenses .			6,601,239	17	10,793,726
18	Grants payable ..........				18
19	Deferred revenue ..........				19
20	Tax-exempt bond liabilities ..........			13,207,783	20	12,917,783
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 ..				23
24	Unsecured notes and loans payable to unrelated third parties ....				24
25	Other liabilities. Complete Part X of Schedule D.....			17,845,432	25	11,405,489
26	Total liabilities. Add lines 17 through 25.....			37,654,454	26	35,116,998
	Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....			49,712,818	27	51,726,068
28	Temporarily restricted net assets .....			1,882,780	28	2,152,138
29	Permanently restricted net assets .....			20,090	29	67,022
	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 .....			51,615,688	33	53,945,228
34	Total liabilities and net assets/fund balances .....			89,270,142	34	89,062,226