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
2010
Open to Public Inspection
A For the calendar year, or tax year beginning 07-01-2010 and ending 06-30-2011
BCheck if applicable:
CName of organization
ST ELIZABETH'S HOSPITAL
OF THE THIRD ORDER OF ST FRANCIS
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
211 SOUTH THIRD STREET
 
Room/suite
City or town, state or country, and ZIP + 4
BELLEVILLE, IL622201998
D Employer identification number

37-0663567
E Telephone number

G Gross receipts $ 179,323,035
F Name and address of principal officer:
Maryann Reese
211 South Third Street
Belleville,IL622201998
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.steliz.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: 1875
M State of legal domicile: IL
Part I
Summary
Activities  & Governance 1 Briefly describe the organization’s mission or most significant activities: To MINISTER TO THOSE IN NEED OF HEALTHCARE IN RESPONSE TO GOD'S CALL TO SERVE EACH OTHER, ESPECIALLY THE POOR. IN THE PERFORMANCE OF ITS MISSION, ST. ELIZABETH'S WILL FOSTER RESPECT, CARE, COMPETENCE AND JOY
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) .... 3 9
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 5
5 Total number of individuals employed in calendar year 2010 (Part V, line 2a) ... 5 1,948
6 Total number of volunteers (estimate if necessary) .... 6 140
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 20,071
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b 1,605
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 1,021,881 366,018
9 Program service revenue (Part VIII, line 2g) ......... 185,756,413 173,382,447
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 720,531 2,249,698
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 1,394,232 1,057,936
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 188,893,057 177,056,099
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 5,000 0
14 Benefits paid to or for members (Part IX, column (A), line 4) .... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 84,036,055 81,215,417
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).... 119,121,615 118,902,735
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 203,162,670 200,118,152
19 Revenue less expenses. Subtract line 18 from line 12...... -14,269,613 -23,062,053
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............ 168,039,041 127,988,273
21 Total liabilities (Part X, line 26)............ 121,623,727 96,905,178
22 Net assets or fund balances. Subtract line 21 from line 20 ..... 46,415,314 31,083,095
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's Use Only Preparer's
signature
Big Right Arrow
Date
right pointing bullet image Preparer’s taxpayer identification number
(see instructions)
Firm’s name (or yours
if self-employed),
address, and ZIP + 4
Big Right Arrow




EIN right pointing bullet image
Phone no. right pointing bullet image
May the IRS discuss this return with the preparer shown above? (see instructions) .........
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2010)
Form 990 (2010)
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: SEE SCHEDULE O.
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 exempt purpose achievements for each of the organization’s three largest program services 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 $ 24,032,679 including grants of $ 0 ) (Revenue $ 23,583,543 )
Cardiac Services - see schedule O
4b (Code:   ) (Expenses $ 10,339,275 including grants of $ 0 ) (Revenue $ 9,286,931 )
orthopedic servicse - see schedule o
4c (Code:   ) (Expenses $ 10,099,274 including grants of $ 0 ) (Revenue $ 9,802,010 )
rehabilitation services - see schedule o
4d Other program services. (Describe in Schedule O.)
(Expenses $ 122,813,758 including grants of $ 0 ) (Revenue $ 130,709,963 )
4e Total program service expensesMediumBullet$ 167,284,986
Form 990 (2010)
Form 990 (2010)
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? Click to see attachment........
2
Yes
 
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 II
Click 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
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts where 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 I
Click 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 IV
Click to see attachment
...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in term, permanent,or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
 
No
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
 
No
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
 
No
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
Yes
 
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, and program service activities outside the United States? If “Yes,” complete Schedule F, Part I.........
14b
 
No
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..
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..
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
Form 990 (2010)
Form 990 (2010)
Page 4
Part IV
Checklist of Required Schedules (continued)
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H..... Click to see attachment
20a
Yes
 
b
Did the organization attach its audited financial statement to this return? Note: All Form 990 filers that operate one or more hospitals must attach audited financial statements. ..... Click to see attachment
20b
Yes
 
21
Did the organization report more than $5,000 of grants and other assistance to governments and organizations in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II..
21
 
No
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.....
22
 
No
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................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
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
 
 
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
 
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...... Click to see attachment
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................ Click to see attachment
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
........................... Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor, or a grant selection committee member, or to a person related to such an individual? If “Yes,” complete Schedule L, Part III............... Click to see attachment
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 ......................... Click to see attachment
28a
Yes
 
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV
................... Click to see attachment
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.. Click to see attachment
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
Yes
 
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
 
35
Is any related organization a controlled entity within the meaning of section 512(b)(13)? .....
35
 
No
a
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
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 (2010)
Form 990 (2010)
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
218
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
 
 
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
1,948
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
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
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
 
 
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 (2010)
Form 990 (2010)
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 ..............
1a
9
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
5
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
Does the organization have members or stockholders? ................
6
Yes
 
7a
Does the organization have members, stockholders, or other persons who may elect one or more members of the governing body? .........................
7a
Yes
 
b
Are any decisions of the governing body subject to approval by members, stockholders, or other persons? ..
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
Does the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” does the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with those of the organization? ....
10b
 
 
11a
Has the organization provided a 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
Does the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Are officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ...........................
12b
Yes
 
c
Does the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this is done ....................
12c
Yes
 
13
Does the organization have a written whistleblower policy? ...............
13
Yes
 
14
Does 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 a or b, 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,” has the organization adopted a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and taken 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 make these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization makes its governing documents, conflict of interest policy, and financial statements available to the public.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
Leslie Eckert
211 SOUTH THIRD
BELLEVILLE,IL622201998
(618) 234-2120
Form 990 (2010)
Form 990 (2010)
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 (check all that apply)
(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) Steven C Wolf
Board Member
1.0 X           0 0 0
(2) Thomas M Egan
Board Secretary
1.0 X   X       0 0 0
(3) William S Lyke
Board Chairperson
1.0 X   X       0 0 0
(4) Sister Marybeth Culnan OSF
Board Member
1.0 X           0 0 0
(5) Dennis E Bielke
Board Vice Chairperson
1.0 X   X       0 0 0
(6) Anwar A Khan MD
Board Member
1.0 X           42,749 0 0
(7) Kevin Pesko
Board Member
1.0 X           0 0 0
(8) Linda A Camp MD
Board Member
1.0 X           0 535,034 0
(9) Rev James E Deiters
Board Member
1.0 X           0 0 0
(10) Maryann L Reese RN
President & CEO
70.0 X   X       0 0 0
(11) Sister Janice Schneider OSF
Board Member
1.0 X           0 0 0
(12) Sister Gertrude O'Connor OSF
Board Member
1.0 X           0 0 0
(13) Johnny E Watkins
Division CFO
35.0     X       236,604 0 40,164
(14) Ann Carr
Treasurer
.25     X       0 191,336 109,542
(15) Leslie Eckert
Chief Financial Officer
70.0     X       127,080 0 19,793
(16) Mark Reifsteck
Division CEO
52.5     X       0 417,093 161,140
(17) Salil K Gupta
Chief Medical Officer
70.0       X     474,639 0 52,376
Form 990 (2010)
Form 990 (2010)
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 (check all that apply)
(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) Robert S Miller
Chief Operating Officer
70.0       X     195,895 0 83,286
(19) Illa J David
Division CIO
52.5       X     140,957 0 13,888
(20) Alice Chatley
Chief Nursing Officer
70.0       X     175,343 0 30,289
(21) Edward Jacquin
Asst Admin-Support Svcs
70.0       X     140,569 0 25,858
(22) Shelley Harris
Chief Nursing Officer
70.0       X     81,535 0 46,908
(23) Terrence Wade MD
Chief Medical Officer
70.0       X     0 0 0
(24) James Rushford
Physician
70.0         X   602,093 0 46,310
(25) Donald Johnston
Physician
70.0         X   576,682 0 40,068
(26) David Haymes
Physician
70.0         X   447,269 0 36,282
(27) Christopher Arett
Physician
70.0         X   289,255 0 12,663
(28) James Burke
Division VP of Legal Services
52.5         X   174,982 0 34,530
(29) Kevin Shrake
Former CEO
0.0           X 0 348,685 74,999


1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 3,705,652 1,492,148 828,096
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 in reportable compensation from the organizationMediumBullet34
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.
(A)
Name and business address
(B)
Description of services
(C)
Compensation
ERLINGER CONSTRUCTION CO
2502 S Belt West
BELLEVILLE,IL62226
construction 4,616,554
PROFESSIONAL THERAPY SVC INC
2810 Frank Scott Pkwy West Suite 8
BELLEVILLE,IL62223
therapist staffing 3,675,133
SODEXO OPERATIONS LLC
4880 Payshere Circle
CHICAGO,IL60674
food service 1,979,904
SLU CARE
1402 S Grand Blvd
ST LOUIS,MO63104
physician services 1,285,818
SOUTHERN IL CARDIOVASCULAR
211 S Third
BELLEVILLE,IL62220
cardiovascular svcs 642,000
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization MediumBullet35
Form 990 (2010)
Form 990 (2010)
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 366,018
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above
1f
 
g Noncash contributions included in lines 1a-1f:$  
h Total. Add lines 1a-1f.......MediumBullet 366,018
 Program Service Revenue Business Code
2a NET PATIENT REVENUE 900,000 171,185,016 171,185,016    
b PHARMACY 446,110 752,184 752,184    
c HEALTH PROGRAMS 900,000 29,155 29,155    
d ONCOLOGY CENTER INCOME 900,000 1,416,092 1,416,092    
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 173,382,447
 Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 2,250,096     2,250,096
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties............MediumBullet 0      
(i) Real (ii) Personal
6a Gross Rents 1,340,515  
b Less: rental expenses 2,200,388  
c Rental income or (loss) -859,873  
d Net rental income or (loss).......MediumBullet -859,873     -859,873
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory   66,150
b Less: cost or other basis and sales expenses   66,548
c Gain or (loss)   -398
d Net gain or (loss)..........MediumBullet -398     -398
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 PURCHASE DISCOUNTS   512,405     512,405
b CAFETERIA SALES 722,210 484,909     484,909
c ADMINISTRATION INCOME   459,794     459,794
d All other revenue .... 460,701   20,071 440,630
e Total. Add lines 11a–11d ......MediumBullet 1,917,809
12 Total revenue. See Instructions....MediumBullet 177,056,099 173,382,447 20,071 3,287,563
Form 990 (2010)
Form 990 (2010)
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).
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII.
(A)
Total expenses
(B)
Program service expenses
(C)
Management and general expenses
(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the U.S. See Part IV, line 21 0  
2 Grants and other assistance to individuals in the U.S. See Part IV, line 22 0 0
3 Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 15 and 16 0  
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 1,247,544 527,301 720,243  
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 58,750,189 50,726,399 8,023,790  
8 Pension plan contributions (include section 401(k) and section 403(b) employer contributions) .... 4,420,734 3,776,459 644,275  
9 Other employee benefits ....... 12,546,117 10,098,139 2,447,978  
10 Payroll taxes ........... 4,250,833 3,631,487 619,346  
11 Fees for services (non-employees):        
a Management ...... 3,051,402   3,051,402  
b Legal ......... 1,410,890   1,410,890  
c Accounting ........... 0      
d Lobbying ........... 0      
e Professional fundraising. See Part IV, line 17.. 0  
f Investment management fees ...... 0      
g Other .......... 26,879,397 21,400,084 5,479,313  
12 Advertising and promotion .... 177,561 122,384 55,177  
13 Office expenses ....... 1,845,519 1,431,934 413,585  
14 Information technology ...... 7,337,437 71,339 7,266,098  
15 Royalties .. 0      
16 Occupancy ........... 4,440,631 3,864,889 575,742  
17 Travel ............ 112,794 73,499 39,295  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 100,558 52,099 48,459  
20 Interest ........... 192,167   192,167  
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 9,313,369 8,919,752 393,617  
23 Insurance .............. 3,372,139 2,731,433 640,706  
24 Other expenses. Itemize expenses not covered above. (Expenses grouped together and labeled miscellaneous may not exceed 5% of total expenses shown on line 25 below.)
a PROVISION FOR BAD DEBTS 24,296,785 24,296,785    
b MEDICAL SUPPLIES 23,863,365 23,863,365    
c LICENSE AND TAXES 6,831,922 6,814,412 17,510  
d MAINTENANCE & REPAIRS 5,248,122 4,769,258 478,864  
e DUES, BOOKS AND SUBSCRIPTIONS 428,677 113,968 314,709  
f All other expenses        
25 Total functional expenses. Add lines 1 through 24f 200,118,152 167,284,986 32,833,166 0
26 Joint costs. Check here MediumBullet if following
SOP 98-2 (ASC 958-720). Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation
       
Form 990 (2010)
Form 990 (2010)
Page 11
Part X Balance Sheet
(A)
Beginning of year
(B)
End of year
Assets 1 Cash—non-interest-bearing ..........   1  
2 Savings and temporary cash investments ....... -1,784,789 2 -2,050,973
3 Pledges and grants receivable, net ......... 4,913,810 3 935,530
4 Accounts receivable, net ......... 25,707,708 4 23,000,542
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..........   5  
6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
Schedule L ..........   6  
7 Notes and loans receivable, net ............. 1,706,906 7 464,693
8 Inventories for sale or use .............. 2,700,040 8 2,400,379
9 Prepaid expenses and deferred charges ............ 1,684,056 9 1,490,338
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 201,545,359
b Less: accumulated depreciation. ..... 10b 137,494,118 61,642,026 10c 64,051,241
11 Investments—publicly traded securities .......... 65,888,347 11 32,839,677
12 Investments—other securities. See Part IV, line 11 ......   12  
13 Investments—program-related. See Part IV, line 11 .. 4,678,593 13 4,344,685
14 Intangible assets ......... 349,631 14 0
15 Other assets. See Part IV, line 11 ........... 552,713 15 512,161
16 Total assets. Add lines 1 through 15 (must equal line 34)... 168,039,041 16 127,988,273
Liabilities 17 Accounts payable and accrued expenses . 15,942,972 17 14,382,276
18 Grants payable ..........   18  
19 Deferred revenue ..........   19 2,130
20 Tax-exempt bond liabilities .......... 49,888,720 20 48,367,764
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22  
23 Secured mortgages and notes payable to unrelated third parties ..   23  
24 Unsecured notes and loans payable to unrelated third parties ....   24  
25 Other liabilities. Complete Part X of Schedule D..... 55,792,035 25 34,153,008
26 Total liabilities. Add lines 17 through 25..... 121,623,727 26 96,905,178
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 ..... 40,981,396 27 24,892,315
28 Temporarily restricted net assets ..... 5,423,387 28 6,146,850
29 Permanently restricted net assets ..... 10,531 29 43,930
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 ..... 46,415,314 33 31,083,095
34 Total liabilities and net assets/fund balances ..... 168,039,041 34 127,988,273
Form 990 (2010)
Form 990 (2010)
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
177,056,099
2
Total expenses (must equal Part IX, column (A), line 25) . . . . .
2
200,118,152
3
Revenue less expenses. Subtract line 2 from line 1 . . . .
3
-23,062,053
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) . .
4
46,415,314
5
Other changes in net assets or fund balances (explain in Schedule O) . . . .
5
7,729,834
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
31,083,095
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
Yes
 
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
Yes
 
Form 990 (2010)
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
2010
Open to Public
Inspection
Name of the organization
ST ELIZABETH'S HOSPITAL
OF THE THIRD ORDER OF ST FRANCIS
Employer identification number

37-0663567
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)
 
 
(ii) a family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
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
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3..            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..            
6 Public Support. Subtract line 5 from line 4.            
Section B. Total Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..            
11 Total support (Add lines 7 through 10).            
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) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public Support (Subtract line 7c from line 6.)            
Section B. Total Support
Calendar year (or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)            
13 Total support (Add lines 9, 10c, 11 and 12.).            
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) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2010
Name of organization
ST ELIZABETH'S HOSPITAL
OF THE THIRD ORDER OF ST FRANCIS
Employer identification number

37-0663567
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule—
Special Rules
......................... Arrow Bullet   $    
Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990, or check the box in the heading of its
Form 990-EZ, or on line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part I
Name of organization
ST ELIZABETH'S HOSPITAL
OF THE THIRD ORDER OF ST FRANCIS
Employer identification number

37-0663567
Part I
Contributors (see Instructions)
     
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Aggregate contributions
(d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED




(Complete Part II if there is
a noncash contribution.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Aggregate contributions
(d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Aggregate contributions
(d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Aggregate contributions
(d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Aggregate contributions
(d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Aggregate contributions
(d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part II
Name of organization
ST ELIZABETH'S HOSPITAL
OF THE THIRD ORDER OF ST FRANCIS
Employer identification number

37-0663567
Part II
Noncash Property (see Instructions)
     
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part III
Name of organization
ST ELIZABETH'S HOSPITAL
OF THE THIRD ORDER OF ST FRANCIS
Employer identification number

37-0663567
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
aggregating more than $1,000 for the year. (Complete columns (a) through (e) and the following line entry.)
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet $  
(a) No.
from
Part I
(b)
Purpose of gift
(c)
Use of gift
(d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I
(b)
Purpose of gift
(c)
Use of gift
(d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I
(b)
Purpose of gift
(c)
Use of gift
(d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I
(b)
Purpose of gift
(c)
Use of gift
(d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Additional Data


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

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

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.
SchCMd Bullet Attach to Form 990 or Form 990-EZ. SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
If the organization answered “Yes,” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes,” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes,” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35a (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
ST ELIZABETH'S HOSPITAL
OF THE THIRD ORDER OF ST FRANCIS
Employer identification number

37-0663567
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 on behalf of or in opposition to candidates for public office 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
$ 0
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$ 0
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 funtion 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) 2010

Schedule C (Form 990 or 990-EZ) 2010
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check
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) 2007 (b) 2008 (c) 2009 (d) 2010 (e) Total
             
2a Lobbying non-taxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e))
         
             
c Total lobbying expenditures          
             
d Grassroots non-taxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))
         
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2010


Schedule C (Form 990 or 990-EZ) 2010
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
(a)
Yes
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? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
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? ........
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? If "Yes," describe in Part IV ..........................
Yes
 
31,328
j
Total. lines 1c through 1i ...................................
31,328
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 carryover 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) if BOTH Part III-A, lines 1 and 2 are answered “No” OR if Part III-A, line 3 is answered “Yes”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) non-deductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
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, line 5; and Part ll-B, line 1i.
Also, complete this part for any additional information.
Identifier Return Reference Explanation
DESCRIPTION OF OTHER LOBBYING ACTIVITIES SCHEDULE C, PART II-B, QUESTION 1I ST. ELIZABETH'S HOSPITAL ("THE HOSPITAL") IS A MEMBER OF THE CATHOLIC HEALTH ASSOCIATION ("CHA"), THE ILLINOIS HEALTH ASSOCIATION ("IHA"), THE NATIONAL ASSOCIATION FOR HOME CARE AND HOSPICE, AND THE AMERICAN HEALTH ASSOCIATION ("AHA"). AS A MEMBER OF THESE ORGANIZATIONS, THE HOSPITAL PAYS DUES, PART OF WHICH ARE ATTRIBUTABLE TO LOBBYING FEES PAID BY THE ORGANIZATIONS. THE AMOUNT LISTED ABOVE IS THE AMOUNT ATTRIBUTABLE TO THE HOSPITAL FROM ITS DUES PAID.
Schedule C (Form 990 or 990EZ) 2010

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, 11, or 12.
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
ST ELIZABETH'S HOSPITAL
OF THE THIRD ORDER OF ST FRANCIS
Employer identification number

37-0663567
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 may be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit. ...................................
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–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 ........ 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the taxable 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, 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, 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 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) 2010

Schedule D (Form 990) 2010
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 ....      
b Contributions ........      
c Investment earnings or losses ...      
d Grants or scholarships .....      
e Other expenditures for facilities
and programs ........
     
f Administrative expenses ....      
g End of year balance ......      
2
Provide the estimated percentage of the year end balance held as:
a
Board designated or quasi-endowment: SchDMd Bullet  
b
Permanent endowment: SchDMd Bullet  
c
Term endowment: SchDMd Bullet  
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)
 
 
(ii) related organizations ........................
3a(ii)
 
 
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
Investments—Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of investment (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land ................. 0 3,630,755 3,630,755
b Buildings ................ 0 106,481,652 74,831,073 31,650,579
c Leasehold improvements ............ 0 359,390 147,081 212,309
d Equipment ................ 0 73,353,841 57,372,197 15,981,644
e Other ................. 0 17,719,721 5,143,767 12,575,954
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........SchDMdBullet 64,051,241
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
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    
Other








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








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








Total. (Column (b) should equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Amount
Federal Income Taxes 0
ACCRUED BENEFIT LIABILITY 23,303,123
RETIREMENT OBLIGATION ASBESTOS 8,021,701
SELF INSURANCE COST 2,828,184






Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)Small Bullet 34,153,008
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1  
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2  
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3  
4 Net unrealized gains (losses) on investments .......................... 4  
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV) ................................. 8  
9 Total adjustments (net). Add lines 4 - 8 ............................. 9  
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10  
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV): ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIV): ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total Revenue. Add lines 3 and 4c. (This should equal Form 990, Part I, line 12.) ...... 5  
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIV): ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIV): ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This should equal Form 990, Part I, line 18.) ...... 5  
Part XIV
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
ASC SUBTOPIC 740-10   ON JULY 1, 2007, HSHS ADOPTED ASC SUBTOPIC 740-10, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES - AN INTERPRETATION OF FASB STATEMENT NO. 109. ASC SUBTOPIC 740-10 ADDRESSES THE DETERMINATION OF HOW TAX BENEFITS CLAIMED OR EXPECTED TO BE CLAIMED ON A TAX RETURN SHOULD BE RECORDED IN THE CONSOLIDATED FINANCIAL STATEMENTS. UNDER ASC SUBTOPIC 740-10, HSHS MUST RECOGNIZE THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY THE TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE TAX BENEFITS RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS FROM SUCH A POSITION ARE MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50% LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT. ASC SUBTOPIC 740-10 ALSO PROVIDES GUIDANCE ON DERECOGNITION, CLASSIFICATION, INTEREST, AND PENALTIES ON INCOME TAXES, ACCOUNTING IN INTERIM PERIODS AND REQUIRES INCREASED DISCLOSURES. AT THE DATE OF ADOPTION, AND AS OF JUNE 30, 2011 AND 2010, HSHS DOES NOT HAVE A LIABILITY FOR UNRECOGNIZED TAX BENEFITS.
Schedule D (Form 990) 2010

Additional Data


Software ID:  
Software Version:  




SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
ST ELIZABETH'S HOSPITAL
OF THE THIRD ORDER OF ST FRANCIS
Employer identification number

37-0663567
Part I
Charity Care and Certain Other Community Benefits at Cost
Yes
No
1a
Does the organization have a charity care policy? If "No," skip to question 6a...........
1a
Yes
 
b
If "Yes," is it a written policy? .......................
1b
Yes
 
2
If the organization has multiple hospitals, indicate which of the following best describes application of the charity care policy to the various hospitals.
3
Answer the following based on the charity care eligibility criteria that applies to the largest number of the organization's patients.
a
Does the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care to low
income individuals? If "Yes," indicate which of the following is the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Does the organization use FPG to determine eligibility for providing discounted care to low income individuals? If
"Yes," indicate which of the following is the family income limit for eligibility for discounted care: .....
3b
Yes
 
c
If the organization does not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization uses an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.
4
Does the organization's policy provide free or discounted care to the "medically indigent"? ......
4
Yes
 
5a
Does the organization budget amounts for free or discounted care provided under its charity care policy? ...
5a
Yes
 
b
If "Yes," did the organization's charity care expenses exceed the budgeted amount?.........
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discounted
care to a patient who was eligibile for free or discounted care?...............
5c
 
No
6a
Does the organization prepare an annual community benefit report?.............
6a
Yes
 
6b
If "Yes," does the organization make it available to the public? ..............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Charity Care and Certain Other Community Benefits at Cost
Charity Care and
Means-Tested Government Programs
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Charity care at cost (from
Worksheets 1 and 2) ..
    4,761,952 0 4,761,952 2.670 %
b Unreimbursed Medicaid (from
Worksheet 3, column a) .
    30,466,222 22,782,760 7,683,462 4.320 %
c Unreimbursed costs—other means-tested government programs (from Worksheet 3, column b) ....     0 0 0 0 %
dTotal Charity Care and
Means-Tested Government Programs .....
    35,228,174 22,782,760 12,445,414 6.990 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) ....
  7,781 59,207 15,614 43,593 0.020 %
f Health professions education
(from Worksheet 5) ..
    0 0 0 0 %
g Subsidized health services
(from Worksheet 6) ..
    0 0 0 0 %
h Research (from Worksheet 7)     1,871,320 465,595 1,405,725 0.790 %
i Cash and in-kind contributions
to community groups
(from Worksheet 8) ..
  831 40,832 0 40,832 0.020 %
jTotal Other Benefits ...   8,612 1,971,359 481,209 1,490,150 0.830 %
kTotal. Add lines 7d and 7j. ..   8,612 37,199,533 23,263,969 13,935,564 7.820 %
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 2
Part II
Community Building Activities Complete this table if the organization conducted any community building activities.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue
(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support 7 485 4,918   4,918 0 %
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building 1 362 5,792   5,792 0 %
7 Community health improvement advocacy            
8 Workforce development 1 185 28,777   28,777 0.020 %
9 Other            
10 Total 9 1,032 39,487   39,487 0.020 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Does the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense (at cost).....
2
7,823,564
3
Enter the estimated amount of the organization's bad debt expense (at cost) attributable to patients eligible under the organization's charity care policy ..
3
0
4
Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
65,095,686
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
71,734,465
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
-6,638,779
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.
Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.
Check the box that describes the method used:
Section C. Collection Practices
9a
Does the organization have a written debt collection policy? ...............
9a
Yes
 
b
If "Yes," does the organization's collection policy contain provisions on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance? Describe in Part VI......
9b
 
No
Part IV
Management Companies and Joint Ventures
(a) Name of entity (b) Description of primary
activity of entity
(c) Organization's
profit % or stock
ownership %
(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership%
(e) Physicians'
profit % or stock
ownership %
1Mem & St Eliz's
 
HEALTHCARE 50.000 % 0 % 0 %
2Healthcare svs
 
       
3Southern Illinois
 
Facilitate cardiovascular svs 50.000 % 0 % 0 %
4cardiovascular fac
 
       
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 3
Part VFacility Information
Section A. Hospital Facilities
(list in order of size, measured by total revenue per facility, from largest to smallest)
How many hospital facilities did the organization operate during the tax year?1
Name and address
Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe)
1 St Elizabeth's Hospital - Belleville
211 South Third Street
Belleville,IL622201998
X                
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:St Elizabeth's Hospital - Belleville
Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 7
Part VFacility Information (continued)

Section C. Other Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, measured by total revenue per facility, from largest to smallest)
How many non-hospital facilities did the organization operate during the tax year?  
Name and address Type of Facility (Describe)
1
2
3
4
5
6
7
8
9
10
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 8
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the description required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 2, 4c, 6i, 7, 11i, 13i, 17l, 18l, 19e, 21d, 25, and 26.
2 Community health needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any community health needs assessments reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Identifier ReturnReference Explanation
Part I, Line 3c   NOT APPLICABLE AS THE ORGANIZATION DOES FOLLOW FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY FOR PROVIDING CHARITY AND DISCOUNTED CARE TO LOW-INCOME UNINSURED AND UNDERINSURED INDIVIDUALS.
Part I, Line 6a   The hospital's community benefit report is available upon request. Please contact Tom Vernier at 618-641-5466.
Part I, Line 7g   Not applicable as the hospital does not have any subsidized health services.
Part I, Line 7, column (F)   The percent of charity care and certain other benefits at cost as a percent of total expense less bad debt is 7.83%. The amount of bad debt expense removed when calculating the percentages in Part I, Line 7, Column (F) was $24,296,785.
Part I, Line 7   Charity care is calculated by determining the total amount from patient billing that is written off to charity care charge codes or allowances. This amount matches the number that is reported on our fiscal year ending 2011 audited financial statements. The total charity care dollar amount is then reduced to cost by applying the Hospital's cost to charge ratio. The cost to charge ratio used was derived by dividing the hospital's operating expenses minus bad debt by net patient service revenue less any non patient care activities.
Part II   An important aspect of community building is representation at the table of community leaders. St. Elizabeth's Hospital has recognized this involvement and participation as two fold. First, it gives this hospital the opportunity to hear first hand the healthcare needs and challenges of this community as perceived by community leaders. Whether it regards the need for more physicians, or supporting an effort within the community and the education institutions of encouraging young people to consider a career in healthcare. These are the types of discussions that need to be heard and mutual support is necessary. Second, when a need is identified, this representation puts us in direct contact with those who have identified the need. This leads to opportunities to build collaboration, and helps strengthen the concept that healthy communities is not only a community need, but also an individual need. Hospitals can only be a part of such effort. Good health applies to all the residents in the village. St. Elizabeth's recognizes that as a healthcare leader, it has the resources, the knowledge, and support material which addresses these needs. Currently St. Elizabeth's Hospital has a member on the Belleville Chamber of Commerce and its subcommittee on healthcare in the greater Belleville area. We also have representation on the Board of Directors of the local YMCA, on two of the Hospice Organizations serving this community, on the Leadership Council of Southern Illinois, active participation with the St. Clair County Board of Commissioners on Pioneering Healthy Communities. The Belleville Diocese conducts meetings of all the healthcare agencies in this Diocese which serves 28 counties adjacent to Indiana, Kentucky, and Missouri. This coalition offers a forum for all the hospitals and Catholic Charities to identify healthcare needs and to share the activities of each agency. Although some of the Diocesan agencies concentrate on serving the poor in these extremely southern counties, many times those needs can be met through a cooperative effort among the participating agencies. In the past, St. Elizabeth's has offered educational programs, and provided informational material to areas where resources are limited. In the past year, St. Elizabeth's conducted two food drives to benefit local pantries and military families whose chief breadwinner was deployed. St. Elizabeth's has worked jointly with the St. Clair County and its Mental Health Board in designing and sponsoring an annual community conference. The conference has adopted the brand of Removing the Stigma from behavioral health. Behavioral health needs exist in all communities. Some of these needs can be met through treatment. Some of the needs are more in the way of education. This involves educating the public to the challenges of patients and family members dealing with a mental condition, understanding the importance of support and where that support can be found, and gaining insight into serving those with behavioral challenges. St. Elizabeth's has developed a strong working relationship with area colleges and some of the area high schools. One example of high school participation is the annual service program. This is a three-week experience where seniors in high school must choose a community service institution, and then volunteer full-time doing a variety of assignments in order to get an understanding of what that service does. This program is required for graduation. This is becoming more and more popular, as it is now being built into the curriculum for students in advanced classes. On the college level, St. Elizabeth's maintains over thirty college affiliation agreements. Interns from nursing, radiology, respiratory therapy, and physical therapy fulfill their required internship training. This training can be formal through classroom instruction or informal through simply observing medical care in the area of studies. There is no compensation associated with these affiliations. The learning experience is so critical to their process of becoming healthcare professionals. St. Elizabeth's has two in-house affiliations. Although the space for these programs is reimbursed, it is the value of all the resources that support these programs which are indirectly a contribution to the community. These students are already shouldering a full academic load. Having access to St. Elizabeth's for their internships certainly reduces their time and travel. The Respiratory Therapy program has a classroom and a lab training room in the hospital. Also on the campus of St. Elizabeth's is a General Practice Residency Program under the auspices of St. Louis University. This is a joint military/civilian residency program. There is an average of 42 residents in the program with half of them coming from the nearby Scott Air Force Base. Rated as one of the top medical residencies in the state of Illinois, this residency program has provided the training which has directly impacted the local area. Many of the graduates have elected to remain in the area, serving especially the rural communities surrounding Belleville. Improving access to healthcare is truly a benefit to any community when a physician chooses to establish a practice serving a rural community. St. Elizabeth's Hospital is in the downtown district. It is the oldest part of town. Within eight blocks of the hospital in all directions are elementary schools with exceptional needs. Managers from St. Elizabeth's give up their time monthly to visit a school. They each are assigned a student who may be experiencing a skills difficulty or is surviving in a dysfunctional environment. Having lunch with the students, listening to their reading or spelling assignment, or simply listening to their life trials is something that is very important to the students. This need is not always met by other factors in the students' lives. In fact, some true friendships have developed through this program, and their mentors have maintained that relationship outside of school hours by including a student on a trip to a local entertainment or attraction. Due to budget limitations, these students were lacking recess supplies. What good is a basketball standard if there is no ball? Those needs were brought to the management team at St. Elizabeth's and personal donations quickly filled that need. How can you measure the needs of mentoring, listening, and caring? These are needs every child has. The highlight of each year is when the mentors and students are introduced at a regular management huddle and they are treated to a grand tour of the hospital.
Part III, Line 4   The hospital strongly believes that its charity care, and the related community benefit obtained from such care, is understated because of those patients that potentially qualify for charity care but do not wish to apply for it. In addition, some care is not classified as charity due to missing documentation on patient resources. Thus, the hospital's bad debt includes a portion that could be classified as charity care if application for such care was sought and/or completed. Currently, the hospital is implementing processes, procedures and systems to more effectively determine charity care that will reduce a patient's documentation requirements and ease the patient's emotional burden in applying for charity care. This will provide a more accurate reporting of charity care services provided by the hospital. During the year, the hospital's bad debt expense (at cost) was $7.8 million. We believe that approximately 10% of this amount is owed by individuals who may qualify for charity care.
Part III, Line 8   The hospital continually strives to provide excellent patient care in the most cost effective fashion. Nonetheless, the Medicare program, in many cases, does not provide payment that covers the full cost of the care provided. Since it is the mission of the hospital to respond to community need, hospital management continually advocates for improved Medicare payment so that the cost of quality care to those patients that are not able to afford it is not compromised and is fairly subsidized by all payers. During the year, the hospital provided $6.6 million (at cost) in excess of Medicare payments. While this shortfall in Medicare payments is not classified as community benefit by the IRS, we nonetheless believe it is an important contribution made by the hospital to the health and well being of the community. Our mission calls us to serve all patients with the highest possible quality and efficiency, even if we are not paid fully for doing so.
Part III, Line 9b   Any patient accounts that are sent to a collection agency have an opportunity to complete a financial application for Charity/Christian Care if the patient makes a request or if the collection agency feels the patient may meet criteria. If an account meets the qualifications for financial assistance, St. Elizabeth's will recall the account from bad debt, open the account back up on the hospital's books, and adjust the appropriate amount off to charity care.
Needs Assessment   St. Elizabeth's Hospital - Belleville - established a formal Community Benefit Committee in January, 2009. This committee consists of interdisciplinary department representatives and community representatives. The Community Benefit Committee consists of seventeen members and meets bi-monthly to assess progress on the goals and targets established for each fiscal year. With a cross-section of community representatives along with hospital leadership, the Community Benefit Committee truly has the appropriate resources and access to relevant data and information to build, coordinate, and offer programs and education which meets the health needs of St. Clair County and the four adjacent counties in our service area. The Commission's focus this year has been developing the strategic assessment and implementation plan for the St. Clair County Health Department's IPLAN 2010 - 2015. St. Elizabeth's actively participated in the design and the assessment. As part of the assessment, a Quality of Life in St. Clair County survey was conducted. St. Elizabeth's served as the host for the community's open forum. The Community Benefit Committee members helped in the Quality of Life survey by completing that survey and making it available to colleagues and hospital visitors. The Quality of Life survey analyzed 1,500 responses to thirteen questions. The study was designed and orchestrated by the Southern Illinois University - Edwardsville, School of Nursing. DATA SOURCES AND FINDINGS: St. Elizabeth's Hospital determines community needs through a collaborative community process directed by the St. Clair County Healthcare Commission. The hospital then incorporates new data and area health assessments into each year's strategic planning process. This year the committee had the most recent demographic healthcare report from St. Louis Division of United Way, the latest study from the Illinois Behavioral Risk Factor Surveillance Report, and the assessment of local communities study produced by the Missouri Hospital Association in 2010. St. Elizabeth's Hospital is included in the metropolitan statistical area ("MSA") study. In addition, St. Elizabeth's used data generated by the University of Wisconsin County Health Rankings which was released in 2011. Information from the Center for Disease Control and Prevention was collected and shared by students at McKendree University as part of this report. Recent statistics and studies indicate there are many opportunities to improve the community's health in St. Clair County and surrounding counties of Madison, Monroe, Clinton, and Bond County. In health outcomes, St. Clair ranked 94th of 102 Illinois counties. In health risk factors, St. Clair ranked 100th among the same population of counties. Findings were not much better in the categories of mortality and morbidity; St. Clair County ranked 96th in mortality and 93rd in morbidity. These rankings coincide with the health behavior rankings where studies show St. Clair County is 101st of 102 counties. The major causes of death in St. Clair County have not seen any significant changes over the past two decades. The latest statistics from the Illinois Department of Public Health show that there were 25,979 deaths in Illinois in 2008 due to heart disease. Heart disease is followed by cancer and cerebrovascular diseases and chronic lower respiratory diseases. This data has some unique breakouts. Among the ages of 5-44, the leading causes of death are motor vehicle accidents and other accidents (total mortality figures for these age groups - 1,694) followed by malignant neoplasms, assault, intentional self-harm, and then diseases of the heart. For those 45 to 64 of age, the leading cause is malignant neoplasms (total mortality figures for this age group - 6,601) followed by heart and then accidents (motor vehicle and other). But again the largest cause of death in Illinois for those ages of 65 and older is disease of heart at 20,675 followed by malignant neoplasms at 16,834 and cerebrovascular diseases at 4,952. One further breakout of the local study is suicide. It is the third leading cause of death for persons aged 15-24 years in St. Clair County. This is becoming a serious concern of local health officials. All of the studies that the Community Benefit Committee reviews mirrors our internal records which show that in 2009, heart related (Diagnosis Related Groupings) DRGs were among the top twenty admitted to St. Elizabeth's. These included heart failure, cardiac arrhythmia, chest pain, and acute myocardial infarction. Of the top twenty total cases admitted to St. Elizabeth's Hospital in 2009, 642 were heart related, or 24% of patients admitted. This was followed by psychoses and various forms of respiratory conditions. A significant change of strategy has occurred with the development of the new 2010 IPLAN. In the past, focus by providers was the reduction of mortality but in an indirect manner. Much attention was devoted to educating the general public about health risks. The new focus is still on public health education but with a laser focus on specific populations and personal prevention. This new approach will be elaborated on later in this report. Blood pressure checks were made available whenever St. Elizabeth's participated in a health fair. A blood pressure check provides the patient a snapshot of their current status but frequently we did not pursue the many causes of this abnormality. Today, we continue to offer blood pressure checks, but spend more time in educating the participant on the contributing factors of high blood pressure. That shift in strategic action is truly in the prevention modality. If we can counsel an individual to choose a healthy diet, eliminate a habit of tobacco use, or direct them to activity centers, we can lower that hypertension, reduce long term healthcare costs and saving the government's reimbursement, and extend the quality life of the individual. As a leading provider in healthcare in this county, St. Elizabeth's has the expertise, resources, and credibility to sponsor community education programs such as lunch with a doctor. This approach underscores the role of St. Elizabeth's Hospital in increasing health care knowledge and ultimately improving the overall health of the communities we serve.
Patient Education of Eligibility for Assistance   As unemployment rises, the number of uninsured patients coming to St. Elizabeth's likewise increases. According to the most recent Illinois Department of Employment Security, St. Clair County has a labor force of 124,858; 111,192 are employed; 13,666 are unemployed. A health insurance study (2009) showed that there were 30,287 adults uninsured. This is 13.5% of the total population in St. Clair County, an increase of 1.8% since 2005. This population puts additional stress on the emergency room resources and impacts our annual Charity Care totals. The number of emergency room visits for FY - 2011 exceeded the previous year's total by 115. Recognizing this influx, special efforts have been put in place to direct those patients unable to afford their care to other resources. Information about how to apply for Christian Assistance is included on the Patient Information Guide which is given to all patients admitted. It is also printed on the bills and monthly guarantor statements which are mailed to the patients. Self Pay (uninsured) inpatients, St. Elizabeth's has contracted with Accordis to assist the uninsured inpatients. Accordis representatives visit uninsured patients and discuss their possibility of applying for Medicaid coverage. Accordis will assist the patient with the application, follow up on requests from Medicaid, conduct home visits with the patient if needed, when they need to file an appeal, and assist with any other qualifying conditions required. If during a visit with a patient, it is determined they do not qualify for Medicaid, then the patient is provided one of St. Elizabeth's Charity (Christian Assistance) applications. Particular attention has been increased for those non-emergent patients seeking hospital care but are lacking the financial resources. These patients are assisted by financial counselors in completing the appropriate applications in order to qualify for care and receive assistance.
Community Information   HEALTH RISK FACTORS FOR ST. CLAIR COUNTY: When one looks at the raw statistics one must consider the health factors which are contributing to the leading causes of mortality and morbidity. Heart disease is preventable. Understanding and incorporating specific behaviors will reduce the incidence of high cholesterol, high blood pressure, diabetes, unhealthy eating habits, physical inactivity, obesity, extreme alcohol intake, use of tobacco products, not to mention one's family history. Use of tobacco products is a major health risk. In some aspects, St. Clair County has seen significant improvements in the reduction of tobacco use. Surveys of 2004-06 indicated that 20% of the adults surveyed were regular smokers. In the most recent survey of 2007-09, there was a 5% reduction in usage; 15% surveyed were regular smokers. Examining our own database of patients admitted, we are able to identify patients who are regular tobacco users. Each of these regular users are visited by a respiratory therapist to discuss and encourage smoking cessation. There is an average of 250 patient visits each month. As part of an information packet, the patient is given a list of local resources should the patient want to pursue cessation. The St. Clair County Health Department also has resources which are available at no cost and the hospital often directs patients to the health department. Obesity is a national health concern. Being obese or overweight is the second leading cause of preventable death in the United States and is measured by body mass index (BMI), a person's weight to height ration. Overweight is defined as having a BMI over 25 and obese is defines as having a BMI above 30. The most recent Premature Mortality Rates (<65 years of age) indicate that over 30% of St. Clair County Adults are considered overweight; slightly under 30% are considered obese. Studies have also found that for the past 13 years in St. Clair County, over 80% of adults have not been getting their recommended daily intake of fruits and vegetables. St. Elizabeth's provides nutritional counseling as part of our patient care plans. In addition, we offer outpatient guidance by registered dietitians for the community. During FY 2011, our dietitians conducted 4,108 nutritional assessments. It is estimated that 600 of those visits had a co-morbidity due to obesity or overweight according to national benchmarks. ST. CLAIR COUNTY DEMOGRAPHICS: Comparison of Select Demographic, Bio-statistical & Behavioral Data St. Clair Co Illinois based on the 2010 census Characteristic St. Clair County Illinois Total Population 270,056 12,910,409 % Male 47.8% % Female 52.2% Age Median Age 35 years Persons 18 years > 74.7% Persons 65 years > 12.6% Race % White 64.6% 79.0 % Black 30.5% 14.9 % Asian 1.2% 15.2 % Hispanic 3.3% Median Household Income $46,368 $53,974 Population Below Poverty 17.1% 13.3% Crude Coronary 2006 Mortality Rate/100,000 173.9 149.0 Premature Coronary 2006 Mortality Rate/100,000 42.6 34.2 % Adults Obese & Overweight 60.9 62.0 % Adults Not Meeting Physical Activity Standards 63.0 63.0 % Adults Eating <5 Fruits / Vegetables / day 83.6 75.0 According to the 2009 estimates of the Social Impact Research Center, the demographic make-up of St. Clair County is 64.6% white, 30.5% black and 7% other. The poverty rate for St. Clair County increased to 17% from 39,468 in 2008 to 44,516 in 2009. This is not statistically significant until one compares the most recent numbers with those of 1999 which was 36,468. The number of people in extreme poverty increased from 16,779 in 2008 to 18,611 in 2009. What is just as alarming is the number of children in poverty which rose again in 2009 to 17,088. The current unemployment rate is 9.7%. All of these social and economic factors have an impact on the health of St. Clair County. A comparison of 2000 to 2007 data of premature deaths under the age of 65 years for Illinois and St. Clair County residents show mortality rates (per 100,000 population) with calculated percent differences that are significantly higher for residents of St. Clair County than their Illinois counterparts for the following causes of death: Breast Cancer (20% higher), Lung Cancer (31.6%), HIV/AIDS (33.3%), Heart Failure (129.4%), Hypertension (209.1%), Stroke (38%), Chronic Obstructive Pulmonary Diseases (125%), Diabetes mellitus (143.1%), Motor Vehicle Fatalities (41.3%), Suicide (50%) and Homicide (87.5%). The increase of incidence of heart failure, which had been at 106.8% and hypertension, previously reported at 96.1% underscores the importance of public education, diet modification, healthy activity levels, and the reduction of the use of tobacco. With the most recent statistics of specific diseases and societal health conditions, the task of St. Elizabeth's Community Benefit committee will be to design a strategy that focuses on prevention specific to heart disease. The risk factors have been clearly spelled out by the Centers for Disease Control and Prevention. Each of those factors will be reviewed by the St. Elizabeth's Community Benefit Committee to assess which of those factors we have the resources and expertise to focus on in collaboration with the local health department. For example, use of tobacco is identified as part of a patient's record. As part of our patient care plan, each patient who acknowledges a tobacco use is visited by either a nurse or a respiratory therapist. In the new fiscal year, St. Elizabeth's will be able to refer patients interested in smoking cessation to the Cancer Treatment Center to acquire free nicotine replacement therapy. Our registered dieticians visit the majority of patients. There are many opportunities to improve the community's health status within the hospital's walls - they are our patients who trust us with their care. Obesity is another key health issue for the population of St. Clair County. Being obese (or even just overweight) is the second leading cause of preventable death in the United States and is measured by body mass index ("BMI"), a person's weight to height ration. Overweight is defined as having a BMI over 25 and obsess is defined a s having a BMI above 30. In St. Clair County, almost a third of adults are overweight, and nearly 28 percent are considered obese. This issue is of particular concern because obese and overweight individuals are at a much higher risk of suffering from various chronic conditions.
Promotion of Community Health   FURTHERING TAX EXEMPT PURPOSE: St. Elizabeth's Hospital offers hope to our community in the tradition of the Hospital Sisters of St. Francis. St. Elizabeth's provides quality medical healthcare regardless of race, creed, sex, national origin, handicap, age, or ability to pay. Although reimbursement for services rendered is critical to the operation and stability of St. Elizabeth's Hospital, it is recognized that not all individuals possess the ability to purchase essential medical services. It is our mission is to serve the sick, especially the poor, with quality healthcare services and healthcare education. We have further defined our mission of identifying those who are at greatest health risk, the elderly, children, expectant mothers and neonates, those coping with mental illness, and those with less means who deserve and depend on quality healthcare. St. Elizabeth's Hospital takes a proactive role in educating its communities on wellness programs, sponsoring health screenings, collaborating with the local health district in targeting local health concerns, sponsoring health presentations by our medical staff at a local senior center, making available flu immunizations at local community sites, and organizing support groups. REINVESTING IN THE NEEDS OF THE COMMUNITY: Because of the hospital's purpose and tradition, it is organized to promote the health of Belleville and the surrounding areas. The hospital is governed by a Board of Directors, the majority of which is comprised of persons who reside in the organization's primary service area and who are neither employees nor contractors of the hospital (nor family members thereof.) The Board ensures that St. Elizabeth's is responding to the community need in accordance with the process described in Sources and Data. Also consistent with its exempt status, St. Elizabeth's has an open medical staff with privileges available to all qualified physicians in the area. As a not-for-profit hospital, St. Elizabeth's reinvests surplus funds into the mission of the organization and health of the community rather than distributing them as profits to shareholders or individuals. Funds not committed to ongoing operation are generally used to upgrade facilities, secure new technologies, improve patient care, and support initiatives designed to promote health and ensure access for all. The hospital's focus on improving health status for cardiac care, maternal and child health, and behavioral health are all examples of how the hospital is responding to community need. As described earlier, St. Elizabeth's is concentrating on quality of our cardiac services by meeting and/or exceeding standards of care. Our door-to-balloon time is an area in which we have consistently exceeded the national standard. Over the past two years, we have exceeded the national benchmark of 90 minutes with an average Door to Balloon time of 65 minutes. We also have begun targeting the female population - that age group in particular that is at greater risk than their male counterparts - primarily through education. In the hospital's core measures, our acute myocardial infarction ("AMI") care has been at 100% compliance in FY - 2011. St. Elizabeth's is in the process of establishing a direct relationship with Prairie Heart Institute - Springfield, IL which is in the top 10% of heart attack care. Heart disease is a health threat in this community and St. Elizabeth's continues to strengthen its position as a leader in heart care. PROVIDING A WIDE RANGE OF COMMUNITY BENEFITS: St. Elizabeth's Hospital provided 50,674 adult and pediatric days of care and had 173,488 outpatient visits during FY 2011. During this period, St. Elizabeth's provided in excess of $13.9 million to support our commitment to the community. Included in this total was $4.7 million at cost of healthcare for individuals unable to afford their care. St. Elizabeth's Hospital also provided care to persons covered by governmental programs at or below cost. This resulted in providing $6.6 million of healthcare to Medicare and $7.7 million to Medicaid patients which was not reimbursed. This resulted in a total of $14.3 million healthcare provided for these two groups. Included in the total was the extensive number of free educational programs, screenings, clinical services and consultations provided at a reduced fee or at no charge to other healthcare agencies and human service agencies in our service area. To the extent that reimbursement was below cost, St. Elizabeth's Hospital recognized these expenses as a cost of fulfilling its mission for the entire community. Included in the above figures are the following initiatives aimed at improving access and promoting health for the people of Belleville and surrounding communities. HEALTH SCREENINGS: * Blood pressure screenings * Car seat inspections, installations, and free car seats * Lung Function screenings * Cardiac screenings at reduced fee * Skin cancer screening * Alzheimer's Disease screening * Anxiety screening * Depression screening * Alcohol screening * Cholesterol screening * Stroke Screening - carotid ultrasound screening at reduced fee * Alcohol Abuse Screenings EDUCATIONAL PROGRAMS: * Student internships with numerous colleges and universities * A work-study program for mentally challenged high school students * Tours for high school students * Healthcare Professions Shadowing * Student volunteer programs (senior community project) * Prenatal classes * Lamaze classes * Mother Child Tours for Expectant Mothers * Adult, infant and child CPR classes * Nutrition classes * Aging conference * Ethics conference * Nursing support for school physicals * Variety of programs for seniors at the PSOP center * Lunch with a Doctor - ten programs NUTRITIONAL SUPPORT: * Meal coupons for the homeless and indigent * Food items collected and donated to needy families and to an interdenominational food pantry in Belleville and to families of deployed soldiers * Clothing collected and donated to the Violence Prevention Center, Pregnancy Care Center, and Catholic Urban Program * Food coupons to local grocery stores * Diabetic Nutritional Counseling * Free prescriptions for patients unable to pay * Bus passes and cab fare SUPPORT GROUPS: * St. Elizabeth's sponsors ten support groups and meetings * Diabetic Support Group * Memorial services for deceased family members * Compassionate Friends * Manic Depressive * Recovery, Inc. (support for those dealing with nervous symptoms and fears) * Parkinson Support Group * Life After Breast Cancer * Alcoholics Anonymous Sponsorship * Mended Hearts * Funeral services conducted by Pastoral Care chaplains * Burial along with graveside services for relatives of fetal/premature deaths * Alzheimer's Support Group * Rehab Support Group * Stroke Support Group * Defibbers Support Group * Narcotics Anonymous Sponsorship HEALTH FAIRS: * At the community events in St. Clair and Monroe County Co-Op * At senior centers and Our Lady of the Snows Retirement Apts * At area churches * For Women, Go Red for Healthy Heart * For area clergy COMMUNITY INVOLVEMENT: * Wellness clinic at the Programs and Services for Older Persons Center * Provided flu shots to the underserved at no charge * Meeting and conference room space for health/civic groups * Actively participate in programs and services of St. Clair County's Health District * Held leadership role in community civic organizations - Healthcare Providers Committee - Greater Belleville Chamber of Commerce * Participated with community groups by providing healthcare information * Host March of Dimes bi-monthly meetings * Conducted Lay Ministry Training Program for all denominations * Sponsored six blood drives * Cooperated with local judicial court on family violence programs * Provided space and equipment for the Family Visitation Exchange program * Charity consults with pharmacists * CPR classes * Participated on the planning committee for the St. Clair County Health conference * Gave support to the local AIDS support and residence service * Conducted quarterly memorial services and reception for family members of deceased patients * Go Red - February Healthy Heart awareness * Community-wide disaster preparation and drills * Career Days * Gateway Hospital Ethics Committee * Provide graveside services at no charge * Linen donations to area nursing homes and other medical supplies to Mission Outreach * School Mentoring Program * School Supplies for Children residing in the Violence Prevention Center * Food Drive for Local Food Pantry * Clinical education/affiliation with area healthcare programs COLLABORATION WITH OTHER AGENCIES: St. Elizabeth's has been an active leader on the St. Clair County Healthcare Commission, a coalition of 20 major health and human service organizations within St. Clair County. The Commission's main goal has been to identify the health needs of this county's residents and to collaborate with other healthcare providers on strategi
Afilliated Health Care System   St. Elizabeth's Hospital is an affiliate of Hospital Sisters Health System. The mission of Hospital Sisters Health System ("HSHS") is to serve those in need through a health care ministry that values compassion, respect and reverence for life. The nearly 14,000 colleagues who make up HSHS are dedicated to this mission and to providing high quality health care to whoever seeks our services. By living our mission each day, HSHS colleagues constantly strive to provide the highest quality and most cost-effective and compassionate health care to those we are privileged to serve. Our health care ministry extends across 12 communities in Wisconsin and Illinois and includes 13 hospitals, dozens of community-based health centers and clinics, and more than 2,000 physician partners. As part of our mission to provide healing and hope to the three million people we serve, we have developed Community Benefit initiatives that 1) expand access to health care, 2) enhance overall health status and 3) promote medical education. In the Fiscal Year that ended June 30, 2011, HSHS hospitals provided $166.1 million in Community Benefits (or 8.7% of total expenses), an increase of $15.7 million from FY 2010. Of this amount, $37.1 million was provided for charity care and $99.8 million was the amount of unreimbursed care provided under the Medicaid program. In addition, HSHS hospitals committed significant resources in serving the Medicare population. The cost of providing services to primarily elderly beneficiaries of the Medicare program, in excess of governmental and managed care contract payments, was $183.8 million during Fiscal Year 2011. HSHS hospitals also recorded $103.9 million in uncollectible accounts. HSHS strengthens the health of our communities by continually reinvesting any surplus revenue from operations and investments into new medical technology, facility infrastructure and health care services. These investments ensure that our hospitals can continue to provide high quality, compassionate care to our patients. During Fiscal Year 2011, HSHS also continued to invest in our Care Integration strategy that places the patient at the center of our work while allowing us to deliver care in a more cost-effective and efficient manner. These investments are designed to better coordinate care, improve health outcomes, create new efficiencies, and help ensure that patients (especially those with chronic conditions) get well and stay well. Our Care Integration strategy is delivering promising results. An example is our three Medical Home pilot projects. Diabetic Patients enrolled in Medical Homes in rural Illinois experienced an average 42 percent decrease in their blood glucose levels while their unplanned readmissions to the hospital dropped to zero. HSHS is making significant progress implementing interoperable health information technologies and robust health information exchanges. In central Illinois, HSHS is joining with other health care providers to develop a statewide Health Information Exchange ("HIE") that will allow health care providers to exchange clinical information, such as medication histories and test results, access that information at the point of care and make better informed decisions with their patients. HSHS understands that our investments in information technology will have a positive impact on the quality, safety and efficiency of health care. 1. Expanding access to health care An integral component of our Community Benefit initiatives is to provide care to every patient who seeks our services without exception. To that end, HSHS hospitals have established Charity Care program guidelines that cover 100% of hospital charges for individuals and families who earn 125% to 250% of the federal poverty level. HSHS hospital's Charity Care guidelines have sliding scales, in some instances providing up to a 50% discount on charges for those earning up to 600% of the federal poverty level. HSHS hospitals have created simple forms for those wishing to apply for Charity Care and assign counselors to visit with inpatients who are uninsured to let them know about our charity care policies and provide assistance filling out applications for financial assistance or enrollment in publicly funded health care programs. HSHS hospitals also work collaboratively with others to enhance access to health care services for those in need. St. John's Hospital in Springfield, IL has partnered with Memorial Medical Center, Southern Illinois University School and Medicine and other community partners to support the Coordinated Access to Community Health ("CATCH") initiative. The free program is being made available to uninsured adults in Sangamon County to help them access routine medical care, specialty doctors and affordable medicine. Launched in May 2011, CATCH enrolls patients as they visit social service agencies or when they leave hospital emergency rooms. Enrollees are then referred to Springfield's federally funded primary care clinic, Capitol Community Health Center, or participating doctors' private offices. Grants from St. John's Hospital, Memorial Medical Center, United Way of Central Illinois and the Dominican Sisters offset CATCH's first year of expenses. Patient advocates at St. John's Hospital and Memorial Medical Center help uninsured patients find primary or specialty doctors and make appointments, and arrange for financial assistance from participating social service agencies for prescription drugs. In the first three months since the program was launched, CATCH signed up more than 250 physicians in the community who agreed to see patients at no charge. The program endeavors to enroll up to 6,000 uninsured patients within the next few years. By making it easier for uninsured residents to get preventive health care services, CATCH organizers believe uninsured patients' medical problems will be addressed early, helping improve their quality of life. St. Mary's Hospital Medical Center in Green Bay, WI supports the NEW Community Clinic, a 38-year-old free health center for the uninsured and underinsured. St. Mary's provides free and discounted laboratory and radiology services to the clinic. More than 70 percent of patients say the clinic's care allowed them to avoid having to seek care in a local Emergency Room. For the past decade, St. Anthony's Memorial Hospital in Effingham, IL has teamed up with Effingham Catholic Charities to co-sponsor the Prescription Assistance Program. Catholic Charities' staff members work with clients who need prescription medication but may not be able to afford them because they are uninsured or underinsured. Due to the financial support of St. Anthony's, the program is able to provide needed prescriptions to dozens of residents each month. St. Francis Hospital in Litchfield, IL collaborated with local dental care providers to coordinate and provide a free day of dental care to uninsured individuals. The collaboration was the result of a community needs assessment that determined access to dental care was a priority in the community. The "Community Day of Dental Care" provided free dental cleanings, X-Rays, and extractions to 90 uninsured individuals. Among those 90 people served included a military veteran who has been unable to obtain dental care after a St. Louis facility closed. He was able to have five teeth extracted. Another person served was a young woman who needed some minor restorative care which greatly improved her appearance. She was very grateful because she had a job interview coming up and would be able to attend the interview feeling better about her appearance. 2. Enhancing the health status of the community Another component of our Community Benefit initiatives is to improve the quality of life in our communities. Our hospitals work closely with a wide array of public and private organizations that share our commitment to enhancing health and wellness. We know that by working together, we can maximize our efforts by sharing resources, reduce duplication of services, and make it easier for residents to get the services and knowledge they need to live healthier lives. HSHS hospitals also understand they need to listen closely to the residents of the communities they serve to ensure the health care needs of all are being met. Sacred Heart Hospital in Eau Claire, WI invited more than 1,400 area residents to share their vision for health care during a series of focus groups. Participants included constituents that are often overlooked: low-income, vulnerable populations and minority groups. The visioning sessions captured the voices of special populations, Among Mutual Assistance Association members, Amish farmers, seniors, young children and other diverse groups. The feedback provided led to more than 100 actionable items that were assessed and/or implemented over the first six months since the sessions concluded. One action taken by Sacred Heart Hospital and St. Joseph's Hospital in Chippe
STATE FILING OF COMMUNITY BENEFIT REPORT 990 SCHEDULE H, PART VI IL,
Schedule H (Form 990) 2010
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
2010
Open to Public Inspection
Name of the organization
ST ELIZABETH'S HOSPITAL
OF THE THIRD ORDER OF ST FRANCIS
Employer identification number

37-0663567
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 orprovision of all the expenses described above? If "No," complete Part III to explain....
1b
 
 
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
 
 
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.
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
 
No
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
 
No
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 Regs. 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) 2010

Schedule J (Form 990) 2010
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use Schedule J-1 if additional space needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) must equal the applicable column (D) or column (E) amounts on Form 990, Part VII, line 1a.
(A) Name (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits
(E) Total of columns
(B)(i)-(D)
(F) Compensation
reported in prior
Form 990 or
Form 990-EZ
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) Kevin Shrake (i)
(ii)
0
348,685
0
0
0
0
0
66,702
0
8,297
0
423,684
0
0
(2) Linda A Camp MD (i)
(ii)
0
518,499
0
0
0
16,535
0
0
0
14,879
0
549,913
0
0
(3) Salil K Gupta (i)
(ii)
458,139
0
0
0
16,500
0
27,921
0
25,344
0
527,904
0
0
0
(4) Robert S Miller (i)
(ii)
195,895
0
0
0
0
0
78,784
0
5,391
0
280,070
0
0
0
(5) Johnny E Watkins (i)
(ii)
236,604
0
0
0
0
0
30,931
0
10,122
0
277,657
0
0
0
(6) Illa J David (i)
(ii)
140,957
0
0
0
0
0
11,418
0
3,040
0
155,415
0
0
0
(7) Ann Carr (i)
(ii)
0
191,336
0
0
0
0
0
92,165
0
17,377
0
300,878
0
0
(8) Alice Chatley (i)
(ii)
165,343
0
10,000
0
0
0
28,989
0
721
0
205,053
0
0
0
(9) Edward Jacquin (i)
(ii)
140,569
0
0
0
0
0
18,366
0
8,155
0
167,090
0
0
0
(10) Mark Reifsteck (i)
(ii)
0
417,093
0
0
0
0
0
133,800
0
27,340
0
578,233
0
0
(11) James Rushford (i)
(ii)
577,093
0
25,000
0
0
0
25,901
0
21,193
0
649,187
0
0
0
(12) Donald Johnston (i)
(ii)
576,682
0
0
0
0
0
19,221
0
21,604
0
617,507
0
0
0
(13) David Haymes (i)
(ii)
447,269
0
0
0
0
0
30,936
0
5,882
0
484,087
0
0
0
(14) Christopher Arett (i)
(ii)
289,255
0
0
0
0
0
0
0
13,284
0
302,539
0
0
0
(15) James Burke (i)
(ii)
174,982
0
0
0
0
0
9,943
0
25,400
0
210,325
0
0
0

Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
Severance Payment Schedule J, Part I, Line 4a Kevin Shrake received $154,740 as a severance payment during the year for his services as CEO.
Schedule J (Form 990) 2010

Additional Data


Software ID:  
Software Version:  
Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBulletSee separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
ST ELIZABETH'S HOSPITAL
OF THE THIRD ORDER OF ST FRANCIS
Employer identification number

37-0663567
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Description of transaction (c) Corrected?
Yes No





2
Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.
(a) Name of interested person and purpose (b) Loan to or from the organization? (c)Original principal amount (d)Balance due (e) In default? (f) Approved by board or committee? (g)Written agreement?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b)Relationship between interested person and the organization (c)Amount of grant or type of assistance
For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2010
Schedule L (Form 990 or 990-EZ) 2010
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) Chicago Land Of Trust for O'Fallon Owner is Board Member 532,253 Rent   No
(2) Mascoutah Plaza Land of Trust Owner is Board Member 274,615 Rent   No
(3) Professional Therapy Service Owner is Board Member 3,675,133 Staffing   No
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
Schedule L (Form 990 or 990-EZ) 2010

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
2010
Open to Public
Inspection
Name of the organization
ST ELIZABETH'S HOSPITAL
OF THE THIRD ORDER OF ST FRANCIS
Employer identification number

37-0663567
Identifier Return Reference Explanation
Organization's Mission Form 990, Part III, Line 1 The mission of St. Elizabeth's Hospital is to minister to those in NEED OF HEALTHCARE IN RESPONSE TO GOD'S CALL TO SERVE EACH OTHER, ESPECIALLY THE POOR. IN THE PERFORMANCE OF ITS MISSION, ST. ELIZABETH'S HOSPITAL WILL FOSTER THE VALUES OF RESPECT, CARE, COMPETENCE, AND JOY. ST. ELIZABETH'S HOSPITAL IS COMMITTED TO PERFORMING ITS MISSION THROUGH COOPERATION WITH OTHER HEALTHCARE PROVIDERS AND THE COMMUNITY, WHENEVER POSSIBLE.
Program Services Form 990, Part III, Line 4a cardiac services St. Elizabeth's provides comprehensive cardiovascular services from diagnosis to surgery to rehabilitation and wellness. St. Elizabeth's is accredited by the Society of Chest Pain Centers, a professional organization focused on improving care for patients with acute coronary syndromes and teaching the public to recognize and react to the early symptoms of a possible heart attack. This accreditation attests that St. Elizabeth's meets strict criteria for recognizing and treating patients who come to the emergency room with heart attack symptoms. We are also a heart attack receiving center. Currently, more than 5 area hospitals send their patients to us for heart attack care. Our patients benefit from our highly credentialed physicians and state-of-the-art technologies, as well as our commitment to superior patient outcomes. Some of the services provided included: Cardiac catheterization, stent placement, stress testing, pacemaker, implantable cardioverter defibrillator ("ICD"), electrocardiography, coronary artery bypass graft (open heart) surgery and cardiac rehabilitation. During FY 2011, St. Elizabeth's Hospital had 8,992 cardiac cases. Form 990, part iii, line 4b orthopedic services St. Elizabeth's specializes in the treatment and prevention of orthopedic problems and sports-related musculoskeletal injuries. We perform surgical and non-surgical procedures. Our orthopedic surgical services are provided on an inpatient and outpatient basis. Our physicians are all board certified and provide first class care. Some of the orthopedic services provided include: General orthopedics, fracture care, total joint replacement, carpal tunnel treatment, arthroscopic and reconstructive surgery, and foot and ankle orthopedic care. During FY 2011, St. Elizabeth's Hospital had 8,843 orthopedic cases. form 990, part iii, line 4c rehabilitation services St. Elizabeth's Hospital's comprehensive rehabilitation unit provides the care that maximizes the patient's capabilities. We assist in achieving full recovery potential allowing patients to live as independently as possible. We support patients families by providing them with the education, resources and encouragement needed to achieve positive outcomes. Our comprehensive integrated inpatient rehabilitation program is accredited by the Commission on Accreditation of Rehabilitation Facilities ("CARF"). We are one of the few accredited rehab facilities in Southern Illinois and the only one available in St. Clair County. The rehabilitation unit is accredited to provide services to those adults who have been affected by stroke, amputation, arthritis, spinal cord injury, joint replacement, hip fracture, neurological disease, and more. When admitted to our program, patients are treated by a multi-disciplinary team of caring professionals. During FY 2011 our Rehabilitation Unit performed 5,257 cases. Total IP days for the fiscal year was 6,287. form 990, part iii, line 4d Healthcare services St. Elizabeth's delivers a comprehensive array of healthcare services to both inpatients and outpatients. Our accredited programs have consistently demonstrated quality outcomes that positively impact our patients, their families and the entire community. We provides quality medical healthcare regardless of race, creed, sex, national origin, handicap, age, or ability to pay. Although reimbursement for services rendered is critical to the operation and stability of St. Elizabeth's Hospital, it is recognized that not all individuals possess the ability to purchase essential medical services. It is our mission to serve the sick, especially the poor, with quality healthcare services and healthcare education. We have further defined our mission of identifying those who are at greatest health risk, the elderly, children, those coping with mental illness, and those with less means who are dependent on quality healthcare. During FY 2011, St. Elizabeth's Hospital provided 50,674 adult and pediatric days of care and had 173,488 outpatient visits. Community Benefit Charity and Government Means-Tested Program: During the period, St. Elizabeth's provided in excess of $13,935,564 million to support our commitment to the community. Included in this total was charity care provided to individuals unable to afford their care. The cost of charity care was $4,761,952. St. Elizabeth's Hospital also provided care to persons covered by governmental programs at or below cost. This resulted in providing $7,683,462 to Medicaid patients which was not reimbursed. Also, included in the total was the extensive number of free educational programs, screenings, clinical services and consultations provided at a reduced fee or at no charge to other healthcare agencies and human service agencies in our service area. To the extent that reimbursement was below cost, St. Elizabeth's Hospital recognized these expenses as a cost of fulfilling its mission for the entire community. Other Benefits: St. Elizabeth's Hospital takes a proactive role in educating its communities on wellness programs, sponsoring health screenings, collaborating with the local health district in targeting local health concerns, and organizing support groups. Included in the above Community Benefit figures are the following initiatives aimed at improving access and promoting health for the people of Belleville and surrounding communities. The total other benefits reported value $1,490,150. *Health Screenings: *Blood pressure screenings; *Car seat inspections, installations, and free car seats; *Reduced fee for mammograms; *Lung Function screenings; *Cardiac blood tests at reduced fee; *Skin cancer screening; *Alzheimer's Disease screening; *Anxiety screening; *Depression screening; *Pulmonary function testing; *Alcohol screening; *Cholesterol screening; *Stroke Screening; *Sports Physicals for local high school; *Bone density assessment; *Body Fat Screening; *Vascular Screenings; *Alcohol Abuse Screenings; *Educational Programs; *Student internships with numerous colleges and universities; *A work-study program for mentally challenged high school students; *Tours for high school students; *Healthcare Professions Shadowing; *Student volunteer programs (senior community project; *Four free community education programs; *Prenatal classes; *Lamaze classes; *Mother Child Tours for Expectant Mothers; *Adult, infant and child CPR classes; *Nutrition classes; *Arthritis self-help classes; *Here's to Your Health (a series of 4 presentations); *Aging conference; *Ethics conference; *Advance Directives Workshop; *Nursing support for school physicals Variety of programs for seniors at the PSOP center *Lunch with a Doctor - ten programs
program services FORM 990, PART Iii, line 4a Nutritional Support *Meal coupons for the homeless and indigent; *Six tons of food items collected and donated to needy families and to an interdenominational food pantry in Belleville; *Over one ton of clothing collected and donated to the Violence Prevention Center, Pregnancy Care Center, and Catholic Urban Program; *Food coupons to local grocery stores; *Diabetic Nutritional Counseling; *Free prescriptions for patients unable to pay Support Groups *St. Elizabeth's sponsors thirteen support groups and meetings; *Grief support (adults); *Memorial services for deceased family members; *Compassionate Friends; *Manic Depressive; *Recovery, Inc. (support for those dealing with nervous symptoms and fears); *Parkinson Support Group; *Life After Breast Cancer; *Alcoholics Anonymous Sponsorship; *Mended Hearts; *Funeral services conducted by Pastoral Care chaplains; *Burial along with graveside services for relatives of fetal/ premature deaths; *Alzheimer's Support Group; *Rehab Support Group; *Stroke Support Group; *Defibbers Support Group; *Narcotics Anonymous Sponsorship; Health Fairs *At the community events in St. Clair and Monroe Counties; *At senior centers and Our Lady of the Snows Retirement Apts; *At area churches; *For Women, By Women Health Fair; *For area clergy; *Lipstick Women's Conference; Community Involvement *Wellness clinic at the Programs and Services for Older Persons Center; *Provided flu shots to the underserved at no charge; *Meeting and conference room space for health/civic groups; *Actively participate in programs and services of St. Clair County's Health District; *Held leadership role in community civic organizations; *Healthcare Providers Committee - Greater Belleville Chamber of Commerce; *Participated with community groups by providing healthcare information; *Participated in major community health events; *Cancer Walk and Ride, Trivia Night, March of Dimes Walk, American Lung, Diabetes Walk, Drug Awareness Red Ribbon Walk, Susan B Komen Denim Day, Ride Belleville, Bethany Anniversary; *Conducted Lay Ministry Training Program for all denominations; *Sponsored six blood drives; *Cooperated with local judicial court on family violence programs; *Provided space and equipment for the Family Visitation Exchange program; *Charity consults with pharmacists; *CPR classes; *Participated on the planning committee for the St. Clair County Health conference; *Gave support to the local AIDS support and residence service; *Conducted quarterly memorial services and reception for family members of deceased patients; *Red Heart Day sponsorship; *Community-wide disaster preparation and drills; *Career Days; *Gateway Hospital Ethics Committee; *Provide graveside services at no charge; *Linen donations to area nursing homes and other medical supplies to Mission Outreach; *School Mentoring Program; *School Supplies for Children residing in the Violence; *Prevention Center; *Food Drive for Local Food Pantry; *Clinical education/affiliation with area healthcare programs In addition to the Community Benefit total, St. Elizabeth's provided 7.8 million (at cost) in uncompensated care to patients that did not qualify for charity care or public assistance, and over $6.6 million (at cost) in excess of Medicare payment for health services. TAX EXEMPT BONDS FORM 990, PART IV, LINE 24 ST ELIZABETH'S HOSPITAL HOLDS A LIABILITY ON ITS BOOKS FOR TAX-EXEMPT BONDS, WHICH IS AN ALLOCATION FROM ITS SOLE CORPORATE MEMBER, HOSPITAL SISTERS SERVICES, INC. AS A RESULT, THIS QUESTION WAS ANSWERED NO, AND SCHEDULE K WILL BE COMPLETED ON THE HOSPITAL SISTERS SERVICES, INC. FORM 990. 990.
RIGHTS OF MEMBERS TO ELECT GOVERNING BODY FORM 990, PART VI, LINEs 6 & 7A THE SENIOR GOVERNING BODY OF ST. ELIZABETH'S HOSPITAL (THE "CORPORATION") IS THE MEMBER OF THE CORPORATION, WHICH IS HOSPITAL SISTERS HEALTH SERVICES, INC. ("HSSI"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. PURSUANT TO SECTION 2.3 OF THE CORPORATION'S BYLAWS, HSSI HAS THE RIGHT TO APPOINT AND REMOVE THE CORPORATION'S BOARD OF DIRECTORS, CHAIRPERSON OF THE BOARD AND PRESIDENT.
MEMBER RESERVED POWERS FORM 990, PART VI, LINE 7B Responsibility for the policy and operations of St. Elizabeth's Hospital (the "Corporation") is vested in its Board of Directors, except with respect to specific powers reserved in the Corporation's Bylaws to the Corporation's Member, Hospital Sisters Health Services, Inc. ("HSSI"), an Illinois not for profit corporation exempt from federal taxation under Section 501(c)(3) of the Internal Revenue Code. The member of HSSI is Hospital Sisters Health System ("HSHS"), an Illinois not for profit corporation exempt from federal taxation under Section 501(c)(3) of the Internal Revenue Code. The members of HSHS are the individual sisters who from time to time are the duly elected Provincial Superior and Provincial Councilors, respectively of the American Province of the Hospital Sisters of St. Francis ("American Province"). The American Province is the United States organization of the Congregation of the Hospital Sisters of the Third Order Regular of St. Francis, a religious institute of the Roman Catholic Church. The governance and operations of the Corporation are subject to HSSI's right to exercise these reserved powers with respect to the Corporation and organizations of which the Corporation is either, directly or indirectly, a controlling member or a controlling shareholder ("Affiliates"). HSSI's right to exercise certain of these reserved powers is, in turn, subject to the approval of HSHS and HSHS' members. The reserved powers include all rights granted to HSSI by law and the right to: (a) Adopt, approve amendments to, or amend any statement of philosophy, mission, mission integration or values or any name, logo, or mark of the Corporation or of any Affiliate; (b) Adopt, approve amendments to, or amend the Articles of Incorporation of the Corporation or of any Affiliate; (c) Adopt, approve amendments to, or amend the Bylaws of the Corporation or of any Affiliate; (d) Appoint and remove the Board of Directors, any one or more of the Directors of the Corporation or of any Affiliate, and the Chairperson and President of the Corporation or of any Affiliate; (e) Approve the recommendation of the Board of Directors to appoint or remove the Board of Directors, any one or more Directors of the Corporation or of any Affiliate, or the Chairperson and President of the Corporation or of any Affiliate. (f) With respect to the Corporation or any Affiliate, approve the purchase, sale, alienation, exchange, lease or encumbrance of any real property of the Corporation or of any Affiliate, which property has a value in excess of limits set from time to time by HSSI; (g) Approve the operating and capital budgets of the Corporation or of any Affiliate, and any deviations by the Corporation or of any Affiliate from such budgets in an amount or percentage specified by HSSI from time to time; (h) Approve the strategic plan and goals of the Corporation or of any Affiliate; (i) Approve the sale of substantially all of the assets of the Corporation or of any Affiliate; (j) Approve the merger or dissolution of the Corporation or of any Affiliate; (k) Adopt or amend the plan for ministry education and governance for the Corporation and its Affiliates; (l) Approve the Corporation's Mission Accountability Reports and those of any Affiliate; (m) Approve the financial policies and procedures of the Corporation or of any Affiliate and approve any deviations from such policies and procedures by the Corporation or any Affiliate; and (n) Adopt policies to implement the Reserved Powers of HSSI.
FORM 990 REVIEW PROCESS FORM 990, PART VI, LINE 11b The hospital employs KPMG to assist in the overall review and electronic submission of its Form 990. KPMG provides guidance in identifying critical errors in the return submission and feedback on quantitative and qualitative responses. Additionally, the hospital CFO performs a thorough review of the return and reviews it with the hospital CEO and/or senior leaders before presenting it in its entirety to the hospital Board for questioning and review prior to the return's signing and submission to the IRS.
CONFLICT OF INTEREST POLICY FORM 990, PART VI, LINE 12C A revised Corporate Compliance Program and Conflict of Interest Policy has been used since January, 2009 to establish the practice of managing conflicts of interest using a system-wide protocol for disclosure statements. In accordance with our Conflict of Interest Policy all Covered Persons have a duty to comply with the Conflict of Interest Policy for any contract, transaction, relationship or activity contemplated, entered into or conducted at HSHS. The policy defines covered persons as A.) Board members, Board committee members, Officers, Board designees, senior management, members of any committee that oversees the approval of pharmaceuticals and medical devices, any other individual who holds a position of trust and B.) Non-employed members of the medical staff who also either: 1) hold paid or unpaid medical administrative positions, such as chairs of clinical departments, section and division chiefs, directors of special care units, directors of research or individual s who otherwise direct or materially influence research; or 2) have procurement responsibility, or the authority effectively to recommend such procurement. On a annual basis HSHS discloses a copy of the Conflict of Interest Policy (and all corresponding procedures, guidelines, forms and tools), to all Covered Persons and advises all Covered Persons in writing of any substantive changes to this Policy and such related materials. The Covered Persons are required to review and complete the corresponding Conflict of Interest Statement. The System Office Vice President, System Responsibility, Vice President, Risk & Compliance or members of the Audit and Integrity Committee ("Committee") are available to answers any questions a Covered Person may have. In addition, if, at any time after submitting an annual Conflict of Interest Statement, a Covered Person becomes aware of an Interest that he or she would have had to disclose at the annual interval, the Covered Person shall promptly disclose the Interest to the Committee using the HSHS Conflict of Interest Disclosure Statement. Completed Conflict of Interest statements are submitted to the Committee of HSHS which is responsible for identifying, assessing, and managing Conflicts of Interest that arise in the course of conducting the affairs of HSHS. If the Committee determines that a Conflict of Interest exists, HSHS shall not engage in or enter into a proposed contract, transaction, relationship, arrangement or activity unless the Committee or, where necessary, the Board of Directors (acting through its disinterested members), has investigated alternatives to the proposed contract, transaction, relationship, arrangement or activity and, in the absence of alternatives that are in the best interests of HSHS, has determined: 1. that, regardless of whether the Covered Person participates in the implementation of the proposed contract, transaction, relationship, arrangement, or activity; 2. the contract, transaction, arrangement or activity is in the best interests of HSHS; 3. the contract, transaction, arrangement or activity is fair and reasonable from the perspective of HSHS;and 4. HSHS cannot obtain a more advantageous contract, transaction, arrangement or activity with reasonable efforts under the circumstances. In determining whether a contract, transaction or arrangement is fair and reasonable to HSHS, the Committee shall consider, where applicable: 1. appraisals or other independent valuations of the Fair Market Value of the contract, transaction or arrangement; 2. information regarding comparable contracts, transactions or arrangements between unrelated parties; 3. offers from comparable competing entities; and/or 4. studies of comparable compensation arrangements. In any case in which the Committee finds, after taking the steps described above, that HSHS should participate in a proposed transaction or arrangement despite the existence of a conflict of interest, the Committee shall develop, implement, monitor, and enforce compliance with, a Conflict Management Plan for managing the Conflict of Interest as it considers necessary for such findings to remain valid throughout the life of the contract, transaction, relationship, arrangement or activity. All Conflict Management Plans shall: 1. state that the Committee will oversee, monitor and enforce compliance with the plan throughout the course of the study and specify means for doing so, including, without limitation, that the appropriate individuals must provide the Committee with written reports pertaining to compliance with the Conflict Management Plan, that the Committee shall have the right to audit the study for such compliance and the right to impose sanctions for non-compliance; 2. state that the Plan must be shared with Covered Person whose Interests it was developed to manage; 3. state that the Plan must be shared with, and periodic reports on compliance with the Plan must be provided to, the Board, senior management and/or government agencies; and 4. provide for such other management steps and mechanisms the Committee considers necessary and appropriate. In addition to the Committee, the System Office Vice Presidents of System Responsibility and Risk & Compliance may retain such independent advisors or experts as deemed necessary to assist in making its determinations and decisions. If the Committee determines that the contemplated transaction, relationship arrangement or activity cannot proceed due to a Conflict of Interest, the Committee shall inform the applicable Covered Person or decision-making body of such determination within one week of the Committee meeting at which the contemplated transaction was discussed. The Committee shall document its rejection of the contemplated transaction in the Committee's meeting minutes.
WHISTLEBLOWER POLICY FORM 990, PART VI, LINE 13 Provisions within the Corporate Compliance Hotline and Conflict of Interest Policy provide protections for whistleblower type activities.
COMPENSATION PROCESS FORM 990, PART VI, LINE 15 The Compensation Committee ("Committee") is comprised of independent members of the Board of Directors. The Committee develops a compensation philosophy for the System and all affiliates. The Committee selects and hires the independent compensation consultant to develop comparability data and advise the Committee during its deliberations regarding all elements of total compensation for all disqualified individuals. Integrated Healthcare Strategies ("IHS"), the consultants utilized by the Committee, use data from multiple tax-exempt peer group sources to determine salary ranges, incentive opportunity ranges and benefits for the disqualified individuals. IHS then assists the Committee in preparing contemporaneous documentation of all actions. Each Committee meeting is conducted with the intent to create a rebuttable presumption of reasonableness for all elements of executive total compensation for the disqualified individuals. The Chairman makes this declaration and also inquires if there are any conflicts of interest by any attendees. Any conflicts are disclosed and the Committee then acts in a manner to avoid any conflicted individual participating in any manner where a conflict might exist. At the end of the meeting, the Committee prepares contemporaneous minutes that record all actions taken during the meeting.
DISCLOSURE: DOCUMENTS AVAILABLE TO THE PUBLIC FORM 990, PART VI, LINE 19 Board-approved financial statements are made available to the public upon request. The governing documents and conflict of interest policy are not made available to the general public at this time.
POOLED INVESTMENT ACCOUNT FORM 990, PART X, LINE 11 PARTICIPATION IN THE POOLED FUND IS LIMITED TO THE 501(C)(3) HOSPITALS AND RELATED HEALTH SERVICES ORGANIZATIONS SPONSORED BY HOSPITAL SISTERS HEALTH SYSTEM. THE POOLED ACCOUNT CONSISTS OF CASH, EQUITY AND DEBT SECURITIES THAT ARE PUBLICLY TRADED. IN ACCORDANCE WITH THE PROVISIONS OF SFAS NO. 124 "ACCOUNTING FOR CERTAIN INVESTMENTS HELD BY NOT-FOR-PROFIT ORGANIZATIONS", INVESTMENTS IN EQUITY SECURITIES WITH READILY DETERMINABLE VALUES AND ALL INVESTMENTS IN DEBT SECURITIES ARE REPORTED AT FAIR VALUE ON THE BALANCE SHEET. INCOME, REALIZED AND UNREALIZED GAINS AND LOSSES ARE POOLED AND ALLOCATED TO THE PARTICIPANTS. INDIVIDUAL COMPONENTS OF ASSETS AND REVENUE ARE NOT IDENTIFIED TO THE PARTICIPANTS.
OTHER CHANGES IN NET ASSETS OR FUND BALANCES FORM 990, PART XI, LINE 5 Unrealized Gain on Investments 3,169,909 Recognition of Changes in pension funded status 12,557,001 Cumulative effect of change in accounting principle (351,058) contributions from related parties (366,018) temporarily restricted net income 1,048,000 permanently restricted net income 33,000 Transfer to Affiliates (8,361,000) ----------- Total Other Changes in Net assets or fund balances 7,729,834 ===========
transactions with related entities Form 990 Schedule R, Part v, line 2 The Transactions reported in Question 1 are between related 501(c)(3) public charities and are not reported in this section.
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Johnny E. Watkins TITLE:Division CFO HOURS:35
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Ann Carr TITLE:Treasurer HOURS:75
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Mark Reifsteck TITLE:Division CEO HOURS:18
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Illa J. David TITLE:Division CIO HOURS:18
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:James Burke TITLE:Division VP of Legal Services HOURS:18
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Kevin Shrake TITLE:Former CEO HOURS:70
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  
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
2010
Open to Public Inspection
Name of the organization
ST ELIZABETH'S HOSPITAL
OF THE THIRD ORDER OF ST FRANCIS
Employer identification number

37-0663567
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)
(a)
Name, address, and EIN of disregarded entity


(b)
Primary activity


(c)
Legal domicile (state
or foreign country)

(d)
Total income



(e)
End-of-year assets


(f)
Direct controlling
entity









(1) SPRINGFIELD HEALTH PARTNERS LLC
4936 LAVERNA ROAD
SPRINGFIELD,IL62707
37-1364419
HEALTHCARE IL 0 0 HSHS MG
 
(2) Kiara Clinical Integration Network LLC
4936 Laverna Rd
springfield,IL62707
26-1417684
HealthCare IL 0 0 Kiara Inc
 








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


(b)
Primary activity


(c)
Legal domicile (state
or foreign country)

(d)
Exempt Code section



(e)
Public charity status
(if section 501(c)(3))

(f)
Direct controlling
entity

(g)
Section 512(b)(13) controlled organization
Yes No
(1) HOSPITAL SISTERS HEALTH SYSTEM

4936 LAVERNA ROAD

SPRINGFIELD,IL62707
37-1058692
HEALTHCARE IL 501(c)(3) 11A NA
 
 
 
(2) HOSPITAL SISTERS SERVICES INC

4936 LAVERNA ROAD

SPRINGFIELD,IL62707
37-1163402
HEALTHCARE IL 501(c)(3) 11A NA
 
 
 
(3) HOSPITAL SISTERS OF ST FRANCIS FDTN

4936 LAVERNA ROAD

SPRINGFIELD,IL62707
37-1186514
HEALTHCARE IL 501(c)(3) 11A NA
 
 
 
(4) HSHS SELF INSURANCE TRUST FUND

4936 LAVERNA ROAD

SPRINGFIELD,IL62707
37-1120626
INSURANCE IL 501(c)(3) 11A NA
 
 
 
(5) HSHS HEALTH CARE PLAN TRUST FUND

4936 LAVERNA ROAD

SPRINGFIELD,IL62707
37-1137724
HEALTHCARE IL 501(c)(9) N/A NA
 
 
 
(6) HOSPITAL SISTERS HEALTHCARE - WEST INC

2661 COUNTY HIGHWAY I

CHIPPEWA FALLS,WI54729
51-0157933
HEALTHCARE WI 501(c)(3) 11A NA
 
 
 
(7) SACRED HEART HOSPITAL

900 WEST CLAIREMONT AVENUE

EAU CLAIRE,WI54701
39-0807060
HEALTHCARE WI 501(c)(3) 3 NA
 
 
 
(8) ST ANTHONY'S HOSPITAL

503 N MAPLE STREET

EFFINGHAM,IL62401
37-0661233
HEALTHCARE IL 501(c)(3) 3 NA
 
 
 
(9) ST JOHN'S HOSPITAL

800 EAST CARPENTER STREET

SPRINGFIELD,IL62769
37-0661238
HEALTHCARE IL 501(c)(3) 3 NA
 
 
 
(10) ST FRANCIS HOSPITAL

1215 FRANCISCAN DRIVE

LITCHFIELD,IL62056
37-0661236
HEALTHCARE IL 501(c)(3) 3 NA
 
 
 
(11) ST JOSEPH'S HOSPITAL

9515 HOLY CROSS LANE

BREESE,IL62230
37-1208459
HEALTHCARE IL 501(c)(3) 3 NA
 
 
 
(12) ST JOSEPH'S HOSPITAL

1515 MAIN STREET

HIGHLAND,IL62249
37-0663568
HEALTHCARE IL 501(c)(3) 3 NA
 
 
 
(13) ST JOSEPH'S HOSPITAL

2661 COUNTY HIGHWAY 1

CHIPPEWA FALLS,WI54729
39-0810545
HEALTHCARE WI 501(c)(3) 3 NA
 
 
 
(14) ST MARY'S HOSPITAL

1800 E LAKE SHORE DRIVE

DECATUR,IL62521
36-2169181
HEALTHCARE IL 501(c)(3) 3 NA
 
 
 
(15) ST MARY'S HOSPITAL

111 SPRING STREET

STREATOR,IL61364
36-2169181
HEALTHCARE IL 501(c)(3) 3 NA
 
 
 
(16) ST NICHOLAS HOSPITAL

3100 SUPERIOR AVENUE

SHEBOYGAN,WI53081
39-0808480
HEALTHCARE WI 501(c)(3) 3 NA
 
 
 
(17) ST VINCENT HOSPITAL

835 S VAN BUREN

GREEN BAY,WI54301
39-0817529
HEALTHCARE WI 501(c)(3) 3 NA
 
 
 
(18) ST MARY'S HOSPITAL MEDICAL CENTER

1726 SHAWANO AVENUE

GREEN BAY,WI54303
39-0818682
HEALTHCARE WI 501(c)(3) 3 NA
 
 
 
(19) HSHS MEDICAL GROUP INC

4936 LAVERNA ROAD

SPRINGFIELD,IL62707
26-3956318
HEALTHCARE IL 501(c)(3) 11A NA
 
 
 
(20) HSHS WISCONSIN MEDICAL GROUP INC

8040 EXCELSIOR DRIVE STE 200

MADISON,WI53717
26-4515959
HEALTHCARE WI 501(c)(3) 11A NA
 
 
 
(21) Orange Cross Ambulance Inc

919 Ashland Ave

sheboygan,WI53081
39-1860942
healthcare WI 501(c)(3) 9 St Nicholas
 
 
 
(22) Wisconsin Upper Pen Onc Mngmt Services

835 S Van Buren

green bay,WI54304
39-1677100
healthcare WI 501(c)(3) 3 St Vincent
 
 
 
(23) Unity Limited Partnerhship

2366 Oak Ridge Circle

De Pere,WI54115
39-1750729
Healthcare WI 501(c)(3) 9 HSSI
 
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



(b)
Primary activity




(c)
Legal
domicile
(state or foreign
country)


(d)
Direct controlling
entity



(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




(g)
Share of end-of-year
assets



(h)
Disproprtionate allocations?




(i)
Code 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) Memorial and St Elizabeth's Healthcare

4000 North Illinois Street
Swansea,IL62226
37-1312961
HealthCare IL NA
 
related 1,416,092 4,344,686   No 0   No 50.000 %
(2) Prairie Heart Institute - Carbondale LL

800 East Carpenter Street
Springfield,IL62769
37-1321197
HealthCare IL St John's
 
related 0 0   No 0   No 0 %
(3) Northeast Wisconsin Radiation Therapy Se

1821 S Webster Avenue Suite 300
Green Bay,WI543079047
26-3749065
HealthCare WI HSSI
 
related 0 0   No 0   No 0 %
(4) Pain Center of Wisconsin

4131 W Loomis Road Suite 300
Greenfield,WI53221
26-3155343
HealthCare WI St Vincent
 
related 0 0   No 0   No 0 %
(5) Surgery Center of Sheboygan LLC

3141 Saemann Ave
Sheboygan,WI53081
26-0822209
HealthCare WI St Nicholas
 
related 0 0   No 0   No 0 %
(6) Prevea Ventures LLC

2710 EXECUTIVE DR
Green Bay,WI54304
20-3775127
HealthCare WI HSSI
 
related 0 0   No 0   No 0 %
(7) CARPENTER STREET HOTEL LLC 36-

 
 
HOTEL IL LASANTE INC
 
RELATED 0 0   No 0   No 0 %
(8) SPRINGFIELD URGENT CARE REAL E

 
 
  IL LASANTE INC
 
RELATED 0 0   No 0   No 0 %
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of related organization



(b)
Primary activity



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


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

(f)
Share of total income



(g)
Share of
end-of-year
assets

(h)
Percentage
ownership


(1) Kiara Inc
4936 Laverna Rd
Springfield,IL62707
37-1163401
HealthCare IL HSHS
 
C Corp 0 0 0 %
(2) LaSante Wisconsin Inc
4936 Laverna Rd
Springfield,IL62707
39-1572196
HealthCare IL Kiara Inc
 
C Corp 0 0 0 %
(3) LaSante Inc
4936 Laverna Rd
Springfield,IL62707
37-1163400
HealthCare IL Kiara Inc
 
C Corp 0 0 0 %
(4) Prairie Cardiovascular
619 East Mason Suite 4P57
Springfield,IL62701
37-1071858
HealthCare IL Kiara Inc
 
C Corp 0 0 0 %
(5) Prevea Health Services
2710 EXECUTIVE DR
Green Bay,WI54304
39-1839351
HealthCare WI HSSI
 
C Corp 0 0 0 %
(6) Prevea Clinic Inc
2710 EXECUTIVE DR
Green Bay,WI54304
39-1839349
HealthCare WI HSSI
 
C Corp 0 0 0 %
(7) Prevea Health Network
2710 EXECUTIVE DR
Green Bay,WI54304
39-2000537
HealthCare WI HSSI
 
C Corp 0 0 0 %
(8) REnaissance Quality Insurance
PO Box 1159 KY1-1102
Grand Cayman,Cayman IslandsKY1-1102
CJ
98-0669953
Insurance CJ HSSI
 
c corp 0 0 0 %
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III or IV.
Yes
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
 
No
b Gift, grant, or capital contribution to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Performance of services or membership or fundraising solicitations for other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations by other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Sharing of facilities, equipment, mailing lists, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of paid employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Reimbursement paid to other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid by other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Other transfer of cash or property to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
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)
(2)

(3)

(4)

(5)

(6)

Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity
(b)
Primary activity
(c)
Legal domicile
(state or foreign
country)
(d)
Are all
partners
section
501(c)(3)
organizations?
(e)
Share of
end-of-year
assets
(f)
Disproprtionate allocations?
(g)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065)
(h)
General or
managing
partner?
Yes No Yes No Yes No






























Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation
Additional Data


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