Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2011
Open to Public Inspection
A For the calendar year, or tax year beginning 01-01-2011 and ending 12-31-2011
BCheck if applicable:
CName of organization
SISTERS OF CHARITY OF LEAVENWORTH
HEALTH SYSTEM INC
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
2420 WEST 26TH AVE
 
Room/suite
City or town, state or country, and ZIP + 4
DENVER, CO80211
D Employer identification number

23-7379161
E Telephone number

G Gross receipts $ 126,461,371
F Name and address of principal officer:
LYDIA W JUMONVILLE
2420 WEST 26TH AVE STE 100-D
DENVER,CO80211
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.sclhealthsystem.org
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet0928
K Form of organization:
 
L Year of formation: 1972
M State of legal domicile: KS
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: WE WILL, IN THE SPIRIT OF THE SISTERS OF CHARITY, REVEAL GOD'S HEALING LOVE BY IMPROVING THE HEALTH OF THE INDIVIDUALS AND COMMUNITIES WE SERVE, ESPECIALLY THOSE WHO ARE POOR OR VULNERABLE.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a)..... 3 15
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 14
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ... 5 342
6 Total number of volunteers (estimate if necessary) .... 6 0
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a -108,419
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b 0
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 3,100 1,082
9 Program service revenue (Part VIII, line 2g) ......... 72,582,296 103,634,794
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 22,559,296 17,743,348
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 6,098,017 5,082,147
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 101,242,709 126,461,371
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 379,320 278,650
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) 40,263,716 54,088,418
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 131,032,929 116,581,852
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 171,675,965 170,948,920
19 Revenue less expenses. Subtract line 18 from line 12....... -70,433,256 -44,487,549
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 1,480,585,187 1,431,133,067
21 Total liabilities (Part X, line 26)............. 1,477,109,961 1,535,000,716
22 Net assets or fund balances. Subtract line 21 from line 20..... 3,475,226 -103,867,649
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid preparer use only
Print/type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name Right pointing arrowhead image

Firm's EIN Right pointing arrowhead image
Firm's address Right pointing arrowhead image



Phone no.
May the IRS discuss this return with the preparer shown above? See instructions .........bullet
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2011)
Form 990 (2011)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III .........
1
Briefly describe the organization’s mission: WE WILL, IN THE SPIRIT OF THE SISTERS OF CHARITY, REVEAL GOD'S HEALING LOVE BY IMPROVING THE HEALTH OF THE INDIVIDUALS AND COMMUNITIES WE SERVE, ESPECIALLY THOSE WHO ARE POOR OR VULNERABLE.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 65,090,114 including grants of $   ) (Revenue $ 19,120,817 )
FINANCE, AUDIT AND DEBT SERVICES - ADMINISTERS FINANCING PROGRAM AND REVIEWS THE CAPITAL FORMATION PROGRAM (FOR ELEVEN HOSPITALS AND FOUR CLINICS). IT ALSO OVERSEES THE AUDITS OF ITS RELATED AFFILIATES TO PROVIDE ASSURANCE REGARDING THE EFFECTIVENESS AND EFFICIENCY OF OPERATIONS AND THE RELIABILITY OF FINANCIAL REPORTING.
4b (Code:   ) (Expenses $ 10,123,329 including grants of $   ) (Revenue $   )
HUMAN RESOURCES - ADMINISTERS PROGRAMS AND OTHER SERVICES TO THE ELEVEN HOSPITALS, FOUR CLINICS AND VARIOUS FOR-PROFIT ENTITIES WHICH ARE AFFILIATES OF SCLHS. PROGRAMS ADMINISTERED INCLUDE EMPLOYEE WELFARE BENEFIT PLANS, RETIREMENT PLANS, AND CERTAIN EXECUTIVE RECRUITING FUNCTIONS.
4c (Code:   ) (Expenses $ 44,477,955 including grants of $   ) (Revenue $ 755,817 )
INFORMATION SYSTEMS - COORDINATES THE CENTRALIZATION OF MANY OF THE INFORMATION SYSTEMS OF THE HEALTH SYSTEM. CURRENTLY, AN ENTERPRISE RESOURCE PLANNING (ERP) SYSTEM AND A RADIOLOGY INFORMATION SYSTEM (RIS) ARE INSTALLED AND BEING OPERATED. IN ADDITION, A CLINICAL AND PATIENT ADMINISTRATIVE SYSTEM IS BEING INSTALLED THROUGHOUT THE HEALTH SYSTEM.
(Code:   ) (Expenses $ 23,823,887 including grants of $   ) (Revenue $ 82,769,649 )
QUALITY, RISK MANAGEMENT, COMMUNICATIONS
(Code:   ) (Expenses $ 491,233 including grants of $   ) (Revenue $ 1,154,819 )
MEDICAL OFFICE BUILDING, DENVER, CO
(Code:   ) (Expenses $ 148,292 including grants of $   ) (Revenue $   )
DEPRECIATION
(Code:   ) (Expenses $ 278,650 including grants of $ 278,650 ) (Revenue $   )
GRANTS RELATED TO SCLHS MISSION
4d Other program services (Describe in Schedule O.)
(Expenses $ 24,742,062 including grants of $ 278,650 ) (Revenue $ 83,924,468 )
4e Total program service expensesMediumBullet$ 144,433,460
Form 990 (2011)
Form 990 (2011)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? ........
2
 
No
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part IIClick to see attachment.........................
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part IIIClick to see attachment........................
5
Yes
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part IClick to see attachment....................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IVClick to see attachment...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
Yes
 
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
Yes
 
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
Yes
 
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Part I......... Click to see attachment
14b
Yes
 
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II.. Click to see attachment
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III.. Click to see attachment
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II..........
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H.....
20a
 
No
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statement to this return? Note. All Form 990 filers that operated one or more hospitals must attach audited financial statements.
20b
 
 
Form 990 (2011)
Form 990 (2011)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.. Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III..... Click to see attachment
22
Yes
 
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................ Click to see list of attachments
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
No
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I......
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II.........................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III.........
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV .........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV...................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV..
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2........... Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2011)
Form 990 (2011)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V .........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
277
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
342
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
Yes
 
b
If "Yes," enter the name of the foreign country: MediumBulletCJ , UK , CA
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
No
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2011)
Form 990 (2011)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI .........
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
If the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
1a
15
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
14
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? .................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ............
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ..........
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
Yes
 
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes? ....
10b
Yes
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form?
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done ....................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes," to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
SHARON OWENS SCL HEALTH SYS
2420 W 26TH AVE STE 100-D
DENVER,CO80211
(303) 813-5190
Form 990 (2011)
Form 990 (2011)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII .........
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(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
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) SISTER LYNN CASEY SCL
BOARD MEMBER
 3.0 X                
(2) SISTER MAUREEN HALL SCL
VICE PRESIDENT
 3.0 X   X            
(3) TERRY HEATH
BOARD MEMBER
 3.0 X                
(4) GORDON HOWIE
CHAIRPERSON
 3.0 X   X            
(5) SISTER EILEEN HURLEY SCL
BOARD MEMBER
 3.0 X                
(6) DONNA J KING
BOARD MEMBER
 3.0 X           1,124    
(7) KNUTE KNUDSON
BOARD MEMBER
 3.0 X                
(8) MATTHEW LAMBERT III MD
VICE CHAIRPERSON
 3.0 X   X            
(9) MAUREEN MAHONEY
BOARD MEMBER
 3.0 X                
(10) MARLON PRIEST MD
BOARD MEMBER
 3.0 X           417    
(11) DENNIS PURTELL
BOARD MEMBER
 3.0 X                
(12) KENT RUSSELL
BOARD MEMBER
 3.0 X                
(13) VINOY SAHNEY PhD
BOARD MEMBER
 3.0 X                
(14) RONALD SPERLING
BOARD MEMBER
 3.0 X                
(15) MICHAEL A SLUBOWSKI
PRESIDENT/CEO
 40.0 X   X       1,304,791 0 10,969
(16) LYDIA W JUMONVILLE
CHIEF FINANCE OFFICER/SVP FIN
 40.0     X       588,823 0 80,777
(17) EDWARD L BARKER
SECRETARY/SVP GENERAL COUNSEL
 40.0     X       618,049 0 87,909
Form 990 (2011)
Form 990 (2011)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(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
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) MARK A WILKINSON
TREASURER / VICE PRESIDENT
 40.0     X       177,017 0 26,043
(19) PAMELA G LOGAN
ASSISTANT SECRETARY
 40.0     X       114,046   19,372
(20) ROBERT W LADENBURGER
EVP CHIEF OPERATING OFFICER
 40.0       X     1,086,761 0 84,694
(21) MARY JO GREGORY
EVP CHIEF OPERATING OFFICER
 40.0       X     1,611,431 0 1,953,275
(22) WILLIAM M ANDERSON
VP CHIEF HUMAN RESOURCES OFFIC
 40.0       X     552,050 0 9,582
(23) ROBERT A BOYSEN
VP CHIEF INTEGRATION OFFICER
 40.0       X     1,098,127 0 1,044,316
(24) BRENDA S CHILMAN
VP REVENUE SERVICES
 40.0       X     38,071 204,285 17,513
(25) TODD A CONKLIN SR
VP CFO HOSPITAL OPERATIONS
 40.0       X     316,994 363,459 75,682
(26) JILL W KENNELLY
VP CHIEF STRATEGY OFFICER
 40.0       X     362,088 0 71,371
(27) RICHARD T LOPES
SVP HEALTH NETWORKS
 40.0       X     420,106 0 43,091
(28) DAVID PECORARO
VP CHIEF INFORMATION OFFICER
 40.0       X     428,616 0 58,070
(29) DEBORAH WELLE-POWELL
VP PAYER CONTRACT-STRATEGY
 40.0       X     256,889 36,104 45,642
(30) LOURDES J LAZATIN
CEO SAINT JOHN'S SANTA MONICA
           X   1,115,556 0 40,050
(31) JAMES T PAQUETTE
SYSTEM PROJECT LEADER
 40.0         X   738,527 0 123,111
(32) ELEANOR L RAMIREZ
COO SAINT JOHN'S SANTA MONICA
           X   648,655 0 32,217
(33) CHERIE L GORBY
COO ST MARY'S GRAND JUNCTION
           X   560,263 0 308,477
(34) BAIN J FARRIS
CEO SAINT JOSEPH DENVER
           X   553,036 0 99,532
(35) WILLIAM M MURRAY
FORMER SCLHS PRESIDENT / CEO
             X 1,848,716 0 23,674
(36) MARGARET J BREEN
FORMER SVP HUMAN RESOURCES
             X 350,968 0 122
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 14,791,121 603,848 4,255,489
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet123
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
Broadlane Inc
13727 NOEL RD
DALLAS,TX75240 		PROF/ADMIN PERSONNEL 5,471,772
Galloway Consulting
5330 CROSS ROADS MANOR
ATLANTA,GA30327 		Consulting 2,798,394
Catholic Healthcare Audit Network
231 SOUTH BEMISTON
ST LOUIS,MO63105 		INT AUDIT SERVICES 2,097,868
ERNST AND YOUNG LLP
PO BOX 660401
DALLAS,TX75260 		AUDIT & TAX SERVICES 1,556,928
MCKINSEY COMPANY INC
PO BOX 7247-7255
PHILADELPHIA,PA191707255 		CONSULTING 1,527,625
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet21
Form 990 (2011)
Form 990 (2011)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d  
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		1,082
g Noncash contributions included in lines 1a-1f:$  
h Total. Add lines 1a-1f.......MediumBullet 1,082
Program Service Revenue Business Code
2a AFFILIATE MANAGEMENT FEES 541,900 83,370,211 83,340,211 30,000  
b PROGRAM RENTAL INCOME 532,000 1,173,766 1,173,766    
c INTEREST INCOME FROM NOTES RECEIVABLE 900,099 19,090,817 19,090,817    
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 103,634,794
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 12,060,660   -138,419 12,199,079
4 Income from investment of tax-exempt bond proceeds..MediumBullet 789,686     789,686
5 Royalties............MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents    
b Less: rental expenses    
c Rental income or (loss)    
d Net rental income or (loss).......MediumBullet        
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 4,652,258 240,744
b Less: cost or other basis and sales expenses    
c Gain or (loss) 4,652,258 240,744
d Net gain or (loss)..........MediumBullet 4,893,002     4,893,002
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..MediumBullet 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...MediumBullet 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..MediumBullet 0      
Miscellaneous Revenue Business Code
11a VENDOR ADMINISTRATION REBATE 900,099 4,915,839     4,915,839
b DEBT GUARANTEE FEES 900,099 143,611 143,611    
c MISCELLANEOUS REVENUE 900,099 22,697 22,697    
d All other revenue ....        
e Total. Add lines 11a–11d ......MediumBullet 5,082,147
12 Total revenue. See Instructions....MediumBullet 126,461,371 103,771,102 -108,419 22,797,606
Form 990 (2011)
Form 990 (2011)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Check if Schedule O contains a response to any question in this Part IX. .........
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 212,300 212,300
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 66,350 66,350
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16 0  
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 9,963,765 9,963,765    
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 37,428,802 22,824,078 14,604,724  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 3,317,685 353,739 2,963,946  
9 Other employee benefits ....... 1,173,905 627,009 546,896  
10 Payroll taxes ........... 2,204,261 1,664,165 540,096  
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 881,137   881,137  
c Accounting ........... 3,056,280   3,056,280  
d Lobbying ........... 75,049 75,049    
e Professional fundraising. See Part IV, line 17.. 0  
f Investment management fees ...... 1,543,195   1,543,195  
g Other .......... 10,130,465 9,713,090 417,375  
12 Advertising and promotion .... 0      
13 Office expenses ....... 2,384,355 2,026,702 357,653  
14 Information technology ...... 8,943,732 7,602,172 1,341,560  
15 Royalties .. 0      
16 Occupancy ........... 1,594,859 1,355,630 239,229  
17 Travel ............ 1,329,829 1,329,829    
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 743,698 743,698    
20 Interest ........... 58,121,303 58,121,303    
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 24,206,233 24,206,233    
23 Insurance .............. 155,795 132,426 23,369  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)
a PROFESSIONAL SERVICES 1,443,331 1,443,331    
b SYSTEM DUES 1,228,680 1,228,680    
c RENTAL LESS DEPRECIATION 739,611 739,611    
d SCHOLARSHIP ADMIN EXPENSE 4,300 4,300    
e
f All other expenses        
25 Total functional expenses. Add lines 1 through 24f 170,948,920 144,433,460 26,515,460 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2011)
Form 990 (2011)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .......... 988 1 128
2 Savings and temporary cash investments ....... 0 2 0
3 Pledges and grants receivable, net ......... 0 3 0
4 Accounts receivable, net ......... 22,615,441 4 38,389,891
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L .......... 0 5 0
6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
Schedule L .......... 0 6 0
7 Notes and loans receivable, net ............. 60,000 7 60,000
8 Inventories for sale or use .............. 0 8 0
9 Prepaid expenses and deferred charges ............ 2,714,583 9 5,034,475
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 214,884,730
b Less: accumulated depreciation. ..... 10b 123,161,968 77,929,574 10c 91,722,762
11 Investments—publicly traded securities .......... 481,273,610 11 539,045,966
12 Investments—other securities. See Part IV, line 11 ...... 340,800,910 12 260,632,603
13 Investments—program-related. See Part IV, line 11 .. 511,801,418 13 475,073,655
14 Intangible assets ......... 0 14 0
15 Other assets. See Part IV, line 11 ........... 43,388,663 15 21,173,587
16 Total assets. Add lines 1 through 15 (must equal line 34)... 1,480,585,187 16 1,431,133,067
Liabilities 17 Accounts payable and accrued expenses . 48,238,199 17 123,251,945
18 Grants payable .......... 0 18 0
19 Deferred revenue .......... 0 19 0
20 Tax-exempt bond liabilities .......... 1,395,010,059 20 1,361,576,377
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L.......... 0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 0 23 0
24 Unsecured notes and loans payable to unrelated third parties .... 0 24 0
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D..... 33,861,703 25 50,172,394
26 Total liabilities. Add lines 17 through 25..... 1,477,109,961 26 1,535,000,716
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets ..... -32,798,405 27 -128,252,848
28 Temporarily restricted net assets ..... 34,273,631 28 22,385,199
29 Permanently restricted net assets ..... 2,000,000 29 2,000,000
Organizations that do not follow SFAS 117, check here MediumBullet 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 ..... 3,475,226 33 -103,867,649
34 Total liabilities and net assets/fund balances ..... 1,480,585,187 34 1,431,133,067
Form 990 (2011)
Form 990 (2011)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI .........
1
Total revenue (must equal Part VIII, column (A), line 12) ...
1
126,461,371
2
Total expenses (must equal Part IX, column (A), line 25) ....
2
170,948,920
3
Revenue less expenses. Subtract line 2 from line 1 ...
3
-44,487,549
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
3,475,226
5
Other changes in net assets or fund balances (explain in Schedule O) ...
5
-62,855,326
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) ....
6
-103,867,649
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII .........
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?....
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant? If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O. ...........................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
 
 
Form 990 (2011)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
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.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
SISTERS OF CHARITY OF LEAVENWORTH
HEALTH SYSTEM INC
Employer identification number

23-7379161
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.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
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.)
10
11
e
f
g
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization? ................
11g(i)
 
No
(ii) a family member of a person described in (i) above? ......................
11g(ii)
 
No
(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
No
h
(i)
Name of supported organization 		(ii)
EIN 		(iii)
Type of organization (described on lines 1- 9 above or IRC section (see instructions)) 		(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?
Yes No Yes No Yes No
(1) PROVIDENCE MEDICAL CENTER INC
  		480784446 03   No Yes   Yes   0
(2) ST FRANCIS HEALTH CENTER INC
  		480547719 03   No Yes   Yes   0
(3) ST JAMES HEALTHCARE
  		810231785 03   No Yes   Yes   0
(4) SAINT JOHN HOSPITAL INC
  		480543768 03   No Yes   Yes   0
(5) SAINT JOHN'S HEALTH CENTER
  		951684082 03   No Yes   Yes   0
(6) SAINT JOSEPH HOSPITAL INC
  		840417134 03   No Yes   Yes   0
(7) EXEMPLA INC
  		841103606 03   No Yes   Yes   0
(8) ST MARY'S HOSPITAL AND MEDICAL CENTER INC
  		840425720 03   No Yes   Yes   0
(9) ST VINCENT HEALTHCARE
  		810232124 03   No Yes   Yes   0
(10) HOLY ROSARY HEALTHCARE
  		810231792 03   No Yes   Yes   0
(11) BETHANY COMMUNITY PLAZA INC
  		481207407 03   No Yes   Yes   0
(12) CARITAS CLINICS INC
  		481009910 03   No Yes   Yes   0
(13) MARIAN CLINIC INC
  		481046905 03   No Yes   Yes   0
(14) MARILLAC CLINIC INC
  		841085822 03   No Yes   Yes   0
(15) MOUNT ST VINCENT HOME INC
  		840405260 03   No Yes   Yes   0
Total                 0

For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3..            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..            
6 Public Support. Subtract line 5 from line 4.            
Section B. Total Support
Calendar year(or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public Support (Subtract line 7c from line 6.)            
Section B. Total Support
Calendar year (or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)            
13 Total support (Add lines 9, 10c, 11 and 12.).            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 4
Part IV
Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2011

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.
SchCMd Bullet Attach to Form 990 or Form 990-EZ. SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, line 35c (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
SISTERS OF CHARITY OF LEAVENWORTH
HEALTH SYSTEM INC
Employer identification number

23-7379161
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c) except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ...................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2011

Schedule C (Form 990 or 990-EZ) 2011
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check expenses, and share of excess lobbying expenditures).
B Check
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(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? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) Total
             
2a Lobbying non-taxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots nontaxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2011


Schedule C (Form 990 or 990-EZ) 2011
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
Yes
No
(b)
Amount
1
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:
a
Volunteers? .........................................
Yes
 
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
Yes
 
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
Yes
 
25,529
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
Yes
 
41,059
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
Yes
 
207,140
i
Other activities? ..........................
 
No
 
j
Total. Add lines 1c through 1i ...............................
273,728
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
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
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2 are answered “No” OR (b) Part III-A, line 3 is answered “Yes”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ...........................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
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? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, Part II-A; line 5; and Part ll-B, line 1.
Also, complete this part for any additional information.
Identifier Return Reference Explanation
Schedule C (Form 990 or 990EZ) 2011

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
SISTERS OF CHARITY OF LEAVENWORTH
HEALTH SYSTEM INC
Employer identification number

23-7379161
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 .......    
5
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? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
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)? ....................................
9
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.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958), relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 52283D
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
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):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
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?........
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.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
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 .... 3,639,978 3,502,137 3,435,586 4,177,114
b Contributions ........   60,804    
c Net investment earnings, gains, and losses ... 17,492 277,272 261,551 -620,022
d Grants or scholarships .....        
e Other expenditures for facilities
and programs ........ 		132,918 200,235 195,000 121,506
f Administrative expenses ....        
g End of year balance ...... 3,524,552 3,639,978 3,502,137 3,435,586
2
Provide the estimated percentage of the year end balance (line 1g) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet56.740 %
c
Temporarily restricted endowment SchDMd Bullet43.260 %
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
No
(ii) related organizations ........................
3a(ii)
 
No
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   37,026,811 37,026,811
b Buildings ................   23,697,877 23,342,511 355,366
c Leasehold improvements ............   1,922,228 1,651,575 270,653
d Equipment ................   152,237,814 98,167,882 54,069,932
e Other .................   0   0
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 91,722,762
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
(3)Other
(A) REAL ESTATE 		102,760,918 F

(B) ABSOLUTE RETURN FUNDS 		79,502,693 F

(C) CORE HEDGE FUNDS 		38,521,851 F

(D) PRIVATE EQUITY 		17,808,620 F

(E) INSTITUTIONAL COMMINGLED FUNDS 		22,038,521 F




Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet 260,632,603
Part VIII
Investments—Program 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
(1) PROVIDENCE MEDICAL CENTER 3,948,802 F
(2) ST. JOHN HOSPITAL, INC. 1,473,298 F
(3) ST. JAMES HEALTHCARE 17,005,666 F
(4) ST. MARY'S HOSPITAL & MEDICAL 39,670,889 F
(5) SAINT JOHN'S HEALTH CENTER 89,000,000 F
(6) EXEMPLA SYSTEM SERVICES 323,975,000 F



Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet 475,073,655
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Book value
Federal Income Taxes 0
DEFERRED COMP 457 PLAN LIAB 8,045,869
INTEREST RATE SWAP LIABILITY 27,697,364
FROZEN DB PLAN 9,864,739
OTHER ACCRUED LIABILITIES 4,564,422





Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 50,172,394
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1  
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2  
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3  
4 Net unrealized gains (losses) on investments .......................... 4  
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV.) ................................. 8  
9 Total adjustments (net). Add lines 4 through 8 ......................... 9  
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10  
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIV.) ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total Revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIV.) ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIV.) ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIV
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
FORM 990, SCHEDULE D, PART V, LINE 4 (ENDOWMENT FUNDS):   SCLHS HAS A PERMANENT ENDOWMENT IN THE AMOUNT OF $2,000,000. THE EARNINGS FROM THE PERMANENT ENDOWMENT ARE A TERM ENDOWMENT TO BE USED FOR EDUCATION PURPOSES AS DETERMINED BY SCLHS MANAGEMENT.
FORM 990, SCHEDULE D, PART X (ASC 740-10 FOOTNOTE DISCLOSURE)   SCLHS DID NOT HAVE A DISCLOSURE OF ASC 740-10 - INCOME TAXES IN ITS DECEMBER 31, 2011 AUDITED FINANCIAL STATEMENTS AS IT WAS NOT MATERIAL.
Schedule D (Form 990) 2011

Additional Data


Software ID:  
Software Version:  




SCHEDULE F(Form 990)
Department of the Treasury
Internal Revenue Service
Statement of Activities Outside the United States
Right pointing arrow large image Complete if the organization answered "Yes" to Form 990,Part IV, line 14b, 15, or 16.Right pointing arrow large image Attach to Form 990. Right pointing arrow large image See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
SISTERS OF CHARITY OF LEAVENWORTH
HEALTH SYSTEM INC
Employer identification number

23-7379161
Part I
General Information on Activities Outside the United States. Complete if the organization answered
“Yes” to Form 990, Part IV, line 14b.
1
For grantmakers. Does the organization maintain records to substantiate the amount of its grants
and other assistance, the grantees' eligibility for the grants or assistance, and the selection criteria used
to award the grants or assistance? ..............................
2
For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of its grants and other
assistance outside the United States.
3
Activites per Region. (Use Part V if additional space is needed.)
(a) Region (b) Number of offices in the region (c) Number of employees or agents in region or independent contractors (d) Activities conducted in region (by type) (e.g., fundraising, program services, investments, grants to recipients located in the region) (e) If activity listed in (d) is a program service, describe specific type of
service(s) in region		 (f) Total
expenditures for region/investments
in region
Central America and the Caribbean 0 0 Program Services CAPTIVE INSURANCE PREM 13,444,858
Central America and the Caribbean 0 0 Investments   109,874,138
Europe (Including Iceland and Greenland) 0 0 Investments   3,035,808
North America 0 0 Investments   0
           
           
           
           
           
           
           
           
           
           
           
           
           
3a Sub-total ..... 0 0 126,354,804
b Total from continuation sheets to Part I ...      
c Totals (add lines 3a and 3b) 0 0 126,354,804
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2011
Schedule F (Form 990) 2011
Page 2
Part II
Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" to Form 990,
Part IV, line 15, for any recipient who received more than $5,000. Check this box if no one recipient received more than $5,000 ........ MediumBullet
Use Part V if additional space is needed.
1 (a) Name of organization (b) IRS code section
and EIN (if applicable)		 (c) Region (d) Purpose of
grant 		(e) Amount of
cash grant 		(f) Manner of
cash
disbursement 		(g) Amount of
of non-cash
assistance 		(h) Description
of non-cash
assistance 		(i) Method of
valuation
(book, FMV,
appraisal, other)
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
2
Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .....MediumBullet
 
3
Enter total number of other organizations or entities ........................MediumBullet
 
Schedule F (Form 990) 2011
Schedule F (Form 990) 2011Page 3
Part III
Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 16.
Use Part V if additional space is needed.
(a) Type of grant or assistance (b) Region (c) Number of recipients (d) Amount of
cash grant 		(e) Manner of cash
disbursement 		(f) Amount of
non-cash
assistance 		(g) Description
of non-cash
assistance 		(h) Method of
valuation
(book, FMV,
appraisal, other)
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
Schedule F (Form 990) 2011
Schedule F (Form 990) 2011
Page 4
Part IV
Foreign Forms
1 Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 926 (see instructions for Form 926).................
2 Did the organization have an interest in a foreign trust during the tax year? If " Yes," the organization may be required to file Form 3520 and/or Form 3520-A. (see instructions for Forms 3520 and 3520-A)..........
3 Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with respect to Certain Foreign Corporations. (see instructions for Form 5471)..............................
4 Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If "Yes," the organization may be required to file Form 8621, Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see instructions for Form 8621)
5 Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with respect to Certain Foreign Partnerships. (see instructions for Form 8865)....................................
6 Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to file Form 5713, International Boycott Report (see instructions for Form 5713)................................................
Schedule F (Form 990) 2011
Schedule F (Form 990) 2011
Page 5
Part V
Supplemental Information
Complete this part to provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information (see instructions).
Identifier ReturnReference Explanation
Schedule F, Part I, Line 3   SCLHS' expenditures (premiums paid) for its captive insurance premiums was $13,444,858 net of premium discounts.
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
Schedule F (Form 990) 2011
Additional Data


Software ID:  
Software Version:  



Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
SISTERS OF CHARITY OF LEAVENWORTH
HEALTH SYSTEM INC
Employer identification number
23-7379161
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) CRISTO REY KANSAS CITY SCHOOL211 W LINWOOD BLVD
KANSAS CITY,MO64111 		43-6033728 501(c)(3) 46,833       SCHOOL SUPPORT
(2) UNIVERSITY OF ST MARY4100 SOUTH 4TH STREET
LEAVENWORTH,KS66048 		48-0547846 501(C)(3) 29,500       FUNDRAISER SPONSOR AND SUPPORT
(3) MOUNT ST VINCENT HOME4159 LOWELL BLVD
DENVER,CO80211 		84-0405260 501(c)(3) 40,000       FUNDRAISER SPONSOR


















2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
3
3
Enter total number of other organizations listed in the line 1 table ......................... . Bullet Image
0
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2011

Schedule I (Form 990) 2011
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance
(1) SECONDARY EDUCATION SCHOLARSHIPS 36 65,350      













Part IV
Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.
Identifier Return Reference Explanation
Form 990, SCHEDULE I, PART I, LINE 2 (MONITORING OF GRANTS)   SCLHS' MISSION DEPARTMENT REQUIRES WRITTEN STATEMENTS THREE TIMES A YEAR REGARDiNG THE PROGRESS AND STATUS OF THE GRANT.
Schedule I (Form 990) 2011


Additional Data


Software ID:  
Software Version:  


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
SISTERS OF CHARITY OF LEAVENWORTH
HEALTH SYSTEM INC
Employer identification number

23-7379161
Part I
Questions Regarding Compensation
Yes
No
1a
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.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all the expenses described above? If "No," complete Part III to explain....
1b
Yes
 
2
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? ....
2
Yes
 
3
Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
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:
a
Receive a severance payment or change-of-control payment? ...............
4a
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
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.
5
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:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
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:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
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 ............
7
Yes
 
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and column (E) for that individual.
(A) Name (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) MICHAEL A SLUBOWSKI (i)
(ii)		 913,849
0 		200,000
0 		190,942
0 		0
0 		10,969
0 		1,315,760
0 		0
0
(2) LYDIA W JUMONVILLE (i)
(ii)		 473,951
0 		57,000
0 		57,872
0 		65,529
0 		15,248
0 		669,600
0 		0
0
(3) EDWARD L BARKER (i)
(ii)		 467,860
0 		0
0 		150,189
0 		71,586
0 		16,323
0 		705,958
0 		0
0
(4) MARK A WILKINSON (i)
(ii)		 143,757
0 		31,990
0 		1,270
0 		16,466
0 		9,577
0 		203,060
0 		0
0
(5) ROBERT W LADENBURGER (i)
(ii)		 607,673
0 		144,615
0 		334,473
0 		73,845
0 		10,849
0 		1,171,455
0 		0
0
(6) MARY JO GREGORY (i)
(ii)		 631,555
0 		374,000
0 		605,876
0 		1,942,602
0 		10,673
0 		3,564,706
0 		85,746
0
(7) WILLIAM M ANDERSON (i)
(ii)		 277,212
0 		0
0 		274,838
0 		0
0 		9,582
0 		561,632
0 		0
0
(8) ROBERT A BOYSEN (i)
(ii)		 379,214
0 		153,560
0 		565,353
0 		1,028,586
0 		15,730
0 		2,142,443
0 		0
0
(9) BRENDA S CHILMAN (i)
(ii)		 37,817
171,114 		0
25,571 		254
7,600 		7,404
3,594 		1,090
5,425 		46,565
213,304 		0
0
(10) TODD A CONKLIN SR (i)
(ii)		 306,694
68,644 		0
196,725 		10,300
98,090 		55,893
3,567 		12,205
4,017 		385,092
371,043 		0
0
(11) JILL W KENNELLY (i)
(ii)		 346,915
0 		0
0 		15,173
0 		60,050
0 		11,321
0 		433,459
0 		0
0
(12) RICHARD T LOPES (i)
(ii)		 304,166
0 		0
0 		115,940
0 		36,475
0 		6,616
0 		463,197
0 		0
0
(13) DAVID PECORARO (i)
(ii)		 330,346
0 		81,212
0 		17,058
0 		47,451
0 		10,619
0 		486,686
0 		0
0
(14) DEBORAH WELLE-POWELL (i)
(ii)		 252,819
8,093 		0
28,011 		4,070
0 		44,100
162 		1,361
19 		302,350
36,285 		0
0
(15) LOURDES J LAZATIN (i)
(ii)		 504,961
0 		517,166
0 		93,429
0 		33,652
0 		6,398
0 		1,155,606
0 		0
0
(16) JAMES T PAQUETTE (i)
(ii)		 418,351
0 		0
0 		320,176
0 		107,885
0 		15,226
0 		861,638
0 		0
0
(17) ELEANOR L RAMIREZ (i)
(ii)		 312,198
0 		242,266
0 		94,191
0 		19,600
0 		12,617
0 		680,872
0 		54,077
0
(18) CHERIE L GORBY (i)
(ii)		 276,361
0 		41,545
0 		242,357
0 		298,052
0 		10,425
0 		868,740
0 		145,948
0
(19) BAIN J FARRIS (i)
(ii)		 428,580
0 		105,122
0 		19,334
0 		88,843
0 		10,689
0 		652,568
0 		0
0
(20) WILLIAM M MURRAY (i)
(ii)		 425,764
0 		0
0 		1,422,952
0 		19,147
0 		4,527
0 		1,872,390
0 		0
0
(21) MARGARET J BREEN (i)
(ii)		 0
0 		0
0 		350,968
0 		0
0 		122
0 		351,090
0 		351,090
0
Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
SCHEDULE J SUPPLEMENTAL DISCLOSURES   SCHEDULE J, PART I, LINE 1a (TRAVEL FOR COMPANION) SCLHS AND ITS AFFILIATES HAVE ANNUAL RETREATS FOR THEIR BOARDS OF DIRECTORS. THE BOARD MEMBERS AND MANAGEMENT ARE ALLOWED TO BE REIMBURSED IF THEY BRING A SPOUSE OR GUEST TO THESE RETREATS. THESE AMOUNTS ARE TREATED AS TAXABLE COMPENSATION. THE INDIVIDUALS LISTED THAT WERE TAXED FOR 2011 WERE: DONNA J KING MARLON PRIEST MD ---------------------------------------------------------------------- SCHEDULE J, PART I, LINE 1a (TAX INDEMNIFICATION AND GROSS-UP PAYMENTS) SCLHS ALLOWS FOR CERTAIN TAX INDEMNIFICATION AND GROSS-UP PAYMENTS IN THE INSTANCES OF RELOCATION AND TEMPORARY HOUSING. THESE AMOUNTS ARE TREATED AS TAXABLE COMPENSATION. THE INDIVIDUALS LISTED THAT WERE TAXED FOR 2011 WERE: MICHAEL A SLUBOWSKI LYDIA W JUMONVILLE MARY JO GREGORY WILLIAM M ANDERSON RICHARD T LOPES JAMES T PAQUETTE ---------------------------------------------------------------------- SCHEDULE J, PART I, LINE 1a (HOUSING ALLOWANCE OR RESIDENCE FOR PERSONAL USE) SCLHS ALLOWS FOR CERTAIN HOUSING PAYMENTS IN THE INSTANCES OF RELOCATION AND TEMPORARY HOUSING. THESE AMOUNTS ARE TREATED AS TAXABLE COMPENSATION. THE INDIVIDUALS LISTED THAT WERE TAXED FOR 2011 WERE: LYDIA W JUMONVILLE JAMES T PAQUETTE ---------------------------------------------------------------------- SCHEDULE J, PART I, LINE 4a (SEVERANCE PAYMENTS) SCLHS PERIODICALLY INCURS SEVERANCE PAYMENTS RELATED TO FORMER EMPLOYEES. THE AMOUNTS PAID TO LISTED INDIVIDUALS FOR SEVERANCE IN 2011 WERE: MARY JO GREGORY-$221,398 ROBERT A BOYSEN-$67,714 CHERI L GORBY-$94,735 WILLIAM M MURRAY-$150,051 MARGARET J BREEN-$350,968 ---------------------------------------------------------------------- SCHEDULE J, PART I, LINE 4b (PAYMENTS FROM SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN) OTHER REPORTABLE COMPENSATION SHOWN IN SCHEDULE J PART II COLUMN (B) (III) CONTAINS AN ANNUAL REPORTING ADJUSTMENT FOR CERTAIN EMPLOYEES WHO PARTICIPATE IN THE SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS. SCLHS PROVIDES NONQUALIFIED RETIREMENT PLANS FOR EXECUTIVES TO COMPENSATE FOR REGULATORY IMPOSED LIMITATIONS IN QUALIFIED RETIREMENT PLANS AND TO PROVIDE A BENEFIT CONSISTENT WITH OTHER NOT FOR PROFIT HEALTH SYSTEMS. THESE PLANS ENABLE THE EXECUTIVE TO EARN BENEFITS DURING EACH YEAR THAT THEY PARTICIPATE. ON THE ADVICE OF COUNSEL, SCLHS HAS DETERMINED THAT THESE BENEFITS SHOULD BE SUBJECT TO TAXATION AS THEY ARE EARNED AND VESTED RATHER THAN WHEN THEY ARE RECEIVED. AS A RESULT, THE TOTAL NONQUALIFIED RETIREMENT PLAN BENEFITS, WHICH WERE ACCRUED AND VESTED IN THE CURRENT YEAR, ARE NOW CONSIDERED TAXABLE AND THUS WERE TAXED TO THE PARTICIPANTS. AN AMOUNT EQUAL TO THE PARTICIPANT'S EXPECTED INCOME TAX LIABILITY WAS WITHDRAWN FROM THE PARTICIPANT'S ACCOUNT AND REMITTED TO THE IRS AS WITHHOLDING ON THE TAXABLE BENEFIT. THE AMOUNTS WITHDRAWN FROM THE PLAN FOR TAXES IN 2011 WERE: MICHAEL A SLUBOWSKI-$38,668 EDWARD L BARKER-$55,995 ROBERT W LADENBURGER-$116,293 WILLIAM M ANDERSON-$28,351 RICHARD T LOPES-$27,413 LOUREDS J LAZATIN-$29,494 JAMES T PAQUETTE-$105,270 ELEANOR L RAMIREZ-$42,023 IN ADDITION, VESTED AMOUNTS ARE PAYABLE UPON END OF EMPLOYMENT. THE VESTED AMOUNTS WITHDRAWN, NOT PREVIOUSLY TAXED, FOR THIS TYPE OF PAYMENT IN 2011 WERE: MARY JO GREGORY-$365,301 ROBERT A BOYSEN-$470,893 CHERI L GORBY-$145,948 WILLIAM M MURRAY-$1,258,479 ---------------------------------------------------------------------- SCHEDULE J, PART I, LINE 7 (OTHER NON-FIXED PAYMENTS) SCLHS HAS MANAGEMENT INCENTIVE PLANS WHICH ARE BASED ON A COMBINATION OF MEASURES. MANAGEMENT AND SENIOR LEADERSHIP ARE ELIGIBLE FOR THE INCENTIVE COMPENSATION. PERFORMANCE CATEGORIES ARE MADE UP OF A COMBINATION OF CLINICAL QUALITY MEASURES AND OPERATING INCOME. THE OPERATING INCOME CATEGORY IS GENERALLY RELATED TO THE NET EARNINGS OF THE CARE SITE IN WHICH THE INDIVIDUAL WORKS, OR IN THE CASE OF SCLHS SENIOR MANAGEMENT, THE NET EARNINGS OF SCLHS. ---------------------------------------------------------------------- SCHEDULE J (ADDITIONAL OFFICER AND BOARD DISCLOSURES) THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. (SCLHS) CONSISTS OF ELEVEN HOSPITALS AND FOUR CLINICS (AFFILIATES) IN FOUR STATES. SCLHS AND ITS AFFILIATES ADHERE TO GOVERNANCE EXCELLENCE STANDARDS INCLUDING TRANSPARENCY AND ACCOUNTABILITY. IN KEEPING WITH SCLHS' CORE VALUE OF STEWARDSHIP, NO BOARD MEMBER SERVING ON SCLHS' BOARD OF DIRECTORS (BOARD) IS COMPENSATED FOR THAT SERVICE. SCLHS' BOARD COMPENSATION COMMITTEE (COMMITTEE) HAS RETAINED THE SERVICES OF SULLIVAN, COTTER AND ASSOCIATES, INC. (SULLIVAN COTTER), AS INDEPENDENT COMPENSATION ADVISORS. SULLIVAN COTTER IS RESPONSIBLE FOR ADVISING THE COMMITTEE ON ALL MATTERS RELATING TO EXECUTIVE COMPENSATION INCLUDING SUPPORTING THE COMMITTEE'S EFFORTS TO ENSURE THAT THE LEVEL OF COMPENSATION PROVIDED OFFICERS IS CONSISTENT WITH MARKET VALUE AND THE PAY PHILOSOPHY SET BY THE BOARD. THE PAY PHILOSOPHY SET BY THE BOARD IS TO PAY AT THE MIDDLE OF THE MARKET FOR EXECUTIVES OF SIMILAR SIZED ORGANIZATIONS OVERALL. SCLHS' EXECUTIVE COMPENSATION IS COMPARABLE TO THAT PROVIDED BY SIMILAR, NOT-FOR-PROFIT HEALTHCARE SYSTEMS AND HOSPITALS. THE SISTERS WHO SERVE AS OFFICERS AND / OR BOARD MEMBERS OF THIS HEALTH SYSTEM ARE MEMBERS OF THE SISTERS OF CHARITY OF LEAVENWORTH (A RELIGIOUS ORDER OF WOMEN). AS MEMBERS OF THIS ORDER, THEY HAVE TAKEN VOWS OF POVERTY AND RECEIVE NO COMPENSATION, EXPENSE ACCOUNT ALLOWANCE, OR CONTRIBUTIONS TO BENEFIT PLANS FOR THEIR SERVICES TO THE HEALTH SYSTEM. HOWEVER, PAYMENT IS MADE DIRECTLY TO THE SISTERS OF CHARITY OF LEAVENWORTH FOR THE SERVICES OF THOSE WHO PERFORM PROFESSIONAL, ADMINISTRATIVE, AND OTHER SUCH SERVICES. ----------------------------------------------------------------------
Schedule J (Form 990) 2011

Additional Data


Software ID:  
Software Version:  
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
SISTERS OF CHARITY OF LEAVENWORTH
HEALTH SYSTEM INC
Employer identification number
23-7379161
Part I
Bond Issues
(a) Issuer Name (b) Issuer EIN (c) CUSIP # (d) Date Issued (e) Issue Price (f) Description of Purpose (g) Defeased (h) On
Behalf of
Issuer 		(i) Pool
financing
Yes No Yes No Yes No
A MONTANA FACILITY FINANCE AUTHORITY
  		81-0302402 61204KBB6 12-05-2003 39,210,000 2/2/1994 REFINANCE+BLDGS+EQUP   X   X   X
B CALIFORNIA HEALTH FACILITIES FINANCING AUTHORTIY
  		52-1643828 13033FQU7 12-05-2003 49,755,000 2/2/1994 REFINANCE   X   X   X
C COLORADO HEALTH FACILITIES AUTHORITY
  		84-0752932 196474K58 12-05-2003 103,035,000 2/2/1994&9/9/1992 REFIN+BLDGS+equi   X   X   X
D MONTANA FACILITY FINANCE AUTHORITY
  		81-0302402 61204KBC4 03-07-2006 35,000,000 CONSTRUCT/REMODEL HOSPITAL FACILIT   X   X   X
KANSAS DEVELOPMENT FINANCE AUTHORITY
  		48-1066589 48542KHB8 03-07-2006 60,000,000 CONSTRUCT/REMODEL HOSPITAL FAC   X   X   X
KANSAS DEVELOPMENT FINANCE AUTHORITY
  		48-1066589 48542KHA0 03-07-2006 25,000,000 CONSTRUCT/REMODEL HOSPITAL FAC   X   X   X
COLORADO HEALTH FACILITIES AUTHORITY
  		84-0752932 19648AST3 05-20-2010 605,460,143 3/24/98&11/13/02&7/18/02 REFI+HOSP   X   X   X
MONTANA FACILITY FINANCE AUTHORITY
  		81-0302402 61204KHV6 05-20-2010 217,535,868 3/24/98&5/25/00 REFI+HOSP FAC   X   X   X
KANSAS DEVELOPMENT FINANCE AUTHORITY
  		48-1066589 48542K5N5 05-20-2010 202,625,401 3/24/98&5/25/00 REFI+HOSP FAC   X   X   X
COLORADO HEALTH FACILITIES AUTHORITY
  		84-0752932   06-15-2011 62,620,000 REFI 7/18/02&2/4/09   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . 0 0 0 0
2 Amount of bonds legally defeased . . . . . . . . . . 0 0 0 0
3 Total proceeds of issue . . . . . . . . . . . . . 39,210,000 49,755,055 103,035,433 35,028,997
4 Gross proceeds in reserve funds . . . . . . . . 0 0 0 0
5 Capitalized interest from proceeds . . . . . . . . . . 0 0 0 0
6 Proceeds in refunding escrows . . . . . . . . . . . 0 0 0 0
7 Issuance costs from proceeds . . . . . . . . . . . 270,531 346,200 714,438 325,299
8 Credit enhancement from proceeds . . . . . . . . . . 0 0 0 0
9 Working capital expenditures from proceeds . . . . . . . 0 0 0 0
10 Capital expenditures from proceeds . . . . . . . . . . 7,630,591 55 22,369,995 34,703,698
11 Other spent proceeds . . . . . . . . . . . 0 0 0 0
12 Other unspent proceeds . . . . . . . . . . . 0 0 0 0
13 Year of substantial completion . . . . . . . . . . . 2003 2003 2003 2006
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . . X   X   X     X
15 Were the bonds issued as part of an advance refunding issue? . . . .   X   X   X   X
16 Has the final allocation of proceeds been made? . . . . . . X   X   X   X  
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . X   X   X   X  
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .   X   X   X   X
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . . X   X   X   X  
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2011
Schedule K (Form 990) 2011
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . X   X   X   X  
b If ‘Yes’ to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . . X   X   X   X  
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . .   X   X   X   X
d If ‘Yes’ to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? .   X   X   X   X
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . SchKMediumBullet 0.00000% 0.00000% 0.00000% 0.00000%
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet 0% 0.00000% 0% 0%
6 Total of lines 4 and 5 . . .. . . . . . . . . 0% 0.00000% 0% 0%
7 Does the bond issue meet the private security or payment test? . . . X   X   X   X  
8 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
X   X   X   X  
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . . X   X   X   X  
2 Is the bond issue a variable rate issue? X   X   X   X  
3a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue? X   X   X   X  
b Name of provider . . . . . . . . Merrill Lynch
  		Merrill Lynch
  		Merrill Lynch
  		 
 
c Term of hedge . . . . . . . . 20. 20. 20. 25.
d Was the hedge superintegrated? . . . .   X   X   X   X
e Was a hedge terminated? . . . . .   X   X   X   X
4a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . .   X   X   X   X
b Name of provider . . . . . . 0
  		0
  		0
  		0
 
c Term of GIC . . . . . . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . . .                
5 Were any gross proceeds invested beyond an available temporary period? . . . . . .   X   X   X   X
6 Did the bond issue qualify for an exception to rebate? .   X   X   X   X
7 Has the organization established written procedures to monitor the requirements of section 148? . . .   X   X   X   X
Schedule K (Form 990) 2011

Schedule K (Form 990) 2011
Page 3
Part V
Procedures To Undertake Corrective Action
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? . . . . . . . . . . . . . .
Part VI
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
FORM 990, SCHEDULE K PART I, COLUMN (C), CUSIP # SCHEDULE K DISCLOSES THE COLORADO HEALTH FACILITIES AUTHORITY BONDS, ISSUED 12/05/2003, WITH AN ISSUE PRICE OF $103,035,000. THIS IS DISCLOSED AS ONE LINE ON SCHEDULE K DUE TO ONLY ONE FORM 8038 BEING ISSUED. THAT SAID, THERE ARE ACTUALLY TWO CUSIP NUMBERS, AS FOLLOWS: PER FORM 8038: CUSIP - 196474 K58 / K41 ACTUAL: CUSIP - 196474 K58 and CUSIP - 196474 K41
Schedule K (Form 990) 2011

Additional Data


Software ID:  
Software Version:  

Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
SISTERS OF CHARITY OF LEAVENWORTH
HEALTH SYSTEM INC
Employer identification number
23-7379161
Part I
Bond Issues
(a) Issuer Name (b) Issuer EIN (c) CUSIP # (d) Date Issued (e) Issue Price (f) Description of Purpose (g) Defeased (h) On
Behalf of
Issuer 		(i) Pool
financing
Yes No Yes No Yes No
A MONTANA FACILITY FINANCE AUTHORITY
  		81-0302402 61204KBB6 12-05-2003 39,210,000 2/2/1994 REFINANCE+BLDGS+EQUP   X   X   X
B CALIFORNIA HEALTH FACILITIES FINANCING AUTHORTIY
  		52-1643828 13033FQU7 12-05-2003 49,755,000 2/2/1994 REFINANCE   X   X   X
C COLORADO HEALTH FACILITIES AUTHORITY
  		84-0752932 196474K58 12-05-2003 103,035,000 2/2/1994&9/9/1992 REFIN+BLDGS+equi   X   X   X
D MONTANA FACILITY FINANCE AUTHORITY
  		81-0302402 61204KBC4 03-07-2006 35,000,000 CONSTRUCT/REMODEL HOSPITAL FACILIT   X   X   X
KANSAS DEVELOPMENT FINANCE AUTHORITY
  		48-1066589 48542KHB8 03-07-2006 60,000,000 CONSTRUCT/REMODEL HOSPITAL FAC   X   X   X
KANSAS DEVELOPMENT FINANCE AUTHORITY
  		48-1066589 48542KHA0 03-07-2006 25,000,000 CONSTRUCT/REMODEL HOSPITAL FAC   X   X   X
COLORADO HEALTH FACILITIES AUTHORITY
  		84-0752932 19648AST3 05-20-2010 605,460,143 3/24/98&11/13/02&7/18/02 REFI+HOSP   X   X   X
MONTANA FACILITY FINANCE AUTHORITY
  		81-0302402 61204KHV6 05-20-2010 217,535,868 3/24/98&5/25/00 REFI+HOSP FAC   X   X   X
KANSAS DEVELOPMENT FINANCE AUTHORITY
  		48-1066589 48542K5N5 05-20-2010 202,625,401 3/24/98&5/25/00 REFI+HOSP FAC   X   X   X
COLORADO HEALTH FACILITIES AUTHORITY
  		84-0752932   06-15-2011 62,620,000 REFI 7/18/02&2/4/09   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . 0 0 0 0
2 Amount of bonds legally defeased . . . . . . . . . . 0 0 0 0
3 Total proceeds of issue . . . . . . . . . . . . . 39,210,000 49,755,055 103,035,433 35,028,997
4 Gross proceeds in reserve funds . . . . . . . . 0 0 0 0
5 Capitalized interest from proceeds . . . . . . . . . . 0 0 0 0
6 Proceeds in refunding escrows . . . . . . . . . . . 0 0 0 0
7 Issuance costs from proceeds . . . . . . . . . . . 270,531 346,200 714,438 325,299
8 Credit enhancement from proceeds . . . . . . . . . . 0 0 0 0
9 Working capital expenditures from proceeds . . . . . . . 0 0 0 0
10 Capital expenditures from proceeds . . . . . . . . . . 7,630,591 55 22,369,995 34,703,698
11 Other spent proceeds . . . . . . . . . . . 0 0 0 0
12 Other unspent proceeds . . . . . . . . . . . 0 0 0 0
13 Year of substantial completion . . . . . . . . . . . 2003 2003 2003 2006
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . . X   X   X     X
15 Were the bonds issued as part of an advance refunding issue? . . . .   X   X   X   X
16 Has the final allocation of proceeds been made? . . . . . . X   X   X   X  
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . X   X   X   X  
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .   X   X   X   X
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . . X   X   X   X  
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2011
Schedule K (Form 990) 2011
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . X   X   X   X  
b If ‘Yes’ to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . . X   X   X   X  
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . .   X   X   X   X
d If ‘Yes’ to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? .   X   X   X   X
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . SchKMediumBullet 0.00000% 0.00000% 0.00000% 0.00000%
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet 0% 0.00000% 0% 0%
6 Total of lines 4 and 5 . . .. . . . . . . . . 0% 0.00000% 0% 0%
7 Does the bond issue meet the private security or payment test? . . . X   X   X   X  
8 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
X   X   X   X  
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . . X   X   X   X  
2 Is the bond issue a variable rate issue? X   X   X   X  
3a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue? X   X   X   X  
b Name of provider . . . . . . . . Merrill Lynch
  		Merrill Lynch
  		Merrill Lynch
  		 
 
c Term of hedge . . . . . . . . 20. 20. 20. 25.
d Was the hedge superintegrated? . . . .   X   X   X   X
e Was a hedge terminated? . . . . .   X   X   X   X
4a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . .   X   X   X   X
b Name of provider . . . . . . 0
  		0
  		0
  		0
 
c Term of GIC . . . . . . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . . .                
5 Were any gross proceeds invested beyond an available temporary period? . . . . . .   X   X   X   X
6 Did the bond issue qualify for an exception to rebate? .   X   X   X   X
7 Has the organization established written procedures to monitor the requirements of section 148? . . .   X   X   X   X
Schedule K (Form 990) 2011

Schedule K (Form 990) 2011
Page 3
Part V
Procedures To Undertake Corrective Action
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? . . . . . . . . . . . . . .
Part VI
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
FORM 990, SCHEDULE K PART I, COLUMN (C), CUSIP # SCHEDULE K DISCLOSES THE COLORADO HEALTH FACILITIES AUTHORITY BONDS, ISSUED 12/05/2003, WITH AN ISSUE PRICE OF $103,035,000. THIS IS DISCLOSED AS ONE LINE ON SCHEDULE K DUE TO ONLY ONE FORM 8038 BEING ISSUED. THAT SAID, THERE ARE ACTUALLY TWO CUSIP NUMBERS, AS FOLLOWS: PER FORM 8038: CUSIP - 196474 K58 / K41 ACTUAL: CUSIP - 196474 K58 and CUSIP - 196474 K41
Schedule K (Form 990) 2011

Additional Data


Software ID:  
Software Version:  

Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
SISTERS OF CHARITY OF LEAVENWORTH
HEALTH SYSTEM INC
Employer identification number
23-7379161
Part I
Bond Issues
(a) Issuer Name (b) Issuer EIN (c) CUSIP # (d) Date Issued (e) Issue Price (f) Description of Purpose (g) Defeased (h) On
Behalf of
Issuer 		(i) Pool
financing
Yes No Yes No Yes No
A MONTANA FACILITY FINANCE AUTHORITY
  		81-0302402 61204KBB6 12-05-2003 39,210,000 2/2/1994 REFINANCE+BLDGS+EQUP   X   X   X
B CALIFORNIA HEALTH FACILITIES FINANCING AUTHORTIY
  		52-1643828 13033FQU7 12-05-2003 49,755,000 2/2/1994 REFINANCE   X   X   X
C COLORADO HEALTH FACILITIES AUTHORITY
  		84-0752932 196474K58 12-05-2003 103,035,000 2/2/1994&9/9/1992 REFIN+BLDGS+equi   X   X   X
D MONTANA FACILITY FINANCE AUTHORITY
  		81-0302402 61204KBC4 03-07-2006 35,000,000 CONSTRUCT/REMODEL HOSPITAL FACILIT   X   X   X
KANSAS DEVELOPMENT FINANCE AUTHORITY
  		48-1066589 48542KHB8 03-07-2006 60,000,000 CONSTRUCT/REMODEL HOSPITAL FAC   X   X   X
KANSAS DEVELOPMENT FINANCE AUTHORITY
  		48-1066589 48542KHA0 03-07-2006 25,000,000 CONSTRUCT/REMODEL HOSPITAL FAC   X   X   X
COLORADO HEALTH FACILITIES AUTHORITY
  		84-0752932 19648AST3 05-20-2010 605,460,143 3/24/98&11/13/02&7/18/02 REFI+HOSP   X   X   X
MONTANA FACILITY FINANCE AUTHORITY
  		81-0302402 61204KHV6 05-20-2010 217,535,868 3/24/98&5/25/00 REFI+HOSP FAC   X   X   X
KANSAS DEVELOPMENT FINANCE AUTHORITY
  		48-1066589 48542K5N5 05-20-2010 202,625,401 3/24/98&5/25/00 REFI+HOSP FAC   X   X   X
COLORADO HEALTH FACILITIES AUTHORITY
  		84-0752932   06-15-2011 62,620,000 REFI 7/18/02&2/4/09   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . 0 0 0 0
2 Amount of bonds legally defeased . . . . . . . . . . 0 0 0 0
3 Total proceeds of issue . . . . . . . . . . . . . 39,210,000 49,755,055 103,035,433 35,028,997
4 Gross proceeds in reserve funds . . . . . . . . 0 0 0 0
5 Capitalized interest from proceeds . . . . . . . . . . 0 0 0 0
6 Proceeds in refunding escrows . . . . . . . . . . . 0 0 0 0
7 Issuance costs from proceeds . . . . . . . . . . . 270,531 346,200 714,438 325,299
8 Credit enhancement from proceeds . . . . . . . . . . 0 0 0 0
9 Working capital expenditures from proceeds . . . . . . . 0 0 0 0
10 Capital expenditures from proceeds . . . . . . . . . . 7,630,591 55 22,369,995 34,703,698
11 Other spent proceeds . . . . . . . . . . . 0 0 0 0
12 Other unspent proceeds . . . . . . . . . . . 0 0 0 0
13 Year of substantial completion . . . . . . . . . . . 2003 2003 2003 2006
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . . X   X   X     X
15 Were the bonds issued as part of an advance refunding issue? . . . .   X   X   X   X
16 Has the final allocation of proceeds been made? . . . . . . X   X   X   X  
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . X   X   X   X  
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .   X   X   X   X
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . . X   X   X   X  
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2011
Schedule K (Form 990) 2011
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . X   X   X   X  
b If ‘Yes’ to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . . X   X   X   X  
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . .   X   X   X   X
d If ‘Yes’ to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? .   X   X   X   X
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . SchKMediumBullet 0.00000% 0.00000% 0.00000% 0.00000%
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet 0% 0.00000% 0% 0%
6 Total of lines 4 and 5 . . .. . . . . . . . . 0% 0.00000% 0% 0%
7 Does the bond issue meet the private security or payment test? . . . X   X   X   X  
8 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
X   X   X   X  
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . . X   X   X   X  
2 Is the bond issue a variable rate issue? X   X   X   X  
3a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue? X   X   X   X  
b Name of provider . . . . . . . . Merrill Lynch
  		Merrill Lynch
  		Merrill Lynch
  		 
 
c Term of hedge . . . . . . . . 20. 20. 20. 25.
d Was the hedge superintegrated? . . . .   X   X   X   X
e Was a hedge terminated? . . . . .   X   X   X   X
4a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . .   X   X   X   X
b Name of provider . . . . . . 0
  		0
  		0
  		0
 
c Term of GIC . . . . . . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . . .                
5 Were any gross proceeds invested beyond an available temporary period? . . . . . .   X   X   X   X
6 Did the bond issue qualify for an exception to rebate? .   X   X   X   X
7 Has the organization established written procedures to monitor the requirements of section 148? . . .   X   X   X   X
Schedule K (Form 990) 2011

Schedule K (Form 990) 2011
Page 3
Part V
Procedures To Undertake Corrective Action
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? . . . . . . . . . . . . . .
Part VI
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
FORM 990, SCHEDULE K PART I, COLUMN (C), CUSIP # SCHEDULE K DISCLOSES THE COLORADO HEALTH FACILITIES AUTHORITY BONDS, ISSUED 12/05/2003, WITH AN ISSUE PRICE OF $103,035,000. THIS IS DISCLOSED AS ONE LINE ON SCHEDULE K DUE TO ONLY ONE FORM 8038 BEING ISSUED. THAT SAID, THERE ARE ACTUALLY TWO CUSIP NUMBERS, AS FOLLOWS: PER FORM 8038: CUSIP - 196474 K58 / K41 ACTUAL: CUSIP - 196474 K58 and CUSIP - 196474 K41
Schedule K (Form 990) 2011

Additional Data


Software ID:  
Software Version:  

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
SISTERS OF CHARITY OF LEAVENWORTH
HEALTH SYSTEM INC
Employer identification number

23-7379161
Identifier Return Reference Explanation
FORM 990 GENERAL EXPLANATIONS_1   FORM 990 (DEFINITION) SCLHS = SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. ------------------------------------------------------------------------- FORM 990, PART VI (GOVERNANCE, MANAGEMENT, & DISCLOSURE) SECTION A. GOVERNING BODY AND MANAGEMENT 6., 7(A)., AND 7(B). SCLHS HAS MEMBERS WHO APPOINT THE BOARD OF DIRECTORS OF SCLHS. THROUGH SEPTEMBER 25, 2011, THE MEMBERS OF SCLHS WERE THE COMMUNITY DIRECTOR AND THOSE PERSONS WHO ARE MEMBERS OF THE COMMUNITY COUNCIL OF THE SISTERS OF CHARITY OF LEAVENWORTH RELIGIOUS COMMUNITY. ON SEPTEMBER 25, 2011, THE SISTERS TRANSFERRED SPONSORSHIP OF SCLHS TO A NEWLY-FORMED ENTITY, LEAVEN MINISTRIES, WHICH HAS BEEN APPROVED AND RECOGNIZED BY THE CATHOLIC CHURCH AS THE SPONSOR OF SCLHS. LEADERSHIP OF THE SISTERS OF CHARITY OF LEAVENWORTH RELIGIOUS COMMUNITY REMAIN INVOLVED IN LEAVEN MINISTRIES. THE MEMBERS OF LEAVEN MINISTRIES INCLUDE THREE SISTERS OF CHARITY OF LEAVENWORTH BOARD MEMBERS AND TWO LAY LEADERS. SECTION B. POLICIES 11(B). SCLHS' GOVERNING BODY, A BOARD OF DIRECTORS, REVIEWS THE FORM 990 BEFORE IT IS FILED WITH THE IRS. THIS PROCESS INVOLVES EACH BOARD MEMBER RECEIVING A DRAFT OF THE FORM 990 AND THE OPPORTUNITY TO REVIEW AND ASK QUESTIONS BEFORE IT IS FILED, THUS ENSURING THAT THE INFORMATION ACCURATELY REFLECTS SCLHS' MISSION, OPERATIONS, COMMUNITY BENEFITS, GOVERNANCE OVERSIGHT, ETC. 12(C). SCLHS REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES ITS CONFLICT OF INTEREST POLICY BY PROVIDING EDUCATION AND TRAINING FOR EACH OF ITS EMPLOYEES, STAFF, OFFICERS AND DIRECTORS, AS WELL AS HAVING EACH OF THESE INDIVIDUALS COMPLETE A CONFLICT OF INTEREST STATEMENT ON AN ANNUAL BASIS TO DISCLOSE ANY POTENTIAL CONFLICT ISSUES. THESE STATEMENTS ARE CAREFULLY REVIEWED AND A REPORT PROVIDED TO SCLHS' PRESIDENT/CEO REGARDING EMPLOYEES AND OFFICERS, AND TO THE CHAIR OF THE BOARD AND CHAIR OF THE GOVERNANCE COMMITTEE REGARDING BOARD MEMBERS. IN THE EVENT OF A CONFLICT OF INTEREST WITH AN SCLHS BOARD MEMBER, THE CONFLICT SHALL PROMPTLY BE REPORTED TO THE SCLHS BOARD CHAIR WHO WILL PRESENT THE FACTS TO THE SCLHS GOVERNANCE COMMITTEE FOR EVALUATION AND PRESENTATION TO THE SCLHS BOARD OF DIRECTORS FOR ITS ACTION. 15(A) & 15(B). SCLHS' PROCESS FOR DETERMINING COMPENSATION FOR THE TOP MANAGEMENT, SENIOR LEADERSHIP, IS THE RESPONSIBILITY OF THE SCLHS COMPENSATION COMMITTEE. THIS COMMITTEE IS COMPOSED OF THREE OR MORE MEMBERS WHO ARE NOT CURRENT EMPLOYEES OF SCLHS, OR FORMER EMPLOYEES WITH NO ACTIVE INTEREST IN THE SCLHS' COMPENSATION PROGRAM, INCLUDING AT LEAST TWO MEMBERS OF THE SCLHS BOARD. SCLHS BELIEVES THAT THE INDEPENDENCE OF THESE MEMBERS IS VITAL TO THE INTEGRITY OF THE PROCESS. THE WORK OF THIS COMMITTEE INCLUDES BEING CONSTANTLY AWARE OF THE CURRENT COMPETITIVE MARKET FOR MANAGEMENT AND SENIOR LEADERS, AS WELL AS COMPILING AND MAINTAINING RECORDS OF COMPARABLE COMPENSATION AND BENEFITS DATA, INCLUDING SURVEYS AND OTHER ANALYSES, TO SUPPORT SCLHS' TOTAL COMPENSATION TO EACH INDIVIDUAL. MINUTES ARE KEPT CONTEMPORANEOUSLY FOR EACH MEETING OF THE COMMITTEE. LIKEWISE, THE COMMITTEE IS RESPONSIBLE FOR ENSURING THAT NO "EXCESS BENEFIT" IS CONFERRED ON AN INDIVIDUAL, OR THAT SUCH COMPENSATION DOES NOT CONSTITUTE PROHIBITED INUREMENT. THIS PROCESS IS COMPLETED FOR ALL SENIOR LEADERSHIP, AT THE AFFILIATE AND SYSTEM LEVEL, AND THE COMMITTEE'S RECOMMENDATION IS THEN SUBMITTED TO THE SCLHS BOARD FOR APPROVAL. THE CHARGE OF THIS COMMITTEE ADHERES TO SCLHS' CORE VALUE OF STEWARDSHIP, ENSURING THAT THE MINISTRY'S RESOURCES HELD IN TRUST ARE NOT WASTED OR MISUSED, AND ARE DEPLOYED TO EFFECTIVELY AND EFFICIENTLY ADVANCE THE MISSION. SECTION C. DISCLOSURE 19. SCLHS' GOVERNANCE MANUAL FOR BOARD MEMBERS IS AVAILABLE TO THE PUBLIC ON THE WEBSITE, WWW.GREATBOARDS.ORG. THE MANUAL SETS FORTH THE STANDARDS AND EXPECTATIONS OF EACH BOARD MEMBER INCLUDING THE FIDUCIARY DUTY OF LOYALTY WHICH REQUIRES THAT EACH MEMBER ABIDE BY SCLHS' CONFLICT OF INTEREST POLICY, DISCLOSE ANY ISSUES WHICH MAY PRESENT A CONFLICT, COMPLETE THE ANNUAL DISCLOSURE STATEMENT, REVIEW POLICIES AND PROCEDURES PERTAINING TO CONFLICTS OF INTEREST, AND PROVIDE OVERSIGHT OF SCLHS' RESPONSIBILITY PROGRAM. FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. ------------------------------------------------------------------------- FORM 990, PART XI (RECONCILIATION OF NET ASSETS) LINE 5: OTHER CHANGES IN NET ASSETS: UNREALIZED LOSS ON INVESTMENTS $(13,702,353) UNREALIZED LOSS ON SWAPS (14,172,902) FROZEN DEFINED BENEFIT RETIREMENT PLAN GAIN 6,520,813 EQUITY TRANSFERS FROM RELATED (3,572,913) FAS 158 LOSS ON DEFINED BENEFIT PLANS (33,548,100) SELF-INSURED LIABILITY REDUCTION (4,379,871) ----------- TOTAL $(62,855,326) =========== ------------------------------------------------------------------------- FORM 990, PART XII, LINE 2 (FINANCIAL STATEMENTS & REPORTING) SCLHS HAS AN INDEPENDENT AUDIT COMPLETED AND REPORTED UPON ANNUALLY ON ITS CONSOLIDATED ORGANIZATION. THERE IS NO SEPARATE AUDIT REPORT FOR SCLHS. IN ADDITION, SCLHS' BOARD HAS AN AUDIT COMMITTEE WHICH HAS OVERSIGHT OF THE EXTERNAL AUDIT PROCESS AND RESULTS AS WELL AS SELECTION OF THE INDEPENDENT AUDITORS. CURRENT INDEPENDENT AUDITORS ARE ERNST & YOUNG, LLP. -------------------------------------------------------------------------
FORM 990 GENERAL EXPLANATIONS_2   FORM 926, STATEMENT PURSUANT TO TREASURY REG. SEC. 1.6038B-1(C): APPLICABLE TO ALL IRS FORMS 926 FILED WITH THIS RETURN. 1. TRANSFEROR NAME: SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. AND U.S. TAXPAYER IDENTIFICATION NUMBER: 23-7379161. 2. TRANSFEREE: A. NAME: VARIOUS, SEE IRS FORMS 926, PART II, LINE 3; TAXPAYER IDENTIFICATION NUMBER: VARIOUS, SEE IRS FORMS 926, PART II, LINE 4; ADDRESS: VARIOUS, SEE IRS FORMS 926, PART II, LINE 5; COUNTRY OF INCORPORATION: VARIOUS, SEE IRS FORMS 926, PART II, LINE 6. B. GENERAL DESCRIPTION OF THE TRANSFER: VARIOUS, GENERALLY CASH, SEE IRS FORMS 926, PART III. 3. CONSIDERATION RECEIVED: SEE AMOUNT ON IRS FORMS 926, PART III. 4. PROPERTY TRANSFERRED, INCLUDING THE ESTIMATED FAIR MARKET VALUE AND ADJUSTED BASIS OF THE PROPERTY: A. ACTIVE BUSINESS PROPERTY: SEE AMOUNT ON IRS FORMS 926, PART III. B. STOCK OR SECURITIES: SEE AMOUNT ON IRS FORMS 926, PART III. I. ACTIVE TRADE OR BUSINESS STOCK. II. APPLICATION OF SPECIAL RULES. C. DEPRECIATED PROPERTY: SEE AMOUNT ON IRS FORMS 926, PART III. D. PROPERTY TO BE LEASED: N/A E. PROPERTY TO BE SOLD: N/A F. TRANSFERS TO FSCS: N/A G. TAINTED PROPERTY: N/A I. INVENTORY, ETC.: PROPERTY DESCRIBED IN SEC. 1.367(A)-5T(B); II. INSTALLMENT OBLIGATIONS, ETC.: PROPERTY DESCRIBED IN SEC. 1.367(A)-5T(C); III. FOREIGN CURRENCY, ETC: PROPERTY DESCRIBED IN SEC. 1.367(A)-5T(D); IV. INTANGIBLE PROPERTY: PROPERTY DESCRIBED IN SEC. 1.367(A)-5T(E); V. LEASED PROPERTY: PROPERTY DESCRIBED IN SEC. 1.367(A)-5T(F). H. FOREIGN LOSS BRANCH: N/A I. OTHER INTANGIBLES: SEE AMOUNT ON IRS FORMS 926, PART III. 5. TRANSFER OF FOREIGN BRANCH WITH PREVIOUSLY DEDUCTED LOSSES: N/A A. BRANCH OPERATION. B. BRANCH PROPERTY. C. PREVIOUSLY DEDUCTED LOSSES. D. CHARACTER OF GAIN IN ACCORDANCE WITH SEC. 1.367(A)-6T(C)(1). N/A ------------------------------------------------------------------------- FORM 926, STATEMENT PURSUANT TO TREASURY REGS. SEC. 1.351-3T(A) AND SEC. 1.351-3T(B): APPLICABLE TO ALL IRS FORMS 926 WHERE SCLHS IS A SIGNIFICANT TRANSFEROR. BY: SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. EIN: 23-7379161 YEAR ENDED DECEMBER 31, 2011. 1. NAME AND EIN (IF ANY) OF TRANSFEREE CORPORATION(S): SEE FORMS 926, PART II, LINES 3 AND 4. 2. DATE(S) OF THE TRANSFER(S) OF ASSETS: VARIOUS DATES. SEE FORMS 926, PART III. 3. IMMEDIATELY BEFORE THE EXCHANGE, THE PROPERTY TRANSFERRED BY THE TRANSFEROR IN EXCHANGE HAD AN: (A) AGGREGATE FAIR MARKET VALUE OF: SEE FORMS 926, PART III WHERE CASH VALUE EXCHANGED WAS REPORTED. (B) AGGREGATE BASIS OF: SINCE CASH WAS EXCHANGED, BASIS IS EQUAL TO FAIR MARKET VALUE ABOVE. 4. DATE AND CONTROL NUMBER OF ANY PRIVATE LETTER RULING(S) ISSUED BY THE INTERNAL REVENUE SERVICE IN CONNECTION WITH THE SECTION 351 EXCHANGE: NOT APPLICABLE. ------------------------------------------------------------------------- FORM 5471, STATEMENT PURSUANT TO TREASURY REG. SEC. 1.351-3T(B): APPLICABLE TO ALL IRS FORMS 5471 FILED WITH THIS RETURN. BY: VARIOUS, SEE ALL FORMS 5471 FILED WITH THIS RETURN. EIN: VARIOUS, SEE ALL FORMS 5471 FILED WITH THIS RETURN. YEAR ENDED DECEMBER 31, 2011. 1. NAME AND EIN (IF ANY) OF TRANSFEREE CORPORATION(S): SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC.; 23-7379161. 2. DATE(S) OF THE TRANSFER(S) OF ASSETS: VARIOUS DATES. SEE FORMS 5471. 3. IMMEDIATELY BEFORE THE EXCHANGE, THE PROPERTY TRANSFERRED BY THE TRANSFEROR IN EXCHANGE HAD AN: (A) AGGREGATE FAIR MARKET VALUE OF: SEE FORMS 5471 WHERE CASH VALUE EXCHANGED WAS REPORTED. (B) AGGREGATE BASIS OF: SINCE CASH WAS EXCHANGED, BASIS IS EQUAL TO FAIR MARKET VALUE ABOVE. 4. DATE AND CONTROL NUMBER OF ANY PRIVATE LETTER RULING(S) ISSUED BY THE INTERNAL REVENUE SERVICE IN CONNECTION WITH THE SECTION 351 EXCHANGE: NOT APPLICABLE. ------------------------------------------------------------------------- FORM 5471, STATEMENT OF REASONABLE CAUSE PURSUANT TO TREASURY REG. SEC. 301.6679-1(A)(3): SCLHS, A SHAREHOLDER OF THE RIVERVIEW MULTI-SERIES FUND SPC, LTD., IS NOT IN POSSESSION OF CERTAIN INFORMATION REQUESTED BY THE IRS ON FORM 5471 AND IS UNABLE TO OBTAIN SUCH INFORMATION FROM RIVERVIEW MULTI-SERIES FUND SPC, LTD. SPECIFICALLY, SCLHS IS NOT IN POSSESSION OF THE FOLLOWING INFORMATION REQUESTED IN FORM 5471: SCHEDULE B: THE IDENTITY, HOLDINGS AND INCOME OF OTHER U.S. SHAREHOLDERS AND THEIR PRO RATA SHARE OF SUBPART F INCOME; THIS STATEMENT IS INTENDED TO SERVE AS A STATEMENT OF REASONABLE CAUSE IN ACCORDANCE WITH TREASURY REG. SEC. 301.6679-1(A)(3). ------------------------------------------------------------------------- FORM 5471, STATEMENT OF REASONABLE CAUSE PURSUANT TO TREASURY REG. SEC. 301.6679-1(A)(3) AND 1.6038-2(K)(3)(II): SCLHS, A SHAREHOLDER OF THE JP MORGAN HEDGE FUND SPC, LTD -ACCESS MAR09 SEGREGATED PORTFOLIO, IS NOT IN POSSESSION OF CERTAIN INFORMATION REQUESTED BY THE IRS ON FORM 5471 AND IS UNABLE TO OBTAIN SUCH INFORMATION FROM JP MORGAN HEDGE FUND SPC, LTD -ACCESS MAR09 SEGREGATED PORTFOLIO. SPECIFICALLY, SCLHS IS NOT IN POSSESSION OF THE FOLLOWING INFORMATION REQUESTED IN FORM 5471: SCHEDULE B: THE IDENTITY, HOLDINGS AND INCOME OF OTHER U.S. SHAREHOLDERS AND THEIR PRO RATA SHARE OF SUBPART F INCOME; SCHEDULE E: THE INCOME, WAR PROFITS, AND EXCESS PROFITS TAXES PAID OR ACCRUED BY THE CORPORATION; SCHEDULE G: THE OTHER INFORMATION REGARDING THE CORPORATION. NOTE ALL BOXES ARE MARKED NO BY DEFAULT OF SCLHS' TAX SOFTWARE. ANSWERS MAY NOT BE ACCURATE; SCHEDULE H: THE CURRENT EARNINGS AND PROFITS OF THE CORPORATION; SCHEDULE I: THE SUMMARY OF SHAREHOLDER'S INCOME FROM FOREIGN CORPORATION. SCHEDULE J: THE INFORMATION REGARDING THE ACCUMULATED EARNINGS AND PROFITS (E&P) OF THE CORPORATION; SCHEDULE M: THE INFORMATION REGARDING TRANSACTIONS BETWEEN CONTROLLED FOREIGN CORPORATIONS AND SHAREHOLDERS OR OTHER RELATED PARTIES; AND SCHEDULE O, PART II, SECTIONS B, E AND F: SOCIAL SECURITY NUMBERS OF U.S. DIRECTORS OF THE CORPORATION, INFORMATION REGARDING THE ORGANIZATION OR REORGANIZATION OF THE FOREIGN CORPORATION, AND THE ADDITIONAL INFORMATION. THIS STATEMENT IS INTENDED TO SERVE AS A STATEMENT OF REASONABLE CAUSE IN ACCORDANCE WITH TREASURY REG. SEC. 301.6679-1(A)(3) AND 1.6038-2(K)(3)(II). ------------------------------------------------------------------------- FORM 5471, STATEMENT OF REASONABLE CAUSE PURSUANT TO TREASURY REG. SEC. 301.6679-1(A)(3) AND 1.6038-2(K)(3)(II): SCLHS, A SHAREHOLDER OF THE JP MORGAN HEDGE FUND SPC, LTD -ACCESS JUN09 SEGREGATED PORTFOLIO, IS NOT IN POSSESSION OF CERTAIN INFORMATION REQUESTED BY THE IRS ON FORM 5471 AND IS UNABLE TO OBTAIN SUCH INFORMATION FROM JP MORGAN HEDGE FUND SPC, LTD -ACCESS JUN09 SEGREGATED PORTFOLIO. SPECIFICALLY, SCLHS IS NOT IN POSSESSION OF THE FOLLOWING INFORMATION REQUESTED IN FORM 5471: SCHEDULE B: THE IDENTITY, HOLDINGS AND INCOME OF OTHER U.S. SHAREHOLDERS AND THEIR PRO RATA SHARE OF SUBPART F INCOME; SCHEDULE E: THE INCOME, WAR PROFITS, AND EXCESS PROFITS TAXES PAID OR ACCRUED BY THE CORPORATION; SCHEDULE G: THE OTHER INFORMATION REGARDING THE CORPORATION. NOTE ALL BOXES ARE MARKED NO BY DEFAULT OF SCLHS' TAX SOFTWARE. ANSWERS MAY NOT BE ACCURATE; SCHEDULE H: THE CURRENT EARNINGS AND PROFITS OF THE CORPORATION; SCHEDULE I: THE SUMMARY OF SHAREHOLDER'S INCOME FROM FOREIGN CORPORATION. SCHEDULE J: THE INFORMATION REGARDING THE ACCUMULATED EARNINGS AND PROFITS (E&P) OF THE CORPORATION; SCHEDULE M: THE INFORMATION REGARDING TRANSACTIONS BETWEEN CONTROLLED FOREIGN CORPORATIONS AND SHAREHOLDERS OR OTHER RELATED PARTIES; AND SCHEDULE O, PART II, SECTIONS B, E AND F: SOCIAL SECURITY NUMBERS OF U.S. DIRECTORS OF THE CORPORATION, INFORMATION REGARDING THE ORGANIZATION OR REORGANIZATION OF THE FOREIGN CORPORATION, AND THE ADDITIONAL INFORMATION. THIS STATEMENT IS INTENDED TO SERVE AS A STATEMENT OF REASONABLE CAUSE IN ACCORDANCE WITH TREASURY REG. SEC. 301.6679-1(A)(3) AND 1.6038-2(K)(3)(II). ------------------------------------------------------------------------- FORM 5471, STATEMENT OF REASONABLE CAUSE PURSUANT TO TREASURY REG. SEC. 301.6679-1(A)(3) AND 1.6038-2(K)(3)(II): SCLHS, A 12.54% SHAREHOLDER WITH NO VOTING RIGHTS IN AUSTIN CAPITAL SAFE HARBOR OFFSHORE FUND, LTD., IS NOT IN POSSESSION OF CERTAIN INFORMATION REQUESTED BY THE IRS ON FORM 5471 AND IS UNABLE TO OBTAIN SUCH INFORMATION FROM AUSTIN CAPITAL SAFE HARBOR OFFSHORE FUND, LTD.. SPECIFICALLY, SCLHS IS NOT IN POSSESSION OF THE FOLLOWING INFORMATION REQUESTED IN FORM 5471: SCHEDULE H: THE CURRENT EARNINGS AND PROFITS OF THE CORPORATION; SCHEDULE I: THE SUMMARY OF SHAREHOLDER'S INCOME FROM FOREIGN CORPORATION. SCHEDULE J: THE INFORMATION REGARDING THE ACCUMULATED EARNINGS AND PROFITS (E&P) OF THE CORPORATION; AS SCLHS IS NOT IN POSSESSION OF THE CURRENT EARNINGS AND PROFITS OF THE CORPORATION. THIS STATEMENT IS INTENDED TO SERVE AS A STATEMENT OF REASONABLE CAUSE IN ACCORDANCE WITH TREASURY REG. SEC. 301.6679-1(A)(3) AND 1.6038-2(K)(3)(II). -------------------------------------------------------------------------
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:LOURDES J LAZATIN TITLE:CEO SAINT JOHN'S SANTA MONICA HOURS:40
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ELEANOR L RAMIREZ TITLE:COO SAINT JOHN'S SANTA MONICA HOURS:40
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:CHERIE L GORBY TITLE:COO ST MARY'S GRAND JUNCTION HOURS:40
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:BAIN J FARRIS TITLE:CEO SAINT JOSEPH DENVER HOURS:40
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2011

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
SISTERS OF CHARITY OF LEAVENWORTH
HEALTH SYSTEM INC
Employer identification number

23-7379161
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)
(a)
Name, address, and EIN of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income
(e)
End-of-year assets


 		(f)
Direct controlling
entity

















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


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled organization
Yes No
(1) CARITAS CLINICS INC

818 NORTH 7TH STREET

LEAVENWORTH,KS66048
48-1009910 		CLINIC SVCS KS 501(c)(3) 3 SCLHS
 
Yes
 
(2) MARIAN CLINIC INC

1001 SW GARFIELD

TOPEKA,KS66604
48-1046905 		CLINIC SVCS KS 501(c)(3) 3 SCLHS
 
Yes
 
(3) MARILLAC CLINIC INC

2333 N 6TH STREET

GRAND JUNCTION,CO81501
84-1085822 		CLINIC SVCS CO 501(c)(3) 3 SCLHS
 
Yes
 
(4) PROVIDENCE MEDICAL CENTER

8929 PARALLEL PARKWAY

KANSAS CITY,KS66112
48-0784446 		HEALTHCARE KS 501(c)(3) 3 SCLHS
 
Yes
 
(5) ST JOHN HOSPITAL INC

3500 SOUTH FOURTH STREET

LEAVENWORTH,KS66048
48-0543768 		HEALTHCARE KS 501(c)(3) 3 PMC
 
Yes
 
(6) BETHANY COMMUNITY PLAZA INC

15 NORTH 12TH STREET

KANSAS CITY,KS66102
48-1207407 		HEALTHCARE KS 501(c)(3) 3 PMC
 
Yes
 
(7) PROVIDENCEST JOHN FOUNDATION INC

8929 PARALLEL PARKWAY

KANSAS CITY,KS66112
48-0925688 		SUPPORT 501C3 KS 501(c)(3) 7 PMC
 
Yes
 
(8) ST FRANCIS HEALTH CENTER INC

1700 SW 7TH STREET

TOPEKA,KS66606
48-0547719 		HEALTHCARE KS 501(c)(3) 3 SCLHS
 
Yes
 
(9) ST FRANCIS HEALTH CENTER FOUNDATION

1700 SW 7TH STREET

TOPEKA,KS66606
48-1092520 		SUPPORT 501C3 KS 501(c)(3) 11A-TYPE I SFHC
 
Yes
 
(10) ST MARYS HOSPITAL & MEDICAL CENTER INC

2635 N 7TH STREET

GRAND JUNCTION,CO81502
84-0425720 		HEALTHCARE CO 501(c)(3) 3 SCLHS
 
Yes
 
(11) ST MARYS HOSPITAL FOUNDATION

2635 N 7TH STREET

GRAND JUNCTION,CO81502
23-7001007 		SUPPORT 501C3 CO 501(c)(3) 11A-TYPE I SMHMC
 
Yes
 
(12) SAINT JOSEPH HOSPITAL FOUNDATION

1835 FRANKLIN STREET

DENVER,CO80218
84-0735096 		SUPPORT 501C3 CO 501(c)(3) 11A-TYPE I SJH
 
Yes
 
(13) HOLY ROSARY HEALTHCARE

2600 WILSON

MILES CITY,MT59301
81-0231792 		HEALTHCARE MT 501(c)(3) 3 SCLHS
 
Yes
 
(14) HOLY ROSARY HEALTHCARE FOUNDATION INC

2600 WILSON

MILES CITY,MT59301
20-2270238 		SUPPORT 501C3 MT 501(c)(3) 11A-TYPE I HRHC
 
Yes
 
(15) ST VINCENT HEALTHCARE

1233 NORTH 30TH

BILLINGS,MT59101
81-0232124 		HEALTHCARE MT 501(c)(3) 3 SCLHS
 
Yes
 
(16) ST VINCENT HEALTHCARE FOUNDATION

PO BOX 35200

BILLINGS,MT59107
81-0468034 		SUPPORT 501C3 MT 501(c)(3) 7 SVHC
 
Yes
 
(17) NORTHWEST RESEARCH & EDUCATION INSTITUTE

315 NORTH 25TH STREET

BILLINGS,MT59101
20-1343024 		COMM HLTH RES MT 501(c)(3) 9 SVHC
 
Yes
 
(18) ST JAMES HEALTHCARE

400 SOUTH CLARK STREET

BUTTE,MT59701
81-0231785 		HEALTHCARE MT 501(c)(3) 3 SCLHS
 
Yes
 
(19) ST JAMES HEALTHCARE FOUNDATION

400 SOUTH CLARK STREET

BUTTE,MT59701
65-1202190 		SUPPORT 501C3 MT 501(c)(3) 11A-TYPE I SJHC
 
Yes
 
(20) SAINT JOHNS HEALTH CENTER

2121 SANTA MONICA BLVD

SANTA MONICA,CA904042091
95-1684082 		HEALTHCARE CA 501(c)(3) 3 SCLHS
 
Yes
 
(21) JOHN WAYNE CANCER INSTITUTE

2000 SANTA MONICA BLVD

SANTA MONICA,CA90404
95-4291515 		CANCER R&D CA 501(c)(3) 4 SJHHC
 
Yes
 
(22) SAINT JOHNS HOSPITAL & HLTH CENTER FNDTN

2121 SANTA MONICA BLVD

SANTA MONICA,CA904042091
95-6100079 		SUPPORT 501C3 CA 501(c)(3) 11A-TYPE I SJHHC
 
Yes
 
(23) EXEMPLA INC FKA LUTHERAN HOSPITAL

2420 W 26TH AVE SUITE 100D

DENVER,CO80211
84-1103606 		HEALTHCARE CO 501(c)(3) 3 SCLHS
 
Yes
 
(24) EXEMPLA LUTHERAN MEDICAL CENTER FNDTN

2480 W 26TH AVESUITE 360B

DENVER,CO80211
20-8846152 		SUPPORT 501C3 CO 501(c)(3) 7 EXEMPLA INC
 
Yes
 
(25) EXEMPLA GOOD SAMARITAN MEDICAL CTR FNDTN

200 EXEMPLA CIRCLE

LAFAYETTE,CO80026
84-1649162 		SUPPORT 501C3 CO 501(c)(3) 7 EXEMPLA INC
 
Yes
 
(26) LUTH MED CNTR PRO&GEN LIAB SELF-INS TRST

2480 W 26TH AVESUITE 360B

DENVER,CO80211
74-2571584 		INSURANCE CO 501(c)(3) 11A-TYPE I EXEMPLA INC
 
Yes
 
(27) SAINT JOSEPH HOSPITAL

1835 FRANKLIN STREET

DENVER,CO80218
84-0417134 		HEALTHCARE CO 501(c)(3) 3 SCLHS
 
Yes
 
(28) MOUNT ST VINCENT HOME INC

4159 LOWELL BOULEVARD

DENVER,CO80211
84-0405260 		RES CARE CO 501(C)(3) 11A-TYPE I SCLHS
 
Yes
 
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(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 V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) PAVILION IMAGING LLC

750 WELLINGTON
GRAND JUNCTION,CO81501
03-0516198 		RADIOLOGY CO NA
  		N/A                
(2) GRAND VALLEY SURGICAL CENTER LLC

710 WELLINGTON
GRAND JUNCTION,CO81501
84-1505075 		OP SURGERY CO NA
  		N/A                
(3) SAN JUAN CANCER CENTER LLC

600 SOUTH 5TH STREET
MONTROSE,CO81401
20-2856331 		OP CANCER CO NA
  		N/A                
(4) BILLINGS MRI CENTER LLC

1041 NORTH 29TH STREET
BILLINGS,MT59101
81-0450943 		MRI-PET SCAN MT NA
  		N/A                
(5) LUTHERAN CAMPUS ASC LLC

3455 LUTHRN PKW SUITE 150
WHEATRIDGE,CO800336028
02-0749532 		OP SURGERY CO NA
  		N/A                
(6) COLORADO SURGICAL VENTURES LLC

30 S WACKER DR SUITE 2302
CHICAGO,IL60605
20-8038915 		OP SURGERY CO NA
  		N/A                
(7) COLORADO SURGICAL HOSPITAL LLC

30 S WACKER DR SUITE 2302
CHICAGO,IL60605
20-8038977 		OP SURGERY CO NA
  		N/A                
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of related organization



 		(b)
Primary activity



 		(c)
Legal domicile
(state or
foreign
country)
 		(d)
Direct controlling
entity


 		(e)
Type of entity
(C corp, S corp,
or trust)

 		(f)
Share of total income



 		(g)
Share of
end-of-year
assets

 		(h)
Percentage
ownership
(1) CARITAS INC AND SUBSIDIARIES
2480 W 26th Avenue STE 100D
Denver,CO80211
48-0941069 		OTHER MEDICAL KS na
  		C CORP 19,578,604 29,975,179 100.000 %
(2) LEAVEN INSURANCE COMPANY LTD
23 Lime Tree Bay Ave
George Town,Grand CaymanKY1-1102
CJ
98-0370522 		Insurance CJ na
  		  3,631,560 66,605,797 100.000 %










Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III or IV.
Yes
No
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 . . . . . . . . . . . . . . . . . . . . . . .
1a
Yes
 
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
 
No
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
Yes
 
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
Yes
 
f Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1k
Yes
 
l Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type(a-r) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) PROVIDENCE MEDICAL CENTER (PMC)

 A 245,970 FMV
(2) ST JOHN HOSPITAL INC (SJL)

 A 67,165 FMV
(3) ST JAMES HEALTHCARE (SJB)

 A 570,005 FMV
(4) ST MARY'S HOSPITAL & MEDICAL CTR (SMGJ)

 A 1,759,533 FMV
(5) ST JOHN'S HEALTH CTR (SJSM)

 A 2,773,717 FMV
(6) EXEMPLA INC FKA LUTHERAN HOSPITAL

 A 7,933,927 FMV
(7) ST JOSEPH HOSPITAL (SJD)

 A 2,565,576 FMV
(8) MOUNT SAINT VINCENT HOME (MSVH)

 B 80,000 FMV
(9) PROVIDENCE MEDICAL CENTER (PMC)

 E 11,714,669 FMV
(10) ST JOHN HOSPITAL INC (SJL)

 E 966,353 FMV
(11) ST JAMES HEALTHCARE (SJB)

 E 3,196,146 FMV
(12) ST MARY'S HOSPITAL & MEDICAL CTR (SMGJ)

 E 4,421,805 FMV
(13) ST JOHN'S HEALTH CTR (SJSM)

 E 16,000,000 FMV
(14) EXEMPLA INC FKA LUTHERAN HOSPITAL

 E 7,485,000 FMV
(15) ST JOSEPH HOSPITAL (SJD)

 D 833,835 FMV
(16) EXEMPLA INC FKA LUTHERAN HOSPITAL

 D 420,000 FMV
(17) PROVIDENCE MEDICAL CENTER (PMC)

 K 7,072,296 FMV
(18) ST FRANCIS HEALTH CENTER INC (SFT)

 K 10,604,240 FMV
(19) HOLY ROSARY HEALTHCARE (HRH)

 K 1,722,881 FMV
(20) ST VINCENT HEATHCARE (SVB)

 K 25,190,634 FMV
(21) ST JAMES HEALTHCARE (SJB)

 K 3,687,331 FMV
(22) ST MARY'S HOSPITAL & MEDICAL CTR (SMGJ)

 K 13,689,913 FMV
(23) ST JOHN'S HEALTH CTR (SJSM)

 K 629,694 FMV
(24) PROVIDENCE MEDICAL CENTER (PMC)

 O 15,877 FMV
(25) ST JAMES HEALTHCARE (SJB)

 O 15,035 FMV
(26) ST VINCENT HEATHCARE (SVB)

 O 71,320 FMV
(27) ST JOHN HOSPITAL INC (SJL)

 k 1,444,920 FMV
(28) LEAVEN INSURANCE COMPANY LTD

 O 13,469,858 FMV
(29) PROVIDENCE MEDICAL CENTER (PMC)

 P 128,166,922 FMV
(30) ST JOHN HOSPITAL INC (SJL)

 P 26,148,435 FMV
(31) ST FRANCIS HEALTH CENTER INC (SFT)

 P 200,817,601 FMV
(32) HOLY ROSARY HEALTHCARE (HRH)

 P 31,427,583 FMV
(33) ST VINCENT HEATHCARE (SVB)

 P 259,952,065 FMV
(34) ST JAMES HEALTHCARE (SJB)

 P 70,944,293 FMV
(35) ST MARY'S HOSPITAL & MEDICAL CTR (SMGJ)

 P 264,741,167 FMV
(36) ST JOHN'S HEALTH CTR (SJSM)

 P 258,739,072 FMV
(37) EXEMPLA INC FKA LUTHERAN HOSPITAL

 P 89,804,546 FMV
(38) ST JOSEPH HOSPITAL (SJD)

 P 1,702,084 FMV
(39) LEAVEN INSURANCE COMPANY LTD

 P 5,551,982 FMV
(40) CARITAS INC & SUBSIDIARIES

 P 88,108 FMV
(41) CARITAS CLINICS INC

 P 1,238,103 FMV
(42) MARIAN CLINIC INC

 P 1,745,289 FMV
(43) JOHN WAYNE CANCER INSTITUTE

 P 16,690,455 FMV
(44) MARILLAC CLINIC INC

 P 71,000 FMV
(45) PROVIDENCE MEDICAL CENTER (PMC)

 Q 5,669 FMV
(46) ST VINCENT HEALTHCARE (SVB)

 Q 7,874 FMV
(47) EXEMPLA INC FKA LUTHERAN HOSPITAL

 Q 2,944,351 FMV
(48) PROVIDENCE MEDICAL CENTER (PMC)

 r 5,107,676 FMV
(49) ST FRANCIS HEALTH CENTER INC (SFT)

 r 5,852,027 FMV
(50) HOLY ROSARY HEALTHCARE (HRH)

 r 957,023 FMV
(51) ST MARY'S HOSPITAL & MEDICAL CTR (SMGJ)

 r 7,273,387 FMV
(52) ST VINCENT HEALTHCARE (SVB)

 r 7,613,663 FMV
(53) ST JOHN'S HEALTH CTR (SJSM)

 r 6,433,335 FMV
(54) ST JAMES HEALTHCARE (SJB)

 r 2,208,246 FMV
(55) MARILLAC CLINIC INC

 b 79,376 fmv
(56) ST VINCENT HEALTHCARE (SVB)

 B 50,000 FMV
(57) ST JAMES HEALTHCARE (SJB)

 D 5,802,374 FMV
(58) EXEMPLA INC FKA LUTHERAN HOSPITAL

 K 4,228,304 FMV
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(e)
Are all
partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation
Additional Data


Software ID:  
Software Version: