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

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2011
Open to Public Inspection
A For the calendar year, or tax year beginning 01-01-2011 and ending 12-31-2011
BCheck if applicable:
CName of organization
FRANCISCAN ALLIANCE INC
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
1515 DRAGOON TRAIL
 
Room/suite
City or town, state or country, and ZIP + 4
MISHAWAKA, IN465444710
D Employer identification number

35-1330472
E Telephone number

G Gross receipts $ 2,369,317,141
F Name and address of principal officer:
KEVIN D LEAHY
1515 DRAGOON TRAIL
MISHAWAKA,IN46544
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.FRANCISCANALLIANCE.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: 1974
M State of legal domicile: IN
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: SEE SCHEDULE O
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a)..... 3 15
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 11
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ... 5 18,201
6 Total number of volunteers (estimate if necessary) .... 6 1,884
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 11,199,651
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b 707,158
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 7,740,999 7,420,568
9 Program service revenue (Part VIII, line 2g) ......... 2,202,782,422 2,255,270,155
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 102,463,339 86,918,390
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 10,406,749 11,057,705
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 2,323,393,509 2,360,666,818
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 6,454,468 60,338
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) 1,038,668,750 1,137,443,940
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 160,348 143,488
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet378,709    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 1,085,499,963 1,076,589,218
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 2,130,783,529 2,214,236,984
19 Revenue less expenses. Subtract line 18 from line 12....... 192,609,980 146,429,834
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 3,688,293,018 3,793,872,644
21 Total liabilities (Part X, line 26)............. 1,799,844,806 1,956,026,290
22 Net assets or fund balances. Subtract line 21 from line 20..... 1,888,448,212 1,837,846,354
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid preparer use only
Print/type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name Right pointing arrowhead image

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



Phone no.
May the IRS discuss this return with the preparer shown above? See instructions .........bullet
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2011)
Form 990 (2011)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III .........
1
Briefly describe the organization’s mission: THE PURPOSES FOR WHICH FRANCISCAN ALLIANCE, INC. IS FORMED ARE: TO CONTINUE THE HEALING MINISTRY OF CHRIST IN ACCORDANCE WITH THE TEACHINGS OF THE ROMAN CATHOLIC CHURCH AND, IN PARTNERSHIP WITH OTHERS, TO PROVIDE A FULL CONTINUUM OF HEALTH CARE SERVICES; TO CARRY ON EDUCATIONAL ACTIVITIES RELATED TO THE PROMOTION OF HEALTH; TO PROMOTE AND CARRY ON SCIENTIFIC RESEARCH RELATED TO HEALTH CARE; AND TO PARTICIPATE IN ANY ACTIVITY DESIGNED AND CONDUCTED TO PROMOTE THE GENERAL HEALTH OF THOSE SERVED BY FRANCISCAN ALLIANCE, INC. THE REVENUES OF FRANCISCAN ALLIANCE, INC. ALLOW FOR THE OPERATION OF HEALTH CARE FACILITIES WHERE THE PURPOSE IS TO RESPECT LIFE AND TO PRESERVE HEALTH AS WELL AS TREAT ILLNESS AND INJURY. THIS ALLOWS FOR THE ACCOMPLISHMENT OF THE CORPORATE MINISTRY WHICH HAS THE FOLLOWING CENTRAL CONCERNS: COMPASSION FOR THOSE IN NEED, RESPECT FOR LIFE AND THE DIGNITY OF PERSONS, WELLNESS AND THE PREVENTION OF ILLNESS, RESTORATION TO HEALTH, AND THE ACCEPTANCE OF DEATH AS THE FINAL ST
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 1,937,190,004 including grants of $ 60,338 ) (Revenue $ 2,246,315,655 )
FRANCISCAN ALLIANCE, INC.'S ("FRANCISCAN") PURPOSE IS TO CONTINUE THE HEALING MINISTRY OF CHRIST IN ACCORDANCE WITH THE TEACHINGS OF THE ROMAN CATHOLIC CHURCH AND IN PARTNERSHIP WITH OTHERS TO PROVIDE A FULL CONTINUUM OF HEALTH CARE SERVICES; TO CARRY ON EDUCATIONAL ACTIVITIES RELATED TO THE PROMOTION OF HEALTH; TO PROMOTE AND CARRY ON SCIENTIFIC RESEARCH RELATED TO HEALTH CARE; AND TO PARTICIPATE IN ACTIVITIES DESIGNED AND CONDUCTED TO PROMOTE THE GENERAL HEALTH OF THOSE SERVED BY FRANCISCAN. PLEASE VIEW "OUR GIVING JOURNAL" AT WWW.FRANCISCANALLIANCE.ORG/COMMUNITYBENEFIT WHICH REFLECTS OUR MISSION OF "CONTINUING CHRIST'S MINISTRY IN OUR FRANCISCAN TRADITION." THE REPORT LOCATED AT WWW.FRANCISCANALLIANCE.ORG/COMMUNITYBENEFIT REFLECTS OUR MISSION OF "CONTINUING CHRIST'S MINISTRY IN OUR FRANCISCAN TRADITION." ALTHOUGH IT IS NOT ALL INCLUSIVE OF THE MANY BENEFITS PROVIDED, IT DOES PORTRAY THE SIGNIFICANT BENEFITS THAT REFLECT THE ORGANIZATION'S COMMITMENT TO HEALTHCARE AND THE COMMUNITIES WE SERVE. AS DETAILED IN THE REFERENCED REPORT, A SUMMARY OF THE COMMUNITY BENEFIT OF FRANCISCAN ALLIANCE, INC. IS AS FOLLOWS: BENEFITS FOR THE POOR --------------------- CHARITY CARE $ 69,346,148 UNPAID COST OF MEDICAID 112,305,383 COMMUNITY SERVICES 7,654,946 ----------- $ 189,306,477 BENEFITS FOR THE COMMUNITY -------------------------- OTHER COMMUNITY BENEFITS $ 63,253,443 BAD DEBT 28,296,882 UNPAID COST OF MEDICARE 173,106,967 ------------ TOTAL BENEFITS $ 264,657,292 TOTAL BENEFITS $ 453,963,769
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$ 1,937,190,004
Form 990 (2011)
Form 990 (2011)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment........
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part IIClick to see attachment.........................
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part III........................
5
 
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part IClick to see attachment....................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IVClick to see attachment...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
Yes
 
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
 
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
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Part I.........
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 IClick to see attachment
17
Yes
 
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.......... Click to see attachment
18
Yes
 
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................... Click to see attachment
19
 
No
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H..... Click to see attachment
20a
Yes
 
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statement to this return? Note. All Form 990 filers that operated one or more hospitals must attach audited financial statements. Click to see list of attachments
20b
Yes
 
Form 990 (2011)
Form 990 (2011)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.. Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III..... Click to see attachment
22
 
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................ Click to see list of attachments
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
Yes
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
No
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I...... Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................ Click to see attachment
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II......................... Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III......... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ......................... Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV................... Click to see attachment
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV.. Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
Yes
 
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2........... Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2011)
Form 990 (2011)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V .........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
2,322
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
18,201
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
Yes
 
b
If "Yes," enter the name of the foreign country: MediumBulletBD
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
Yes
 
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
Yes
 
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 (2011)
Form 990 (2011)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI .........
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
If the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
1a
15
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
11
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
 
No
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? .................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ............
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ..........
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes? ....
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form?
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done ....................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes," to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
Yes
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
IL , IN
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
MARGUERITE EICHELBERGER
1515 DRAGOON TRAIL
MISHAWAKA,IN465444710
(574) 254-6268
Form 990 (2011)
Form 990 (2011)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII .........
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

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

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

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

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) SISTER M ALINE SHULTZ
TRUSTEE & VP OF MARKETING
 40.0 X                
(2) SISTER M CLARE REUILLE
TRUSTEE
 5.0 X                
(3) SISTER ROSE AGNES PFAUTSCH
TRUSTEE
 5.0 X                
(4) SISTER M ANGELA MELLADY
TRUSTEE
 5.0 X                
(5) SISTER M MARLENE SHAPLEY
TRUSTEE
 40.0 X                
(6) SISTER MARILYN OLIVER
TRUSTEE
 5.0 X                
(7) KATHLEEN GOEPPINGER PHD
TRUSTEE
 5.0 X                
(8) SISTER M MADONNA ROUGEAU
TRUSTEE & VP OF MISSION - FSJH
 40.0 X                
(9) JOHN LADOWICZ
TRUSTEE
 5.0 X                
(10) JAMES D ROGGE MD
TRUSTEE
 5.0 X                
(11) SISTER JANE MARIE KLEIN
CHAIRPERSON AND TRUSTEE
 40.0 X   X            
(12) SISTER M ANN KATHLEEN MAGIERA
TREASURER AND TRUSTEE
 40.0 X   X            
(13) KEVIN D LEAHY
PRESIDENT AND TRUSTEE
 40.0 X   X       1,542,487 0 1,565,450
(14) SISTER M CORITA LAST
VICE PRESIDENT, SECRETARY
 40.0 X   X            
(15) DONALD J KERNER MD
TRUSTEE
 10.0 X           38,462 0 1,751
(16) JAIRO CRUZ MD
TRUSTEE
 40.0 X           242,506 0 0
(17) SISTER LETHIA MARIE LEVEILLE
ASSISTANT SECRETARY
 40.0     X            
Form 990 (2011)
Form 990 (2011)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) EUGENE C DIAMOND
REGIONAL CEO NIR
 40.0       X     864,620 0 1,354,417
(19) ROBERT J BRODY
REGIONAL CEO CIR
 40.0       X     865,014 0 1,215,312
(20) JENNIFER P MARION
SENIOR VP FINANCE, CFO
 40.0       X     681,005 0 236,371
(21) TERRANCE E WILSON
REGIONAL CEO WIR
 40.0       X     646,388 0 577,281
(22) SETH CR WARREN
REGIONAL CEO SSCR
 40.0       X     645,280 0 338,840
(23) LOUIS METZMAN MD
PHYSICIAN
 40.0         X   1,189,020 0 58,697
(24) JEFFREY L PIERSON MD
PHYSICIAN
 40.0         X   1,384,874 0 40,132
(25) JOHN B MEDING MD
PHYSICIAN
 40.0         X   841,159 0 53,873
(26) MICHAEL E BEREND MD
PHYSICIAN
 40.0         X   871,656 0 32,364
(27) ROBERT A MALINZAK MD
PHYSICIAN
 40.0         X   704,665 0 32,743






1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 10,517,136 0 5,507,231
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet993
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. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
METT THERAPY
801 SOUTH BRIGGS STREET
JOLIET,IL60433 		PHYSICIAN FEES 7,806,606
PRICEWATERHOUSECOOPERS LLP
PO BOX 75647
CHICAGO,IL606755647 		ACCOUNTING 2,916,528
WEBMEDX INC
3350 RIVERWOOD PARKWAY SUITE 1850
ATLANTA,GA30339 		BILLING SERVICES 2,734,438
MEDICAL REIMBURSEMENTS OF AMERICA
7105 MOORES LANE SUITE 7
BRENTWOOD,TN37027 		BILLING SERVICES 2,672,271
KRIEG DEVAULT LLP
ONE INDIANA SQUARE
INDIANAPOLIS,IN462042079 		LEGAL 2,495,041
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet151
Form 990 (2011)
Form 990 (2011)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c 249,802
d Related organizations...1d 40,000
e Government grants (contributions)1e 400,470
f All other contributions, gifts, grants, and
similar amounts not included above1f 		6,730,296
g Noncash contributions included in lines 1a-1f:$  
h Total. Add lines 1a-1f.......MediumBullet 7,420,568
Program Service Revenue Business Code
2a PATIENT AND OTHER REVENUES 900,099 2,117,342,503 2,116,264,124   1,078,379
b PREMIUM REVENUE 900,099 78,345,233 78,345,233    
c LAUNDRY 812,300 2,438,273   2,438,273  
d PHARMACY 446,110 53,120,961 50,555,512 923,348 1,642,101
e CAFETERIA 722,210 4,023,185     4,023,185
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 2,255,270,155
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 87,976,025     87,976,025
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0     0
5 Royalties............MediumBullet 0     0
(i) Real (ii) Personal
6a Gross rents 8,845,121  
b Less: rental expenses 5,534,375  
c Rental income or (loss) 3,310,746  
d Net rental income or (loss).......MediumBullet 3,310,746 1,150,786   2,159,960
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory   1,499,193
b Less: cost or other basis and sales expenses   2,556,828
c Gain or (loss)   -1,057,635
d Net gain or (loss)..........MediumBullet -1,057,635     -1,057,635
8a Gross income from fundraising events (not including
$ 249,802
of contributions reported on line 1c). See Part IV, line 18 ...
a 166,972
b Less: direct expenses ...b 287,145
c Net income or (loss) from fundraising events..MediumBullet -120,173   -120,173
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     0
10a Gross sales of inventory, less
returns and allowances .
a 301,077
b Less: cost of goods sold ..b 271,975
c Net income or (loss) from sales of inventory..MediumBullet 29,102     29,102
Miscellaneous Revenue Business Code
11a OTHER OPERATING REVENUE 900,099 7,838,030   7,838,030  
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ......MediumBullet 7,838,030
12 Total revenue. See Instructions....MediumBullet 2,360,666,818 2,246,315,655 11,199,651 95,730,944
Form 990 (2011)
Form 990 (2011)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Check if Schedule O contains a response to any question in this Part IX. .........
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 60,338 60,338
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 0  
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16 0  
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 14,119,443 7,782,495 6,336,948 0
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0      
7 Other salaries and wages 875,334,591 776,290,097 98,889,011 155,483
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 39,555,261 35,439,560 4,106,184 9,517
9 Other employee benefits ....... 158,488,611 133,515,961 24,947,967 24,683
10 Payroll taxes ........... 49,946,034 45,207,187 4,727,111 11,736
11 Fees for services (non-employees):        
a Management ...... 9,796,849 7,953,178 1,843,671 0
b Legal ......... 3,079,684 420,936 2,658,748 0
c Accounting ........... 1,831,641 909,162 922,479 0
d Lobbying ........... 624,798 694 624,104 0
e Professional fundraising. See Part IV, line 17.. 143,488 143,488
f Investment management fees ...... 0      
g Other .......... 145,861,758 129,081,415 16,779,223 1,120
12 Advertising and promotion .... 14,653,746 4,071,600 10,582,146 0
13 Office expenses ....... 124,180,369 106,216,020 17,963,814 535
14 Information technology ...... 87,415,917 87,415,917 0 0
15 Royalties .. 0      
16 Occupancy ........... 40,624,450 37,986,847 2,636,893 710
17 Travel ............ 3,054,789 1,700,054 1,353,850 885
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 592,872 415,517 174,467 2,888
20 Interest ........... 33,505,320 33,505,320    
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 98,483,303 91,160,239 7,318,697 4,367
23 Insurance .............. 31,741,544 28,218,629 3,517,866 5,049
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)
a MEDICAL SUPPLIES/ DRUGS 197,377,609 197,377,609 0 0
b PURCHASED SERVICES 130,342,565 100,473,721 29,855,622 13,222
c REPAIRS AND MAINTENANCE 27,251,958 25,409,310 1,842,648 0
d FEDERAL UBI AND STATE TAXES 116,000 0 116,000 0
e
f All other expenses 126,054,046 86,578,198 39,470,822 5,026
25 Total functional expenses. Add lines 1 through 24f 2,214,236,984 1,937,190,004 276,668,271 378,709
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2011)
Form 990 (2011)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .......... 0 1 0
2 Savings and temporary cash investments ....... 191,029,979 2 154,566,684
3 Pledges and grants receivable, net ......... 0 3 0
4 Accounts receivable, net ......... 245,465,370 4 313,901,189
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L .......... 0 5 0
6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
Schedule L .......... 0 6 0
7 Notes and loans receivable, net ............. 722,368 7 206,803
8 Inventories for sale or use .............. 36,514,501 8 36,330,201
9 Prepaid expenses and deferred charges ............ 46,044,255 9 51,352,023
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 2,783,690,537
b Less: accumulated depreciation. ..... 10b 1,310,950,487 1,369,664,400 10c 1,472,740,050
11 Investments—publicly traded securities .......... 1,587,928,706 11 1,531,323,211
12 Investments—other securities. See Part IV, line 11 ...... 113,044,850 12 124,034,580
13 Investments—program-related. See Part IV, line 11 .. 0 13 0
14 Intangible assets ......... 23,403,699 14 27,828,383
15 Other assets. See Part IV, line 11 ........... 74,474,890 15 81,589,520
16 Total assets. Add lines 1 through 15 (must equal line 34)... 3,688,293,018 16 3,793,872,644
Liabilities 17 Accounts payable and accrued expenses . 225,422,597 17 218,401,833
18 Grants payable .......... 0 18 0
19 Deferred revenue .......... 287,404 19 0
20 Tax-exempt bond liabilities .......... 1,134,004,299 20 1,120,603,835
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L.......... 0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 0 23 0
24 Unsecured notes and loans payable to unrelated third parties .... 11,071,886 24 8,467,438
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D..... 429,058,620 25 608,553,184
26 Total liabilities. Add lines 17 through 25..... 1,799,844,806 26 1,956,026,290
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 ..... 1,868,678,493 27 1,818,403,962
28 Temporarily restricted net assets ..... 10,793,940 28 10,215,536
29 Permanently restricted net assets ..... 8,975,779 29 9,226,856
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 ..... 1,888,448,212 33 1,837,846,354
34 Total liabilities and net assets/fund balances ..... 3,688,293,018 34 3,793,872,644
Form 990 (2011)
Form 990 (2011)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI .........
1
Total revenue (must equal Part VIII, column (A), line 12) ...
1
2,360,666,818
2
Total expenses (must equal Part IX, column (A), line 25) ....
2
2,214,236,984
3
Revenue less expenses. Subtract line 2 from line 1 ...
3
146,429,834
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
1,888,448,212
5
Other changes in net assets or fund balances (explain in Schedule O) ...
5
-197,031,692
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
1,837,846,354
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII .........
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?....
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant? If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O. ...........................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
Yes
 
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
Yes
 
Form 990 (2011)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
FRANCISCAN ALLIANCE INC
 
Employer identification number

35-1330472
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization? ................
11g(i)
 
No
(ii) a family member of a person described in (i) above? ......................
11g(ii)
 
No
(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
No
h
(i)
Name of supported organization 		(ii)
EIN 		(iii)
Type of organization (described on lines 1- 9 above or IRC section (see instructions)) 		(iv)
Is the organization in col. (i) listed in your governing document? 		(v)
Did you notify the organization in col. (i) of your support? 		(vi)
Is the organization in col. (i) organized in the U.S.? 		(vii)
Amount of support?
Yes No Yes No Yes No
Total                  

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

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2011
Name of organization
FRANCISCAN ALLIANCE INC
 
Employer identification number

35-1330472
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......................... Arrow Bullet   $    
Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2, of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 2
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
FRANCISCAN ALLIANCE INC
  		Employer identification number

35-1330472
Part I
Contributors (see Instructions). Use duplicate copies of Part I if additional space is needed.
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED




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

     
 
   

$  




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

     
 
   

$  




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

     
 
   

$  




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

     
 
   

$  




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

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 3
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
FRANCISCAN ALLIANCE INC
  		Employer identification number

35-1330472
Part II
Noncash Property (see Instructions). Use duplicate copies of Part II if additional space is needed.
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 4
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
FRANCISCAN ALLIANCE INC
  		Employer identification number

35-1330472
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet $  
Use duplicate copies of Part III if additional space is needed
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Additional Data


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

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

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

35-1330472
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

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

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

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

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










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

Schedule C (Form 990 or 990-EZ) 2011
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check expenses, and share of excess lobbying expenditures).
B Check
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(b) Affiliated group
totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

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


Schedule C (Form 990 or 990-EZ) 2011
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
Yes
No
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
Yes
 
28,954
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
Yes
 
369,193
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? ..........................
Yes
 
226,651
j
Total. Add lines 1c through 1i ...............................
624,798
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
No
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2 are answered “No” OR (b) Part III-A, line 3 is answered “Yes”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ...........................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, Part II-A; line 5; and Part ll-B, line 1.
Also, complete this part for any additional information.
Identifier Return Reference Explanation
SCHEDULE C, PART IV   Franciscan Alliance, Inc. ("FRANCISCAN") engages in insubstantial amounts of lobbying activities. FRANCISCAN makes grants to other organizations that lobby on its behalf including various health and hospital associations. FRANCISCAN also engages in direct contact with legislators and their staffs on topics related to FRANCISCAN's healthcare mission.
Schedule C (Form 990 or 990EZ) 2011

Additional Data


Software ID:  
Software Version:  

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

35-1330472
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .......    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) ...    
4 Aggregate value at end of year .......    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................
9
In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958), relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 52283D
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIV.
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current Year (b)Prior Year (c)Two Years Back (d)Three Years Back (e)Four Years Back
1a Beginning of year balance .... 8,975,779 15,030,221 14,207,054 13,918,880
b Contributions ........     568,167 1,795,174
c Net investment earnings, gains, and losses ... 274,000 267,000 255,000 -1,507,000
d Grants or scholarships .....        
e Other expenditures for facilities
and programs ........ 		22,923 6,321,442    
f Administrative expenses ....        
g End of year balance ...... 9,226,856 8,975,779 15,030,221 14,207,054
2
Provide the estimated percentage of the year end balance (line 1g) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet100.000 %
c
Temporarily restricted endowment SchDMd Bullet  
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
No
(ii) related organizations ........................
3a(ii)
 
No
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   83,134,218 83,134,218
b Buildings ................   1,004,766,956 546,953,232 457,813,724
c Leasehold improvements ............   28,388,283 16,902,262 11,486,021
d Equipment ................   1,286,718,564 721,406,064 565,312,500
e Other .................   356,506,053 14,852,466 341,653,587
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 1,459,400,050
Schedule D (Form 990) 2011

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








Total. (Column (b) must 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) must 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) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Book value
Federal Income Taxes 0
DUE TO THIRD PARTY PAYORS 5,551,049
ACCRUED PAYROLL 77,551,354
OTHER SHORT & LONG TERM LIABIL 77,020,761
ACCRUED PROF & GEN'L LIABILITY 11,714,711
ACCRUED PENSION LIABILITY 329,731,477
SWAP VALUATION 105,964,374
ASSET RETIREMENT OBLIGATION 1,019,458


Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 608,553,184
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1 2,360,666,818
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2 2,214,236,984
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3 146,429,834
4 Net unrealized gains (losses) on investments .......................... 4 -129,867,773
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV.) ................................. 8 -67,163,919
9 Total adjustments (net). Add lines 4 through 8 ......................... 9 -197,031,692
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10 -50,601,858
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 2,169,529,084
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a -129,867,773
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV.) ............ 2d -67,091,481
e Add lines 2a through 2d ..................... 2e -196,959,254
3 Subtract line 2e from line 1..................... 3 2,366,488,338
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 -5,821,520
c Add lines 4a and 4b....................... 4c -5,821,520
5 Total Revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5 2,360,666,818
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1 2,220,058,504
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 5,821,520
e Add lines 2a through 2d...................... 2e 5,821,520
3 Subtract line 2e from line 1..................... 3 2,214,236,984
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIV.) ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5 2,214,236,984
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
PART V, LINE 4   FRANCISCAN ALLIANCE, INC. USES ITS ENDOWMENT FUNDS FOR CAPITAL EXPENDITURES FOR EQUIPMENT, CAPITAL PROJECTS, OR OTHER CAPITAL NEEDS; MEDICAL EDUCATION PROGRAMS; AND HEALTH CARE PROGRAMS FOR MEDICAL AND PATIENT SERVICES IN ACCORDANCE WITH ANY STIPULATED DONOR RESTRICTIONS.
PART XI, LINE 8   EQUITY IN EARNINGS OF AFFILIATES $ 18,065,159 MINORITY INTEREST IN AFFILIATES (17,213,000) NET ASSETS RELEASED FOR OPERATIONS 2,964,082 NET ASSETS RELEASED FROM RESTRICTION 796,000 EQUITY TRANSFERS TO/FROM AFFILIATES 9,574,949 CHANGE IN PENSION & POST-RETIREMENT BENEFITS OTHER THAN NET PERIODIC PENSION COSTS INCLUDED IN ACCRUED PENSION LIABILITY (93,872,000) OTHER CHANGES IN NET ASSETS 12,593,329 NET ASSET RECLASS 254,889 CHANGE IN TEMPORARILY RESTRICTED NET ASSETS (578,404) CHANGE IN PERMANENTLY RESTRICTED NET ASSETS 251,077 ------------- TOTAL OTHER CHANGES IN NET ASSETS (67,163,919)
PART XII, LINE 2D   EQUITY IN EARNINGS OF AFFILIATES $ 18,065,159 MINORITY INTEREST IN AFFILIATES (17,213,000) NET ASSETS RELEASED FOR OPERATIONS 2,964,082 NET ASSETS RELEASED FROM RESTRICTION 796,000 EQUITY TRANSFERS TO/FROM AFFILIATES 9,574,949 CHANGE IN PENSION & POST-RETIREMENT BENEFITS OTHER THAN NET PERIODIC PENSION COSTS INCLUDED IN ACCRUED PENSION LIABILITY (93,872,000) OTHER CHANGES IN NET ASSETS 12,593,329 ------------- TOTAL REVENUE/EXPENSE ON BOOKS NOT ON RETURN (67,091,481)
PART XII, LINE 4B   RENT EXPENSE $ (5,534,375) SPECIAL EVENTS EXPENSE (287,145) ----------- TOTAL EXPENSE ON RETURN NOT ON BOOKS (5,821,520)
PART XIII, LINE 2D   RENT EXPENSE $ 5,534,375 SPECIAL EVENTS EXPENSE 287,145 ----------- TOTAL EXPENSE ON BOOKS NOT ON RETURN 5,821,520
Schedule D (Form 990) 2011

Additional Data


Software ID:  
Software Version:  




SCHEDULE G (Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Supplemental Information Regarding
Fundraising or Gaming Activities
Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19,or if the organization entered more than $15,000 on Form 990-EZ, line 6a.right arrowAttach to Form 990 or Form 990-EZ. right arrowSee separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
FRANCISCAN ALLIANCE INC
 
Employer identification number

35-1330472
Part I
Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17.
1
Indicate whether the organization raised funds through any of the following activities. Check all that apply.
a e
b f
c g
d
2a
Did the organization have a written or oral agreement with any individual (including officers, directors, trustees
or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?
b
If “Yes,” list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization. Form 990-EZ filers are not required to complete this table.
(i) Name and address of individual
or entity (fundraiser) 		(ii) Activity (iii) Did fundraiser have custody or control of contributions? (iv) Gross receipts
from activity 		(v) Amount paid to
(or retained by)
fundraiser listed in
col. (i) 		(vi) Amount paid to
(or retained by)
organization
Yes No
LAURUS BRUNI SEE PART IV DEVELOPMENT SERVICES   No   143,488  
Total .................right arrow   143,488  
3
List all states in which the organization is registered or licensed to solicit funds or has been notified it is exempt from registration or licensing.
IL, IN
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50083H
Schedule G (Form 990 or 990-EZ) 2011
Schedule G (Form 990 or 990-EZ) 2011
Page 2
Part II
Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 on Form 990-EZ, line 6a. List events with gross receipts greater than $5,000.
(a) Event #1

NIR GALA
(event type) 		(b) Event #2

 
(event type) 		(c) Other Events

0
(total number) 		(d) Total Events
(Add col. (a) through col. (c))
VerticalRevenue 1 Gross receipts . . . 416,774     416,774
2 Less: Charitable
contributions . . . 		249,802     249,802
3 Gross income (line 1
minus line 2) . . . 		166,972     166,972
VerticalDirectExpenses 4 Cash prizes . . . 5,500     5,500
5 Non-cash prizes . .        
6 Rent/facility costs . . 215,590     215,590
7 Food and beverages . .        
8 Entertainment . . . 4,500     4,500
9 Other direct expenses . 61,555     61,555
10 Direct expense summary. Add lines 4 through 9 in column (d) ........... right arrow 287,145
11 Net income summary. Combine lines 3 and 10 in column (d)............ right arrow -120,173
Part III
Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.
VerticalRevenue (a) Bingo (b) Pull tabs/Instant
bingo/progressive bingo 		(c) Other gaming (d) Total gaming (Add col. (a) through col. (c))
1 Gross revenue . . . .        
VerticalDirectExpenses 2 Cash prizes . . . .        
3 Non-cash prizes . . .        
4 Rent/facility costs . . .        
5 Other direct expenses . .        
6 Volunteer labor . . .
 
 
 
7 Direct expense summary. Add lines 2 through 5 in column (d) ........... right arrow  
8 Net gaming income summary. Combine lines 1 and 7 in column (d) .......... right arrow  
9
Enter the state(s) in which the organization operates gaming activities:
a
Is the organization licensed to operate gaming activities in each of these states? ............
b
If "No," Explain:
 
10a
Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? .....
b
If "Yes," Explain:
 
11
Does the organization operate gaming activities with nonmembers? .................
12
Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity
formed to administer charitable gaming? ..........................
Schedule G (Form 990 or 990-EZ) 2011
Schedule G (Form 990 or 990-EZ) 2011
Page 3
13
Indicate the percentage of gaming activity operated in:
a
The organization's facility ......................
13a
 
b
An outside facility ........................
13b
 
14
Provide the name and address of the person who prepares the organization's gaming/special events books and records:
Name right arrow
Address right arrow
15a
Does the organization have a contract with a third party from whom the organization receives gaming
revenue? ......................................
b
If "Yes," enter the amount of gaming revenue received by the organization right arrow $   and the
amount of gaming revenue retained by the third party right arrow $   .
c
If "Yes," enter name and address:
Name right arrow
Address right arrow
 
 
16
Gaming manager information:
Name right arrow
Gaming manager compensation right arrow $  
Description of services provided right arrow
 
17
Mandatory distributions:
a
Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license? ............................
b
Enter the amount of distributions required under state law distributed to other exempt organizations or spent
in the organization's own exempt activities during the tax year right arrow$  
Part IV
Complete this part to provide additional information for responses to quuestion on Schedule G (see instructions.)
Identifier ReturnReference Explanation
SCHEDULE G, PART I, LINE 2   FRANCISCAN ALLIANCE, INC. COMPENSATES THIS PROFESSIONAL FUNDRAISER BUT CONTRIBUTIONS AND GRANTS ARE RECEIVED BY A RELATED TAX-EXEMPT ORGANIZATION, ST. JAMES COMMUNITY FOUNDATION. ST. JAMES COMMUNITY FOUNDATION RECEIVED $1,564,612 IN CONTRIBUTIONS AND GRANTS DURING 2011.
Schedule G (Form 990 or 990-EZ) 2011
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
2011
Open to Public Inspection
Name of the organization
FRANCISCAN ALLIANCE INC
 
Employer identification number

35-1330472
Part I
Charity Care and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a....
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Did the organization use FPG to determine eligibility for providing discounted care? If "Yes," indicate which of the
following was the family income limit for eligibility for discounted care: ............
3b
Yes
 
c
If the organization did 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 used an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

5a

 

No
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount?......
5b
 
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care?...............
5c
 
 
6a
Did the organization prepare a community benefit report during the tax year?...........
6a
Yes
 
b
If "Yes," did 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
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance
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 Financial Assistance at cost
(from Worksheet 1) .. 		    69,346,148 0 69,346,148 3.130 %
b Medicaid (from Worksheet 3, column a) .....     251,928,493 139,623,110 112,305,383 5.070 %
c Costs of other means-tested government programs (from Worksheet 3, column b) .     4,486,353 966,383 3,519,970 0.160 %
dTotal Financial Assistance and
Means-Tested Government Programs ..... 		    325,760,994 140,589,493 185,171,501 8.360 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) .... 		    5,267,449 430,584 4,836,865 0.220 %
f Health professions education
(from Worksheet 5) .. 		    21,811,401 6,416,604 15,394,797 0.700 %
g Subsidized health services
(from Worksheet 6) .. 		    113,042,402 69,454,788 43,587,614 1.970 %
h Research (from Worksheet 7)     785,648 188,658 596,990 0.030 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) ....     2,005,985 23,430 1,982,555 0.090 %
jTotal Other Benefits ...     142,912,885 76,514,064 66,398,821 3.010 %
kTotal. Add lines 7d and 7j. ..     468,673,879 217,103,557 251,570,322 11.370 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(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     463 0 463 0 %
2 Economic development            
3 Community support     15,247 0 15,247 0 %
4 Environmental improvements            
5 Leadership development and training for community members     546 0 546 0 %
6 Coalition building     74,040 0 74,040 0 %
7 Community health improvement advocacy     71,827 0 71,827 0 %
8 Workforce development     3,713,624 2,887,630 825,634 0.040 %
9 Other     1,841 0 1,841 0 %
10 Total     3,877,588 2,887,630 989,598 0.040 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did 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........
2
28,296,882
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance 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
416,383,621
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
589,490,588
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
-173,106,967
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
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures
(see instructions)
(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 %
1SEE PART VI
  		       
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest)
How many hospital facilities did the organization operate during the tax year?13
Name and address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe)
1 FRANCISCAN ST FRANCIS HEALTH -
INDIANAPOLIS 8111 SOUTH EMERSON AV
INDIANAPOLIS,IN46217 		X X   X     X X  
2 FRANCISCAN ST ELIZABETH HEALTH -
LAFAYETTE EAST 1701 S CREASY LANE
LAFAYETTE,IN47905 		X X         X    
3 FRANCISCAN ST ANTHONY HEALTH -
CROWN POINT 1201 SOUTH MAIN STREET
CROWN POINT,IN46307 		X X         X    
4 FRANCISCAN ST FRANCIS HEALTH -
BEECH GROVE 1600 ALBANY STREET
BEECH GROVE,IN46107 		X X   X   X X X  
5 FRANCISCAN ST MARGARET HEALTH -
HAMMOND 5454 HOHMAN AVENUE
HAMMOND,IN46320 		X X   X     X    
6 FRANCISCAN ST JAMES HEALTH -
CHICAGO HEIGHTS 1423 CHICAGO ROAD
CHICAGO HEIGHTS,IL60411 		X X   X     X    
7 FRANCISCAN ST ANTHONY HEALTH -
MICHIGAN CITY 301 W HOMER STREET
MICHIGAN CITY,IN46360 		X X       X X    
8 FRANCISCAN ST MARGARET HEALTH -
DYER 24 JOLIET STREET
DYER,IN46311 		X X   X     X    
9 FRANCISCAN ST JAMES HEALTH -
OLYMPIA FIELDS 20201 SOUTH CRAWFOR
OLYMPIA FIELDS,IL60461 		X X   X   X X    
10 FRANCISCAN ST FRANCIS HEALTH -
MOORESVILLE 1201 HADLEY ROAD
MOORESVILLE,IN46158 		X X   X     X X  
11 FRANCISCAN ST ELIZABETH HEALTH -
CRAWFORDSVILLE 1710 LAFAYETTE ROAD
CRAWFORDSVILLE,IL47933 		X X         X    
12 FRANCISCAN PHYSICIANS HOSPITAL LLC
701 SUPERIOR STREET
MUNSTER,IN46321 		X X              
13 FRANCISCAN ST ELIZABETH HEALTH -
LAFAYETTE CENTRAL 1501 HARTFORD ST
LAFAYETTE,IN47904 		X X         X    
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
FRANCISCAN ST FRANCIS HEALTH -
Name of Hospital Facility:  
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 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 300.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
FRANCISCAN ST ELIZABETH HEALTH -
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):2

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 300.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
FRANCISCAN ST ANTHONY HEALTH -
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):3

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 300.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
FRANCISCAN ST FRANCIS HEALTH -
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):4

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 300.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
FRANCISCAN ST MARGARET HEALTH -
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):5

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 300.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
FRANCISCAN ST JAMES HEALTH -
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):6

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 300.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
FRANCISCAN ST ANTHONY HEALTH -
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):7

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 300.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
FRANCISCAN ST MARGARET HEALTH -
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):8

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 300.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
FRANCISCAN ST JAMES HEALTH -
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):9

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 300.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
FRANCISCAN ST FRANCIS HEALTH -
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):10

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 300.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
FRANCISCAN ST ELIZABETH HEALTH -
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):11

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 300.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
FRANCISCAN PHYSICIANS HOSPITAL LLC
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):12

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 300.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
FRANCISCAN ST ELIZABETH HEALTH -
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):13

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 300.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?150
Name and address Type of Facility (describe)
1 IIMC
701 E COUNTY LINE ROAD SUITE 101
GREENWOOD,IN46143 		PHYSICIAN PRACTICE
2 INDIANA ORTHOPEDIC SURGERY CENTER
5255 E STOP 11 ROAD SUITE 110
INDIANAPOLIS,IN46237 		AMBULATORY SURGERY CENTER
3 FRANCISCAN SURGERY CENTER
5255 E STOP 11 ROAD SUITE 100
INDIANAPOLIS,IN46237 		AMBULATORY SURGERY CENTER
4 THE ENDOSCOPY CENTER AT ST FRANCIS
8051 S EMERSON AVENUE SUITE 150
INDIANAPOLIS,IN46237 		ENDOSCOPY CENTER
5 ST FRANCIS RADIATION THERAPY CENTERS
8111 S EMERSON AVENUE
INDIANAPOLIS,IN46239 		RADIATION THERAPY
6 INDIANA HEART PHYSICIANS
5330 E STOP 11 ROAD
INDIANAPOLIS,IN46237 		PHYSICIAN PRACTICE
7 HEALTH PARTNERS
1225 E COOLSPRING AVENUE
MICHIGAN CITY,IN46360 		PHYSICIAN PRACTICE
8 SOUTH EMERSON SURGERY CENTER
8141 S EMERSON AVENUE SUITE C
INDIANAPOLIS,IN46237 		AMBULATORY SURGERY CENTER
9 COOPERATIVE MANAGED CARE SERVICES
9045 RIVER ROAD SUITE 250
INDIANAPOLIS,IN46240 		MANAGED CARE
10 INDIANA BLODD AND MARROW TRANSPLANTATION
1500 ALBANY STREET SUITE 911
BEECH GROVE,IN46107 		BLOOD AND MARROW TRANSPLANT
11 FRANCISCAN ST JAMES HEALTH-HOME HEALTH
1400 OTTO BOULEVARD
CHICAGO HEIGHTS,IL60411 		HOME HEALTH
12 MOORESVILLE SURGERY CENTER
1215 HADLEY ROAD SUITE 100
MOORESVILLE,IN46260 		AMBULATORY SURGERY CENTER
13 ATHENS ORTHOPEDIC AND SPORTS MEDICINE
1702 LAFAYETTE ROAD
CRAWFORDSVILLE,IN47933 		PHYSICIAN PRACTICE
14 JOINT REPLACEMENT SURGEONS
1199 HADLEY ROAD
MOORESVILLE,IN46158 		PHYSICIAN PRACTICE
15 ONCOLOGY AND HEMATOLOGY SPECIALISTS
8111 S EMERSON AVENUE SUITE A
INDIANAPOLIS,IN46237 		PHYSICIAN PRACTICE
16 SOUTH INDY MRI AND REHAB
8141 S EMERSON AVENUE SUITE A
INDIANAPOLIS,IN46237 		RADIOLOGY AND PHYSICAL SERVICES
17 MOORESVILLE ENDOSCOPY CENTER
1215 HADLEY ROAD SUITE 101
MOORESVILLE,IN46158 		ENDOSCOPY CENTER
18 FAMILY PRACTICE NETWORK
9470 BROADWAY
CROWN POINT,IN46307 		PHYSICIAN PRACTICE
19 SIGMA MEDICAL GROUP
2708 FERRY STREET
LAFAYETTE,IN47904 		PHYSICIAN PRACTICE
20 FRANCISCAN ST JAMES HEALTH -
HEALTH WELLNESS CENTER 100 W 197
CHICAGO HEIGHTS,IL60411 		WELLNESS CENTER
21 GREENWOOD PEDIATRIC ASSOCIATES
900 AVERITT ROAD
GREENWOOD,IN46143 		PHYSICIAN PRACTICE
22 SIGMA MEDICAL GROUP
915 SAGAMORE PARKWAY WEST
WEST LAFAYETTE,IN47906 		PHYSICIAN PRACTICE
23 ST FRANCIS IMAGING CENTER
3147 W SMITH VALLEY ROAD SUITE D
GREENWOOD,IN46143 		RADIOLOGY
24 SIGMA MEDICAL GROUP
1701 SOUTH CREASY LANE
LAFAYETTE,IN47905 		PHYSICIAN PRACTICE
25 FAMILY PRACTICE NETWORK
1505 SOUTH COURT STREET
CROWN POINT,IN46307 		PHYSICIAN PRACTICE
26 FAMILY PRACTICE NETWORK
12800 MISSISSIPPI PARKWAY
CROWN POINT,IN46307 		PHYSICIAN PRACTICE
27 FAMILY PRACTICE NETWORK
2421 LAPORTE AVENUE
VALPARAISO,IN46385 		PHYSICIAN PRACTICE
28 AMER HEALTH NETWORK - MUNCIE
3631 N MORRISON ROAD
MUNCIE,IN47304 		PT, IMAGING, SURGERY
29 ATHENS MEDICAL SPECIALIST
1630 LAFAYETTE ROAD SUITE 300
CRAWFORDSVILLE,IN47933 		PHYSICIAN PRACTICE
30 HEALTH PARTNERS
8865 W 400 NORTH
MICHIGAN CITY,IN46360 		PHYSICIAN PRACTICE
31 SIGMA MEDICAL GROUP
3900 SAINT FRANCIS WAY STE 200
LAFAYETTE,IN47905 		PHYSICIAN PRACTICE
32 AMER HEALTH NETWORK - GROUP ONE
4880 CENTURY PLAZA ROAD SUITE 100
INDIANAPOLIS,IN46254 		IMAGING
33 AMER HEALTH NETWORK - AVON
5250 E US 36 SUITE 610
AVON,IN46123 		IMAGING
34 ATHENS CRAWFORDSVILLE FAMILY CARE
308 W MARKET STREET
CRAWFORDSVILLE,IN47933 		PHYSICIAN PRACTICE
35 ATHENS GREENACRES
1500 DARLINGTON AVENUE SUITE 300
CRAWFORDSVILLE,IN47933 		PHYSICIAN PRACTICE
36 HEALTH PARTNERS
1507 WABASH STREET
MICHIGAN CITY,IN46360 		PHYSICIAN PRACTICE
37 FAMILY PRACTICE NETWORK
11161 RANDOLPH STREET
CROWN POINT,IN46307 		PHYSICIAN PRACTICE
38 SOUTHPORT FP AND SPORTS MEDICINE
7855 S EMERSON AVENUE SUITE P
INDIANAPOLIS,IN46237 		PHYSICIAN PRACTICE
39 FAMILY PRACTICE NETWORK
1205 S MAIN STREET
CROWN POINT,IN46307 		PHYSICIAN PRACTICE
40 ST MARGARET MEDICAL ASSOCIATES
701 SUPERIOR AVE SUITE E
MUNSTER,IN46321 		PHYSICIAN PRACTICE
41 ALVERNO DURABLE MEDICAL EQUIPMENT
16149 SOUTH CLINTON STREET
HARVEY,IL60426 		DURABLE MEDICAL EQUIPMENT
42 IMPACT CENTER
1201 HADLEY ROAD
MOORESVILLE,IN46158 		PHYSICIAN PRACTICE
43 ST MARGARET MEDICAL ASSOCIATES
840 RICHARD ROAD
DYER,IN46311 		PHYSICIAN PRACTICE
44 BEECH GROVE FAMILY MEDICINE
2030 CHURCHMAN AVENUE
BEECH GROVE,IN46107 		PHYSICIAN PRACTICE
45 INDIANA SLEEP CENTER
701 E COUNTY LINE ROAD SUITE 207
GREENWOOD,IN46143 		SLEEP CENTER
46 HEALTH PARTNERS
810 MICHAEL DRIVE
CHESTERTON,IN46304 		PHYSICIAN PRACTICE
47 FAMILY PRACTICE NETWORK
CHERRY CREEK CENTER
CROWN POINT,IN46307 		PHYSICIAN PRACTICE
48 NORTHRIDGE MEDICAL GROUP
1704 LAFAYETTE ROAD SUITE 8
CRAWFORDSVILLE,IN47933 		PHYSICIAN PRACTICE
49 DIABETES AND ENDOCRINOLOGY SPECIALISTS
5230A E STOP 11 ROAD SUITE 150
INDIANAPOLIS,IN46237 		PHYSICIAN PRACTICE
50 ST MARGARET MEDICAL ASSOCIATES
14785 WEST 101ST AVENUE
DYER,IN46311 		PHYSICIAN PRACTICE
51 KENDRICK FAMILY MEDICINE
1001 HADLEY ROAD SUITE 101
MOORESVILLE,IN46158 		PHYSICIAN PRACTICE
52 CRAWFORDSVILLE GYN
407 E MARKET STREET SUITE 101
CRAWFORDSVILLE,IN47933 		PHYSICIAN PRACTICE
53 MOORESVILLE FAMILY CARE
1001 HADLEY ROAD SUITE 102
MOORESVILLE,IN46158 		PHYSICIAN PRACTICE
54 AMER HEALTH NETWORK - SLEEP (CARMEL)
12425 OLD MERIDIAN STREET SUITE A-
CARMEL,IN46032 		SLEEP CENTER
55 NEUROSURGICAL SPECIALISTS
8051 S EMERSON AVENUE SUITE 300
INDIANAPOLIS,IN46237 		PHYSICIAN PRACTICE
56 GRAY ROAD FAMILY MEDICINE
7825 MCFARLAND LANE SUITE A
INDIANAPOLIS,IN46237 		PHYSICIAN PRACTICE
57 AMER HEALTH NETWORK - FRANKLIN
1300 W JEFFERSON STREET SUITE C
FRANKLIN,IN46131 		PT, IMAGING
58 ORTHOPEDIC SPECIALISTS
5230A E STOP 11 ROAD SUITE 250
INDIANAPOLIS,IN46237 		PHYSICIAN PRACTICE
59 AMER HEALTH NETWORK - KOKOMO
2330 S DIXON ROAD
KOKOMO,IN46902 		IMAGING
60 CENTER GROVE FAMILY MEDICINE
362 MERIDIAN PARKE LANE
GREENWOOD,IN46142 		PHYSICIAN PRACTICE
61 SOUTH 31 FAMILY CARE
610 E SOUTHPORT ROAD SUITE 205
INDIANAPOLIS,IN46227 		PHYSICIAN PRACTICE
62 SOUTHEAST FAMILY MEDICINE
5136 E STOP 11 ROAD SUITE 30
INDIANAPOLIS,IN46237 		PHYSICIAN PRACTICE
63 FAMILY PRACTICE NETWORK
2050 NORTH MAIN STREET
CROWN POINT,IN46307 		PHYSICIAN PRACTICE
64 FRANCISCAN ST JAMES HEALTH - AMBULANCE &
EMS 20201 SOUTH CRAWFORD AVENUE
OLYMPIA FIELDS,IL60461 		AMBULANCE SERVICES
65 ST MARGARET MEDICAL ASSOCIATES
8242 CALUMET AVENUE
MUNSTER,IN46321 		PHYSICIAN PRACTICE
66 VASCULAR SPECIALISTS
5255 E STOP 11 ROAD SUITE 200
INDIANAPOLIS,IN46237 		PHYSICIAN PRACTICE
67 ST JAMES HEALTH OUTPATIENT PHARMACY
3700 203RD STREET SUITE 108
OLYMPIA FIELDS,IL60461 		PHARMACY
68 FRANKLIN TOWNSHIP FAMILY MEDICINE
8325 E SOUTHPORT ROAD SUITE 100
INDIANAPOLIS,IN46259 		PHYSICIAN PRACTICE
69 ST MARGARET MEDICAL ASSOCIATES
1573 N CLINE AVENUE
GRIFFITH,IN46319 		PHYSICIAN PRACTICE
70 HEARTLAND CROSSING PEDIATRICS
10701 ALLIANCE DRIVE
CAMBY,IN46113 		PHYSICIAN PRACTICE
71 IRVINGTON FAMILY MEDICINE
5839 E WASHINGTON STREET
INDIANAPOLIS,IN46219 		PHYSICIAN PRACTICE
72 MAJOR HOSPITAL CARDIAC DIAGNOSTICS
150 WEST WASHINGTON STREET
SHELBYVILLE,IN46176 		CARDIOVASCULAR TESTING
73 ATHENS ENT
1630 LAFAYETTE ROAD SUITE 500
CRAWFORDSVILLE,IN47933 		PHYSICIAN PRACTICE
74 EASTSIDE FAMILY MEDICINE
2056 LEBANON ROAD
CRAWFORDSVILLE,IN47933 		PHYSICIAN PRACTICE
75 SPINE SPECIALISTS
8051 S EMERSON AVENUE SUITE 360
INDIANAPOLIS,IN46237 		PHYSICIAN PRACTICE
76 MADISON AVE FAMILY MEDICINE
8778 S MADISON AVENUE SUITE 200
INDIANAPOLIS,IN46227 		PHYSICIAN PRACTICE
77 ATHENS PRIMARY CARE
1601 LAFAYETTE ROAD
CRAWFORDSVILLE,IN47933 		PHYSICIAN PRACTICE
78 AMER HEALTH NETWORK - PERU
315 W OLD KEY DRIVE IMAGING SUITE
PERU,IN46970 		IMAGING
79 HEARTLAND INTERNAL MEDICINE
10701 ALLIANCE DRIVE
CAMBY,IN46113 		PHYSICIAN PRACTICE
80 FAMILY PRACTICE NETWORK
200 3RD COURT SE
DEMOTTE,IN46310 		PHYSICIAN PRACTICE
81 COUNTY LINE PEDIATRICS
8325 S EMERSON SUITE B1
INDIANAPOLIS,IN46237 		PHYSICIAN PRACTICE
82 ST MARGARET MEDICAL ASSOCIATES
5530 HOHMAN AVENUE
HAMMOND,IN46320 		PHYSICIAN PRACTICE
83 ST MARGARET MEDICAL ASSOCIATES
221 US HWY 41 SUITE I
SCHERERVILLE,IN46375 		PHYSICIAN PRACTICE
84 HONEY GROVE FAMILY MEDICINE
1711 S STATE ROAD 135 SUITE C
GREENWOOD,IN46143 		PHYSICIAN PRACTICE
85 FAMILY PRACTICE NETWORK
297 WEST FRANCISCAN LANE SUITE 104
CROWN POINT,IN46307 		PHYSICIAN PRACTICE
86 SIGMA MEDICAL GROUP
1012 N 14TH STREET
LAFAYETTE,IN47904 		PHYSICIAN PRACTICE
87 ATHENS OBGYN
1630 LAFAYETTE ROAD SUITE 200
CRAWFORDSVILLE,IN47933 		PHYSICIAN PRACTICE
88 ST MARGARET MEDICAL ASSOCIATES
2068 LUCAS PARKWAY
LOWELL,IN46356 		PHYSICIAN PRACTICE
89 SIGMA MEDICAL GROUP
3875 KENSINGTON DRIVE
LAFAYETTE,IN47905 		PHYSICIAN PRACTICE
90 GYNECOLOGIC ONCOLOGY SPECIALISTS
5255 E STOP 11 ROAD SUITE 310
INDIANAPOLIS,IN46237 		PHYSICIAN PRACTICE
91 ATHENS WILLIAMS FAMILY PRACTICE
1660 LAFAYETTE ROAD SUITE 170
CRAWFORDSVILLE,IN47933 		PHYSICIAN PRACTICE
92 PLAINFIELD FAMILY MEDICINE
315 DAN HONES ROAD SUITE 100
PLAINFIELD,IN46168 		PHYSICIAN PRACTICE
93 PSYCHIATRIC SPECIALISTS
610 E SOUTHPORT ROAD SUITE 200
INDIANAPOLIS,IN46227 		PHYSICIAN PRACTICE
94 FAMILY PRACTICE NETWORK
10860 MAPLE LANE
SAINT JOHN,IN46373 		PHYSICIAN PRACTICE
95 FRANCISCAN IMAGING EQUIPMENT LEASING
1600 ALBANY STREET
BEECH GROVE,IN46107 		LEASING RADIOLOGY EQUIPMENT
96 ST MARGARET MEDICAL ASSOCIATES
3831 HOHMAN AVENUE
HAMMOND,IN46327 		PHYSICIAN PRACTICE
97 FRANCISCAN ST JAMES HEALTH CENTERS FOR
DIABETES 20201 SOUTH CRAWFORD AVEN
OLYMPIA FIELDS,IL60461 		DIABETES CLINIC
98 PLEASANT VIEW FAMILY MEDICINE
12524 SOUTHEASTERN AVENUE
INDIANAPOLIS,IN46259 		PHYSICIAN PRACTICE
99 AMER HEALTH NETWORK - EAGLE HIGHLANDS
6820 PARKDALE PLACE 105
INDIANAPOLIS,IN46254 		IMAGING
100 ST MARGARET MEDICAL ASSOCIATES
24 JOLIET STREET SUITE 101
DYER,IN46311 		PHYSICIAN PRACTICE
101 RHEUMATOLOGY & OSTEOPOROSIS SPECIALISTS
5255 E STOP 11 ROAD SUITE 320
INDIANAPOLIS,IN46237 		PHYSICIAN PRACTICE
102 WEIGHT LOSS SPECIALISTS
5230A E STOP 11 ROAD SUITE 190
INDIANAPOLIS,IN46237 		PHYSICIAN PRACTICE
103 ST MARGARET MEDICAL ASSOCIATES
10860 MAPLE LANE
ST JOHN,IN46373 		PHYSICIAN PRACTICE
104 FRANCISCAN ST JAMES HEALTH - FAMILY
HEALTH TINLEY PARK 17859 S 80TH A
TINLEY PARK,IL60477 		PHYSICIAN PRACTICE
105 ST MARGARET MEDICAL ASSOCIATES
5454 HOHMAN AVENUE
HAMMOND,IN46320 		PHYSICIAN PRACTICE
106 HEALTH PARTNERS
500 W BUFFALO STREET
NEW BUFFALO,MI49117 		PHYSICIAN PRACTICE
107 ST MARGARET MEDICAL ASSOCIATES
8437 KENNEDY AVENUE
HIGHLAND,IN46322 		PHYSICIAN PRACTICE
108 FAMILY PRACTICE NETWORK
5985 EAST 1015 NORTH
ROSELAWN,IN46372 		PHYSICIAN PRACTICE
109 ST MARGARET MEDICAL ASSOCIATES
5500 HOHMAN AVENUE SUITE 2A
HAMMOND,IN46320 		PHYSICIAN PRACTICE
110 MOORESVILLE AFTER HOURS CLINIC
1001 HADLEY ROAD SUITE 101
MOORESVILLE,IN46158 		PHYSICIAN PRACTICE
111 HEALTH PARTNERS
6916 W JOHNSON ROAD
LAPORTE,IN46350 		PHYSICIAN PRACTICE
112 SIGMA MEDICAL GROUP
3218 DAUGHERTY DRIVE SUITE 140
LAFAYETTE,IN47909 		PHYSICIAN PRACTICE
113 BREAST SPECIALISTS
5255 E STOP 11 ROAD SUITE 250
INDIANAPOLIS,IN46237 		PHYSICIAN PRACTICE
114 HEALTH PARTNERS
3340 MONROE ST
LAPORTE,IN46350 		PHYSICIAN PRACTICE
115 INDY SOUTH AFTER HOURS CLINIC
7855 S EMERSON AVENUE SUITE P
INDIANAPOLIS,IN46237 		PHYSICIAN PRACTICE
116 SFMG REHABILITATION SPECIALISTS
8051 S EMERSON AVENUE SUITE 360
INDIANAPOLIS,IN46237 		PHYSICIAN PRACTICE
117 ST MARGARET MEDICAL ASSOCIATES
5454 HOHMAN AVENUE
HAMMOND,IN46320 		PHYSICIAN PRACTICE
118 BEECH GROVE INTERNAL MEDICINE
2030 CHURCHMAN AVENUE
BEECH GROVE,IN46107 		PHYSICIAN PRACTICE
119 SFMG PAIN SPECIALISTS
8051 S EMERSON AVENUE SUITE 360
INDIANAPOLIS,IN46237 		PHYSICIAN PRACTICE
120 BEECH GROVE AFTER HOURS CLINIC
2030 CHURCHMAN AVENUE
BEECH GROVE,IN46107 		PHYSICIAN PRACTICE
121 ST MARGARET MEDICAL ASSOCIATES
8230 CALUMET AVENUE
MUNSTER,IN46321 		PHYSICIAN PRACTICE
122 MATERNAL FETAL SPECIALISTS
8051 S EMERSON AVENUE SUITE 450B
INDIANAPOLIS,IN46237 		PHYSICIAN PRACTICE
123 PLASTIC SURGERY SPECIALISTS
8051 S EMERSON AVENUE SUITE 450
INDIANAPOLIS,IN46237 		PHYSICIAN PRACTICE
124 ST JAMES COMMUNITY HEALTH CENTER -
BEECHER 989 DIXIE HIGHWAY
BEECHER,IL60401 		PHYSICAL THERAPY SERVICES
125 NEIGHBORHOOD CLINIC
407 E MARKET STREET SUITE 101
CRAWFORDSVILLE,IN47933 		PHYSICIAN PRACTICE
126 ST MARGARET MEDICAL ASSOCIATES
5454 HOHMAN AVENUE
HAMMOND,IN46320 		PHYSICIAN PRACTICE
127 ST MARGARET MEDICAL ASSOCIATES
19400 NORTH CREEK DRIVE
LYNWOOD,IL60411 		PHYSICIAN PRACTICE
128 SIGMA MEDICAL GROUP
510 WEST JACKSON STREET
MULBERRY,IN46058 		PHYSICIAN PRACTICE
129 FRANCISCAN ST JAMES HEALTH - FAMILY
HEALTH HOMEWOOD 18636 DIXIE HIGHWA
HOMEWOOD,IL60430 		PHYSICIAN PRACTICE
130 SIGMA MEDICAL GROUP
212 EAST MAIN STREET
BROOK,IN47922 		PHYSICIAN PRACTICE
131 PLAINFIELD SPORTS AND FAMILY MEDICINE
315 DAN JONES ROAD SUITE 150
PLAINFIELD,IN46168 		PHYSICIAN PRACTICE
132 AMER HEALTH NETWORK - SLEEP (MUNCIE)
3631 N MORRISON ROAD
MUNCIE,IN47304 		SLEEP CENTER
133 REDOX REACTIVE REAGENTS
1600 ALBANY STREET
BEECH GROVE,IN46107 		AUTOIMMUNE DISEASE TREATMENT
134 AMER HEALTH NETWORK - NOBLESVILLE
18051 RIVER AVENUE SUITE 103
NOBLESVILLE,IN46062 		IMAGING
135 MONTICELLO MEDICAL CENTER
826 N 6TH ST
MONTICELLO,IN47960 		MEDICAL PRACTICE
136 DR RENE S GUTIERREZ MD
902 FOXWOOD COURT
MONTICELLO,IN47960 		MEDICAL PRACTICE
137 FRANCISCAN PHYSICIANS HOSPITAL SLEEP CTR
7905 CALUMET AVENUE
MUNSTER,IN463214209 		SLEEP CENTER
138 FRANCISCAN HAMMOND CLINIC
7905 CALUMET AVENUE
MUNSTER,IN46321 		SPECIALTY CENTER/URGENT CARE
139 FRANCISCAN HAMMOND CLINIC
9800 VALPARAISO DRIVE
MUNSTER,IN46321 		FAMILY WELLNESS CENTER
140 FRANCISCAN HAMMOND CLINIC
11355 WEST 97TH LANE
ST JOHN,IN46373 		PRIMARY CARE
141 FAMILY PRACTICE NETWORK
952 COURT STREET
CROWN POINT,IN46307 		FAMILY PRACTICE
142 FAMILY PRACTICE NETWORK
297 WEST FRANCISCAN LANE SUITE 203
CROWN POINT,IN46307 		FAMILY PRACTICE
143 ST JAMES HEALTH SURGERY CENTER
333 DIXIE HIGHWAY
CHICAGO HEIGHTS,IL60411 		OP SURGERY CENTER
144 FRANCISCAN ST JAMES HEALTH-FAMILY HEALTH
3700 WEST 203RD STREET SUITE 112
OLYMPIA FIELDS,IL60461 		PHYSICIAN PRACTICE
145 FRANKFORT REHABILITATION SERVICES
10043 LINCOLN HIGHWAY 2ND FLOOR
FRANKFORT,IL60423 		PHYSICAL THERAPY
146 DIXIE HIGHWAY REHABILITATION SERVICES
211 DIXIE HIGHWAY
CHICAGO HEIGHTS,IL60411 		PHYSICAL THERAPY
147 GREENWOOD IMMEDIATE CARE
1001 N MADISON AVENUE
GREENWOOD,IN46142 		IMMEDIATE CARE CENTER
148 CHAPEL HILL IMMEDIATE CARE
650 N GIRLS SCHOOL ROAD
INDIANAPOLIS,IN46214 		IMMEDIATE CARE CENTER
149 NORA IMMEDIATE CARE
860 E 86TH STREET
INDIANAPOLIS,IN46240 		IMMEDIATE CARE CENTER
150 WASHINGTON SQUARE IMMEDIATE CARE
992 N MITTHOEFFER
INDIANAPOLIS,IN46229 		IMMEDIATE CARE CENTER
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the descriptions 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, 3, 4, 5c, 6i, 7, 9, 10, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any 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
SUPPLEMENTAL INFORMATION   SCHEDULE H, PART VI, ITEM 2 NEEDS ASSESSMENT Franciscan Alliance, Inc. ("FRANCISCAN") hospitals assess the health care needs of the communities we serve by collaborating with public and private agencies to determine community health needs and how best to address them. Franciscan's Corporate Community Benefit Committee, as well as committees in the local facilities, committed to an ongoing assessment of community health needs and priorities based upon health initiatives of the municipal, county, and state health departments, community-based assessments by other public sector partners, professional research consultant reports, and faith-based partners within the communities served. In addition, our hospitals address public agency and community group requests to provide community benefit activities and programs that meet certain specialty or hybrid needs or populations. ------------------------------------------------ SCHEDULE H, PART VI, ITEM 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE Franciscan's hospitals inform and educate patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under Franciscan's financial assistance and charity care policy. For patients not initially identified as qualifying for financial assistance, Franciscan communicates the availability of charity care and financial assistance in the applicable languages of the hospital community through the following means: 1. Franciscan communicates the availability of financial assistance in appropriate care settings such as emergency departments, admitting/registration areas, billing offices, outpatient service settings, and on our hospitals' websites. Signs/postings inform patients that free or reduced cost care may be available to qualifying patients who complete a financial assistance application. 2. Brochures summarizing our financial assistance programs are available throughout each Franciscan hospital. 3. Financial counselors and business office personnel are available to help patients understand and apply for local, state, and federal health care programs and Franciscan's financial assistance programs. 4. All bills and statements for services inform uninsured patients that financial assistance is available. 5. Patients/guarantors may request a copy of the financial assistance application by calling the Franciscan billing office or downloading a copy at no cost from Franciscan hospital's websites. 6. Patients/guarantors can request financial assistance information by calling Franciscan's billing office phone line on a 24-hour basis. 7. Individuals other than the patient, such as the patient's physician, family members, community or religious groups, social services, or hospital personnel may make requests for financial assistance on the patient's behalf, subject to applicable privacy laws. 8. Franciscan sends a minimum of 4 statements and makes 7 phone call attempts to contact the patient/guarantor at the address and phone number provided by the patient/guarantor. Statements and communications inform the patient of the amount due and if they cannot pay their balance the availability of financial assistance. --------------------------------------------- SCHEDULE H, PART VI, ITEM 4 COMMUNITY INFORMATION FRANCISCAN ALLIANCE SERVICES A LARGE GEOGRAPHIC AREA WHICH INCLUDES 17 COUNTIES IN INDIANA (BENTON, CARROLL, FOUNTAIN, JASPER, JOHNSON, LAKE, LAPORTE, MARION, MONTGOMERY, MORGAN, NEWTON, PORTER, SHELBY, STARKE, TIPPECANOE, WARREN AND WHITE) AND 3 COUNTIES IN ILLINOIS (COOK, KANKAKEE, AND WILL). THE POPULATION OF THE COMMUNITIES THAT WE SERVE WAS ESTIMATED AT OVER 3.8 MILLION PEOPLE WITH AN AVERAGE HOUSEHOLD INCOME OF APPROXIMATELY $61,000 IN 2011. FOR THESE COMMUNITIES, THE PERCENTAGE OF RESIDENTS BELOW THE FEDERAL POVERTY LEVEL WAS ESTIMATED AT 16.3% IN 2011. THE PERCENTAGE OF INPATIENTS FROM THESE COMMUNITIES WHO WERE SERVED BY MEDICAID WAS 16.9%. AND THE PERCENTAGE OF INPATIENTS FROM THESE COMMUNITIES WHO WERE UNINSURED WAS APPROXIMATELY 2.7%. IN COMPARISON, THE PERCENTAGES OF MEDICAID AND UNINSURED TREATED BY FRANCISCAN ALLIANCE WERE 15.9% AND 4.9% RESPECTIVELY IN 2011. THERE WERE 54 OTHER HOSPITALS IN 2011 THAT SERVE WITHIN THESE COMMUNITIES AS WELL. ----------------------------------------- SCHEDULE H, PART VI, ITEM 5 OTHER INFORMATION FRANCISCAN continues to provide access to health care services and a wide variety of community education/health and wellness programs. All of our facilities reach out to their communities by providing access to free, public web sites and online resources. Each web site provides the latest medical information to visitors, in a bi-lingual format, through the use of interactive A to Z health libraries. There are online centers that focus on information related to medical conditions in specialty areas such as the heart, bones, kidneys and nerves. They further offer condition and disease-specific information on topics like cancer, pregnancy and geriatrics that provide illustrations, graphics and narrated videos. The web sites also provide unlimited free access to online health risk assessment tools such as the heart risk assessment that uses an established algorithm to calculate risk factors for heart attack based upon user-entered parameters. The sites also offer condition-specific recommendations for managing chronic illnesses and conditions such as diabetes, high blood pressure and asthma, among others. Finally, the sites have healthy living sections that offer tips and suggestions on beginning and maintaining diet and exercise regiments to optimize healthy lifestyles. Our hospitals provide urgent care clinics within the communities they serve to help minimize cost of non-critical, emergent medical care. We engage in a tremendous amount of university-affiliated medical education and training programs including but not limited to; all levels of nursing (LPN, ASN, BSN and MSN), pharmacy, emergency medical technicians and paramedics, respiratory therapists, physical/occupational/speech therapists and internships/residencies for physicians. We also provide continuing medical education programs. Several of our hospitals participate in clinical trials, medical research programs and pharmaceutical trials. MOREOVER, THERE ARE OTHER FACTORS THAT DEMONSTRATE THAT FRANCISCAN IS OPERATED FOR A PUBLIC RATHER THAN A PRIVATE INTEREST. FRANCISCAN'S GOVERNING BODY IS COMPOSED OF INDEPENDENT MEMBERS REPRESENTING THE BROAD COMMUNITY SERVED BY FRANCISCAN. MEDICAL STAFF PRIVILEGES ARE AVAILABLE TO QUALIFIED PHYSICIANS. FRANCISCAN ALSO USES ITS SURPLUS FOR IMPROVEMENT IN PATIENT CARE, TO EXPAND AND REPLACE FACILITIES AND EQUIPMENT, AMORTIZATION OF INDEBTEDNESS, AND MEDICAL TRAINING, EDUCATION, AND RESEARCH. ----------------------------------------- SCHEDULE H, PART VI, ITEM 6 ROLE OF AFFILIATES Every hospital within our system has the degree of autonomy and flexibility to meet the needs of the communities it serves. Each facility performs a mission assessment that is specifically designated for the identified health care needs within the individual service areas. The individual and regional community benefit plans are designed to be part of an overall FRANCISCAN system vision to provide for the ongoing healthcare needs of the communities we are privileged to serve. ------------------------------------------------ SCHEDULE H, PART II COMMUNITY BUILDING ACTIVITIES FRANCISCAN is involved in and actively participates in numerous community building activities. We work to provide quality care and community building activities by partnering with other health care providers, government agencies, and not-for-profit social service agencies to serve our communities' diverse health care needs. The community building activities offered by FRANCISCAN are provided without reimbursement, serve at-risk populations, and provide health education to key community groups. We monitor these activities for outcomes by identifying changes in health behaviors and knowledge. Some examples of community health programs Franciscan provides include: health education, health fairs, free or low cost health screening, access to healthcare services, immunization services, prescription medication assistance programs, nutritional counseling, enrollment assistance in Medicaid, free spa services for cancer patients, food assistance, transportation assistance, referral assistance, breast cancer and childhood obesity initiatives, healthy choices initiatives, childhood alcoholism prevention, and other various community outreach programs as further described in "Our Giving Journal" at www.franciscanalliance.org/communitybenefit. Additionally, several of our hospitals have been identified by the federal government as designated regional medication distribution sites in the event of a national disaster or epidemic/pandemic. Responding to federal, state and local needs in the event of national or lo
STATE FILING OF COMMUNITY BENEFIT REPORT 990 SCHEDULE H, PART VI IL,IN,
Schedule H (Form 990) 2011
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
FRANCISCAN ALLIANCE INC
 
Employer identification number
35-1330472
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) AMERICAN HEART ASSOCIATION5108 Sagamore Parkway West
West Lafayette,IN47906 		13-5613797 501(c)(3) 10,000   FMV NONE SPONSOR LAFAYETTE HEART WALK
(2) LAFAYETTE MEDICAL EDUCATION FOUNDATION1501 HARTFORD STREET RM 1128A
LAFAYETTE,IN47093 		35-1314750 501(C)(3) 10,000   FMV NONE MED. EDUC.




















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

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













Part IV
Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.
Identifier Return Reference Explanation
PART I, LINE 2   CONTRIBUTIONS ARE GIVEN TO TAX-EXEMPT ORGANIZATIONS WHICH USE THE FUNDS FOR CHARITABLE PURPOSES IN FURTHERANCE OF MEDICAL RESEARCH, MEDICAL INITIATIVES, EDUCATION, AND/ OR COMMUNITY ACTIVITIES.
Schedule I (Form 990) 2011


Additional Data


Software ID:  
Software Version:  


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

35-1330472
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all the expenses described above? If "No," complete Part III to explain....
1b
 
 
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. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ...............
4a
 
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 Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2011

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

Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and column (E) for that individual.
(A) Name (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) KEVIN D LEAHY (i)
(ii)		 1,496,500
0 		0
0 		45,987
0 		1,536,002
0 		29,448
0 		3,107,937
0 		0
0
(2) EUGENE C DIAMOND (i)
(ii)		 816,500
0 		0
0 		48,120
0 		1,327,062
0 		27,355
0 		2,219,037
0 		0
0
(3) ROBERT J BRODY (i)
(ii)		 816,500
0 		0
0 		48,514
0 		1,200,668
0 		14,644
0 		2,080,326
0 		0
0
(4) JENNIFER P MARION (i)
(ii)		 662,786
0 		0
0 		18,219
0 		210,975
0 		25,396
0 		917,376
0 		0
0
(5) TERRANCE E WILSON (i)
(ii)		 615,000
0 		0
0 		31,388
0 		564,567
0 		12,714
0 		1,223,669
0 		0
0
(6) SETH CR WARREN (i)
(ii)		 604,900
0 		0
0 		40,380
0 		313,415
0 		25,425
0 		984,120
0 		0
0
(7) LOUIS METZMAN MD (i)
(ii)		 1,148,943
0 		10,000
0 		30,077
0 		36,313
0 		22,384
0 		1,247,717
0 		0
0
(8) JEFFREY L PIERSON MD (i)
(ii)		 1,326,384
0 		16,364
0 		42,126
0 		37,087
0 		3,045
0 		1,425,006
0 		0
0
(9) JAIRO CRUZ MD (i)
(ii)		 224,670
0 		0
0 		17,836
0 		0
0 		0
0 		242,506
0 		0
0
(10) JOHN B MEDING MD (i)
(ii)		 499,228
0 		319,008
0 		22,923
0 		40,151
0 		13,722
0 		895,032
0 		0
0
(11) MICHAEL E BEREND MD (i)
(ii)		 653,687
0 		183,413
0 		34,556
0 		29,319
0 		3,045
0 		904,020
0 		0
0
(12) ROBERT A MALINZAK MD (i)
(ii)		 517,582
0 		190,492
0 		-3,409
0 		23,320
0 		9,423
0 		737,408
0 		0
0




Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
SCHEDULE J, PART II, COLUMN (C)   Deferred compensation includes split-dollar life insurance, employer deferral to section 403(B) Plan, and change in present value of the qualified and, if applicable, nonqualified defined benefit plan. The value of the nonqualified defined benefit plan is subject to a significant risk of forfeiture and as such possibly may never be paid to the executives participating in the plan. No benefits have been paid out to executives participating in the nonqualified defined benefit plan.
SCHEDULE J, PART I, LINE 4B   Franciscan Alliance, Inc. ("FRANCISCAN") maintains a supplemental executive retirement plan. These benefits are subject to a significant risk of forfeiture and as such possibly may never be paid out to the executives participating in the plan.
Schedule J (Form 990) 2011

Additional Data


Software ID:  
Software Version:  
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
FRANCISCAN ALLIANCE INC
 
Employer identification number
35-1330472
Part I
Bond Issues
(a) Issuer Name (b) Issuer EIN (c) CUSIP # (d) Date Issued (e) Issue Price (f) Description of Purpose (g) Defeased (h) On
Behalf of
Issuer 		(i) Pool
financing
Yes No Yes No Yes No
A INDIANA FINANCE AUTHORITY (06E)
  		36-1602316 454795DW2 04-25-2008 85,150,922 REFUND PRIOR ISSUE DATED 5/16/06   X   X   X
B INDIANA FINANCE AUTHORITY (08AB)
  		35-1602316 45470YAB7 05-12-2008 162,960,000 REFINANCING AND REFUND PRIOR ISSUE   X   X   X
C INDIANA FINANCE AUTHORITY (08C)
  		35-1602316 45470YAX9 09-15-2008 291,837,375 REFUND PRIOR ISSUE DATED 5/2/06   X   X   X
D INDIANA FINANCE AUTHORITY (08DEFGH)
  		35-1602316 45470YBE0 10-10-2008 279,345,000 REFUND PRIOR ISSUE DATED 11/20/03   X   X   X
INDIANA FINANCE AUTHORITY (08IJ)
  		35-1602316 45470YBL4 11-20-2008 81,850,000 REFUND PRIOR ISSUE DATED 5/16/06   X   X   X
INDIANA FINANCE AUTHORITY (09A)
  		35-1602316 45470YCF6 11-05-2009 221,309,385 REFUNDING AND NEW PROJECTS   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . 475,922 615,000 7,007,375 0
2 Amount of bonds legally defeased . . . . . . . . . . 0 0 0 0
3 Total proceeds of issue . . . . . . . . . . . . . 86,903,209 162,624,820 290,462,634 278,919,324
4 Gross proceeds in reserve funds . . . . . . . . 0 0 0 0
5 Capitalized interest from proceeds . . . . . . . . . . 0 0 0 0
6 Proceeds in refunding escrows . . . . . . . . . . . 0 0 0 0
7 Issuance costs from proceeds . . . . . . . . . . . 144,210 1,924,820 1,505,785 503,876
8 Credit enhancement from proceeds . . . . . . . . . . 0 0 0 0
9 Working capital expenditures from proceeds . . . . . . . 0 0 0 0
10 Capital expenditures from proceeds . . . . . . . . . . 42,830,183 0 0 124,873,123
11 Other spent proceeds . . . . . . . . . . . 43,928,816 160,700,000 288,956,849 153,542,325
12 Other unspent proceeds . . . . . . . . . . . 0 0 0 0
13 Year of substantial completion . . . . . . . . . . . 2007 2011
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . . X   X   X   X  
15 Were the bonds issued as part of an advance refunding issue? . . . .   X   X   X   X
16 Has the final allocation of proceeds been made? . . . . . . X   X   X   X  
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . X   X   X   X  
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .   X   X       X
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . . X   X       X  
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2011
Schedule K (Form 990) 2011
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . X   X       X  
b If ‘Yes’ to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . . X   X       X  
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . X   X       X  
d If ‘Yes’ to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? . X   X       X  
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . SchKMediumBullet 0% 0% 0% 0%
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet 0% 0%   %   %
6 Total of lines 4 and 5 . . .. . . . . . . . . 0% 0%   % 0%
7 Does the bond issue meet the private security or payment test? . . . X   X       X  
8 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
X   X       X  
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . .   X   X   X   X
2 Is the bond issue a variable rate issue?   X X     X X  
3a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X   X   X   X
b Name of provider . . . . . . . . 0
  		0
  		0
  		 
 
c Term of hedge . . . . . . . .        
d Was the hedge superintegrated? . . . .                
e Was a hedge terminated? . . . . .                
4a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . .   X   X   X   X
b Name of provider . . . . . . 0
  		0
  		0
  		0
 
c Term of GIC . . . . . . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . . .                
5 Were any gross proceeds invested beyond an available temporary period? . . . . . . X   X   X     X
6 Did the bond issue qualify for an exception to rebate? .   X   X   X X  
7 Has the organization established written procedures to monitor the requirements of section 148? . . .   X   X   X X  
Schedule K (Form 990) 2011

Schedule K (Form 990) 2011
Page 3
Part V
Procedures To Undertake Corrective Action
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? . . . . . . . . . . . . . .
Part VI
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
SCHEDULE K, PART II, LINE 13 0 FOR THE INDIANA FINANCE AUTHORITY 2008A/B BONDS, 2008 I/J BONDS, AND 2009A BONDS, A YEAR OF SUBSTANTIAL COMPLETION HAS NOT BEEN ENTERED SINCE A SUBSTANTIAL AMOUNT OF THE FINANCED PROPERTY HAS NOT BEEN PLACED IN SERVICE AS OF THE DATE OF FILING. FOR THE INDIANA FINANCE AUTHORITY 2008C BONDS, THESE BONDS SOLELY REFUNDED PRIOR ISSUES, SO THE YEAR OF SUBSTANTIAL COMPLETION HAS NOT BEEN ENTERED.
SCHEDULE K, PART III 0 FOR THE INDIANA FINANCE AUTHORITY 2008C BONDS, PART III IS NOT COMPLETED SINCE ALL BOND PROCEEDS WERE USED TO REFUND BONDS ISSUED BEFORE JANUARY 1, 2003.
SCHEDULE K, PART IV, LINE 5 0 For the Indiana Finance Authority 2006E, Indiana Finance Authority 2008A/B, Indiana Finance Authority 2008C, and Indiana Finance Authority 2008I/J issues, only small amounts of proceeds related to the costs of issuance were not expended at the end of the temporary periods.
Schedule K (Form 990) 2011

Additional Data


Software ID:  
Software Version:  

Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
FRANCISCAN ALLIANCE INC
 
Employer identification number
35-1330472
Part I
Bond Issues
(a) Issuer Name (b) Issuer EIN (c) CUSIP # (d) Date Issued (e) Issue Price (f) Description of Purpose (g) Defeased (h) On
Behalf of
Issuer 		(i) Pool
financing
Yes No Yes No Yes No
A INDIANA FINANCE AUTHORITY (06E)
  		36-1602316 454795DW2 04-25-2008 85,150,922 REFUND PRIOR ISSUE DATED 5/16/06   X   X   X
B INDIANA FINANCE AUTHORITY (08AB)
  		35-1602316 45470YAB7 05-12-2008 162,960,000 REFINANCING AND REFUND PRIOR ISSUE   X   X   X
C INDIANA FINANCE AUTHORITY (08C)
  		35-1602316 45470YAX9 09-15-2008 291,837,375 REFUND PRIOR ISSUE DATED 5/2/06   X   X   X
D INDIANA FINANCE AUTHORITY (08DEFGH)
  		35-1602316 45470YBE0 10-10-2008 279,345,000 REFUND PRIOR ISSUE DATED 11/20/03   X   X   X
INDIANA FINANCE AUTHORITY (08IJ)
  		35-1602316 45470YBL4 11-20-2008 81,850,000 REFUND PRIOR ISSUE DATED 5/16/06   X   X   X
INDIANA FINANCE AUTHORITY (09A)
  		35-1602316 45470YCF6 11-05-2009 221,309,385 REFUNDING AND NEW PROJECTS   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . 475,922 615,000 7,007,375 0
2 Amount of bonds legally defeased . . . . . . . . . . 0 0 0 0
3 Total proceeds of issue . . . . . . . . . . . . . 86,903,209 162,624,820 290,462,634 278,919,324
4 Gross proceeds in reserve funds . . . . . . . . 0 0 0 0
5 Capitalized interest from proceeds . . . . . . . . . . 0 0 0 0
6 Proceeds in refunding escrows . . . . . . . . . . . 0 0 0 0
7 Issuance costs from proceeds . . . . . . . . . . . 144,210 1,924,820 1,505,785 503,876
8 Credit enhancement from proceeds . . . . . . . . . . 0 0 0 0
9 Working capital expenditures from proceeds . . . . . . . 0 0 0 0
10 Capital expenditures from proceeds . . . . . . . . . . 42,830,183 0 0 124,873,123
11 Other spent proceeds . . . . . . . . . . . 43,928,816 160,700,000 288,956,849 153,542,325
12 Other unspent proceeds . . . . . . . . . . . 0 0 0 0
13 Year of substantial completion . . . . . . . . . . . 2007 2011
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . . X   X   X   X  
15 Were the bonds issued as part of an advance refunding issue? . . . .   X   X   X   X
16 Has the final allocation of proceeds been made? . . . . . . X   X   X   X  
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . X   X   X   X  
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .   X   X       X
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . . X   X       X  
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2011
Schedule K (Form 990) 2011
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . X   X       X  
b If ‘Yes’ to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . . X   X       X  
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . X   X       X  
d If ‘Yes’ to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? . X   X       X  
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . SchKMediumBullet 0% 0% 0% 0%
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet 0% 0%   %   %
6 Total of lines 4 and 5 . . .. . . . . . . . . 0% 0%   % 0%
7 Does the bond issue meet the private security or payment test? . . . X   X       X  
8 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
X   X       X  
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . .   X   X   X   X
2 Is the bond issue a variable rate issue?   X X     X X  
3a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X   X   X   X
b Name of provider . . . . . . . . 0
  		0
  		0
  		 
 
c Term of hedge . . . . . . . .        
d Was the hedge superintegrated? . . . .                
e Was a hedge terminated? . . . . .                
4a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . .   X   X   X   X
b Name of provider . . . . . . 0
  		0
  		0
  		0
 
c Term of GIC . . . . . . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . . .                
5 Were any gross proceeds invested beyond an available temporary period? . . . . . . X   X   X     X
6 Did the bond issue qualify for an exception to rebate? .   X   X   X X  
7 Has the organization established written procedures to monitor the requirements of section 148? . . .   X   X   X X  
Schedule K (Form 990) 2011

Schedule K (Form 990) 2011
Page 3
Part V
Procedures To Undertake Corrective Action
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? . . . . . . . . . . . . . .
Part VI
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
SCHEDULE K, PART II, LINE 13 0 FOR THE INDIANA FINANCE AUTHORITY 2008A/B BONDS, 2008 I/J BONDS, AND 2009A BONDS, A YEAR OF SUBSTANTIAL COMPLETION HAS NOT BEEN ENTERED SINCE A SUBSTANTIAL AMOUNT OF THE FINANCED PROPERTY HAS NOT BEEN PLACED IN SERVICE AS OF THE DATE OF FILING. FOR THE INDIANA FINANCE AUTHORITY 2008C BONDS, THESE BONDS SOLELY REFUNDED PRIOR ISSUES, SO THE YEAR OF SUBSTANTIAL COMPLETION HAS NOT BEEN ENTERED.
SCHEDULE K, PART III 0 FOR THE INDIANA FINANCE AUTHORITY 2008C BONDS, PART III IS NOT COMPLETED SINCE ALL BOND PROCEEDS WERE USED TO REFUND BONDS ISSUED BEFORE JANUARY 1, 2003.
SCHEDULE K, PART IV, LINE 5 0 For the Indiana Finance Authority 2006E, Indiana Finance Authority 2008A/B, Indiana Finance Authority 2008C, and Indiana Finance Authority 2008I/J issues, only small amounts of proceeds related to the costs of issuance were not expended at the end of the temporary periods.
Schedule K (Form 990) 2011

Additional Data


Software ID:  
Software Version:  

Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBulletSee separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
FRANCISCAN ALLIANCE INC
 
Employer identification number

35-1330472
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Description of transaction (c) Corrected?
Yes No





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

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.
(a) Name of interested person and purpose (b) Loan to or from the organization? (c)Original principal amount (d)Balance due (e) In default? (f) Approved by board or committee? (g)Written agreement?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b)Relationship between interested person and the organization (c)Amount of grant or type of assistance
For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2011
Schedule L (Form 990 or 990-EZ) 2011
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) TONN AND BLANK CONSTRUCTION LLC COMMON DIRECTORS&OFFICERS 84,962,228 PURCHASE OF CONSTRUCTION SERVS   No
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
SCHEDULE L, PART IV   TONN AND BLANK CONSTRUCTION COMPANY, LLC IS A LIMITED LIABILITY COMPANY IN WHICH FRANCISCAN ALLIANCE, INC. HOLDS A MEMBERSHIP INTEREST. THE FOLLOWING CURRENT TRUSTEES AND OFFICERS OF FRANCISCAN ALLIANCE, INC. ARE ALSO BOARD MEMBERS OF TONN AND BLANK CONSTRUCTION COMPANY, LLC: SISTER JANE MARIE KLEIN AND KEVIN D. LEAHY. TONN AND BLANK CONSTRUCTION COMPANY, LLC PROVIDES CONSTRUCTION SERVICES TO FRANCISCAN ALLIANCE, INC. FOR THE CONSTRUCTION AND IMPROVEMENT OF ITS HEALTHCARE FACILITIES.
Schedule L (Form 990 or 990-EZ) 2011

Additional Data


Software ID:  
Software Version:  




SCHEDULE O
(Form 990 or 990-EZ)

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

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

35-1330472
Identifier Return Reference Explanation
FORM 990, PART I, LINE 1   FRANCISCAN ALLIANCE, INC.'S ("FRANCISCAN") PURPOSE IS TO CONTINUE THE HEALING MINISTRY OF CHRIST IN ACCORDANCE WITH THE TEACHINGS OF THE ROMAN CATHOLIC CHURCH AND IN PARTNERSHIP WITH OTHERS TO PROVIDE A FULL CONTINUUM OF HEALTH CARE SERVICES; TO CARRY ON EDUCATIONAL ACTIVITIES RELATED TO THE PROMOTION OF HEALTH; TO PROMOTE AND CARRY ON SCIENTIFIC RESEARCH RELATED TO HEALTH CARE; AND TO PARTICIPATE IN ACTIVITIES DESIGNED AND CONDUCTED TO PROMOTE THE GENERAL HEALTH OF THOSE SERVED BY FRANCISCAN. PLEASE VIEW "OUR GIVING JOURNAL" AT WWW.FRANCISCANALLIANCE.ORG/COMMUNITYBENEFIT WHICH REFLECTS OUR MISSION OF "CONTINUING CHRIST'S MINISTRY IN OUR FRANCISCAN TRADITION." FORM 990, PART VI, SECTION A, LINE 7A THE SISTERS OF THE EASTERN PROVINCE ("PROVINCE") OF THE SISTERS OF ST. FRANCIS OF PERPETUAL ADORATION, A RELIGIOUS CONGREGATION OF WOMEN OF THE ROMAN CATHOLIC CHURCH ("CONGREGATION"), SERVING ON THE PROVINCIAL AND THE PROVINCIAL COUNCIL (COLLECTIVELY "PROVINCIAL LEADERSHIP"), THE PROVINCIAL TREASURER, THE DIRECTOR OF HEALTHCARE OF THE PROVINCE, AND SIX ADDITIONAL SISTERS APPOINTED BY THESE LISTED ABOVE SHALL BE MEMBERS OF FRANCISCAN ALLIANCE, INC. THE BOARD OF TRUSTEES SHALL CONSIST OF 15 INDIVIDUALS INCLUDING: (A) THREE TRUSTEES SHALL BE MEMBERS OF THE PROVINCIAL LEADERSHIP OF THE PROVINCE, ONE WHOM SHALL BE THE PROVINCIAL, OR HER DESIGNEE, AND THE REMAINING TWO SHALL BE ELECTED BY THE PROVINCIAL LEADERSHIP; (B) THE TREASURER OF THE PROVINCE WHO MAY ALSO BE ONE OF THE PROVINCIAL LEADERSHIP REPRESENTATIVES AS DESCRIBED IN (A); (C) THE DIRECTOR OF ALL OF THE HEALTH CARE SERVICES OF THE PROVINCE, WHO MAY ALSO BE ONE OF THE PROVINCIAL LEADERSHIP REPRESENTATIVES AS DESCRIBED IN (A); (D) THE PRESIDENT/CHIEF EXECUTIVE OFFICER OF THE CORPORATION; AND (E)THE MEMBERS SHALL ELECT THE REMAINING TRUSTEES.
FORM 990, PART VI, SECTION A, LINE 7B   NO ACTION ON THE PART OF THE BOARD OF TRUSTEES IN RESPECT OF ANY OF THE FOLLOWING MATTERS SHALL BE EFFECTIVE UNLESS THE ACTION HAS BEEN APPROVED BY A MAJORITY OF THE MEMBERS; NAMELY: (A) CORPORATE MISSION AND PHILOSOPHY; (B) APPOINTMENT OR REMOVAL OF THE CHAIRPERSON, PRESIDENT, SECRETARY, OR TREASURER OF THE CORPORATION; (C) ALIENATION OF PROPERTY AS DEFINED IN CANON LAW; OR (D) ENCUMBRANCE OF DEBT AS DEFINED BY CANON LAW.
FORM 990, PART VI, SECTION B, LINE 11B   THE INFORMATION TO PREPARE THE FORM 990 OF FRANCISCAN ALLIANCE, INC. ("FRANCISCAN") IS GATHERED BY FINANCE STAFF AND PROVIDED TO ITS ACCOUNTING FIRM WHO PREPARES THE RETURN. SENIOR MANAGEMENT THEN REVIEWS THE RETURN PRIOR TO FILING. THE FORM 990 IS ALSO MADE AVAILABLE TO FRANCISCAN'S BOARD OF TRUSTEES PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12C   The Corporation requires annual conflict of interest statements from each director, principal officer, members of committees with board designated powers, key employees, and operation committee members which affirms that they have received, read, and understand the conflict of interest policy and have agreed to comply with the policy. In connection with any actual or possible conflict of interest a director, principal officer or member of a committee with board designated powers must disclose the existence and nature of the financial interest to the directors and members of committees with board delegated powers considering the proposed transaction or arrangements. If after disclosure of the financial interest, the director, principal or committee member shall leave the board or committee meeting while the financial interest is discussed and vote taken. In addition, ongoing reviews and assessments are made to make certain that the Corporation operates in a manner consistent with its charitable purposes. In conducting the ongoing reviews and assessments, the Corporation uses internal and external advisors. Reviews include compensation arrangements, acquisitions, partnerships, joint venture arrangements, and agreements to provide health care products/services, etc.
FORM 990, PART VI, SECTION B, LINE 15   Franciscan Alliance, Inc.'s ("Franciscan") process for determining compensation for the organization's President/CEO, officers and key employees consists of annual compensation studies obtained from up to eight different national compensation surveys. These studies are used to benchmark the organization's President/CEO, officers and key employees based on comparable positions within the healthcare industry. In addition to compensation surveys, Franciscan has periodic external reviews completed by independent compensation consultants. The Executive Committee of the Board of Trustees approves the proposed compensation and benefits at an annual compensation review meeting held each year. The organization's President/CEO recuses himself from the vote on executive compensation.
FORM 990, PART XI, LINE 5   EQUITY IN EARNINGS OF AFFILIATES 18,065,159 MINORITY INTEREST IN AFFILIATES (17,213,000) NET ASSETS RELEASED FOR OPERATIONS 2,964,082 NET ASSETS RELEASED FROM RESTRICTION 796,000 EQUITY TRANSFERS TO/FROM AFFILIATES 9,574,949 CHANGE IN PENSION & POST-RETIREMENT BENEFITS OTHER THAN NET PERIODIC PENSION COSTS INCLUDED IN ACCRUED PENSION LIABILITY (93,872,000) OTHER CHANGES IN NET ASSETS 12,593,329 NET ASSET RECLASS 254,889 CHANGE IN TEMPORARILY RESTRICTED NET ASSETS (578,404) CHANGE IN PERMANENTLY RESTRICTED NET ASSETS 251,077 CHANGES IN NET UNREALIZED GAINS/(LOSSES) (129,867,773) ------------- TOTAL OTHER CHANGES IN NET ASSETS (197,031,692)
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SISTER M MARLENE SHAPLEY TITLE:TRUSTEE HOURS:5
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SISTER M MADONNA ROUGEAU TITLE:TRUSTEE & VP OF MISSION - FSJH HOURS:6
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SISTER JANE MARIE KLEIN TITLE:CHAIRPERSON AND TRUSTEE HOURS:6
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SISTER M ANN KATHLEEN MAGIERA TITLE:TREASURER AND TRUSTEE HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:KEVIN D LEAHY TITLE:PRESIDENT AND TRUSTEE HOURS:6
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SISTER M CORITA LAST TITLE:VICE PRESIDENT, SECRETARY HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DONALD J. KERNER MD TITLE:TRUSTEE HOURS:5
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2011

Additional Data


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

OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
FRANCISCAN ALLIANCE INC
 
Employer identification number

35-1330472
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)
(a)
Name, address, and EIN of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

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


 		(f)
Direct controlling
entity







(1) ATHENS OUTPATIENT SERVICES LLC
1710 LAFAYETTE ROAD
CRAWFORDSVILLE,IN47933
20-3686603 		MEDICAL SRVCS IN 25,671,887 7,077,456 FRANCISCAN
 
(2) FRANCISCAN ALLIANCE ACCOUNTABLE CARE ORG
1515 DRAGOON TRAIL
MISHAWAKA,IN465444710
45-2884517 		ACCOUNT. CARE IN     FRANCISCAN
 
(3) SIGMA MEDICAL GROUP LLC
2400 SOUTH STREET
LAFAYETTE,IN47904
20-1716029 		MEDICAL SRVCS IN 14,545,769 3,720,663 FRANCSICAN
 
(4) ST FRANCIS INSURANCE SERVICES LLC
1600 ALBANY STREET
BEECH GROVE,IN46107
20-0048077 		INSURANCE IN 381,404 0 FRANCISCAN
 
(5) WELLGROUP HEALTH PARTNERS LLC
333 DIXIE HIGHWAY
CHICAGO HEIGHTS,IL60411
05-0540914 		PHYSICIAN IL 60,633,444 16,190,134 FRANCISCAN
 
(6) FAITH HOPE AND LOVE CANCER CENTER LLC
1250 SOUTH CREASY LN STE A
LAFAYETTE,IN47905
68-0612977 		MEDICAL SRVCS IN 5,912,755 952,015 FRANCISCAN
 
(7) FRANCISCAN HAMMOND CLINIC LLC
7905 CALUMET AVENUE
MUNSTER,IN46321
27-4958737 		MEDICAL SRVCS IN 33,695,422 16,366,584 FRANCISCAN
 
(8) FRANCISCAN PHYSICIANS HOSPITAL LLC
701 SUPERIOR STREET
MUNSTER,IN46321
20-8411919 		HOSPITAL IN 29,651,387 53,852,416 FRANCISCAN
 
(9) SOLUTIONS HEALTHCARE MGMT LLC
5224 S EAST STREET SUITE 3
INDIANAPOLIS,IN46227
27-2919869 		HEALTHCARE IN 5,868,175 1,875,380 FRANCISCAN
 
(10) ST FRANCIS MEDICAL GROUP LLC
5330 E STOP 11 RD
INDIANAPOLIS,IN46237
26-3877295 		MEDICAL SVCS IN 174,066,888 9,688,583 FRANCISCAN
 
(11) HEALTHPARTNERS MEDICAL GROUP LLC
1225 E COLLSPRING AVENUE
MICHIGAN CITY,IN46320
20-0474054 		HEALTHCARE IN 12,028,961 -3,734,809 FRANCISCAN
 
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) ALVERNO CLINICAL LABS INC

2434 INTERSTATE PLAZA DRIVE

HAMMOND,IN46324
35-2060754 		LAB SERVICES IN 501(C)(3) 11 - Type 1 FRANCISCAN
 
Yes
 
(2) HILLS INSURANCE COMPANY INC

1515 DRAGOON TRAIL

MISHAWAKA,IN46544
03-0372512 		CAPTIVE INS VT 501(C)(3) 11 - Type 1 FRANCISCAN
 
Yes
 
(3) SISTERS OF ST FRANCIS OF PERPETUAL ADOR

PO BOX 766

MISHAWAKA,IN46546
35-1328145 		RELIGIOUS IN 501(C)(3) 1 NA
 
 
No
(4) ST ALEXIS HOSPITAL ASSOCIATION

PO BOX 1290

MISHAWAKA,IN465461290
34-0714485 		SUPPORT ALEXA OH 501(C)(3) 3 FRANCISCAN
 
Yes
 
(5) FRANCISCAN ALLIANCE FOUNDATION INC

1600 ALBANY STREET - FINANCE 9010

BEECH GROVE,IN46107
35-1955283 		FUNDRAISING IN 501(C)(3) 11 - Type 2 FRANCISCAN
 
Yes
 
(6) ST JAMES COMMUNITY FOUNDATION

1423 CHICAGO ROAD

CHICAGO HEIGHTS,IL60411
20-4249251 		FUNDRAISING IL 501(C)(3) 7 FRANCISCAN
 
Yes
 
(7) VNS AT ST FRANCIS INC

4701 N KEYSTONE AVE S418

INDIANAPOLIS,IN46205
35-0868199 		HOME HEALTH IN 501(C)(3) 9 FRANCISCAN
 
Yes
 
(8) AT YOUR SERVICE HOME CARE INC

4701 N KEYSTONE AVE

INDIANAPOLIS,IN46205
35-2107306 		HEALTHCARE IN 501(C)(3) 9 FRANCISCAN
 
Yes
 
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



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

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




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



 		(k)
Percentage
ownership
Yes No Yes No
(1) FRANCISCAN IMAGING EQUIPMENT LEASING LLC

1600 ALBANY STREET
BEECH GROVE,IN46107
35-2282509 		EQUIPMENT LEA IN FRANCISCAN
  		RELATED 34,234 328,906   No 0   No 59.670 %
(2) FRANCISCAN PHYSICIANS HOSPITAL LLC

701 SUPERIOR STREET
MUNSTER,IN46321
20-8411919 		HOSPITAL IN FRANCISCAN
  		RELATED -545,577 0   No 0   No 0 %
(3) FRANCISCAN PHYSICIANS REAL PROPERTY LLC

701 SUPERIOR STREET
MUNSTER,IN46321
26-0787231 		REAL PROP LEA IN FRANCISCAN
  		RELATED 2,643,128 36,939,796   No 0   No 89.560 %
(4) FRANCISCAN SURGERY CENTER LLC

1600 ALBANY ROAD
BEECH GROVE,IN46107
35-2128334 		MEDICAL SERVS IN FRANCISCAN
  		RELATED 4,527,297 2,764,599   No 0   No 54.050 %
(5) LAFAYETTE HEART PROGRAM HOLDINGS LLC

1501 HARTFORD STREET
LAFAYETTE,IN47904
38-3750811 		MEDICAL SERVS IN FRANCISCAN
  		RELATED 902,016 14,397,410   No 0   No 51.000 %
(6) ST ANTHONY HEALTH NETWORK LLC

PO BOX 310
MISHAWAKA,IN465460310
35-1985170 		CLAIMS PROCESSING IN FRANCISCAN
  		RELATED -45,902 485,012   No 0   No 88.070 %
(7) ST FRANCIS MOORESVILLE SURGERY CENTER

1215 HADLEY ROAD SUITE 100
MOORESVILLE,IN46158
20-2256900 		MEDICAL SERVS IN FRANCISCAN
  		RELATED 1,063,662 566,268   No 0   No 59.520 %
(8) ST FRANCIS RADIATION THERAPY CENTERS LLC

1600 ALBANY STREET
BEECH GROVE,IN46107
77-0663631 		MEDICAL SERVS IN FRANCISCAN
  		RELATED 6,585,933 8,328,482   No 0   No 86.740 %
(9) MAJOR HOSPITAL CARDIAC DIAGNOSTICS LLC

150 West Washington Street
Shelbyville,IN46176
20-8715441 		MEDICAL SERVS IN FRANCISCAN
  		RELATED 288,332 235,895   No 0   No 53.600 %
(10) ST FRANCIS IMAGING CTR GREENWOOD LLC

3147 W SMITH VALLEY RD
GREENWOOD,IN46143
20-4607426 		IMAGING SERVS IN FRANCISCAN
  		RELATED 500,411 720,718   No 0   No 60.000 %
(11) TONN AND BLANK CONST LLC

1623 GREENWOOD AVE
MICHIGAN CITY,IN46360
26-3919039 		CONSTRUCTION IN FRANCISCAN
  		RELATED 2,073,953 3,729,266   No 77,046   No 56.500 %
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) FRANCISCAN HOLDING CORPORATION
1515 DRAGOON TRAIL
MISHAWAKA,IN46544
36-3593505 		HOLDING COMP IN FRANCISCAN
  		C CORP 1,675,428 41,337,029 100.000 %
(2) ST FRANCIS HEALTH NETWORK
112 N 17TH AVENUE SUITE 210
BEECH GROVE,IN46107
35-1904455 		INSURANCE IN FRANCISCAN
  		C CORP 72,106,259 4,289,238 100.000 %
(3) ST JAMES PHO INC
1423 CHICAGO ROAD
CHICAGO HEIGHTS,IL60411
36-3945083 		MANAGED CARE IL FRANCISCAN
  		C CORP 48 1,433,752 50.000 %








Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III or IV.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
Yes
 
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
Yes
 
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
Yes
 
j Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
 
No
p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property from related 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) ALVERNO CLINICAL LABORATORIES INC

 B 382,182 FMV
(2) FRANCISCAN ALLIANCE FOUNDATION INC

 C 2,072,213 FMV
(3) FRANCISCAN ALLIANCE FOUNDATION INC

 P 403,751 FMV
(4) FRANCISCAN PHYSICIANS HOSPITAL LLC

 I 805,200 FMV
(5) FRANCISCAN PHYSICIANS HOSPITAL LLC

 C 5,419,945 FMV
(6) FRANCISCAN PHYSICIANS REAL PROPERTY LLC

 C 2,215,592 FMV
(7) FRANCISCAN SURGERY CENTER LLC

 C 4,309,480 FMV
(8) MAJOR HOSPITAL CARDIAC DIAGNOSTICS LLC

 C 151,525 FMV
(9) ST ALEXIS HOSPITAL ASSOCIATION

 B 175,000 FMV
(10) ST ANTHONY HEALTH NETWORK LLC

 C 158,980 FMV
(11) ST FRANCIS IMAGING CENTER (GREENWOOD) LLC

 C 422,400 FMV
(12) ST FRANCIS MOORESVILLE SURGERY CENTER LLC

 C 1,035,000 FMV
(13) ST FRANCIS RADIATION THERAPY CENTERS LLC

 C 6,588,775 FMV
(14) ST JAMES COMMUNITY FOUNDATION

 C 217,056 FMV
(15) TONN AND BLANK CONSTRUCTION LLC

 C 66,344 FMV
(16) TONN AND BLANK CONSTRUCTION LLC

 L 84,962,228 FMV
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

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




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






























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


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