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 10-01-2010 and ending 09-30-2011
BCheck if applicable:
CName of organization
VIA CHRISTI REHABILITATION HOSPITAL INC
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
1151 N ROCK ROAD
 
Room/suite
City or town, state or country, and ZIP + 4
WICHITA, KS672061262
D Employer identification number

48-1158274
E Telephone number

G Gross receipts $ 24,885,788
F Name and address of principal officer:
CINDY LAFLEUR
1151 N ROCK RD
WICHITA,KS67206
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.VIA-CHRISTI.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: 1994
M State of legal domicile: KS
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: INSPIRED BY THE GOSPEL AND OUR CATHOLIC TRADITION, WE SERVE AS A HEALING PRESENCE WITH SPECIAL CONCERN FOR OUR NEIGHBORS WHO ARE VULNERABLE.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) .... 3 11
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 6
5 Total number of individuals employed in calendar year 2010 (Part V, line 2a) ... 5 386
6 Total number of volunteers (estimate if necessary) .... 6 9
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 91,339
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b 17,224
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 0 0
9 Program service revenue (Part VIII, line 2g) ......... 22,939,211 22,856,686
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 798,841 1,128,611
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 1,075,187 897,886
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 24,813,239 24,883,183
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 0 0
14 Benefits paid to or for members (Part IX, column (A), line 4) .... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 15,241,430 14,544,621
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).... 7,867,135 7,852,569
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 23,108,565 22,397,190
19 Revenue less expenses. Subtract line 18 from line 12...... 1,704,674 2,485,993
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............ 27,714,075 28,364,907
21 Total liabilities (Part X, line 26)............ 6,374,600 6,418,937
22 Net assets or fund balances. Subtract line 21 from line 20 ..... 21,339,475 21,945,970
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
signatureBig 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 + 4Big 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: AS PART OF VIA CHRISTI HEALTH, WE SHARE THIS MISSION: INSPIRED BY THE GOSPEL AND OUR CATHOLIC TRADITION, WE SERVE AS A HEALING PRESENCE WITH SPECIAL CONCERN FOR OUR NEIGHBORS WHO ARE VULNERABLE.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the 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 $ 19,261,410 including grants of $   ) (Revenue $ 23,554,590 )
PROVIDE REHABILITATION OUTPATIENT AND INPATIENT SERVICES FOR THE BENEFIT, CARE AND TREATMENT OF SICK, INJURED, AGED & DISABLED PATIENTS OF SOUTH CENTRAL KANSAS & SURROUNDING AREAS.
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services. (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet$ 19,261,410
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? ........
2
 
No
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part I..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part II.........................
4
 
No
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 III........................
5
 
 
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 IClick to see attachment.......................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IVClick to see attachment...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in 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......
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II...........................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor, or a grant selection committee member, or to a person related to such an individual? If “Yes,” complete Schedule L, Part III...............
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV .........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV...................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV..
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
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
37
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
386
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
11
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
6
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
KS
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
SHELLY TRENT
8200 E THORN DR SUITE 300
WICHITA,KS67226
(316) 719-3200
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) LAURIE LABARCA
EX-OFFICIO
 1.0 X           0 461,748 58,529
(2) CINDY LAFLEUR
EX-OFFICIO
 25.0 X   X       0 171,497 34,455
(3) SISTER ANNE DOLORES LAPLANTE
EX-OFFICIO
 1.0 X           0 140,519 12,685
(4) SISTER SHERRI MARIE KUHN
EX-OFFICIO
 1.0 X           0 223,457 28,043
(5) CINDI UNRUH
TRUSTEE
 1.0 X           0 0 0
(6) DANIEL J PROHASKA MD
TRUSTEE
 1.0 X           0 0 0
(7) GLEN BAKER
PRESIDENT
 1.0 X   X       0 0 0
(8) JAMES THAYER
TRUSTEE
 1.0 X           0 0 0
(9) KEVIN RIEG MD
TRUSTEE
 1.0 X           21,550 0 0
(10) NAOMI SHIELDS MD
TRUSTEE
 1.0 X           0 0 0
(11) V JIM PAUL
SECRETARY/TREASURER
 1.0 X   X       0 0 0
(12) PACKARD LAMONT
PHARMACIST
 40.0         X   138,362 0 20,316
(13) KIM YEAROUT
DIRECTOR OF OP REHABILITATION
 40.0         X   115,214 0 14,622
(14) EDNA BECKING IRVING
DIRECTOR OF IP REHABILITATION
 40.0         X   100,499 0 20,209






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;


























1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 375,625 997,221 188,859
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 in reportable compensation from the organizationMediumBullet3
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
 
No
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
PROMED PHYSICIAN SERVICES PA
2456 N WOODLAWN
WICHITA,KS67220 		PHYSICIAN SERVICES 831,678
SLEEP ELITE LLC
16675 ROSEROCK CIR
CHOCTAW,OK73020 		SLEEP THERAPY 428,714
ADVANCED ORTHOPAEDIC ASSOCIATES PA
2778 N WEBB ROAD
WICHITA,KS67226 		PHYSICIAN SERVICES 324,691
GENESIS HEALTH CLUBS
6100 E CENTRAL 3
WICHITA,KS67208 		RENTALS 177,741
KANSAS SURGERY AND RECOVERY CENTER
2770 N WEBB ROAD
WICHITA,KS67226 		SURGERY SERVICES 484,368
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization MediumBullet12
Form 990 (2010)
Form 990 (2010)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, gifts, grants and other similar amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d  
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		 
g Noncash contributions included in lines 1a-1f:$  
h Total. Add lines 1a-1f.......MediumBullet 0
Program Service Revenue Business Code
2a NET PATIENT REVENUE 621,110 22,856,686 22,856,686    
b
c
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 22,856,686
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 474,772     474,772
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties............MediumBullet 0      
(i) Real (ii) Personal
6a Gross Rents 14,275  
b Less: rental expenses    
c Rental income or (loss) 14,275  
d Net rental income or (loss).......MediumBullet 14,275     14,275
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 656,444 0
b Less: cost or other basis and sales expenses   2,605
c Gain or (loss) 656,444 -2,605
d Net gain or (loss)..........MediumBullet 653,839     653,839
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 PRISM CONTRACT SERVICES 561,499 83,293 65,303 17,990  
b CAFETERIA 722,210 86,877     86,877
c PRISM NETWORK   554,867 481,518 73,349  
d All other revenue .... 158,574 151,083   7,491
e Total. Add lines 11a–11d ......MediumBullet 883,611
12 Total revenue. See Instructions....MediumBullet 24,883,183 23,554,590 91,339 1,237,254
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  
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 .... 112,908   112,908  
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 11,390,844 10,412,838 978,006  
8 Pension plan contributions (include section 401(k) and section 403(b) employer contributions) .... 576,054 519,405 56,649  
9 Other employee benefits ....... 1,594,698 1,347,641 247,057  
10 Payroll taxes ........... 870,117 775,968 94,149  
11 Fees for services (non-employees):        
a Management ...... 771,876   771,876  
b Legal ......... 1,575   1,575  
c Accounting ........... 69,734   69,734  
d Lobbying ........... 0      
e Professional fundraising. See Part IV, line 17.. 0  
f Investment management fees ...... 0      
g Other .......... 3,034,907 2,633,689 401,218  
12 Advertising and promotion .... 21,750 15,480 6,270  
13 Office expenses ....... 1,585,394 1,515,675 69,719  
14 Information technology ...... 261,370   261,370  
15 Royalties .. 0      
16 Occupancy ........... 1,147,894 1,147,894    
17 Travel ............ 37,543 16,088 21,455  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 16,117 2,809 13,308  
20 Interest ........... 60,091 60,091    
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 634,199 631,009 3,190  
23 Insurance .............. 113,460 113,460    
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 MEMBERSHIP DUES 28,679 11,902 16,777  
b VEHICLE FUEL & MAINTENANCE 21,748 21,748    
c BOOKS & SUBSCRIPTIONS 9,694 2,643 7,051  
d INCOME TAX EXPENSE 5,120 5,120    
e EMPLOYEE RECOGNITION 3,514 71 3,443  
f All other expenses 27,904 27,879 25  
25 Total functional expenses. Add lines 1 through 24f 22,397,190 19,261,410 3,135,780 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 .......... 1,830 1 7,685
2 Savings and temporary cash investments ....... 1,658,498 2 4,447,561
3 Pledges and grants receivable, net .........   3  
4 Accounts receivable, net ......... 4,582,080 4 4,368,739
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..........   5  
6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
Schedule L ..........   6  
7 Notes and loans receivable, net .............   7  
8 Inventories for sale or use .............. 115,516 8 96,374
9 Prepaid expenses and deferred charges ............ 74,422 9 114,140
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 14,463,416
b Less: accumulated depreciation. ..... 10b 10,343,472 4,719,692 10c 4,119,944
11 Investments—publicly traded securities .......... 16,112,603 11 14,845,786
12 Investments—other securities. See Part IV, line 11 ......   12  
13 Investments—program-related. See Part IV, line 11 ..   13  
14 Intangible assets ......... 184,137 14 142,968
15 Other assets. See Part IV, line 11 ........... 265,297 15 221,710
16 Total assets. Add lines 1 through 15 (must equal line 34)... 27,714,075 16 28,364,907
Liabilities 17 Accounts payable and accrued expenses . 2,891,742 17 2,607,585
18 Grants payable ..........   18  
19 Deferred revenue ..........   19  
20 Tax-exempt bond liabilities ..........   20  
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22  
23 Secured mortgages and notes payable to unrelated third parties ..   23  
24 Unsecured notes and loans payable to unrelated third parties ....   24  
25 Other liabilities. Complete Part X of Schedule D..... 3,482,858 25 3,811,352
26 Total liabilities. Add lines 17 through 25..... 6,374,600 26 6,418,937
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 ..... 21,339,475 27 21,945,970
28 Temporarily restricted net assets .....   28  
29 Permanently restricted net assets .....   29  
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 ..... 21,339,475 33 21,945,970
34 Total liabilities and net assets/fund balances ..... 27,714,075 34 28,364,907
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
24,883,183
2
Total expenses (must equal Part IX, column (A), line 25) . . . . .
2
22,397,190
3
Revenue less expenses. Subtract line 2 from line 1 . . . .
3
2,485,993
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) . .
4
21,339,475
5
Other changes in net assets or fund balances (explain in Schedule O) . . . .
5
-1,879,498
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
21,945,970
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII . . . . . . . . . .
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?..
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O............................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
 
 
Form 990 (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
VIA CHRISTI REHABILITATION HOSPITAL INC
 
Employer identification number

48-1158274
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 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
VIA CHRISTI REHABILITATION HOSPITAL INC
 
Employer identification number

48-1158274
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 .................   992,106 992,106
b Buildings ................   7,627,310 5,521,032 2,106,278
c Leasehold improvements ............   0 0 0
d Equipment ................   5,234,197 4,335,008 899,189
e Other .................   609,803 487,432 122,371
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........SchDMdBullet 4,119,944
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
PENSION DEPOSIT PAYABLE 2,603,713
VCH LOAN PAYABLE 1,207,639







Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)Small Bullet 3,811,352
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
FIN 48 SCHEDULE D, PART X THE ORGANIZATION FOLLOWS THE FIN 48 POLICY OF VIA CHRISTI HEALTH, INC. (VCH) AND THE POLICY IS PROVIDED IN THE VCH CONSOLIDATED AUDITED FINANCIAL STATEMENTS. WITH THE EXCEPTION OF CERTAIN ENTITIES, ALL OF THE ENTITIES IN THE HEALTH SYSTEM ARE ORGANIZATIONS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND ARE GENERALLY EXEMPT FROM PAYMENT OF INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE INTERNAL REVENUE CODE. SUBSIDIARIES, WHICH ARE FOR-PROFIT ORGANIZATIONS, ARE SUBJECT TO FEDERAL AND STATE INCOME TAXES. TAX ASSETS AND LIABILITIES ARE RECOGNIZED FOR THE FUTURE TAX CONSEQUENCES ATTRIBUTABLE TO DIFFERENCES BETWEEN THE FINANCIAL STATEMENT CARRYING AMOUNTS OF EXISTING ASSETS AND LIABILITIES AND THEIR RESPECTIVE TAX BASES AND OPERATING LOSS AND TAX CREDIT CARRYFORWARD. INCOME TAX EXPENSE OR BENEFIT IS INCLUDED IN OTHER NON-OPERATING GAINS AND LOSSES IN THE CONSOLIDATED STATEMENTS OF OPERATION AND CHANGES IN NET ASSETS. DEFERRED TAX ASSETS AND LIABILITIES ARE MEASURED USING ENACTED TAX RATES EXPECTED TO BE RECOVERED OR SETTLED. THE EFFECT ON DEFERRED TAX ASSETS AND LIABILITIES OF A CHANGE IN TAX RATES IS RECOGNIZED IN INCOME IN THE PERIOD THAT INCLUDES THE ENACTMENT DATE.
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
VIA CHRISTI REHABILITATION HOSPITAL INC
 
Employer identification number

48-1158274
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) .. 		    175,033 0 175,033 0.780 %
b Unreimbursed Medicaid (from
Worksheet 3, column a) . 		    1,660,000 507,000 1,153,000 5.150 %
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 ..... 		    1,835,033 507,000 1,328,033 5.930 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) .... 		    163,751 0 163,751 0.730 %
f Health professions education
(from Worksheet 5) .. 		    73,558 0 73,558 0.330 %
g Subsidized health services
(from Worksheet 6) .. 		    0 0 0 0 %
h Research (from Worksheet 7)     0 0 0 0 %
i Cash and in-kind contributions
to community groups
(from Worksheet 8) .. 		    74,728 27,413 47,315 0.210 %
jTotal Other Benefits ...     312,037 27,413 284,624 1.270 %
kTotal. Add lines 7d and 7j. ..     2,147,070 534,413 1,612,657 7.200 %
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     67 0 67 0 %
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building     146 0 146 0 %
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total     213 0 213 0 %
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
61,021
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
7,652,828
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
5,542,710
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
2,110,118
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
Yes
 
Part IV
Management Companies and Joint Ventures
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership% 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2010
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 VIA CHRISTI REHABIILTATION HOSPITAL INC
1151 N ROCK ROAD
WICHITA,KS67206 		X               REHABILITATION
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:VIA CHRISTI REHABIILTATION HOSPITAL INC
Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
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?12
Name and address Type of Facility (Describe)
1 Via Christi Therapy Center-East Shannon
10100 Shannon Woods
Wichita,KS67226 		THERAPY
2 Via Christi Therapy Center-East Shannon
10100 Shannon Woods
Wichita,KS67226 		THERAPY
3 Via Christi Therapy Center-East Shannon
10100 Shannon Woods
Wichita,KS67226 		THERAPY
4 Via Christi Therapy Center-East Shannon
10100 Shannon Woods
Wichita,KS67226 		THERAPY
5 Via Christi Therapy Center-East Shannon
10100 Shannon Woods
Wichita,KS67226 		THERAPY
6 Via Christi Therapy Center-East Shannon
10100 Shannon Woods
Wichita,KS67226 		THERAPY
7 Via Christi Therapy Center-East Shannon
10100 Shannon Woods
Wichita,KS67226 		THERAPY
8 Via Christi Therapy Center-East Shannon
10100 Shannon Woods
Wichita,KS67226 		THERAPY
9 Via Christi Therapy Center-East Shannon
10100 Shannon Woods
Wichita,KS67226 		THERAPY
10 Via Christi Therapy Center-East Shannon
10100 Shannon Woods
Wichita,KS67226 		THERAPY
11 Via Christi Therapy Center-East Shannon
10100 Shannon Woods
Wichita,KS67226 		THERAPY
12 Via Christi Therapy Center-East Shannon
10100 Shannon Woods
Wichita,KS67226 		THERAPY
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
Annual Community Benefit Report PART I, LINE 6A Annually, a community benefit report is prepared and printed in the Via Christi Health's annual report which is released in various formats to the public and which is also available from the Via Christi Health webpage at www.viachristi.org. In addition, Via Christi Hospitals and their ministries are happy to make public presentations when requested on the findings of the health needs assessment.
COMMUNITY BENEFIT PROGRAMS Part I, line 7 For examples of some of the community benefit programs provided by Via Christi Rehabilitation Hospital see the Schedule O footnote for Part III, Statement of Program Services.
COMMUNITY BUILDING ACTIVITIES PART II Community building activities are essential roles for health-care organizations in that they address many of the underlying determinants of health. Research has consistently shown that when the socioeconomic factors influencing health are explored, health care actually plays the smaller role proportionately. A report in the Journal of American Medical Association and the Center for Disease Control suggests that the factors impacting health are as follows: lifestyle and behaviors, 50 percent; environment, 20 percent; genetics and human biology, 20 percent and health care, 10 percent. Community building activities help to address the other indicators outside of the role, traditionally played by health care organizations. These activities are almost exclusively done in some form of partnership in which the community or other organizations are better suited to address identified community needs. VCH provides timely and specific resources to help community organizations through donations to fulfill their missions of improving the well-being of the community and contributing to its overall health status in ways that may differ from direct clinical services provided by the hospital. Donations such as staff time and expertise for trainings or presentations to Chamber, Rotary or other service groups, special population outreach efforts for at-risk children in need of mentoring, assistance in building homes for the homeless or domestic violence victims, donating outdated equipment to free clinics, or other durable goods provided to area shelters and other organizations are all ways to maximize those agencies' resources so they can provide more program services. Participation in various community groups is, many times, based on the specific resources we bring to the table in terms of staff expertise, leadership skills and/or hospital resources. To suggest that many of the activities listed below do not meet a health need seems very blinded, especially when so many of them include community partnerships where the need for medical involvement is not so narrowly defined and is welcomed. The following activities should be considered Community Benefit as our participation certainly benefits the community more than our ministry. For example: Participating in the Advocates for Southern Kansas Kids Coalition whose focus is on providing care to children who are deaf or hard of hearing. The mission of the coalition is to promote the collaboration, communication, educational opportunities, community awareness and resources for parents and professionals associated with children who exhibit deaf or hard of hearing disorders. Participating and taking a leadership role in the Safe Kids Coalition whose mission is to prevent unintentional childhood injuries. Unintentional injuries kill more than 830,000 children between the ages of 1 - 14 annually worldwide and permanently disable many more. Through education, media awareness campaigns, community outreach and public policy efforts, thousands of children and their families are reached with lifesaving interventions. Safe Kids' health experts conduct research and develop and execute data-driven childhood injury prevention and advocacy programs. In partnership with law enforcement officers, firefighters, paramedics, health professionals, educators, businesses, public policy makers, parents and children themselves kids enjoys the support of a grassroots organization. Participation in the Workforce Initiative for Economic Development (WIRED). This board manages a federal grant for workforce development which assists in training the unemployed and underemployed, as well as small business developers in working with composite materials. Hospital-wide recycling efforts have taken on a new dimension as green team members look for opportunities to recycle all kinds of materials that collect in the hospital. Aluminum cans and tabs are collected every two weeks and driven to Ronald McDonald House or St Cecilia's Church, where they are combined with other collections to bring in money for the not-for-profit organizations. Participation in the Greater Wichita Sports Commission, which was developed to improve the quality of life and the Wichita economy through sports as well as provide medical support to existing sporting events in and around Wichita. Participation in the Wichita Water Advisory Council whose sole purpose is to ensure the safety and supply of water to over half a million Wichita and Sedgwick County residents.
Bad Debt Expense Part III, line 3 The organization has no suitable basis for estimating bad debt expense that would be attributable to patients eligible under the organization's charity care policy.
Audit Footnote - Bad Debt Expense Part III, line 4 The provision for bad debt expense is based upon management's assessment of expected net collections considering economic conditions, historical experience, trends in health care coverage, and other collection indicators. Periodically throughout the year, management assesses the adequacy of the allowance for uncollectible accounts based upon historical write-off experience by payer category, including those amounts not covered by insurance. The results of this review are then used to make any modifications to the provision for bad debt expense to establish an appropriate allowance for uncollectible accounts. After satisfaction of amounts due from insurance and reasonable efforts to collect from the patient have been exhausted, The Health System follows established guidelines for placing certain past-due patient balances with collection agencies, subject to terms of certain restrictions on collection efforts as determined by the Health System. Accounts receivable are written off after collections efforts have been followed in accordance with the Health System's policies. VCRH reports bad debts in accordance with generally accepted accounting principles (GAAP). Healthcare Financial Management Statement 15 is followed to the extent that it aligns with the guidelines set forth by GAAP. Bad debt expense at cost is determined using the same cost-to-charge ratio that is used for charity care and Medicaid shortfall. VCRH follows the guidance from CHA and does not consider bad debt as a community benefit.
Medicare Shortfall Part III, line 8 VCRH follows the CHA guidelines regarding Medicare and does not include it as community benefit. The methodology described in the instructions to Schedule H, Part III, Section B, Line 7 does not take into account all costs incurred by the Hospital and does not represent the total Medicare reimbursement scenario. The Medicare information reported on Schedule H, Part III, Section B, Line 7 was determined using information from the organizations Medicare cost report (using the Medicare Cost report step-down methodology of allocating costs). However, utilizing an internal cost accounting system actually results in a lesser Medicare gain of $481,915. The most common reason for a difference between the Medicare shortfall/gain reported on Schedule H and the actual shortfall/gain reported above include inclusion of Medicare Advantage revenue and expenses; inclusion of Medicare Part B Revenue and Expenses; inclusion of other fee schedule revenue, other timing issues, and costs that are considered unallowable on the Medicare cost report that are, in fact, related to Medicare patient care
Debt Collection Policy Part III, line 9b It is the policy of VCRH to promote socially just practices for billing and collections for all patients receiving care. The policy is intended to further THE VCRH mission by requiring ethical conduct in billing and collecting self-pay balances from patient/guarantor's regardless of ability to pay. The policy ensures that prior to turning an account OVER to a Third Party Collection Agent (Agent) for collection activity, VCRH will perform a reasonable review of each account to verify that the patient/guarantor is not potentially eligible for any government assistance program (e.g., Medicaid, Medicare, etc.) and would likely not qualify for charity care. VCRH will direct its staff and Agents to periodically assess each patient/guarantor's ability to pay or to determine eligibility for charity care. The review and assessment should include but may not be limited to the following: a. Ensure the patient/guarantor has been notified of VCRH's financial assistance policy; b. Ensure the patient/guarantor was offered a financial assistance application; c. Ensure documentation of any known extraordinary financial circumstances of the patient/guarantor or if they are medically indigent
Needs Assessment Part VI, line 2 Ministry representatives are involved with numerous coalitions that periodically assess community needs (e.g. Visioneering, United Way of the Plains, Central Plains Area Agency on Aging Community Services Advisory Board, Central Plains Regional Healthcare Foundation, Health & Wellness Coalition, KS Health Care Collaborative, KS Mental Health Coalition, SG Co Health Access Project, Wichita Business Coalition on HealthCare, Wichita Center for Graduate Medical Education and others) and in 2009 VCH conducted their own assessment for the Wichita MSA coverage area. Secondary data, other community assessments and one-on-one interviews with community leaders, social service providers, health care providers and government representatives were used to conduct the MRHC and WCH assessments.
Patient Eligibility for Assistance Part VI, line 3 VCH financial assistance staff is trained on how to qualify patients for Medicaid, SCHIP and other such income-based programs. During the patient's registration, admissions and discharge processes, VCH attempts to identify patients who may be eligible for charity or discounted care through the charity care policy. In addition, VCH uses a percentage of the Federal Poverty Guidelines (FPG) to determine free and discounted care.
Community Information Part VI, line 4 The primary counties for Via Christi Health include Sedgwick and Butler Counties. Sedgwick County has a land area of 999 square miles with a 2010 population of 498,365. Butler County has a land area of 1,428 square miles with a 2008 population of 65,880. Sedgwick County's population demographics include: 76.3% white, 9.3% Black, 1.2% American Indian; 4.1% Asian and 13.0% persons of Hispanic or Latino origin. The diversity of the population in Sedgwick County is greater than for either Butler County or the State of Kansas as a whole. Racial breakout for Butler County include: 93.5% white; 1.7% Black; 1.0% American Indian; 0.7% Asian persons; 3.9% persons of Hispanic or Latino origin. It was reported by 11.8% of the Sedgwick County and 3.2% of the Butler County residents that a language other than English is spoken at home. When it comes to education, 88.1% of Sedgwick County residents completed high school and 27.2% had a bachelor's degrees or higher. This compares to 91.33% for high school graduates and 23.9% bachelor's degrees for Butler County. Median household income for Sedgwick County residents in 2010 was $48,071 compared to $54,165 for Butler County. The median value of owner-occupied housing units in Sedgwick County was $113,600 in 2009 compared to $116,800 for Butler County residents. Sedgwick County reports 13.5% of its residents are below poverty level compared to 9.3% for Butler County. The Statewide poverty level is around 13.2%. There are ten inpatient health care facilities in or around Wichita, Kansas. Of these facilities, only Via Christi Health ministries are considered not-for-profit. Via Christi's Burn Center is the only one in the state, so it takes care of all burn victims throughout the area when needed.
Promotion of Community Health Part VI, line 5 VCRH and its affiliates enrich the communities in which they operate as well as the broader community, improving medicine through research, educating physicians and other healthcare providers, and providing care and support to people in need. VCRH further supports this mission with a community board, open medical staff and an emergency room available to patients regardless of ability to pay. Community representation on the Governing Body - The Board of Trustees is the governing body of VCRH. The majority of its members are external members comprised of persons who reside in or around Sedgwick County and has overall responsibility for the charitable mission of the organization as set forth in its Articles of Incorporation and By Laws. These trustees are selected based on their expertise, experience and other criteria established by the nominating committee of the Board of Trustees. Areas of expertise and experience include such areas as healthcare, finance, education, and local government. The Board actively debates and sets policy and strategic direction for the ministry but does not get involved in issues related to daily operations. The Board takes a balanced approach when addressing community and business/financial concerns. The Board is also the primary group for determining the use of surplus funds generated by the organization which are reinvested in the ministry in order to allow the ministry to sustain its mission and prepare for the future. Open Medical Staff - The medical staff of VCRH is an open medical staff and is composed of physicians, dentists and podiatrists licensed to practice medicine in the State of Kansas. VCRH staff also participates in the community on boards of other not-for-profit organizations, government entities, foundations, area colleges and university committees, state-wide coalitions, etc.
Affiliated Health Care System Part VI, line 6 VCRH is an affiliate of Via Christi Health, Inc. (VCH). VCH's affiliates are large multi-faceted, integrated, not-for-profit ministries including Hospital and Non-Hospital ministries (Physician Group Practices, Hospital organizations, Research, Home Health, Durable Medical Equipment and Senior Facilities). These ministries work together to care for patients, joined by common systems and a philosophy of serving as a healing presence with special concern for our neighbors, especially those who are vulnerable. This community benefit happens through its focus on patient care, education and research. The organizations work together to serve their communities at the local, regional and state level.
State Filing of Community Benefit Report Part VI, line 7 Not Applicable - Kansas does not require hospitals to file community benefit reports but Via Christi Health distributes our community benefit totals and activities annually in press releases as well as in our annual report.
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
VIA CHRISTI REHABILITATION HOSPITAL INC
 
Employer identification number

48-1158274
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
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
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) LAURIE LABARCA (i)
(ii)		 0
362,948 		0
90,475 		0
8,325 		0
47,726 		0
10,803 		0
520,277 		0
0
(2) CINDY LAFLEUR (i)
(ii)		 0
149,357 		0
18,711 		0
3,429 		0
24,354 		0
10,101 		0
205,952 		0
0
(3) SISTER ANNE DOLORES LAPLANTE (i)
(ii)		 0
118,794 		0
21,005 		0
720 		0
11,259 		0
1,426 		0
153,204 		0
0
(4) SISTER SHERRI MARIE KUHN (i)
(ii)		 0
188,143 		0
32,941 		0
2,373 		0
19,399 		0
8,644 		0
251,500 		0
0
(5) PACKARD LAMONT (i)
(ii)		 136,919
0 		200
0 		1,243
0 		11,876
0 		8,440
0 		158,678
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
supplemental non-qualified retirement plan paid by a related organization part i, question 4b Laurie Labarca $29,350.61 Cindy LaFleur $ 9,902.69
Schedule J (Form 990) 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
VIA CHRISTI REHABILITATION HOSPITAL INC
 
Employer identification number

48-1158274
Identifier Return Reference Explanation
COMMUNITY BENEFIT REPORT PART III VIA CHRISTI REHABILITATION HOSPITAL, Inc. (VCRH), IS A MEMBER OF VIA CHRISTI HEALTH, Inc. (VCH). As a Catholic health care system, its origins are in faith-based responses to health needs of our communities, with a particular concern for those living in poverty and who are vulnerable. In addition to typical inpatient and outpatient services, VCH operates primary care clinics, a low income neighborhood outreach clinic, specialty hospitals and centers, home medical services, therapy centers and long-term care villages. The obligation to reach out to those in need and to improve community health flows directly from VCH's identity as a faith-based healing ministry. VCH continues its tradition in providing community benefit because we are committed to: - Promoting and defending human dignity - Caring for persons living in poverty and other vulnerable populations - Promoting the common good - Stewarding resources responsibly According to the VCH' mission statement, "As a part of Via Christi Health, we share this Mission: Inspired by the Gospel and our Catholic tradition, we serve as a healing presence with special concern for our neighbors who are vulnerable." The financial information in this report was prepared in accordance with the Catholic Health Association's (CHA) A Guide for Planning and Reporting Community Benefit Guidelines. Per these Guidelines, we report the net expense for community benefit services (i.e., the total community benefit expense minus any associated revenue from patients, residents, payers, and other external sources). The CHA Guidelines reflect a conservative approach to reporting quantifiable community benefit. The goal of the Guidelines is to produce community benefit financial reports that reflect true costs and that describe community benefit activities that increase access to health care and improve community health for all. The following are VCRH definitions for quantifiable community benefits. Charity Care - Free or discounted health services provided to persons who cannot afford to pay and who meet VCH's criteria for financial assistance. Charity care is reported in terms of costs, not charges. Charity care does not include bad debt. Government Sponsored Means-Tested Health Care - Includes unpaid costs of public programs for low-income persons - the shortfall created when VCH receives payments that are less than the cost of caring for public program beneficiaries. This payment shortfall is not the same as a contractual allowance, which is the full difference between charges and government payments. Health Professions Education - Helping to prepare future health care professionals is a distinguishing characteristic of not-for-profit health care and constitutes a significant community benefit. This category includes programs and financial assistance for physicians and medical students, nurses and nursing students, interns and other health professionals. For fiscal year ended September 30, 2011 Community Benefit (VCRH): 1. Charity care - at cost $0.2 million 2. Government sponsored health care - net expense $1.1 million Unpaid cost of public indigent care programs (includes Medicaid, SCHIP, other safety net programs; does not include Medicare shortfall) 3. Community Benefit Programs - net expense $0.3 million 4. Total Quantifiable Community Benefit $1.6 million Listed below are just a few of the community benefit programs offered by (VCRH). This is not a complete listing but a sampling of how the hospital gives back to the Wichita/Sedgwick County area while meeting current needs. Sports Medicine Outreach to Youth - VCRH has dedicated athletic trainers to Wichita and area high schools. Trainers perform rounds to examine injured athletes and consult with the coaching staff on safety concerns. Trainers also provide coverage of home sporting events. In addition, VCRH leadership provides support to the Greater Wichita Sports Commission through the BOD of the organization. The un-reimbursed cost of providing this Sports Medicine Outreach in 2011 was $206,754. Sports Medicine staff also hosted a Coaches conference for USD 259 for the purpose of educating coaches on athletic injury prevention, common injuries and hot topics. The conference was provided to 412 high school coaches and staff. The Sports Medicine staff provided their services in performing 32 sports physicals to USD 259 high school students at reduced cost. Health Professionals Education and Training - Health Profession Education of area health care professionals who are either looking for continuing education credits, wanting more hands-on training, or are in need of field practicum placements, etc are welcomed at VCRH for additional training opportunities. Approximately 11 health care professionals and/or students hoping to enter the health care field received training opportunities at a cost of nearly $50,527. Support Groups - Support Groups & Educational Presentations are hosted including amputee, stroke, lymphedema, Spinal cord injury, sleep, Scleroderma, and Brain Injury support groups. 55 Alive driving - VCRH provides a "55 Alive driving" education course for the community at large so that the aging population in the Wichita area can get education on how to continue to be a safe driver with some of the challenges of aging. Community Benefit Operations - Community benefit staff uses and trains others to use the Community Benefit Inventory Social Accountability (CBISA) software, developed by Lyon Software and used by over 1,700 hospitals throughout the country. CBISA software follows the reporting guidelines adopted by Catholic Health Association and does not include bad debt or unpaid Medicare reimbursements as community benefit.
FORM 990 REVIEW PART VI, SECTION B, QUESTION 11 VIA CHRISTI REHABILITATION HOSPITAL, INC. SHARES VIA CHRISTI HOSPITALS WICHITA, INC.'S AUDIT COMMITTEE. The audit committee reviews and approves the Form 990 prior to the date of filing. The audit committee reports on the review to the Board of Trustees and assures that the Board has the opportunity to review the final Form 990 as filed. A COPY OF FORM 990 IS PROVIDED TO THE BOARD OF TRUSTEES VIA A SECURE EMAIL PRIOR TO FILING WITH THE IRS.
CONFLICT OF INTEREST POLICY PART VI, SECTION B, QUESTION 12C THE ORGANIZATION MONITORS AND ENFORCES THE CONFLICT OF INTEREST POLICY AS FOLLOWS: 1) AT TIME OF APPOINTMENT AND ANNUALLY THEREAFTER, ALL INTERESTED PERSONS, INCLUDING BOARD AND COMMITTEE MEMBERS COMPLETE A DISCLOSURE STATEMENT WHICH ADDRESSES ACTUAL OR POTENTIAL CONFLICTS OF INTEREST. 2) THE DISCLOSURE STATEMENT IS DONE ELECTRONICALLY AND THE RETURN OF THE COMPLETED STATEMENT IS A CONDITION OF CONTINUED APPOINTMENT, EMPLOYMENT OR PARTICIPATION WITH THE ORGANIZATION. 3) ALL ACTUAL OR POTENTIAL CONFLICTS ARE REVIEWED, INVESTIGATED AND RESOLVED BY THE CHIEF GOVERNANCE OFFICER AND THE CORPORATE RESPONSIBILITY OFFICER, WITH THE RESULTS SHARED WITH THE CHIEF EXECUTIVE OF THE ORGANIZATION. 4) PERIODIC REVIEWS ARE CONDUCTED BY GOVERNANCE, COMPLIANCE AND INTERNAL AUDIT TO ENSURE THE ORGANZIATION IS OPERATING CONSISTENT WITH THE POLICY AND ENFORCING THE POLICY'S TERMS.
COMPENSATION REVIEW PART VI, SECTION B, QUESTION 15 Via Christi Rehabilitation Hospital, Inc. uses the policies established by Via Christi Health, Inc. (VCH). VCH has established a common philosophy, strategy, and processes for executive compensation to be used throughout the Via Christi Health System. VCH's philosophy, strategy and process for executive compensation are described next. Through the oversight of the VCH Executive Compensation Committee, executive compensation is competitively positioned at its stated market position when compared to the compensation paid by relevant organizations (comparably-sized health systems, hospitals, and long-term care providers). VCH recognizes its responsibility to ensure that its executive compensation program is appropriate in view of its mission and tax-exempt status and that its compensation levels and expenditures are reasonable and not excessive. To ensure these ends, the VCH Executive Compensation Committee has established and approved the executive compensation philosophy for VCH and all related entities. It will also approve all changes in the compensation package for VCH executives in advance. On an annual basis, the Committee conducts a comprehensive review of total compensation for all executives. It also reviews and approves "off-cycle" compensation transactions as needed. In their review, the Committee considers the following factors: * Market data from independent compensation surveys and sources that reflect comparable positions in organizations of similar size and scope * Difficulties in recruiting and retaining executives * Skills, experience and performance history of individual executives * Critical business or strategic issues that the organization may face * Market position for total compensation The adequacy, competitiveness, and cost of the VCH total executive compensation program are reviewed on an ongoing basis and changes are made as the Committee determines appropriate. The executive compensation program will be maintained such that it will fall within the safe harbor guidelines established by the Intermediate Sanctions regulations. The Committee also employs the services of an independent compensation consultant to prepare market analysis to aid and support the Committee's actions, provide documentation of market trends for budget setting purposes, review annual compensation changes to ensure "reasonableness" and provide attestation, and provide consultation on all executive compensation issues. The Committee also relies on third-party validation of performance measures used in the determination of compensation.
GOVERNING DOCUMENTS PART VI, SECTION C, QUESTION 19 VIA CHRISTI REHABILITATION HOSPITAL, INC.'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
MEMBERS PART VI, SECTION A, Q6, 7A, AND 7B VIA CHRISTI HOSPITALS WICHITA, INC. IS THE SOLE MEMBER. THE MEMBER MAY APPROVE AND REMOVE INDIVIDUALS ON THE BOARD OF TRUSTEES. ARTICLE 2 OF THE BYLAWS PROVIDE THE MEMBER WITH THE FOLLOWING POWERS: * RATIFICATION OF THE PHILOSOPHY AND MISSION OF THE CORPORATION DEVELOPED BY THE BOARD OF TRUSTEES OF THE CORPORATION; * AMENDMENT, ADOPTION OR REPEAL OF THE ARTICLES OF INCORPORATION OR BYLAWS OF THE CORPORATION; * CHANGE IN THE MEMBERSHIP OF THE CORPORATION; * APPOINTMENT AND EVALUATION OF THE PERFORMANCE OF THE ADMINISTRATOR AND TRUSTEES OF THE CORPORATION; * APPROVAL OF CAPITAL EXPENDITURES OF THE CORPORATION IN EXCESS OF LIMITS ESTABLISHED FROM TIME TO TIME BY THE MEMBER; * APPROVAL OF CAPITAL EXPENDITURES OF THE CORPORATION IN EXCESS OF LIMITS ESTABLISHED FROM TIME TO TIME BY THE MEMBER; * APPROVAL OF THE ACQUISITION, ALIENATION, ENCUMBRANCE, EXCHANGE, LEASE, SALE, TRANSFER OR OTHER DISPOSITION OF ASSETS, LAND, BUILDINGS, OR EQUIPMENT BY THE CORPORATION IN EXCESS OF LIMITS ESTABLISHED FROM TIME TO TIME BY THE MEMBER; * ADOPTION, EXECUTION, REVOCATION OR ABANDONMENT OF ANY PLAN OF MERGER, CONSOLIDATION, REORGANIZATION, DISSOLUTION OR OTHER MAJOR CORPORATE CHANGE TO THE CORPORATION; * REVIEW AND APPROVAL OF THE CORPORATION'S BUDGETS AND UNDBUDGETED EXPENDITURES IN EXCESS OF LIMITS ESTABLISHED FROM TIME TO TIME BY THE MEMBER.
TAX EXEMPT BONDS PART IV, QUESTION 24A Via Christi Rehabilitation Hospital, Inc. (VCRH) along with Via Christi Health, Inc. (VCH) and other Health System hospitals (the 'Obligated Group"), entered into a master trust indenture and an obligated group agreement whereby they were jointly and severally liable for all amounts due under any and all notes and guarantees issued pursuant to the master trust indenture. The Obligated Group consists of the Via Christi Health, Inc., Via Christi Hospital Wichita, Inc., Via Christi Rehabilitation Hospital, Inc., Via Christi Hospital Wichita St Teresa, Inc. and Via Christi Hospital Pittsburg, Inc. All bond debt is reported on the books of VCH with intercompany debt reported on the respective hospital ministries. For the year ended September 30, 2011 VCRH had intercompany debt outstanding payable to VCH in the amount of $1,207,639. This debt relates to the following tax exempt bond issues outstanding and report on VCH form 990. Series XI 1999 Hospital Facility Improvement and Refinancing Revenue Bonds EIN: 48-600653 CUSIP: 967250 DATE ISSUED: 10/1/1999 ISSUE PRICE: $1,990,972 PURPOSE: Refunding old bonds and facility improvement
RELATED TAX-EXEMPT ORGANIZATIONS SCHEDULE R, PART II VIA CHRISTI REHABILITATION CENTER, INC. IS INDIRECTLY CONTROLLED BY VIA CHRISTI HEALTH, INC. VIA CHRISTI HEALTH, INC. IS JOINTLY SPONSORED AND CONTROLLED BY ASCENSION HEALTH AND MARIAN HEALTH SYSTEM, WHICH IN TURN ARE SPONSORED BY THE SISTERS OF THE SORROWFUL MOTHER, FOUR PROVINCES OF THE DAUGHTERS OF CHARITY, THE CONGREGATION OF ST. JOSEPH, AND THE SISTERS OF ST. JOSEPH OF CARONDELET. DUE TO SUCH SPONSORSHIP AND CONTROL, AND IN THE INTEREST OF INCREASED CLARITY AND TRANSPARENCY, BOTH ASCENSION HEALTH AND MARIAN HEALTH SYSTEM ARE BEING LISTED AS RELATED ORGANIZATIONS ON SCHEDULE R.
OTHER CHANGES IN NET ASSETS PART XI, QUESTION 5 UNREALIZED LOSS: (1,074,626) Change in Pension (804,872) ------------ TOTAL (1,879,498)
BAD DEBT EXPENSE Parts VIII and IX In July 2011, the FASB issued ASU 2011-07, Health Care Entities (Topic 954): Presentation and Disclosure of Patient Services Revenue, Provision for Bad Debts, and the Allowance for Doubtful Accounts for Certain Health Care Entities. ASU 2011-07 includes amendments to FASB's ASC Topic 954, Health Care Entities. The objective of the update is to provide financial statement users with greater transparency about a health care entity's net patient service revenue and the related allowance for doubtful accounts. The amendments requires health care entities that recognize significant amounts of patient service revenue at the time services are rendered, even though they do not immediately assess the patients' ability to pay, to present the provision for bad debts related to patient service revenue as a deduction from patient service revenue (net of contractual allowances and discounts) on their statement of operations. The Heath System elected to adopt this standard as of September 30, 2011, which did not have a significant impact on the consolidated financial statements.
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:LAURIE LABARCA TITLE:EX-OFFICIO HOURS:49
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:CINDY LAFLEUR TITLE:EX-OFFICIO HOURS:25
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SISTER ANNE DOLORES LAPLANTE TITLE:EX-OFFICIO HOURS:49
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SISTER SHERRI MARIE KUHN TITLE:EX-OFFICIO HOURS:49
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


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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
VIA CHRISTI REHABILITATION HOSPITAL INC
 
Employer identification number

48-1158274
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)
(a)
Name, address, and EIN of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

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


 		(f)
Direct controlling
entity

















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


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

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

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled organization
Yes No
(1) Catholic Care Center Inc

6700 E 45th St N

Wichita,KS67226
48-1067110 		Rtrmnt Home KS 501(C)(3) 9 NA
 
 
 
(2) CIBOR INC

9229 E 27TH ST N SUITE 200

Wichita,KS67226
27-0564463 		Research KS 501(C)(3) 7 NA
 
 
 
(3) Cornerstone Assisted Living Inc

3636 N Ridge Road

Wichita,KS67205
48-1241079 		Rtrmnt Home KS 501(C)(3) 9 NA
 
 
 
(4) Gerard House Inc

3144 N Hood

Wichita,KS67204
48-1049532 		Shelter KS 501(C)(3) 7 NA
 
 
 
(5) Marian Health System Inc

1923 South Utica Avenue

Tulsa,OK74104
36-3659989 		Hospital Supp DE 501(C)(3) 11 NA
 
 
 
(6) Mercy Community Health Foundation Inc

1823 College Ave

Manhattan,KS66502
48-1152279 		Foundation KS 501(C)(3) 11 NA
 
 
 
(7) Mercy Regional Health Center Inc

1823 College Ave

Manhattan,KS66502
48-1186704 		Hospital KS 501(C)(3) 3 NA
 
 
 
(8) Mercy Regional Home Medical Services LLC

2439 Claflin Road

Manhattan,KS66502
43-2024491 		Home Medical KS 501(C)(3) 11 NA
 
 
 
(9) Mount Carmel Foundation Inc

1102 E Centennial Dr

Pittsburg,KS66762
48-0961283 		Foundation KS 501(C)(3) 11 NA
 
 
 
(10) Salina Regional Home Medical Services

520 S Santa Fe Ave Ste 140

Salina,KS67401
43-1948057 		Home Medical KS 501(C)(3) 11 NA
 
 
 
(11) St John's Inc

2225 Cantebury Dr

Hays,KS67601
20-2828680 		Rtrmnt Home KS 501(C)(3) 9 NA
 
 
 
(12) Via Christi Foundation Inc

723 N McLean Blvd

Wichita,KS67203
48-1173588 		Foundation KS 501(C)(3) 11 NA
 
 
 
(13) Via Christi Health Partners Inc

8200 E Thorn Dr SUITE 300

Wichita,KS67226
48-0958974 		Mgmnt Co. KS 501(C)(3) 9 NA
 
 
 
(14) Via Christi Health Inc

8200 E Thorn Dr SUITE 300

Wichita,KS67226
48-1172107 		Hospital Supp KS 501(C)(3) 9 NA
 
 
 
(15) Via Christi Healthcare Outreach Program

2622 W Central Suite 100

Wichita,KS67203
48-1236589 		PACE Commun. KS 501(C)(3) 9 NA
 
 
 
(16) Via Christi Home Health Wichita Inc

555 S Washington

Wichita,KS67211
48-1046371 		Home Health KS 501(C)(3) 9 NA
 
 
 
(17) Via Christi Hospital Pittsburg Inc

1102 E Centennial Dr

Pittsburg,KS66762
48-0543778 		Hospital KS 501(C)(3) 3 NA
 
 
 
(18) Via Christi Hospital Wichita St Teresa

14800 W St Teresa

Wichita,KS67235
27-1965272 		Hospital KS 501(C)(3) 3 NA
 
 
 
(19) Via Christi Hospitals Wichita Inc

929 N St Francis

Wichita,KS67214
48-1172106 		Hospital KS 501(C)(3) 3 NA
 
 
 
(20) VC IMMEDIATE CARE MOTHER MARY ANNE INC

929 N St Francis

Wichita,KS67214
20-8374099 		Med. Clinic KS 501(C)(3) 9 NA
 
 
 
(21) Via Christi Property Services Inc

1100 N St Francis Suite 240

Wichita,KS67214
48-0948571 		Property Mgmt KS 501(C)(4) N/A NA
 
 
 
(22) Via Christi Village Georgetown Inc

1655 S Georgetown

Wichita,KS67218
48-1129325 		Rtrmnt Home KS 501(C)(3) 9 NA
 
 
 
(23) Via Christi Village Manhattan Inc

2800 Willowgrove Rd

Manhattan,KS66502
48-1078862 		Rtrmnt Home KS 501(C)(3) 9 NA
 
 
 
(24) Via Christi Village McLean Inc

777 N McLean Blvd

Wichita,KS67203
48-1247723 		Rtrmnt Home KS 501(C)(3) 9 NA
 
 
 
(25) Via Christi Village Ponca City Inc

1601 Academy Rd

Ponca City,OK74604
73-1153337 		Rtrmnt Home OK 501(C)(3) 9 NA
 
 
 
(26) Via Christi Village Pittsburg Inc

1502 E Centennial Dr

Pittsburg,KS66762
74-3070971 		Rtrmnt Home KS 501(C)(3) 9 NA
 
 
 
(27) Via Christi Villages Inc

2622 W Central Suite 100

Wichita,KS67203
48-0559086 		Mgmnt Co. KS 501(C)(3) 11 NA
 
 
 
(28) Wamego Hospital Association

711 Genn Dr

Wamego,KS66547
72-1526400 		Hospital KS 501(C)(3) 3 NA
 
 
 
(29) ASCENSION HEALTH

PO BOX 45998

ST LOUIS,MO63145
31-1662309 		HLTH SYS GOV MO 501(C)(3) 11 NA
 
 
 
(30) VIA CHRISTI INMYHOME INC

2622 W CENTRAL SUITE 100

WICHITA,KS67203
27-1889960 		HLTH AGENCY KS 501(C)(3) 9 NA
 
 
 
(31) VIA CHRISTI CLINIC SERVICES INC

8200 THORN DRIVE SUITE 300

WICHITA,KS67226
27-3984287 		MED. CLINIC KS 501(C)(3) 11 NA
 
 
 
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) ST JOSEPH MRI LLC

8200 E THORN DR SUITE 300
WICHITA,KS67226
48-1007220 		MEDICAL SVCS KS NA
  		N/A 0 0     0     0 %
(2) AMBULATORY SURGERY CENTER LP

8200 E THORN DR SUITE 300
WICHITA,KS67226
48-1114690 		SURGERY CTR KS NA
  		N/A 0 0     0     0 %
(3) KANSAS SURGERY AND RECOVERY CTR LLC

8200 E THORN DR SUITE 300
WICHITA,KS67226
48-1148580 		SURGERY CTR KS NA
  		N/A 0 0     0     0 %
(4) MR IMAGING CENTER LLC

8200 E THORN DR SUITE 300
WICHITA,KS67226
48-1000538 		RADIOLOGY SVC KS NA
  		N/A 0 0     0     0 %
(5) VIA CHRISTI CYBERKNIFE LLC

8200 E THORN DR SUITE 300
WICHITA,KS67226
35-4588711 		RADIOLOGY SVC KS NA
  		N/A 0 0     0     0 %
(6) AMS DIAGNOSTICS LLC

8200 E THORN DR SUITE 300
WICHITA,KS67226
48-1223653 		RADIOLOGY SVC KS NA
  		N/A 0 0     0     0 %
(7) PREFERRED PET IMAGING OF KS LLC

8200 E THORN DR SUITE 300
WICHITA,KS67226
48-1250123 		DIAGNOSTIC IM KS NA
  		N/A 0 0     0     0 %
(8) PFI LLC

8200 E THORN DR SUITE 300
WICHITA,KS67226
72-1557076 		MED CHEM MFG KS NA
  		N/A 0 0     0     0 %
(9) MERCY IMAGING LLC

8200 E THORN DR SUITE 300
WICHITA,KS67226
48-1251984 		DIAGNOSTIC IM KS NA
  		N/A 0 0     0     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) AFFILIATED MEDICAL SERVICES LAB INC
2916 E CENTRAL
WICHITA,KS67214
48-1239522 		MEDICAL LAB KS NA
  		C-CORP 12,321,597 7,892,802 100.000 %
(2) SUNFLOWER ASSURANCE LTD
PO BOX 1085
GRAND CAYMAN,CAYMAN ISLANDSKY1-1102
CJ
98-0223159 		INSURANCE CO. CJ NA
  		FOREIGN CORP 3,651,768 38,500,707 100.000 %
(3) INTEGRATED HEALTHCARE SYSTEMS INC
3311 EAST MURDOCK
WICHITA,KS67208
48-0941549 		CLINIC SERVICES KS NA
  		C CORP 58,758,618 41,790,046 100.000 %
(4) VCH IOWA PC TRUST
8200 THORN DRIVE SUITE 300
WICHITA,KS67226
27-6937322 		BENEFICIARY TRUST IA NA
  		TRUST 0 0 100.000 %
(5) VCH IOWA PC
8200 THORN DRIVE SUITE 300
WICHITA,KS67226
27-3983977 		PROF. CORP IA NA
  		CORP 0 0 100.000 %
(6) VIA CHRISTI CLINIC PA
3311 EAST MURDOCK
WICHITA,KS67208
48-0993446 		PROF. CORP KS NA
  		CORP 116,439,508 24,067,602 100.000 %


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
 
No
d Loans or loan guarantees to or for other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
Yes
 
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
Yes
 
m Sharing of facilities, equipment, mailing lists, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of paid employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Reimbursement paid to other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid by other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
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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