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

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2010
Open to Public Inspection
A For the calendar year, or tax year beginning 07-01-2010 and ending 06-30-2011
BCheck if applicable:
CName of organization
DUBUIS HEALTH SYSTEM INC
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
1700 W LOOP SOUTH NO 1100A
 
Room/suite
City or town, state or country, and ZIP + 4
HOUSTON, TX770270000
D Employer identification number

72-1270964
E Telephone number

G Gross receipts $ 41,031,336
F Name and address of principal officer:
PAUL VEILLON
1700 W LOOP SOUTH NO 1100A
HOUSTON,TX770270000
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.DUBUIS.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 MediumBullet  
K Form of organization:
 
L Year of formation: 1994
M State of legal domicile: LA
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: TO CONTINUE THE HEALING MINISTRY OF JESUS CHRIST ACROSS THE CONTINUUM OF CARE.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) .... 3 6
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 5
5 Total number of individuals employed in calendar year 2010 (Part V, line 2a) ... 5 14
6 Total number of volunteers (estimate if necessary) .... 6 5
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b 0
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 827 2,296
9 Program service revenue (Part VIII, line 2g) ......... 38,258,491 40,945,677
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... -7,557 6,920
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 398,560 76,443
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 38,650,321 41,031,336
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 1,673 927
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) 16,164,423 16,675,622
16a Professional fundraising fees (Part IX, column (A), line 11e).... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 22,495,472 23,297,436
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 38,661,568 39,973,985
19 Revenue less expenses. Subtract line 18 from line 12...... -11,247 1,057,351
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............ 26,395,316 29,383,741
21 Total liabilities (Part X, line 26)............ 3,080,056 5,011,130
22 Net assets or fund balances. Subtract line 21 from line 20 ..... 23,315,260 24,372,611
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid Preparer's Use Only Preparer's
signatureBig Right Arrow 		Date
right pointing bullet image Preparer’s taxpayer identification number
(see instructions)
Firm’s name (or yours
if self-employed),
address, and ZIP + 4Big Right Arrow




 		EIN right pointing bullet image
Phone no. right pointing bullet image
May the IRS discuss this return with the preparer shown above? (see instructions) .........
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2010)
Form 990 (2010)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III . . . . . . . . . .
1
Briefly describe the organization’s mission: TO CONTINUE THE HEALING MINISTRY OF JESUS CHRIST ACROSS THE CONTINUUM OF CARE. WE ARE AN INTERDISCIPLINARY TEAM OF HEALTHCARE PROFESSIONALS WHO ENABLE PATIENTS TO ACHIEVE MEDICAL AND THERAPEUTIC GOALS BY PROVIDING LONG-TERM ACUTE INPATIENT HOSPITAL CARE.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the exempt purpose achievements for each of the organization’s three largest program services by expenses.
Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 37,555,500 including grants of $ 927 ) (Revenue $ 41,015,202 )
TO FULFILL ITS MISSION, DUBUIS HEALTH SYSTEM, INC. PROVIDES LONG TERM ACUTE INPATIENT CARE TO INDIVIDUALS WHOSE CONDITION IS SO SIGNIFICANT THAT A HOSPITAL STAY OF ONE MONTH OR MORE IS ANTICIPATED. THE HOSPITAL CARES FOR PATIENTS WHO ARE MEDICALLY COMPLEX AND MAY REQUIRE DAILY MONITORING; VENTILATOR DEPENDENT PATIENTS, OXYGEN DEPENDENT PATIENTS NEEDING RESPIRATORY REHABILITATION, PATIENTS WITH SLOW HEALING WOUNDS, PATIENTS BENEFITING FROM PHYSICAL, OCCUPATIONAL OR SPEECH THERAPY, AND FOR PATIENTS REQUIRING PALLIATIVE AND END OF LIFE CARE. THE MEDICAL AND THERAPEUTIC NEEDS OF THE PATIENTS ARE MET USING AN INTERDISCIPLINARY, HOLISTIC TEAM APPROACH INCORPORATING MEDICAL MANAGEMENT, PHYSICAL, RESPIRATORY, OCCUPATIONAL AND SPEECH THERAPIES IN AN EFFORT TO RESTORE INDIVIDUAL QUALITY OF LIFE TO AS HIGH A DEGREE AS POSSIBLE AND TO PROMOTE SELF-HELP AND INDEPENDENCE TO THE EXTENT FEASIBLE. THE SPIRITUAL NEEDS OF THE PATIENTS, FAMILIES AND SIGNIFICANT OTHERS ARE PROVIDED FOR AS WELL.PATIENT CARE PROGRAM SERVICESTO THE LIMITS OF ITS RESOURCES, DUBUIS HEALTH SYSTEM, INC. IS AN INSTITUTION OF PUBLIC CHARITY; THUS, THE MOST TANGIBLE EXPRESSION OF DUBUIS' CHARITABLE PURPOSE IS THE PROVISION OF HEALTHCARE SERVICES TO THOSE PERSONS WHO ARE UNABLE TO PAY. THIS FALLS INTO TWO CATEGORIES: CHARITY CARE AND UNREIMBURSED MEDICAID.INPATIENT CHARITY CARE - UNREIMBURSED COSTS OF PROVIDING CARE FOR THE FINANCIALLY AND MEDICALLY INDIGENTIN KEEPING WITH ITS MISSION, VALUES, AND VISION, DUBUIS HEALTH SYSTEM, INC. PROVIDES CHARITY CARE SERVICES IN A MANNER THAT RESPECTS THE DIGNITY OF THE PATIENTS AND THEIR FAMILIES. CHARITY CARE IS PROVIDED WITHOUT CHARGE OR AT A CHARGE THAT IS LESS THAN THE USUAL CHARGE FOR SUCH SERVICES. THE DETERMINATION AS TO THE AMOUNT TO BE CHARGED, IF ANY, IS MADE ACCORDING TO A PATIENT'S ABILITY TO PAY, CONSIDERATION OF THE PATIENT'S ASSETS AND LIABILITIES, AND DETERMINED BY THE ESTABLISHED ELIGIBILITY CRITERIA BASED ON THE MOST CURRENT FEDERAL POVERTY GUIDELINES. A FINANCIALLY INDIGENT PATIENT IS ONE WHO IS UNINSURED OR UNDERINSURED AND WHOSE ECONOMIC CIRCUMSTANCES PLACE THEM AT OR UNDER 200% OF THE FEDERAL POVERTY GUIDELINES. A MEDICALLY INDIGENT PATIENT IS A PERSON WHO'S MEDICAL OR HOSPITAL BILLS AFTER PAYMENT BY THIRD-PARTY PAYERS EXCEEDS 25% OF THEIR ANNUAL GROSS INCOME. NO PATIENT IS REFUSED NECESSARY MEDICAL CARE ON THE BASIS OF THEIR INABILITY TO PAY.UNRECOVERED COSTS OF PROGRAMS BENEFITING THE POOR (UNREIMBURSED GOVERNMENT SPONSORED INDIGENT CARE)(MEDICAID)DUBUIS HEALTH SYSTEM, INC. IS AN ACTIVE PARTICIPANT IN THE STATE OF TEXAS MEDICAID PROGRAM. THAT PROGRAM SEEKS TO PROVIDE PAYMENT FOR HEALTH CARE SERVICES TO INDIVIDUALS WHO MEET CERTAIN FINANCIAL AND OTHER REQUIREMENTS. FINANCIAL REQUIREMENTS INCLUDE EVALUATION OF BOTH ASSETS AND INCOME.OTHER COMMUNITY BENEFITSUNREIMBURSED GOVERNMENT SPONSORED PROGRAMSIN ADDITION TO THE PROVISION OF CARE WITHOUT EXPECTATION OF PAYMENT (CHARITY CARE), DUBUIS HEALTH SYSTEM, INC. PROVIDES SERVICES TO PERSONS COVERED UNDER GOVERNMENT SPONSORED PROGRAMS, INCLUDING MEDICARE, TRICARE (FORMERLY CHAMPUS WHICH PROVIDES CIVILIAN HEALTH CARE BENEFITS TO MILITARY PERSONNEL, MILITARY RETIREES AND THEIR DEPENDENTS, AND SOME MEMBERS OF THE RESERVE COMPONENT) AND TRICARE FOR LIFE (A MEDICARE SUPPLEMENT INSURANCE PROGRAM AVAILABLE TO INDIVIDUALS WHO HAD BEEN ELIGIBLE FOR TRICARE).AS ALREADY CITED, DUBUIS HEALTH SYSTEM, INC. PROVIDED MEDICAL SERVICES TO PERSONS COVERED UNDER THE FEDERAL MEDICARE PROGRAM WHICH, IN FACT, COMPRISED THE LARGEST SINGLE PAYER CLASSIFICATION OF PATIENTS SERVED BY THIS HEALTH SYSTEM. THE PAYMENT RATE FOR INPATIENT SERVICES IS ON A PER DISCHARGE RATE, CALCULATED BASED ON THE DIAGNOSTIC-RELATED GROUP INTO WHICH THE PATIENT IS CATEGORIZED. NUMBER OF PATIENTS SERVED: 1,210NUMBER OF PATIENT DAYS OF CARE PROVIDED: 31,584NUMBER OF PATIENT DAYS OF CHARITY CARE PROVIDED: 1,065CHARITY CARE COST: $471,254CHARITY CARE CHARGES: $1,336,132OTHER COMMUNITY BENEFITS: $23,000UNREIMBURSED MEDICAID: $40,972
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$ 37,555,500
Form 990 (2010)
Form 990 (2010)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? ........
2
 
No
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part 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 where donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete
Schedule D, Part IClick to see attachment.......................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IVClick to see attachment...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in term, permanent,or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
 
No
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
 
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
Yes
 
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
 
No
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, and program service activities outside the United States? If “Yes,” complete Schedule F, Part I.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II..
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III..
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II..........
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
Form 990 (2010)
Form 990 (2010)
Page 4
Part IV
Checklist of Required Schedules (continued)
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H..... Click to see attachment
20a
Yes
 
b
Did the organization attach its audited financial statement to this return? Note: All Form 990 filers that operate one or more hospitals must attach audited financial statements. ..... Click to see attachment
20b
Yes
 
21
Did the organization report more than $5,000 of grants and other assistance to governments and organizations in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II..
21
 
No
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III.....
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
 
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I......
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II...........................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor, or a grant selection committee member, or to a person related to such an individual? If “Yes,” complete Schedule L, Part III...............
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV .........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV...................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV..
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35
Is any related organization a controlled entity within the meaning of section 512(b)(13)? .....
35
 
No
a
Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2........... Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2010)
Form 990 (2010)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V . . . . . . . . . .
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
55
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
 
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
14
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
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2010)
Form 990 (2010)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI . . . . . . . . . .
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year ..............
1a
6
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
5
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? ..
3
Yes
 
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Does the organization have members or stockholders? ................
6
Yes
 
7a
Does the organization have members, stockholders, or other persons who may elect one or more members of the governing body? .........................
7a
Yes
 
b
Are any decisions of the governing body subject to approval by members, stockholders, or other persons? ..
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Does the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” does the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with those of the organization? ....
10b
 
 
11a
Has the organization provided a copy of this Form 990 to all members of its governing body before filing the form?
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Does the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Are officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ...........................
12b
Yes
 
c
Does the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this is done ....................
12c
Yes
 
13
Does the organization have a written whistleblower policy? ...............
13
Yes
 
14
Does the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line a or b, describe the process in Schedule O. (See instructions.)
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If “Yes,” has the organization adopted a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and taken steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you make these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization makes its governing documents, conflict of interest policy, and financial statements available to the public.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
PAUL VEILLON CFO
1700 W LOOP SOUTH SUITE 1100A
HOUSTON,TX77027
(713) 277-2330
Form 990 (2010)
Form 990 (2010)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII . . . . . . . . . .
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

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

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

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

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) STEPHEN A MILLS
CHIEF EXECUTIVE OFFICER
 41.00 X   X       160,748 0 16,565
(2) MARY BROWN
BOARD MEMBER
 1.00 X           0 0 0
(3) DR NHAN NGUYEN
BOARD MEMBER
 1.00 X           0 0 0
(4) ANN MARY BRANGAN
BOARD MEMBER
 1.00 X           0 0 0
(5) JEAN JENSEN
BOARD MEMBER
 1.00 X           0 0 0
(6) SR BETTE BLUHM
BOARD MEMBER
 1.00 X           0 0 0
(7) PAUL VEILLON
CFO
 6.00     X       0 175,959 13,973
(8) MATTHEW E SMITH
CORPORATE SECRETARY
 6.00     X       0 58,939 19,374
(9) HOLLY POWELL
ADMINISTRATOR
 40.00         X   101,136 0 21,998
(10) WILLIAM L WILLIS
ADMINISTRATOR
 40.00         X   103,762 0 20,565
(11) DIANE KAISER
ADMINISTRATOR
 40.00         X   108,940 0 12,679
(12) CHARLES GILBERT
ADMINISTRATOR
 40.00         X   96,776 0 16,438
(13) SAM BARKMAN
FMR OFFICER/VP OPERATIONS
 40.00           X 81,080 0 22,032
(14) ELLEN SMITH
FMR OFFICER/CEO
 0.00           X 0 256,354 0
(15) TRACEY RICHARD
FMR OFFICER/ADMINISTRATOR
 0.00           X 0 22,517 400
(16) KEITH ROGERS
FMR OFFICER/REG. ADMINISTRATOR
 0.00           X 0 173,759 910


Form 990 (2010)
Form 990 (2010)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;


























1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 555,666 687,528 128,496
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 in reportable compensation from the organizationMediumBullet6
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
WADLEY REGIONAL MEDICAL CENTER
922 OLIVE STREET
TEXARKANA,TX75501 		ANCILLARY SERVICES 1,322,371
PRIORITY STAFFING
8660 FERN AVE STE 160
SHREVEPORT,LA711055694 		CONTRACT LABOR 639,346
AMS STAFFING
PO BOX 4729
WINTER PARK,FL327934729 		CONTRACT LABOR 497,466
ALPHA NURSING SERVICES INC
820 JORDAN SUITE 308
SHREVEPORT,LA71112 		CONTRACT LABOR 393,629
ADVANTAGE NURSING SERVICES LLC
3340 SEVERN AVE STE 320
METAIRIE,LA700027410 		CONTRACT LABOR 318,778
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization MediumBullet12
Form 990 (2010)
Form 990 (2010)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, gifts, grants and other similar amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d  
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		2,296
g Noncash contributions included in lines 1a-1f:$  
h Total. Add lines 1a-1f.......MediumBullet 2,296
Program Service Revenue Business Code
2a INPATIENT REVENUE NET 900,099 40,945,677 40,945,677    
b
c
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 40,945,677
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 6,920     6,920
4 Income from investment of tax-exempt bond proceeds..MediumBullet        
5 Royalties............MediumBullet        
(i) Real (ii) Personal
6a Gross Rents    
b Less: rental expenses    
c Rental income or (loss)    
d Net rental income or (loss).......MediumBullet        
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory    
b Less: cost or other basis and sales expenses    
c Gain or (loss)    
d Net gain or (loss)..........MediumBullet        
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet      
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        
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet        
Miscellaneous Revenue Business Code
11a VENDING MACHINE COMM 900,099 6,918     6,918
b MEDICARE INTEREST REV 900,099 1,133 1,133    
c            
d All other revenue .... 68,392 68,392    
e Total. Add lines 11a–11d ......MediumBullet 76,443
12 Total revenue. See Instructions....MediumBullet 41,031,336 41,015,202 0 13,838
Form 990 (2010)
Form 990 (2010)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the U.S. See Part IV, line 21 927 927
2 Grants and other assistance to individuals in the U.S. See Part IV, line 22    
3 Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 15 and 16    
4 Benefits paid to or for members    
5 Compensation of current officers, directors, trustees, and key employees .... 174,724   174,724  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....        
7 Other salaries and wages 13,148,210 12,006,462 1,141,748  
8 Pension plan contributions (include section 401(k) and section 403(b) employer contributions) .... 434,970 391,995 42,975  
9 Other employee benefits ....... 1,971,315 1,776,549 194,766  
10 Payroll taxes ........... 946,403 852,898 93,505  
11 Fees for services (non-employees):        
a Management ...... 2,133,145 2,133,145    
b Legal ......... 56   56  
c Accounting ...........        
d Lobbying ........... 5,255   5,255  
e Professional fundraising. See Part IV, line 17..    
f Investment management fees ......        
g Other .......... 448,570 251,633 196,937  
12 Advertising and promotion .... 6,363   6,363  
13 Office expenses ....... 183,533 73,032 110,501  
14 Information technology ......        
15 Royalties ..        
16 Occupancy ...........        
17 Travel ............ 108,545 22,214 86,331  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ......        
19 Conferences, conventions, and meetings .... 55,203 499 54,704  
20 Interest ...........        
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization ..... 676,677 676,677    
23 Insurance .............. 169,964 127,473 42,491  
24 Other expenses. Itemize expenses not covered above. (Expenses grouped together and labeled miscellaneous may not exceed 5% of total expenses shown on line 25 below.)
a PURCHASED SERVICES 6,766,667 6,658,998 107,669  
b SUPPLIES 5,047,379 4,967,710 79,669  
c CONTRACT LABOR 3,291,634 3,288,457 3,177  
d LEASE EXPENSE 3,036,015 3,036,015 0  
e EQUIPMENT RENTAL 838,217 798,925 39,292  
f All other expenses 530,213 491,891 38,322  
25 Total functional expenses. Add lines 1 through 24f 39,973,985 37,555,500 2,418,485 0
26 Joint costs. Check here MediumBullet if following
SOP 98-2 (ASC 958-720). Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation 		       
Form 990 (2010)
Form 990 (2010)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing ..........   1  
2 Savings and temporary cash investments ....... 6,571,799 2 10,185,547
3 Pledges and grants receivable, net .........   3  
4 Accounts receivable, net ......... 4,217,424 4 5,783,169
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..........   5  
6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
Schedule L ..........   6  
7 Notes and loans receivable, net ............. 12,694,215 7 10,954,370
8 Inventories for sale or use .............. 301,227 8 306,177
9 Prepaid expenses and deferred charges ............ 22,716 9 76,626
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 7,195,973
b Less: accumulated depreciation. ..... 10b 5,118,121 2,587,934 10c 2,077,852
11 Investments—publicly traded securities ..........   11  
12 Investments—other securities. See Part IV, line 11 ......   12  
13 Investments—program-related. See Part IV, line 11 ..   13  
14 Intangible assets .........   14  
15 Other assets. See Part IV, line 11 ........... 1 15  
16 Total assets. Add lines 1 through 15 (must equal line 34)... 26,395,316 16 29,383,741
Liabilities 17 Accounts payable and accrued expenses . 1,146,939 17 2,215,917
18 Grants payable ..........   18  
19 Deferred revenue ..........   19  
20 Tax-exempt bond liabilities ..........   20  
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22  
23 Secured mortgages and notes payable to unrelated third parties ..   23  
24 Unsecured notes and loans payable to unrelated third parties ....   24  
25 Other liabilities. Complete Part X of Schedule D..... 1,933,117 25 2,795,213
26 Total liabilities. Add lines 17 through 25..... 3,080,056 26 5,011,130
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 ..... 23,315,260 27 24,372,611
28 Temporarily restricted net assets .....   28  
29 Permanently restricted net assets .....   29  
Organizations that do not follow SFAS 117, check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ..... 23,315,260 33 24,372,611
34 Total liabilities and net assets/fund balances ..... 26,395,316 34 29,383,741
Form 990 (2010)
Form 990 (2010)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI . . . . . . . . . .
1
Total revenue (must equal Part VIII, column (A), line 12) . . .
1
41,031,336
2
Total expenses (must equal Part IX, column (A), line 25) . . . . .
2
39,973,985
3
Revenue less expenses. Subtract line 2 from line 1 . . . .
3
1,057,351
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) . .
4
23,315,260
5
Other changes in net assets or fund balances (explain in Schedule O) . . . .
5
0
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
24,372,611
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
 
No
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
 
 
Form 990 (2010)
Additional Data


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

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

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
DUBUIS HEALTH SYSTEM INC
 
Employer identification number

72-1270964
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization? ................
11g(i)
 
 
(ii) a family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
(i)
Name of supported organization 		(ii)
EIN 		(iii)
Type of organization (described on lines 1- 9 above or IRC section (see instructions)) 		(iv)
Is the organization in col. (i) listed in your governing document? 		(v)
Did you notify the organization in col. (i) of your support? 		(vi)
Is the organization in col. (i) organized in the U.S.? 		(vii)
Amount of support?
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3..            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..            
6 Public Support. Subtract line 5 from line 4.            
Section B. Total Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public Support (Subtract line 7c from line 6.)            
Section B. Total Support
Calendar year (or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)            
13 Total support (Add lines 9, 10c, 11 and 12.).            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2010

Additional Data


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

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

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

72-1270964
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization's direct and indirect political campaign activities on behalf of or in opposition to candidates for public office in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
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 funtion activities ....................................SchCMd Bullet

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

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










For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2010

Schedule C (Form 990 or 990-EZ) 2010
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check
B Check
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
Organization's
Totals 		(b) Affiliated Group
Totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) Total
             
2a Lobbying non-taxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots non-taxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2010


Schedule C (Form 990 or 990-EZ) 2010
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
(a)
Yes
No
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? If "Yes," describe in Part IV ..........................
Yes
 
5,255
j
Total. lines 1c through 1i ...................................
5,255
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carryover lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) if BOTH Part III-A, lines 1 and 2 are answered “No” OR if Part III-A, line 3 is answered “Yes”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) non-deductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ...........................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; and Part ll-B, line 1i.
Also, complete this part for any additional information.
Identifier Return Reference Explanation
EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: A PERCENTAGE OF DUES PAID TO ORGANIZATIONS WERE USED FOR LOBBYING. THESE INCLUDE DUES PAID TO AMERICAN NURSES ASSOCIATION, TEXAS NURSES ASSOCIATION, CATHOLIC HEALTH ASSOCIATION OF TEXAS, LOUISIANA HOSPITAL ASSOCIATION, AMERICAN COLLEGE OF HEALTHCARE EXECUTIVES AND NATIONAL ASSOCIATION OF LONG-TERM CARE HOSPITALS.
Schedule C (Form 990 or 990EZ) 2010

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11, or 12.
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
DUBUIS HEALTH SYSTEM INC
 
Employer identification number

72-1270964
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .......    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) ...    
4 Aggregate value at end of year .......    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds may be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit. ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a–2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06 ........ 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the taxable year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................
9
In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116, not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116, to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 52283D
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIV.
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current Year (b)Prior Year (c)Two Years Back (d)Three Years Back (e)Four Years Back
1a Beginning of year balance ....      
b Contributions ........      
c Investment earnings or losses ...      
d Grants or scholarships .....      
e Other expenditures for facilities
and programs ........ 		     
f Administrative expenses ....      
g End of year balance ......      
2
Provide the estimated percentage of the year end balance held as:
a
Board designated or quasi-endowment: SchDMd Bullet  
b
Permanent endowment: SchDMd Bullet  
c
Term endowment: SchDMd Bullet  
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
 
(ii) related organizations ........................
3a(ii)
 
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Investments—Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of investment (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................      
b Buildings ................        
c Leasehold improvements ............   3,114,025 2,228,435 885,590
d Equipment ................   4,081,948 2,889,686 1,192,262
e Other .................        
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........SchDMdBullet 2,077,852
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) should equal Form 990, Part X, col.(B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








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








Total. (Column (b) should equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Amount
Federal Income Taxes  
ACCRUED EMPLOYEE COMPENSATION AND BENEFITS 1,698,220
THIRD PARTY PAYOR SETTLEMENTS 1,096,993







Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)Small Bullet 2,795,213
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1 41,031,336
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2 39,973,985
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3 1,057,351
4 Net unrealized gains (losses) on investments .......................... 4  
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV) ................................. 8  
9 Total adjustments (net). Add lines 4 - 8 ............................. 9 0
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10 1,057,351
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 41,031,336
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV): ............ 2d  
e Add lines 2a through 2d ..................... 2e 0
3 Subtract line 2e from line 1..................... 3 41,031,336
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIV): ........... 4b  
c Add lines 4a and 4b....................... 4c 0
5 Total Revenue. Add lines 3 and 4c. (This should equal Form 990, Part I, line 12.) ...... 5 41,031,336
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1 39,973,985
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIV): ............ 2d  
e Add lines 2a through 2d...................... 2e 0
3 Subtract line 2e from line 1..................... 3 39,973,985
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 0
5 Total expenses. Add lines 3 and 4c. (This should equal Form 990, Part I, line 18.) ...... 5 39,973,985
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
Schedule D (Form 990) 2010

Additional Data


Software ID:  
Software Version:  




SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
DUBUIS HEALTH SYSTEM INC
 
Employer identification number

72-1270964
Part I
Charity Care and Certain Other Community Benefits at Cost
Yes
No
1a
Does the organization have a charity care policy? If "No," skip to question 6a...........
1a
Yes
 
b
If "Yes," is it a written policy? .......................
1b
Yes
 
2
If the organization has multiple hospitals, indicate which of the following best describes application of the charity care policy to the various hospitals.
3
Answer the following based on the charity care eligibility criteria that applies to the largest number of the organization's patients.
a
Does the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care to low
income individuals? If "Yes," indicate which of the following is the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Does the organization use FPG to determine eligibility for providing discounted care to low income individuals? If
"Yes," indicate which of the following is the family income limit for eligibility for discounted care: .....
3b
Yes
 
c
If the organization does not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization uses an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.
4
Does the organization's policy provide free or discounted care to the "medically indigent"? ......
4
Yes
 
5a
Does the organization budget amounts for free or discounted care provided under its charity care policy? ...
5a
Yes
 
b
If "Yes," did the organization's charity care expenses exceed the budgeted amount?.........
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discounted
care to a patient who was eligibile for free or discounted care?...............
5c
 
No
6a
Does the organization prepare an annual community benefit report?.............
6a
Yes
 
6b
If "Yes," does the organization make it available to the public? ..............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Charity Care and Certain Other Community Benefits at Cost
Charity Care and
Means-Tested Government Programs		 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Charity care at cost (from
Worksheets 1 and 2) .. 		    428,706   428,706 1.080 %
b Unreimbursed Medicaid (from
Worksheet 3, column a) . 		           
c Unreimbursed costs—other means-tested government programs (from Worksheet 3, column b) ....     50,394 9,422 40,972 0.100 %
dTotal Charity Care and
Means-Tested Government Programs ..... 		    479,100 9,422 469,678 1.180 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) .... 		           
f Health professions education
(from Worksheet 5) .. 		    22,759   22,759 0.060 %
g Subsidized health services
(from Worksheet 6) .. 		           
h Research (from Worksheet 7)            
i Cash and in-kind contributions
to community groups
(from Worksheet 8) .. 		    241   241 0 %
jTotal Other Benefits ...     23,000   23,000 0.060 %
kTotal. Add lines 7d and 7j. ..     502,100 9,422 492,678 1.240 %
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 2
Part II
Community Building Activities Complete this table if the organization conducted any community building activities.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total            
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Does the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense (at cost).....
2
95,571
3
Enter the estimated amount of the organization's bad debt expense (at cost) attributable to patients eligible under the organization's charity care policy ..
3
 
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
28,845,792
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
30,295,075
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
-1,449,283
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.
Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.
Check the box that describes the method used:
Section C. Collection Practices
9a
Does the organization have a written debt collection policy? ...............
9a
Yes
 
b
If "Yes," does the organization's collection policy contain provisions on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance? Describe in Part VI......
9b
Yes
 
Part IV
Management Companies and Joint Ventures
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership% 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 3
Part VFacility Information
Section A. Hospital Facilities
(list in order of size, measured by total revenue per facility, from largest to smallest)
How many hospital facilities did the organization operate during the tax year?5
Name and address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe)
1 DUBUIS HOSPITAL OF SHREVEPORT
ONE ST MARY PLACE 9TH FLOOR
SHREVEPORT,LA71101 		X               LONG-TERM ACUTE CARE FACILITY
2 DUBUIS HOSPITAL OF LAKE CHARLES
524 DR MICHAEL DEBAKEY DRIVE 5TH
FLOOR
LAKE CHARLES,LA70601 		X               LONG-TERM ACUTE CARE FACILITY
3 DUBUIS HOSPITAL OF TEXARKANA - NORTH
2400 ST MICHAEL DRIVE 2ND FLOOR
TEXARKANA,TX75503 		X               LONG-TERM ACUTE CARE FACILITY
4 DUBUIS HOSPITAL OF CORPUS CHRISTI
600 ELIZABETH STREET 3RD FLOOR
CORPUS CHRISTI,TX78404 		X               LONG-TERM ACUTE CARE FACILITY
5 DUBUIS HOSPITAL OF TEXARKANA - SOUTH
1000 PINE STREET 6TH FLOOR
TEXARKANA,TX75501 		X               LONG-TERM ACUTE CARE FACILITY
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

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

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

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

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

Section C. Other Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, measured by total revenue per facility, from largest to smallest)
How many non-hospital facilities did the organization operate during the tax year?  
Name and address Type of Facility (Describe)
1
2
3
4
5
6
7
8
9
10
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 8
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the description required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 2, 4c, 6i, 7, 11i, 13i, 17l, 18l, 19e, 21d, 25, and 26.
2 Community health needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any community health needs assessments reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Identifier ReturnReference Explanation
    PART I, LINE 6A: A REPORT OF COMMUNITY BENEFIT IS INCLUDED IN A WRITTEN ANNUAL REPORT FOR CHRISTUS HEALTH, THE ORGANIZATION'S PARENT COMPANY. CHRISTUS HEALTH IS AN INTERNATIONAL, CATHOLIC, FAITH BASED HEALTH SYSTEM FORMED IN 1999 WITH A MISSION "TO EXTEND THE HEALING MINISTRY OF JESUS CHRIST". THE ANNUAL COMMUNITY BENEFIT REPORT SUMMARIZES ACTIVITIES AND PROGRAMS CONDUCTED DURING THE PAST YEAR TO IMPROVE HEALTH INCLUDING PROACTIVE COMMUNITY HEALTH SERVICES. HOWEVER, THE ANNUAL REPORT IS ONLY A SNAPSHOT OF HOW THE ORGANIZATION DISTINGUISHES ITSELF IN ITS VISION TO BE A LEADER, A PARTNER, AND AN ADVOCATE IN CREATING INNOVATIVE HEALTH AND WELLNESS SOLUTIONS THAT IMPROVE THE LIVES OF INDIVIDUALS AND COMMUNITIES.
    PART I, LINE 7: THE COMMUNITY BENEFIT COST OF CHARITY CARE WAS CALCULATED AS THE TOTAL VOLUNTARY FREE CARE TIMES THE RATIO OF COST TO GROSS PATIENT BILLING. THE COMMUNITY BENEFIT OF OTHER MEANS-TESTED GOVERNMENT PROGRAMS WAS CALCULATED AS GROSS MEDICAID BILLING TIMES THE RATIO OF COST TO GROSS PATIENT BILLING. THE ASSOCIATED REVENUE OF OTHER MEANS-TESTED GOVERNMENT PROGRAMS IS NET OF MEDICAID REVENUE AND THE DENOMINATOR WAS ADJUSTED FOR BAD DEBT EXPENSE. THE TOTAL COMMUNITY BENEFIT EXPENSE FOR COMMUNITY HEALTH IMPROVEMENT SERVICES AND HEALTH PROFESSIONALS EDUCATION WAS ACCUMULATED ON A PROJECT BY PROJECT BASIS USING DIRECT COSTING. THE COMMUNITY BENEFIT FOR IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS WAS ESTIMATED BASED ON SQUARE FOOTAGE CONTRIBUTED AND ACTUAL FACILITY SPACE COST.
    PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 270970.
    PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE ARE FROM PATIENTS AND THIRD PARTY PAYERS FOR MEDICAL SERVICES AND ARE NET OF ALLOWANCES FOR CONTRACTUAL ADJUSTMENTS AND DOUBTFUL ACCOUNTS. ALLOWANCES ARE ESTIMATED BASED ON ESTABLISHED RATES AND HISTORICAL EXPERIENCE. COST WERE ESTIMATED USING THE RATIO OF PATIENT COST TO GROSS PATIENT REVENUE.
    PART III, LINE 8: THE SHORTFALL REPORTED IN LINE 7 IS NOT TREATED AS COMMUNITY BENEFIT. THE AMOUNT ON SCHEDULE H, PART III, LINE 6 IS DETERMINED BY CALCULATING MEDICARE ALLOWABLE COSTS USING WORKSHEET A OF THE MEDICARE COST REPORT. WORKSHEET A OF THE MEDICARE COST REPORT REQUIRES THE ORGANIZATION TO REMOVE NON-ALLOWABLE EXPENSES FROM TOTAL EXPENSES VIA THE ADJUSTMENTS TO EXPENSES WORKSHEETS WITH THE MEDICARE COST REPORT.
    PART III, LINE 9B: UPON ADMISSION, PATIENTS WHO HAVE NO INSURANCE COVERAGE AND NO ABILITY TO PAY WILL BE GIVEN CONSIDERATION FOR CHARITY CARE. EVERY EFFORT WILL BE MADE TO OBTAIN THE APPROPRIATE FINANCIAL DOCUMENTATION TO DETERMINE THE ABILITY TO PAY FOR SERVICES. THE FILING ORGANIZATION DOES NOT OUTSOURCE PATIENT BALANCES TO A THIRD PARY DEBT COLLECTION AGENCY. ALL COLLECTIONS ARE DONE BY IN-HOUSE COLLECTORS USING COLLECTION LETTERS. PATIENTS ARE NOT SUBJECT TO HARASSMENT OR LEGAL ACTION DUE TO THEIR INABILITY TO PAY. PATIENTS THAT ARE UNABLE TO PAY ARE PROVIDED CHARITY CARE INFORMATION. PATIENTS RECEIVE PRIVATE LETTERS/BILLS EACH MONTH INDICATING THEIR BALANCE DUE. PATIENTS WHO HAVE NOT MADE PAYMENTS FOR A 30-DAY PERIOD WILL RECEIVE A LETTER REQUESTING PAYMENT. PATIENTS WHO ARE UNABLE TO PAY THEIR BALANCE WILL BE CONSIDERED FOR CHARITY CARE IF APPROPRIATE. COLLECTION EFFORTS WILL CONTINUE FOR 120 DAYS WITH THE PATIENT/GUARANTOR RECEIVING AT LEAST THREE LETTERS REQUESTING PAYMENT. ACCOUNTS THAT ARE NOT DEEMED ELIGIBLE FOR CHARITY CARE OR MEDICAL INDIGENCE WILL BE BE WRITTEN OFF AS BAD DEBT FOLLLOWING THE 120 DAY COLLECTION PERIOD.
    PART VI, LINE 2: DUBUIS HEALTH SYSTEM HAS DEVELOPED A COMMUNITY BENEFIT PLAN BASED UPON PRIORITIZATION OF THE COMMUNITY HEALTH NEEDS ASSESSMENT. THE NEEDS ASSESSMENT WAS DEVELOPED BASED ON INFORMATION PROVIDED BY COMMUNITY GROUPS IN LOCATIONS BEING SERVED AND CONSOLIDATED METROPOLITAN STATISTICAL AREA (CMSA) REPORTS. DUBUIS HEALTH SYSTEM PROVIDES CARE TO PATIENTS WHO REQUIRE ACUTE CARE OVER AN EXTENDED PERIOD OF TIME. OUR STAFF PROVIDES SPECIALTY CARE THAT IS TAILORED TO THE INDIVIDUAL NEEDS OF EVERY PATIENT, RESULTING IN EXCELLENT CLINICAL OUTCOMES.
    PART VI, LINE 3: DUBUIS HEALTH SYSTEM MAKES EVERY EFFORT TO EDUCATE PATIENTS ON ITS CHARITY AND DISCOUNT POLICY AND ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS DURING THE REGISTRATION PROCESS. IN ADDITION, A PUBLIC NOTICE IS POSTED REGARDING THE CHARITY CARE POLICY AND INFORMATION ON FINANCIAL ASSISTANCE INCLUDES EXPLANATIONS ON THE AVAILABILITY OF FINANCIAL ASSISTANCE, WHO QUALIFIES, AND HOW TO APPLY FOR FINANCIAL ASSISTANCE. AFTER THE REGISTRATION PROCESS, PATIENTS THAT ARE UNABLE TO PAY ARE PROVIDED CHARITY CARE INFORMATION.
    PART VI, LINE 4: DUBUIS HEALTH SYSTEM HAS SERVICE AREAS IN TEXAS AND LOUISIANA. THE TEXAS SERVICE AREA INCLUDES LONG-TERM ACUTE CARE FACILITIES LOCATED IN CORPUS CHRISTI AND TEXARKANA. THE LOUISIANA SERVICE ARE INCLUDES LONG-TERM ACUTE CARE FACILITIES LOCATED IN SHREVEPORT AND LAKE CHARLES. TEXARKANA, TEXAS IS LOCATED IN BOWIE COUNTY WHERE THE MEDIAN HOUSEHOLD INCOME IS 37.5 PERCENT OF THE FEDERAL POVERTY LEVEL. ACCORDING TO 2006 U. S. CENSUS INFORMATION, 18.6 PERCENT OF THE POPULATION THAT ARE 64 YEARS OF AGE AND UNDER ARE UNINSURED. THE SHREVEPORT LOUISIANA SERVICE AREA IS ANTICIPATING ITS LARGEST POPULATION GROWTH IN THE 65 AND OLDER POPULATION. THE POVERTY RATE FOR THE SHREVEPORT SERVICE AREA IS 22.8 PERCENT WHILE THE MEDIAN INCOME IS BELOW 200 PERCENT OF THE FEDERAL POVERTY LEVEL.CORPUS CHRISTI, TEXAS IS LOCATED ALONG THE LOWER TEXAS COASTAL AREA AND ITS SERVICE AREA INCLUDES A 15-COUNTY AREA WITH A POPULATION IN EXCESS OF 586,000. THE ETHNIC BREAKDOWN OF THE REGION IS 60 PERCENT HISPANIC, 35 PERCENT CAUCASIAN, 4 PERCENT AFRICAN AMERICAN, AND 1 PERCENT ASIAN PACIFIC ISLANDERS. APPROXIMATELY 55 PERCENT OF ALL HOUSEHOLDS LIVE AT OR BELOW THE FEDERAL POVERTY LEVEL. NEARLY HALF OF THE POPULATION RELIES ON MEDICAID OR IS UNINSURED.THE LAKE CHARLES, LOUISIANA SERVICE AREA'S POPULATION IS 300,000 AND IS PREDOMINATELY CAUCASIAN. THE POVERTY RATE FOR THE REGION IS HIGHER THAN THE STATE AND NATIONAL AVERAGES DUE TO A COMBINATION OF LOW WAGE JOBS AND HIGH UNEMPLOYMENT. CONSEQUENTLY, THE REGION HAS A HIGHER UNINSURED RATE THAN BOTH LOUISIANA AND THE NATION.
    PART VI, LINE 6: IN ADDITION TO THE PROVISION OF LONG TERM INPATIENT CARE, DUBUIS HEALTH SYSTEM HAS FULFILLED ITS EXEMPT PURPOSES THROUGH A VARIETY OF OTHER MEANS. THESE INCLUDE, BUT ARE NOT LIMITED TO, PRESENTATIONS AND LECTURES ON HEALTH EDUCATION RELATED TOPICS TO ADULT AND STUDENT YOUTH GROUPS, PROVISION OF SPACE AT NO CHARGE FOR RECOGNIZED SELF-HELP GROUP MEETINGS, PROGRAMS TO ENCOURAGE THE PURSUIT OF NURSING CAREERS, GENERAL MEDICAL INFORMATION RESOURCES PROVIDED TO THE GENERAL PUBLIC THROUGH THE ORGANIZATION'S WEBSITE, AND EVEN DONATIONS BY EMPLOYEES TO SUPPORT CHARITIES AND OTHER ORGANIZATIONS.
    PART VI, LINE 7: DUBUIS HEALTH SYSTEM IS SPONSORED BY CHRISTUS HEALTH, AN INTERNATIONAL CATHOLIC, FAITH-BASED NONPROFIT HEALTH SYSTEM COMPRISED OF NEARLY 350 SERVICES AND FACILITIES INCLUDING MORE THAN 50 HOSPITALS AND LONG-TERM CARE FACILITIES, 175 CLINICS AND OUTPATIENT CENTERS, AND OTHER COMMUNITY HEALTH MINISTRIES AND COMMUNITY DEVELOPMENT VENTURES. CHRISTUS SERVES AREAS IN ARKANSAS, GEORGIA, IOWA, LOUISIANA, MISSOURI, NEW MEXICO, TEXAS AND SIX PROVINCES OF MEXICO. EACH ORGANIZATION DEVELOPS FIVE-YEAR AND TEN-YEAR STRATEGIC PLANS THAT HELP ESTABLISH ANNUAL PLANS AND BUDGETS. THE AFFILIATED ORGANIZATIONS' STRATEGIC GOALS ARE DEVELOPED IN COLLABORATION WITH CHRISTUS HEALTH INCLUDING METRICS THAT WILL BE USED TO MEASURE COMMUNITY BENEFIT, CLINICAL OUTCOMES, PATIENT SATISFACTION AND ASSOCIATE ENGAGEMENT. CHRISTUS HEALTH PROVIDES UPDATED MARKET DEMOGRAPHICS AND HEALTH INDICATOR STATISTICS ON AN ANNUAL BASIS.
REPORTS FILED WITH STATES PART VI, LINE 7 TX,LA
Schedule H (Form 990) 2010
Additional Data


Software ID:  
Software Version:  
Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
DUBUIS HEALTH SYSTEM INC
 
Employer identification number

72-1270964
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement orprovision of all the expenses described above? If "No," complete Part III to explain....
1b
Yes
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....
2
Yes
 
3
Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply.
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
 
No
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regs. section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2010

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

Note. The sum of columns (B)(i)-(iii) must equal the applicable column (D) or column (E) amounts on Form 990, Part VII, line 1a.
(A) Name (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported in prior
Form 990 or
Form 990-EZ
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) STEPHEN A MILLS (i)
(ii)		 157,403
0 		3,345
0 		0
0 		9,645
0 		6,920
0 		177,313
0 		0
0
(2) PAUL VEILLON (i)
(ii)		 0
170,190 		0
5,769 		0
0 		0
13,973 		0
0 		0
189,932 		0
0
(3) SAM BARKMAN (i)
(ii)		 80,561
0 		519
0 		0
0 		5,135
0 		16,897
0 		103,112
0 		0
0
(4) ELLEN SMITH (i)
(ii)		 0
248,976 		0
7,378 		0
0 		0
0 		0
0 		0
256,354 		0
0
(5) TRACEY RICHARD (i)
(ii)		 0
22,517 		0
0 		0
0 		0
0 		0
400 		0
22,917 		0
0
(6) KEITH ROGERS (i)
(ii)		 0
173,759 		0
0 		0
0 		0
0 		0
910 		0
174,669 		0
0










Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
  PART I, LINE 1A THE EXECUTIVE COMPENSATION PACKAGE PROVIDED TO THE CEO EFFECTIVE 2006 INCLUDES A PROVISION FOR REIMBURSEMENT OF A TAXABLE ANNUAL ALLOWANCE UP TO $6,000 FOR APPROVED PERQUISITES IN ANY OF THE FOLLOWING CATEGORIES: ATHLETIC CLUB MEMBERSHIP; LUNCHEON/DINNER CLUB DUES; PERSONAL FINANCIAL/ESTATE PLANNING; PERSONAL TAX RETURN PREPARATION; NON-BUSINESS RELATED FAMILY TRAVEL TO ACCOMPANY CEO ON BUSINESS TRIPS; SPORTS/CULTURAL EVENTS; NON-JOB RELATED EDUCATIONAL COURSES OR OTHER APPROVED ACTIVITIES. THE REIMBURSEMENT IS SUBJECT TO CLAIMS REPORT PROCESSES, AND IS APPROVED BY THE VICE PRESIDENT OF HR, CONTROLLER, AND THE CHAIRMAN OF THE BOARD OF DIRECTORS. THE CEO OF DUBUIS HEALTH SYSTEM, INC., STEPHEN MILLS AND ALL OTHER OFFICERS AND BOARD OF DIRECTORS ARE ENTITLED TO REIMBURSEMENT FOR COMPANION TRAVEL TO BUSINESS RELATED EVENTS. THE REIMBURSEMENT IS SUBJECT TO CLAIMS REPORT PROCESSES, AND IS APPROVED BY THE VICE PRESIDENT OF HR, CONTROLLER, AND THE CHAIRMAN OF THE BOARD OF DIRECTORS.
Schedule J (Form 990) 2010

Additional Data


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

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

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
DUBUIS HEALTH SYSTEM INC
 
Employer identification number

72-1270964
Identifier Return Reference Explanation
FORM 990, PART VI, SECTION A, LINE 3   DUBUIS HEALTH SYSTEM, INC. ENTERED INTO A MANAGEMENT AGREEMENT WITH CHRISTUS CONTINUING CARE (CCC) EFFECTIVE JULY 1, 2009.
FORM 990, PART VI, SECTION A, LINE 6   CHRISTUS HEALTH IS THE SOLE CORPORATE MEMBER OF THE FILING ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 7A   CHRISTUS HEALTH, THE SOLE MEMBER, IS PERMITTED TO ELECT A NUMBER OF BOARD MEMBERS EQUAL TO THE NUMBER OF BOARD MEMBERS ELECTED DIRECTLY BY MAJORITY VOTE OF THE BOARD OF DIRECTORS. A LIST OF QUALIFIED CANDIDATES NOMINATED FOR OFFICE BY THE BOARD OF THE CORPORATION IS PROVIDED TO CHRISTUS HEALTH FROM WHICH THEY MAY CHOOSE THE BOARD MEMBERS THEY WISH TO ELECT.
FORM 990, PART VI, SECTION A, LINE 7B   THE BYLAWS OF THE CORPORATION STATE THAT THE CORPORATE MEMBER (CHRISTUS HEALTH) MUST APPROVE THE FOLLOWING ACTIONS: ANY AMENDMENT, MODIFICATION OR RESTATEMENT OF THE BYLAWS OR THE CORPORATION'S ARTICLES OF INCORPORATION; ANY ACTION OR INACTION AT VARIANCE WITH ANY POLICIES OF THE CORPORATE MEMBER MADE APPLICABLE TO THE CORPORATION EXCEPT FOR THE CORPORATION'S OR ANY HOSPITAL'S MANAGEMENT AND OPERATIONS; ANY CREATION OR ACQUISITION OF OTHER CORPORATIONS OR BUSINESS ENTITIES BY THE CORPORATION; ANY SALE, LEASE, MORTGAGE OR OTHER TRANSFER OR ENCUMBRANCE OF THE REAL PROPERTY OF ANY HOSPITAL OR THE CORPORATION AND ANY MERGER, CONSOLIDATION, LIQUIDATION OR DISSOLUTION OF THE CORPORATION; IN THE EVENT THE CORPORATION HAS OUTSTANDING INDEBTEDNESS TO THE CORPORATE MEMBER, ANY LONG-TERM BORROWING, LOAN OR LEASE FINANCING IN EXCESS OF $250,000; ANY MATTERS STATED IN THE BYLAWS AS RESERVED FOR APPROVAL BY THE CORPORATE MEMBER, OR REQUIRED BY LAW TO BE SUBMITTED TO THE CORPORATE MEMBER, OR AS TO WHICH THE PRESIDENT OR THE BOARD DETERMINES THAT SUBMISSION IS ADVISABLE.
FORM 990, PART VI, SECTION B, LINE 11   THE RETURN IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM. THE ORGANIZATION REVIEWS THE PREPARED RETURN FOR ACCURACY. UPON COMPLETION OF THE FINAL FORM 990 BY THE INDEPENDENT ACCOUNTING FIRM, THE 990 IS SUBMITTED TO THE BOARD OF DIRECTORS PRIOR TO FILING THE RETURN WITH THE IRS.
  FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION MAINTAINS SEPARATE CONFLICT OF INTEREST POLICIES FOR EMPLOYEES OF THE ORGANIZATION AND FOR THE MEMBERS OF THE BOARD OF DIRECTORS. BOTH POLICIES REQUIRE ANNUAL DISCLOSURE OF ANY CONFLICTS OF INTEREST. THE EMPLOYEE POLICY INCLUDES OFFICERS, MEDICAL DIRECTORS AND OTHER DIRECTORS, AND ALL OTHER ASSOCIATES. THE EMPLOYEE DISCLOSURE IS REVIEWED BY THE EMPLOYEE'S IMMEDIATE SUPERVISOR. IN ADDITION, KEY LEADERS MUST CERTIFY ANNUALLY THEIR RECEIPT AND UNDERSTANDING OF THE CONFLICT OF INTEREST POLICY. IF ANY CONFLICTS ARE PRESENT, THE EMPLOYEE AND THE ORGANIZATION'S ADMINISTRATION WILL IMPLEMENT A MUTUALLY AGREED UPON PLAN TO RESOLVE THE CONFLICT. IN ADDITION, THE ORGANIZATION IMPLEMENTS AN INTEGRITY PROGRAM TO SUPPORT AND MAINTAIN THE CORPORATE INTEGRITY OF THE ORGANIZATION. THE POLICY FOR THE MEMBERS OF THE BOARD OF DIRECTORS REQUIRES ANY BOARD MEMBER UPON DETERMINATION OF A CONFLICT OF INTEREST, TO ABSENT HIMSELF OR HERSELF WITHOUT COMMENT FROM NOT ONLY THE VOTE BUT ALSO FROM THE DELIBERATION. BOARD MEMBERS ARE NOT ALLOWED TO BE EMPLOYED BY THE ORGANIZATION UNLESS THEY HAVE FIRST RESIGNED FROM THE BOARD. IN ADDITION, AT THE BEGINNING OF EACH BOARD MEETING, THE BOARD CHAIR ASKS THE BOARD MEMBERS TO REVIEW THE AGENDA AND SHARE ANY POTENTIAL CONFLICTS OF INTEREST PRIOR TO THE BEGINNING OF BUSINESS.
  FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION FOR STEPHEN MILLS, CEO, WAS APPROVED BY THE BOARD OF DIRECTORS DURING THE YEAR AND WAS BASED ON AN INDEPENDENT STUDY PREPARED BY SULLIVAN COTTER. PAUL VEILLON, CFO, AND MATTHEW SMITH, SECRETARY, ARE NOT COMPENSATED BY THE FILING ORGANIZATION.
  FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. THE ARTICLES OF INCORPORATION ARE AVAILABLE TO THE PUBLIC FROM THE LOUISIANA SECRETARY OF STATE.
AVG HOURS DEVOTED TO RELATED ORG(S) WHEN RELATED COMP IS REPORTED: FORM 990, PART VII: PAUL VEILLON (VP FINANCE) IS AN UNPAID OFFICER OF DUBUIS HEALTH SYSTEM. HE IS EMPLOYED BY CHRISTUS CONTINUING CARE WHICH IS A RELATED ORGANIZATION. MR. VEILLON SPENDS APPROXIMATELY 6 HOURS PER WEEK IN FULFILLMENT OF HIS DUTIES AS VP FINANCE, DUBUIS HEALTH SYSTEM AND WORKS AN AVERAGE OF 34 HOURS PER WEEK IN SERVICE TO THE ORGANIZATION THAT EMPLOYS HIM. DUBUIS HEALTH SYSTEM IS PART OF THE CHRISTUS HEALTH SYSTEM AND SOME REPORTABLE INDIVIDUALS RECEIVE COMPENSATION FOR SERVICES RENDERED TO MORE THAN ONE ORGANIZATION WITHIN THE SYSTEM. THE COMPENSATION SHOWN ON PART VII AND SCHEDULE J REFLECTS THE TOTAL COMPENSATION EARNED FOR THE OFFICERS/DIRECTORS FOR THE COMBINED AVERAGE OF 40 HOURS PER WEEK THAT IS SPENT WORKING FOR ALL ENTITIES IN THE ORGANIZATION. HOWEVER, THE HOURS REFLECTED IN PART VII, SECTION A ARE THE ESTIMATED HOURS SPENT WORKING ONLY ON BEHALF OF THIS FILING ENTITY.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2010

Additional Data


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

OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
DUBUIS HEALTH SYSTEM INC
 
Employer identification number

72-1270964
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)
(a)
Name, address, and EIN of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

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


 		(f)
Direct controlling
entity

















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


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

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

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled organization
Yes No
(1) CHRISTUS HEALTH ARK-LA-TEX

2600 ST MICHAEL DR

TEXARKANA,TX75503
75-2796815 		HEALTHCARE SERVICES TX 501(C)(3) LINE 3 CH
 
 
No
(2) CHRISTUS HEALTH CENTRAL LOUISIANA

3330 MASONIC DRIVE

ALEXANDRIA,LA71301
72-0408984 		HEALTHCARE SERVICES LA 501(C)(3) LINE 3 CH
 
 
No
(3) CHRISTUS HEALTH NORTHERN LOUISIANA

ONE ST MARY PLACE

SHREVEPORT,LA71101
72-0408982 		HEALTHCARE SERVICES LA 501(C)(3) LINE 3 CH
 
 
No
(4) CHRISTUS CONTINUING CARE

1700 W LOOP SOUTH SUITE 1100

HOUSTON,TX77027
74-2898615 		HEALTHCARE SERVICES TX 501(C)(3) LINE 3 CH
 
 
No
(5) CHRISTUS SPOHN HEALTH SYSTEM CORPORATION

600 ELIZABETH STREET

CORPUS CHRISTI,TX78404
74-1109836 		HEALTHCARE SERVICES TX 501(C)(3) LINE 3 CH
 
 
No
(6) CHRISTUS HEALTH GULF COAST

PO BOX 922037

HOUSTON,TX77292
76-0591592 		HEALTHCARE SERVICES TX 501(C)(3) LINE 3 CH
 
 
No
(7) CHRISTUS HEALTH SOUTHEAST TEXAS

2830 CALDER STREET

BEAUMONT,TX77726
76-0591590 		HEALTHCARE SERVICES TX 501(C)(3) LINE 3 CH
 
 
No
(8) CHRISTUS HEALTH SOUTHWESTERN LOUISIANA

524 DR MICHAEL DEBAKEY DRIVE

LAKE CHARLES,LA70601
72-0411322 		HEALTHCARE SERVICES LA 501(C)(3) LINE 3 CH
 
 
No
(9) CHRISTUS SANTA ROSA HEALTH CARE CORP

333 N SANTA ROSA STREET

SAN ANTONIO,TX78207
74-1109665 		HEALTHCARE SERVICES TX 501(C)(3) LINE 3 CH
 
 
No
(10) CHRISTUS HEALTH UTAH

2707 NORTH LOOP WEST

HOUSTON,TX77008
87-0231682 		HEALTHCARE SERVICES UT 501(C)(3) LINE 9 CH
 
 
No
(11) CH WILKINSON PHYSICIAN NETWORK

1700 WEST LOOP SOUTH SUITE 400B

HOUSTON,TX77027
76-0422435 		HEALTHCARE SERVICES TX 501(C)(3) LINE 11A, I CH
 
 
No
(12) ST JOSEPH COMMUNITY FOUNDATION

2800 LAMAR AVE CAPITAL ONE

PARIS,TX75460
42-1619230 		SUPPORT HEALTHCARE SERVICES TX 501(C)(3) LINE 11A, I CH
 
 
No
(13) CHRISTUS STEHLIN FOUNDATION FOR CANCER RESEARCH

10301 STELLA LINK SUITE A

HOUSTON,TX77025
74-1622404 		CANCER RESEARCH TX 501(C)(3) LINE 9 CH
 
 
No
(14) CHRISTUS HEALTH FOUNDATION

2707 NORTH LOOP WEST

HOUSTON,TX77008
61-1500100 		SUPPORT HEALTHCARE SERVICES TX 501(C)(3) LINE 11A, I CH
 
 
No
(15) ST FRANCIS CABRINI HPL FDN OF ALEXANDRIA

3330 MASONIC DRIVE

ALEXANDRIA,LA71301
72-0998302 		SUPPORT HEALTHCARE SERVICES LA 501(C)(3) LINE 7 CNLA
 
 
No
(16) CHRISTUS FOUNDATION FOR HEALTH CARE

PO BOX 1919

HOUSTON,TX77251
74-6074210 		SUPPORT HEALTHCARE SERVICES TX 501(C)(3) LINE 7 GULF COAST
 
 
No
(17) CHRISTUS SCHUMPERT HEALTH SYSTEM FD

ONE ST MARY PLACE

SHREVEPORT,LA71101
72-1219280 		SUPPORT HEALTHCARE SERVICES LA 501(C)(3) LINE 7 NOLA
 
 
No
(18) CHRISTUS SPOHN HTH SYSTEM DEVELOPMENT FD

600 ELIZABETH STREET

CORPUS CHRISTI,TX78404
74-1906005 		SUPPORT HEALTHCARE SERVICES TX 501(C)(3) LINE 7 SPOHN HS
 
 
No
(19) CHRISTUS HEALTH FDN OF SOUTHEAST OF TX

2830 CALDER

BEAUMONT,TX77702
76-0136274 		SUPPORT HEALTHCARE SERVICES TX 501(C)(3) LINE 11A, I SETX
 
 
No
(20) FRIENDS OF SANTA ROSA FOUNDATION

333 N SANTA ROSA STREET

SAN ANTONIO,TX78207
74-2723391 		SUPPORT HEALTHCARE SERVICES TX 501(C)(3) LINE 11A, I CSRHCC
 
 
No
(21) SANTA ROSA FAMILY HEALTH CENTER

333 N SANTA ROSA STREET

SAN ANTONIO,TX78207
74-2806531 		HEALTHCARE SERVICES TX 501(C)(3) LINE 9 CSRHCC
 
 
No
(22) SANTA ROSA CHILDREN'S HOSPITAL FDTN

343 WEST HOUSTON ST STE 505

SAN ANTONIO,TX78205
74-1224362 		SUPPORT HEALTHCARE SERVICES TX 501(C)(3) LINE 7 SRHCC
 
 
No
(23) CHRISTUS HEALTH LIAB RETENTION TRUST

2707 NORTH LOOP WEST

HOUSTON,TX77008
76-0259623 		SELF INSURANCE TRUST TX 501(C)(3) LINE 11A, I CH
 
 
No
(24) CHRISTUS SANTA ROSA MEDICAL CENTER AUX

2827 BABCOCK ROAD

SAN ANTONIO,TX78229
73-1655493 		SUPPORT HEALTHCARE SERVICES TX 501(C)(3) LINE 9 CSRHCC
 
 
No
(25) SANTA ROSA GENERAL HOSPITAL AUXILARY

333 N SANTA ROSA STREET

SAN ANTONIO,TX78207
74-1278312 		SUPPORT HEALTHCARE SERVICES TX 501(C)(3) LINE 3 CSRHCC
 
 
No
(26) SANTA ROSA CHILDREN'S HOSP ENDOWMENT FD

333 W HOUSTON STREET STE 505

SAN ANTONIO,TX78205
74-1902391 		SUPPORT HEALTHCARE SERVICES TX 501(C)(3) LINE 11A, I CSRHCC
 
 
No
(27) THE FRIENDS OF THE STEHLIN FOUNDATION

10301 STELLA LINK SUITE A

HOUSTON,TX77025
74-2200613 		SUPPORT CCR RESEARCH TX 501(C)(3) LINE 11C, III-FI CSFCR
 
 
No
(28) CHRISTUS HEALTH PLAN

600 ELIZABETH STREET

CORPUS CHRISTI,TX78404
45-2106295 		MEDICAID HMO TX 501(C)(3) LINE 9 CSHSC
 
 
No
(29) CHRISTUS HEALTH

2707 NORTH LOOP WEST

HOUSTON,TX77008
76-0590551 		SUPPORT HEALTHCARE FACILITIES TX 501(C)(3) LINE 11A, I  
 
No
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



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

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




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



 		(k)
Percentage
ownership
Yes No Yes No
(1) LA ATHLETIC CLUB LLC

COLLEGE DR
PINEVILLE,LA71359
72-1461793 		HELATH CLUB LA N/A
                  
(2) HEART CTR CNTRL LA

TEXAS AVE
ALEXANDRIA,LA71301
72-1325012 		HEALTH CARE SERVICES LA N/A
                  
(3) W HOUSTON RE DEVEL

W LOOP SOUTH
HOUSTON,TX77027
26-2330994 		HEALTH CARE SERVICES TX N/A
                  
(4) SE TX PAIN MGMT LLC

PO BOX 5405
BEAUMONT,TX77726
26-1678856 		PAIN MGMT HTH SERVICES TX N/A
                  
(5) ST ELIZ REHAB PTNRS

2830 CALDER
BEAUMONT,TX77702
20-5657181 		HEALTH CARE SERVICES TX N/A
                  
(6) SOUTH RYAN MRI LLC

DR M DEBAKEY DR
LAKE CHARLES,LA70601
74-3103662 		IMAGING SERVICES LA N/A
                  
(7) MCKENNA LSNG GP LLC

UN AVE
NEW BRAUNFELS,TX78130
74-1191729 		INVESTMENT TX N/A
                  
(8) MCKENNA EQ LSING LP

UN AVE
NEW BRAUNFELS,TX78130
20-4177842 		MEDICAL EQUIPMENT LEASING TX N/A
                  
(9) NEW BNRFLS SURG CTR

UN AVE
NEW BRAUNFELS,TX78130
81-0571408 		HEALTH CARE SERVICES TX N/A
                  
(10) CSR OTPT SUR NB

UN AVE
NEW BRAUNFELS,TX78130
81-0571409 		HEALTH CARE SERVICES TX N/A
                  
(11) CSR SURGERY CTR LLP

DALLAS PARKWAY
ADDISON,TX75001
20-0424958 		HEALTH CARE SERVICES TX N/A
                  
(12) CSR AMB SUR CTR

333 SANTA ROSA
SAN ANTONIO,TX78207
41-2092141 		HEALTH CARE SERVICES TX N/A
                  
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of related organization



 		(b)
Primary activity



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


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

 		(f)
Share of total income



 		(g)
Share of
end-of-year
assets

 		(h)
Percentage
ownership
(1) ARK-LA-TEX HEALTH NETWORK
P O BOX 2911
TEXARKANA,TX755042911
75-2562459 		HEALTHCARE SERVICES TX N/A
 C      
(2) AK INTEGRATED COMM HLTH NTWK
2600 ST MICHAEL DRIVE
TEXARKANA,TX75503
76-0480684 		HEALTHCARE SERVICES TX N/A
 C      
(3) HOUSTON METROPOLITAN HLTH NTWK
1700 WEST LOOP SOUTH SUITE 400A
HOUSTON,TX77027
76-0427193 		HEALTHCARE SERVICES TX N/A
 C      
(4) SCH MGMNT SOLUTIONS INC
ONE ST MARY PLACE
SHREVEPORT,LA71101
72-1270625 		MGT JOINT VENTURE LA N/A
 C      
(5) SPOHN HEALTH NETWORK
600 EL1ZABETH STREET
CORPUS CHRISTI,TX78404
74-2616328 		HEALTH PLAN ADMINISTRATION TX N/A
 C      
(6) SPOHN INVESTMENT CORPORATION
600 EL1ZABETH STREET
CORPUS CHRISTI,TX78404
74-2322574 		RENTALS TX N/A
 C      
(7) CHRISTUS SOUTHEAST TEXAS PHO
3010 HARRISON STREET SUITE 202
BEAUMONT,TX77702
76-0429902 		MEDICAL SERVICES TX N/A
 C      
(8) HEALTH VENTURES OF SE TEXAS
1700 WEST LOOP SOUTH SUITE 400A
HOUSTON,TX77027
76-0397263 		BUILDING RENTAL TX N/A
 C      
(9) OCCUPATIONAL HEALTH SVSC INC
524 DR MICHAEL DEBAKEY DRIVE
LAKE CHARLES,LA70601
72-1217389 		MEDICAL SERVICES LA N/A
 C      
(10) SOUTHWESTERN LOUISIANA PHO
524 DR MICHAEL DEBAKEY DRIVE
LAKE CHARLES,LA70601
72-1275526 		HEALTHCARE SERVICES LA N/A
 C      
(11) SOUTH RYAN DEVELOPMENT CORP
524 DR MICHAEL DEBAKEY DRIVE
LAKE CHARLES,LA70601
72-1183790 		LEASING BUILDINGS LA N/A
 C      
(12) MCKENNA PROF BLDG OWNERS ASSOC
6363 N HIGHWAY 161 SUITE 450
IRVIN,TX75038
74-2727562 		BUILDING ASSOCIATION TX N/A
 C      
(13) CSR MEDICAL GROUP
6243 IH 10 WEST SUITE 480
SAN ANTONIO,TX78201
74-2782184 		HEALTH SERVICES TX N/A
 C      
(14) SOUTH TEXAS HEALTH ALLIANCE
6243 IH 10 WEST SUITE 480
SAN ANTONIO,TX78201
74-2782184 		HEALTH SERVICES TX N/A
 C      
(15) CHRISTUS AT HOME INC
1700 WEST LOOP SOUTH SUITE 400A
HOUSTON,TX77027
61-1563879 		HEALTHCARE SERVICES TX N/A
 C      
(16) CHRISTUS MUGUERZA SAPI DE CV
HIDALGO PTE 2525 64060 COL OBISPAD
MONTERREY, N.L.    
MX
12-3456789 		HEALTHCARE SERVICES MX N/A
 C      
(17) EMERALD ASSURANCE CAYMAN LTD
PO BOX 1051 KY1-1102
GRAND CAYMAN    
CJ
98-0407545 		INSURANCE CJ N/A
 C      
(18) NORTHERN LOUISIANA PHO
915 MARGARET PLACE
SHREVEPORT,LA71120
72-1274151 		HEALTHCARE SERVICES LA N/A
 C      
(19) SUPERCAMPTO INC
10301 STELLA LINK SUITE A
HOUSTON,TX77025
76-0534968 		MEDICAL RESEARCH TX N/A
 C      
(20) ROMLAC INC
10301 STELLA LINK SUITE A
HOUSTON,TX77025
74-1674943 		REAL ESTATE INVESTMENT TX N/A
 C      
(21) CHRISTUS LOUISIANA HEALTH PLAN
3330 MASONIC DRIVE
ALEXANDRIA,LA71301
45-2515179 		HEALTH PLAN ADMINISTRATION LA N/A
 C      
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III or IV.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
 
No
d Loans or loan guarantees to or for other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
Yes
 
k Performance of services or membership or fundraising solicitations for other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations by other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Sharing of facilities, equipment, mailing lists, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of paid employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Reimbursement paid to other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
 
No
p Reimbursement paid by other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Other transfer of cash or property to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type(a-r) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1)
(2)
(3)
(4)
(5)
(6)
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Are all
partners
section
501(c)(3)
organizations? 		(e)
Share of
end-of-year
assets 		(f)
Disproprtionate allocations? 		(g)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065) 		(h)
General or
managing
partner?
Yes No Yes No Yes No






























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


Software ID:  
Software Version: