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
PORTERCARE ADVENTIST HEALTH SYSTEM
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
2525 S Downing St
 
Room/suite
City or town, state or country, and ZIP + 4
Denver, CO80210
D Employer identification number

84-0438224
E Telephone number

G Gross receipts $ 817,566,826
F Name and address of principal officer:
Gary Campbell
188 INVERNESS DR W Suite 500
Englewood,CO80112
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
N/A
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 MediumBullet1071
K Form of organization:
 
L Year of formation: 1968
M State of legal domicile: CO
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: Our company, a faith based organization, invests in charity care, community programs and sponsorships designed to nurture the health of the people of Colorado with a goal to keep them healthy.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) .... 3 3
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 0
5 Total number of individuals employed in calendar year 2010 (Part V, line 2a) ... 5 4,726
6 Total number of volunteers (estimate if necessary) .... 6 1,137
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 2,187,735
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b -1,146,630
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 1,079,843 1,381,385
9 Program service revenue (Part VIII, line 2g) ......... 714,851,396 790,151,213
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 10,381,798 19,011,977
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 6,797,748 6,556,378
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 733,110,785 817,100,953
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 1,135,228 1,276,130
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) 271,165,471 282,214,009
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).... 390,591,115 439,391,596
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 662,891,814 722,881,735
19 Revenue less expenses. Subtract line 18 from line 12...... 70,218,971 94,219,218
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............ 1,144,889,489 1,220,174,007
21 Total liabilities (Part X, line 26)............ 486,262,334 478,868,494
22 Net assets or fund balances. Subtract line 21 from line 20 ..... 658,627,155 741,305,513
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: We extend the healing ministry of Christ by caring for those who are ill and by nurturing the health of the people in our communities.
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 $ 624,031,395 including grants of $ 1,276,130 ) (Revenue $ 790,649,449 )
See Schedule H
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$ 624,031,395
Form 990 (2010)
Form 990 (2010)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment........
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part I..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part II.........................
4
 
No
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part III........................
5
 
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts where donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete
Schedule D, Part IClick to see attachment.......................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IVClick to see attachment...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in term, permanent,or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
 
No
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
Yes
 
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, and program service activities outside the United States? If “Yes,” complete Schedule F, Part I.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II..
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III..
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II..........
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
Form 990 (2010)
Form 990 (2010)
Page 4
Part IV
Checklist of Required Schedules (continued)
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H..... Click to see attachment
20a
Yes
 
b
Did the organization attach its audited financial statement to this return? Note: All Form 990 filers that operate one or more hospitals must attach audited financial statements. ..... Click to see list of attachments
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.. Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III..... Click to see attachment
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
 
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I...... Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................ Click to see attachment
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II........................... Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor, or a grant selection committee member, or to a person related to such an individual? If “Yes,” complete Schedule L, Part III............... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ......................... Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV................... Click to see attachment
28b
Yes
 
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV.. Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
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
Yes
 
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
0
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
4,726
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2010)
Form 990 (2010)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI . . . . . . . . . .
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year ..............
1a
3
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
0
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? ..
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Does the organization have members or stockholders? ................
6
Yes
 
7a
Does the organization have members, stockholders, or other persons who may elect one or more members of the governing body? .........................
7a
Yes
 
b
Are any decisions of the governing body subject to approval by members, stockholders, or other persons? ..
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Does the organization have local chapters, branches, or affiliates? ............
10a
Yes
 
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
Yes
 
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
Yes
 
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
 
No
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
Kyle Engman
188 Inverness Dr West 500
Englewood,CO80112
(303) 804-8108
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) ROBERT HENDERSCHEDT
BOARD MEMBER
 1.0 X             961,047 131,668
(2) TERRY SHAW
ASST TREASURER/SECRETARY
 1.0 X   X         1,096,656 219,036
(3) RICHARD REINER
VICE PRESIDENT/CHAIRMAN
 1.0 X   X         1,173,953 208,519
(4) GARY CAMPBELL
PRESIDENT/CEO
 1.0     X            
(5) RANDY HAFFNER
CEO-PORTER HOSPITAL
 40.0     X       628,373   191,151
(6) RANDY SAFADY
EVP CFO
 1.0     X            
(7) JOHN SACKETT
CEO-AVISTA ADVENTIST HOSP
 40.0       X     381,277   96,755
(8) KENNETH BACON
CEO-LITTLETON ADVENTIST HOSP
 40.0       X     438,241   137,674
(9) STEVEN CHEN
CFO-PORTER ADVENTIST HOSP
 40.0       X     307,307   45,991
(10) CHERYL CURRY
CFO-AVISTA ADVENTIST HOSP
 40.0       X     218,964   33,305
(11) ANDREW GAASCH
CFO-PARKER ADVENTIST HOSP
 40.0       X     224,888   24,300
(12) DAVID SMITH
VP OPS-AVISTA ADVENTIST HOSP
 40.0       X     213,663   18,254
(13) TODD FOLKENBERG
COO-PORTER ADVENTIST HOSP
 40.0       X     290,174   43,404
(14) KARSTEN RANDOLPH
CFO-LITTLETON ADVENTIST HOSP
 40.0       X     275,481   48,150
(15) TERRY FORDE
CEO-PARKER ADVENTIST HOSP
 40.0       X     396,070   93,708
(16) JOHN PRALL
PHYSICIAN
 40.0         X   1,221,488   27,086
(17) DAVID VANSICKLE
PHYSICIAN
 40.0         X   1,065,282   34,591
Form 990 (2010)
Form 990 (2010)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) DAVID SCHRIER
PHYSICIAN
 40.0         X   753,811   37,213
(19) BERNARD GUIOT
PHYSICIAN
 40.0         X   740,700   21,873
(20) Robert Bess
Physician
 40.0         X   687,716   34,710
(21) MICHAEL BLAIR
VP FINANCE-ROCKY MOUNTAIN GROU
 40.0           X 149,760    


















1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 7,993,195 3,231,656 1,447,388
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 in reportable compensation from the organizationMediumBullet236
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
Yes
 
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
Critical Care Pulmonary and Sleep A
274 Union Blvd Suite
Lakewood,CO80228 		Physician Services 1,701,682
Triage Consulting Group
221 Main St Suite 1100
San Francisco,CA94105 		Collections 832,271
PREMIER SUGERY
7780 S BROADWAY STE 250
LITTLETON,CO80122 		PHYSICIAN SERVICES 404,814
Neurosurgical and Spine Specialists
9399 Crown Crest Blvd Suite 240
Parker,CO80138 		Physician Services 350,000
Brigitta Robinson MD
7690 S Hudson St
Centennial,CO80122 		Physician Services 213,925
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization MediumBullet15
Form 990 (2010)
Form 990 (2010)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, gifts, grants and other similar amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 1,330,813
e Government grants (contributions)1e 50,572
f All other contributions, gifts, grants, and
similar amounts not included above1f 		 
g Noncash contributions included in lines 1a-1f:$  
h Total. Add lines 1a-1f.......MediumBullet 1,381,385
Program Service Revenue Business Code
2a Patient Services 900,099 782,854,897 782,854,897    
b Equity changes of unconsolidated orgs 900,099 4,389,653 4,986,006 -596,353  
c Rental Income 900,099 2,665,598 2,665,598    
d Education 611,710 142,948 142,948    
e Research 900,099 98,117   98,117  
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 790,151,213
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 16,424,993   357 16,424,636
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties............MediumBullet 0      
(i) Real (ii) Personal
6a Gross Rents 97,745  
b Less: rental expenses 244,876  
c Rental income or (loss) -147,131  
d Net rental income or (loss).......MediumBullet -147,131     -147,131
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 235,523 2,572,458
b Less: cost or other basis and sales expenses   220,997
c Gain or (loss) 235,523 2,351,461
d Net gain or (loss)..........MediumBullet 2,586,984     2,586,984
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a Pharmacy Services 446,110 2,692,795   2,472,780 220,015
b Cafeteria 722,100 2,847,532     2,847,532
c Gift Shop 453,220 417,139     417,139
d All other revenue .... 746,043   212,834 533,209
e Total. Add lines 11a–11d ......MediumBullet 6,703,509
12 Total revenue. See Instructions....MediumBullet 817,100,953 790,649,449 2,187,735 22,882,384
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 1,276,130 1,276,130
2 Grants and other assistance to individuals in the U.S. See Part IV, line 22 0  
3 Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 15 and 16 0  
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees ....        
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0      
7 Other salaries and wages 227,274,396 181,819,517 45,454,879  
8 Pension plan contributions (include section 401(k) and section 403(b) employer contributions) .... 12,525,315 10,020,252 2,505,063  
9 Other employee benefits ....... 26,485,031 21,188,025 5,297,006  
10 Payroll taxes ........... 15,929,267 12,743,414 3,185,853  
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 46,563   46,563  
c Accounting ........... 175,560   175,560  
d Lobbying ........... 0      
e Professional fundraising. See Part IV, line 17.. 0  
f Investment management fees ...... 0      
g Other .......... 105,499,294 84,399,435 21,099,859  
12 Advertising and promotion .... 2,376,907 1,901,526 475,381  
13 Office expenses ....... 144,325,667 141,348,769 2,976,898  
14 Information technology ...... 0      
15 Royalties .. 0      
16 Occupancy ........... 13,875,208 11,100,166 2,775,042  
17 Travel ............ 1,237,690 990,152 247,538  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 147,921 118,337 29,584  
20 Interest ........... 19,001,439 19,001,439    
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 40,636,336 32,509,069 8,127,267  
23 Insurance .............. 2,835,731 2,268,585 567,146  
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 PHYSICIAN FEES 16,813,250 13,450,600 3,362,650  
b Bad debts 47,841,208 47,841,208    
c Dues & subscriptions 1,060,876 848,701 212,175  
d Repairs and maintenance 10,925,281 8,740,225 2,185,056  
e Provider Tax 30,990,868 30,990,868    
f All other expenses 1,601,797 1,474,977 126,820 0
25 Total functional expenses. Add lines 1 through 24f 722,881,735 624,031,395 98,850,340 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 .......... 982,036 1 628,592
2 Savings and temporary cash investments ....... 53,374,931 2 34,568,396
3 Pledges and grants receivable, net .........   3  
4 Accounts receivable, net ......... 86,331,560 4 95,981,428
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 ............. 4,310,807 7 4,804,161
8 Inventories for sale or use .............. 14,508,898 8 13,983,713
9 Prepaid expenses and deferred charges ............ 1,695,685 9 2,030,926
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 752,399,105
b Less: accumulated depreciation. ..... 10b 277,474,129 444,241,626 10c 474,924,976
11 Investments—publicly traded securities ..........   11  
12 Investments—other securities. See Part IV, line 11 ...... 40,104,141 12 49,685,722
13 Investments—program-related. See Part IV, line 11 .. 381,895,244 13 448,926,581
14 Intangible assets ......... 88,111,520 14 88,097,520
15 Other assets. See Part IV, line 11 ........... 29,333,041 15 6,541,992
16 Total assets. Add lines 1 through 15 (must equal line 34)... 1,144,889,489 16 1,220,174,007
Liabilities 17 Accounts payable and accrued expenses . 56,842,743 17 57,943,097
18 Grants payable ..........   18  
19 Deferred revenue .......... 26,007 19 49,216
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..... 429,393,584 25 420,876,181
26 Total liabilities. Add lines 17 through 25..... 486,262,334 26 478,868,494
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 ..... 657,533,420 27 740,211,778
28 Temporarily restricted net assets ..... 1,093,735 28 1,093,735
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 ..... 658,627,155 33 741,305,513
34 Total liabilities and net assets/fund balances ..... 1,144,889,489 34 1,220,174,007
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
817,100,953
2
Total expenses (must equal Part IX, column (A), line 25) . . . . .
2
722,881,735
3
Revenue less expenses. Subtract line 2 from line 1 . . . .
3
94,219,218
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) . .
4
658,627,155
5
Other changes in net assets or fund balances (explain in Schedule O) . . . .
5
-11,540,860
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
741,305,513
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII . . . . . . . . . .
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?..
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O............................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
 
 
Form 990 (2010)
Additional Data


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

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

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

84-0438224
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization? ................
11g(i)
 
 
(ii) a family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
(i)
Name of supported organization 		(ii)
EIN 		(iii)
Type of organization (described on lines 1- 9 above or IRC section (see instructions)) 		(iv)
Is the organization in col. (i) listed in your governing document? 		(v)
Did you notify the organization in col. (i) of your support? 		(vi)
Is the organization in col. (i) organized in the U.S.? 		(vii)
Amount of support?
Yes No Yes No Yes No
Total                  

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

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2010
Name of organization
PORTERCARE ADVENTIST HEALTH SYSTEM
 
Employer identification number

84-0438224
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




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

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part I
Name of organization
PORTERCARE ADVENTIST HEALTH SYSTEM
  		Employer identification number

84-0438224
Part I
Contributors (see Instructions)
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED




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

     
 
   

$  




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

     
 
   

$  




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

     
 
   

$  




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

     
 
   

$  




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

     
 
   

$  




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

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part II
Name of organization
PORTERCARE ADVENTIST HEALTH SYSTEM
  		Employer identification number

84-0438224
Part II
Noncash Property (see Instructions)
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part III
Name of organization
PORTERCARE ADVENTIST HEALTH SYSTEM
  		Employer identification number

84-0438224
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
aggregating more than $1,000 for the year. (Complete columns (a) through (e) and the following line entry.)
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet $  
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Additional Data


Software ID:  
Software Version:  
SCHEDULE 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
PORTERCARE ADVENTIST HEALTH SYSTEM
 
Employer identification number

84-0438224
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 ................. 1,395,329 64,274,184 65,669,513
b Buildings ................ 298,071 451,079,166 161,862,039 289,515,198
c Leasehold improvements ............   0 0 0
d Equipment ................ 17,564 167,109,950 108,244,930 58,882,584
e Other .................   68,224,841 7,367,160 60,857,681
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........SchDMdBullet 474,924,976
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
(1) AHS Investment 444,498,872 C
(2) DSRF 4,427,709 F







Total. (Column (b) should equal Form 990, Part X, col.(B) line 13.)Small Bullet 448,926,581
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) should equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Amount
Federal Income Taxes 0
Charitable Remainder Trust 713,224
Professional Liability Reserve 8,836,340
Unemployment Claims 113,508
Intercompany Payable 409,944,933
Environmental Remediation 364,996
Other Miscellaneous 903,181



Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)Small Bullet 420,876,181
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1  
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2  
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3  
4 Net unrealized gains (losses) on investments .......................... 4  
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV) ................................. 8  
9 Total adjustments (net). Add lines 4 - 8 ............................. 9  
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10  
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV): ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIV): ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total Revenue. Add lines 3 and 4c. (This should equal Form 990, Part I, line 12.) ...... 5  
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIV): ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIV): ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This should equal Form 990, Part I, line 18.) ...... 5  
Part XIV
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
REPORTING OF LIABILITY FOR UNCERTAIN TAX POSITIONS UNDER FIN 48 (ASC 740) Schedule D Part X Portercare Adventist Health System's financial information is included in the consolidated audited financial statements of ADVENTIST HEALTH SYSTEM (AHS), a related organization. AHS's FIN 48 FOOTNOTE FOR THE YEAR ENDED DECEMBER 31, 2010 IS AS FOLLOWS: "The Income Taxes Topic of the ASC (ASC 740) prescribes the accounting for uncertainty In Income tax positions recognized In financial statements. ASC 740 prescribes a recognition threshold and measurement attribute for the financial statement recognition and measurement of a tax position taken or expected to be taken In a tax return."
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
PORTERCARE ADVENTIST HEALTH SYSTEM
 
Employer identification number

84-0438224
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) .. 		    21,257,628   21,257,628 3.150 %
b Unreimbursed Medicaid (from
Worksheet 3, column a) . 		    20,295,015   20,295,015 3.010 %
c Unreimbursed costs—other means-tested government programs (from Worksheet 3, column b) ....            
dTotal Charity Care and
Means-Tested Government Programs ..... 		    41,552,643   41,552,643 6.160 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) .... 		    1,515,865 36,311 1,479,554 0.220 %
f Health professions education
(from Worksheet 5) .. 		    2,795,232   2,795,232 0.410 %
g Subsidized health services
(from Worksheet 6) .. 		           
h Research (from Worksheet 7)            
i Cash and in-kind contributions
to community groups
(from Worksheet 8) .. 		    881,216   881,216 0.130 %
jTotal Other Benefits ...     5,192,313 36,311 5,156,002 0.760 %
kTotal. Add lines 7d and 7j. ..     46,744,956 36,311 46,708,645 6.920 %
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 2   3,211   3,211  
10 Total 2   3,211   3,211  
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
17,616,287
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
160,690,242
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
230,895,082
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
-70,204,840
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?4
Name and address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe)
1 Porter Adventist Hospital
2525 S Downing St
Denver,CO80210 		X X       X X    
2 Littleton Adventist Hospital
7700 S Broadway
Littleton,CO80122 		X X         X X Childrens ER
3 Parker Adventist Hospital
9395 Crown Point Blvd
Parker,CO80138 		X X         X    
4 Avista Adventist Hospital
100 Health Park Drive
Louisville,CO80027 		X X         X    
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:Porter Adventist Hospital
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 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:Littleton Adventist Hospital
Line Number of Hospital Facility (from Schedule H, Part V, Section A):2

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 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 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:Parker Adventist Hospital
Line Number of Hospital Facility (from Schedule H, Part V, Section A):3

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 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 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:Avista Adventist Hospital
Line Number of Hospital Facility (from Schedule H, Part V, Section A):4

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 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?37
Name and address Type of Facility (Describe)
1 Dimension Pain Management
80 Health Park Drive Suite 50
Louisville,CO80027 		EMP PHYSICIAN GROUP
2 Dimension Pain Management
80 Health Park Drive Suite 50
Louisville,CO80027 		EMP PHYSICIAN GROUP
3 Dimension Pain Management
80 Health Park Drive Suite 50
Louisville,CO80027 		EMP PHYSICIAN GROUP
4 Dimension Pain Management
80 Health Park Drive Suite 50
Louisville,CO80027 		EMP PHYSICIAN GROUP
5 Dimension Pain Management
80 Health Park Drive Suite 50
Louisville,CO80027 		EMP PHYSICIAN GROUP
6 Dimension Pain Management
80 Health Park Drive Suite 50
Louisville,CO80027 		EMP PHYSICIAN GROUP
7 Dimension Pain Management
80 Health Park Drive Suite 50
Louisville,CO80027 		EMP PHYSICIAN GROUP
8 Dimension Pain Management
80 Health Park Drive Suite 50
Louisville,CO80027 		EMP PHYSICIAN GROUP
9 Dimension Pain Management
80 Health Park Drive Suite 50
Louisville,CO80027 		EMP PHYSICIAN GROUP
10 Dimension Pain Management
80 Health Park Drive Suite 50
Louisville,CO80027 		EMP PHYSICIAN GROUP
11 Dimension Pain Management
80 Health Park Drive Suite 50
Louisville,CO80027 		EMP PHYSICIAN GROUP
12 Dimension Pain Management
80 Health Park Drive Suite 50
Louisville,CO80027 		EMP PHYSICIAN GROUP
13 Dimension Pain Management
80 Health Park Drive Suite 50
Louisville,CO80027 		EMP PHYSICIAN GROUP
14 Dimension Pain Management
80 Health Park Drive Suite 50
Louisville,CO80027 		EMP PHYSICIAN GROUP
15 Dimension Pain Management
80 Health Park Drive Suite 50
Louisville,CO80027 		EMP PHYSICIAN GROUP
16 Dimension Pain Management
80 Health Park Drive Suite 50
Louisville,CO80027 		EMP PHYSICIAN GROUP
17 Dimension Pain Management
80 Health Park Drive Suite 50
Louisville,CO80027 		EMP PHYSICIAN GROUP
18 Dimension Pain Management
80 Health Park Drive Suite 50
Louisville,CO80027 		EMP PHYSICIAN GROUP
19 Dimension Pain Management
80 Health Park Drive Suite 50
Louisville,CO80027 		EMP PHYSICIAN GROUP
20 Dimension Pain Management
80 Health Park Drive Suite 50
Louisville,CO80027 		EMP PHYSICIAN GROUP
21 Dimension Pain Management
80 Health Park Drive Suite 50
Louisville,CO80027 		EMP PHYSICIAN GROUP
22 Dimension Pain Management
80 Health Park Drive Suite 50
Louisville,CO80027 		EMP PHYSICIAN GROUP
23 Dimension Pain Management
80 Health Park Drive Suite 50
Louisville,CO80027 		EMP PHYSICIAN GROUP
24 Dimension Pain Management
80 Health Park Drive Suite 50
Louisville,CO80027 		EMP PHYSICIAN GROUP
25 Dimension Pain Management
80 Health Park Drive Suite 50
Louisville,CO80027 		EMP PHYSICIAN GROUP
26 Dimension Pain Management
80 Health Park Drive Suite 50
Louisville,CO80027 		EMP PHYSICIAN GROUP
27 Dimension Pain Management
80 Health Park Drive Suite 50
Louisville,CO80027 		EMP PHYSICIAN GROUP
28 Dimension Pain Management
80 Health Park Drive Suite 50
Louisville,CO80027 		EMP PHYSICIAN GROUP
29 Dimension Pain Management
80 Health Park Drive Suite 50
Louisville,CO80027 		EMP PHYSICIAN GROUP
30 Dimension Pain Management
80 Health Park Drive Suite 50
Louisville,CO80027 		EMP PHYSICIAN GROUP
31 Dimension Pain Management
80 Health Park Drive Suite 50
Louisville,CO80027 		EMP PHYSICIAN GROUP
32 Dimension Pain Management
80 Health Park Drive Suite 50
Louisville,CO80027 		EMP PHYSICIAN GROUP
33 Dimension Pain Management
80 Health Park Drive Suite 50
Louisville,CO80027 		EMP PHYSICIAN GROUP
34 Dimension Pain Management
80 Health Park Drive Suite 50
Louisville,CO80027 		EMP PHYSICIAN GROUP
35 Dimension Pain Management
80 Health Park Drive Suite 50
Louisville,CO80027 		EMP PHYSICIAN GROUP
36 Dimension Pain Management
80 Health Park Drive Suite 50
Louisville,CO80027 		EMP PHYSICIAN GROUP
37 Dimension Pain Management
80 Health Park Drive Suite 50
Louisville,CO80027 		EMP PHYSICIAN GROUP
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 8
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the description required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 2, 4c, 6i, 7, 11i, 13i, 17l, 18l, 19e, 21d, 25, and 26.
2 Community health needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any community health needs assessments reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Identifier ReturnReference Explanation
PART I, Line 3c   If applicable, describe the income-based criteria for determining eligibility for free or discounted care under the organization's charity care policy. Also describe whether the organization uses the asset test or other threshold regardless of income to determine eligibility for free or discounted care. Portercare Adventist Health System has an established charity care policy based on the Federal Poverty Level. Charity is provided to patients based on a sliding scale that considers the patient's family size and income level. The charity provided ranges from 100% of the patient's bill for individuals whose household income is at 100% or less of the Federal poverty level, to a 60% deduction for individuals whose income is at 400% of the Federal poverty level. In addition, Portercare Adventist Health System takes into account specific facts and circumstances in granting charity in situations such as a catastrophic illness where the patient does not have liquid assets.
PART I, Line 6a   If the organization's community benefit report is contained in a report prepared by a related organization, rather than a separate report prepared by the organization, identify the related organization. Portercare Adventist Health System is operated by Centura Health Corporation (CHC). CHC prepares its own written community benefit report which includes the activities of Portercare Adventist Health System and other entities managed by CHC. The annual report is published on Centura's website and available to anyone interested.
Part I, Line 7, Column (f)   If applicable, state 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. Portercare Adventist Health System recorded $47.8 million in bad debt expense for the fiscal year. The bad debt expense recorded, while included in functional expenses, was excluded from the calculation of community benefit expense.
Part I, Line 7   Provide an explanation of the costing methodology used to calculate the amounts reported in the table. If a cost accounting system was used, indicate whether the cost accounting system addresses all patient segments (for example, inpatient, outpatient, emergency room, private insurance, Medicaid, Medicare, uninsured or self pay). Also indicate whether a cost-to-charge ratio was used for any of the figures reported in the table. Describe whether this cost-to-charge ratio was derived from Worksheet 2, and, if not, what kind of cost-to-charge ratio was used and how it was derived. If some other costing methodology was used besides a cost accounting system, cost-to-charge ratio, or a combination of the two, describe the method used. Portercare Adventist Health System does not use a cost accounting system to determine the cost of charity care provided. The estimated cost of care is calculated by applying the ratio of each facility's total expenses to total gross revenue, applied to the applicable gross revenues (e.g. Medicare, Medicaid). Worksheet 2 was not used to develop the cost to charge ratio.
Part III, Section A, Line 4   Provide the rationale and the costing methodology used to determine the amount reported in Part III lines 2 and 3. Describe how the organization accounts for discounts and payments on patient accounts in determining bad debt expense. Also describe the method the organization uses to determine the amount that reasonably could be attributable to patients who likely would qualify for financial assistance under the hospital's charity care policy, if sufficient information has been available to make a determination as to their eligibility. Also, provide if applicable, the text of the footnote to the organization's financial statements that describes bad debt expense. If the organization's financial statements include a footnote on these issues that also includes other information, report only the relevant portions of the footnote. If the organization's financial statements do not contain such a footnote, state that the organization's financial statements do not include such a footnote and explain how the financial statements account for bad debt, if at all. Portercare Adventist Health System uses the overall cost to gross charge ratio applicable to each facility to determine the costs in Part III lines 2 and 3. Portercare Adventist Health System automatically discounts all self pay patient accounts by 30% and also offers a prompt pay discount. This allowance is not included in the calculation of the cost of bad debts in instances where a patient does not pay his or her bill. Portercare Adventist Health System provides information to patients at the time of registration with respect to its financial assistance policies. However, in some instances patients do not complete the necessary forms to apply for financial assistance. As a result, Portercare Adventist Health System uses an outside vendor to assist in determining a patient's eligibility for financial assistance. This includes a review of the patient's financial situation based on the vendor's database of external information. In instances where the review indicates that the patient qualifies for financial assistance, Portercare Adventist Health System adjusts the patient's bill to match its charity policy and does not pursue collection from the patient for the portion of the patient's obligation that qualifies for charity. Portercare Adventist Health System does not issue separate audited financial statements; however, PAHS is included in the consolidated financial statements of AHS and their footnote is referenced below. Bad debt expense is reported on Portercare Adventist Health System's internal financial statements as an expense. The amount reported is based on the amount deemed to not be collectible by patients who have the ability to pay. Financial Statement Footnote Related to Accounts Receivable and Allowance for Uncollectible Accounts: The System serves certain patients whose medical care costs are not paid at established rates. These patients include those sponsored under government programs such as Medicare and Medicaid, those sponsored under private contractual agreements, charity patients, and other uninsured patients who have limited ability to pay. Patient service revenue is reported at estimated net realizable amounts from patients, third-party payors, and others for services rendered. The System is subject to retroactive revenue adjustments due to future audits, reviews, and investigations. Retroactive adjustments are considered in the recognition of revenue on an estimated basis in the period the related services are rendered, and such amounts are adjusted in future periods as adjustments become known or as years are no longer subject to such audits, reviews, and investigations. Adjustments to revenue related to prior period increased patient service revenue by approximately $29,500,000 and $23,900,000 for the years ended December 31, 2010 and 2009, respectively. Revenue from the Medicare and Medicaid programs represents approximately 35% of the System's patient service revenue for the years ended December 31, 2010 and 2009. Laws and regulations governing the Medicare and Medicaid programs are extremely complex and subject to interpretation. As a result, there is at least a reasonable possibility that recorded estimates will change by a material amount in the near term. The System grants credit without collateral to its patients, most of whom are local residents and are insured under third-party payor arrangements. To the extent the System realizes additional losses resulting from higher credit risk for patients who are not identified as meeting or do not meet the charity definition described below, such additional losses are included in the provision for bad debts. Other than the accounts receivable related to the Medicare and Medicaid programs, there are no significant concentrations of accounts receivable due from an individual payor at December 31, 2010 and 2009. The provision for bad debts is based on management's assessment of historical and expected net collections, considering business and economic conditions, trends in healthcare coverage, and other collection indicators. Throughout the year, management assesses the adequacy of the allowance for uncollectible accounts based upon the payor composition and aging of accounts receivable as well as retrospective reviews of subsequent cash collections. The results of these reviews are then used to make any modifications to the provision for bad debts to establish an estimated allowance for uncollectible accounts. Accounts receivable are written off after collection efforts have been followed in accordance with the System's policies.
Part III, Section B, Line 8   Describe the costing methodology used to determine the Medicare allowable costs reported in the organization's Medicare Cost Report, as reflected in the amount reported in Part III, line 6. Describe, if applicable, the extent to which any shortfall reported in Part III, line 7 should be treated as a community benefit, and the rationale for the organization's position. Cost for each hospital's cost report is pulled from year end trial balances. The cost is then evaluated and all non-allowable cost is removed via adjustments. The remaining allowable cost is then allocated to appropriate patient care and non-patient care cost centers based on Medicare allocation principles. Rationale for Including a Medicare Shortfall as Community Benefit: As a 501(c)(3) organization, the filing organization provides emergency and non-elective care to all regardless of ability to pay. All hospital services are provided in a non-discriminatory manner to patients who are covered beneficiaries under the Medicare program. As a public insurance program, Medicare provides a pre-established reimbursement rate/amount to health care providers for the services they provide to patients. In some cases, the reimbursement amount provided to a hospital may exceed its costs of providing a particular service or services to a patient. In other cases, the Medicare reimbursement amount may result in the hospital experiencing a shortfall of reimbursement received over costs incurred. In those cases where an overall shortfall is generated for providing services to all Medicare patients, the shortfall amount should be considered as a benefit to the community. Tax-exempt hospitals are required to accept all Medicare patients regardless of the profitability, or lack thereof, with respect to the services they provide to Medicare patients. The population of individuals covered under the Medicare program is sufficiently large so that the provision of services to the population is a benefit to the community and relieves the burdens of government. In those situations where the provision of services to the total Medicare patient population of a tax-exempt hospital during any year results in a shortfall of reimbursement received over the cost of providing care, the tax-exempt hospital has provided a benefit to a class of persons broad enough to be considered a benefit to the community. Despite a financial shortfall, a tax-exempt hospital must and will continue to accept and care for Medicare patients. Typically, tax-exempt hospitals provide health care services based upon an assessment of the health care needs of their community as opposed to their taxable counterparts where profitability often drives decisions about patient care services that are offered. Patient care provided by tax-exempt hospitals that results in Medicare shortfalls should be considered as providing a benefit to the community and relieving the burdens of government.
Part III, Section C, Line 9b   If the organization has a written debt collection policy and answered "yes" to Part III, line 9b, describe the collection practices set forth in the policy that apply to patients who it knows qualify for charity care or financial assistance, whether or not such practices apply specifically to such patients or more broadly to also cover other types of patients. Portercare Adventist Health System's debt collection policy provides the performance of a reasonable review of each patient's account prior to turning an account over to a third-party collection agent and prior to instituting any legal action for non-payment. The review of patient accounts is done to assure that the patient or their guarantor is not eligible for assistance through Portercare Adventist Health System's charity care policy, uninsured discount policy or another financial assistance program (i.e. Medicaid). Portercare Adventist Health System requires the following of its third-party collection agencies: -Neither Portercare Adventist Health System hospitals or their collection agencies will request bench or arrest warrants as a result of non-payment; -Neither Portercare Adventist Health System hospitals or their collection agencies will seek liens that would require the sale or foreclosure of a primary residence; and -No Portercare Adventist Health System collection agency may seek court action without hospital approval.
Part VI, Items 2,4,5   Line 2: Describe how the organization assesses the health care needs of the communities it serves. Line 4: Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves. Line 5: Describe how the organization's community building activities, as reported in Part II, promote the health of the communities the organization serves. Provide any other information important to describing how the organization's hospitals or other health care facilities further its exempt purpose by promoting health of the community (e.g. open medical staff, community board, use of surplus funds, etc). PorterCare Adventist Health System Colorado Across Colorado, more than 4,000 associates of PorterCare Adventist Health System (PAHS) are changing lives in our hospitals, senior living communities, clinics and homes in which they work. Through the many community programs and the charity care they provide for people throughout Colorado, PAHS associates receive great satisfaction from fulfilling a mission of extending the healing ministry of Christ. The Community Benefit Report is a collective list of various activities through which PAHS supports its neighbors throughout the state. Community benefits are offered in the form of outreach and education, support groups, activities and clinics, as well as charity care. As a nonprofit, faith-based organization, PAHS is committed to providing support and programs for those less fortunate in our communities. In hard times those numbers grow, while resources shrink. In response to this, we seek how to make the most impact in every community we touch. In the most recent fiscal year PAHS invested the following in its communities: Community Benefit Annual Report FY 2011 Summary Introduction PorterCare Adventist Health System (PAHS), a faith-based, nonprofit health care entity, since their earliest days, have placed an emphasis on whole person care and on illness prevention, have preserved an unwavering commitment to their values and an understanding of the vital role that ministering to spiritual needs can play in health care. Committed to the mission of continuing the healing ministry of Christ, PAHS builds upon its unique history, heritage and traditions to create a faith-based entity designed to advance the mission of their individual organizations. Today, PAHS operates 4 hospitals: Avista Adventist Hospital, Littleton Adventist Hospital, Parker Adventist Hospital and Porter Adventist Hospital. In keeping with our mission, PAHS provides care for all regardless of ability to pay. In fiscal year 2011, PAHS provided $46.7 million in healthcare to underprivileged individuals and the broader community through charity care, community education and outreach, and unpaid costs of Medicaid. Quality healthcare is delivered to persons in these service areas - Denver, Boulder, Littleton, Parker and their surrounding communities in the State of Colorado. Uncompensated Care PorterCare Adventist Health System provides a significant amount of uncompensated care each year. The above table indicates that in fiscal year 2011, the cost of traditional charity care provided was $21.2 million. PAHS also incurred $20.3 million in unreimbursed costs for services provided to Medicaid patients. Frequently, the costs of providing services to participants of Medicaid are greater than the payments received from the program. The same is true for Medicare. PAHS incurred $70.2 million in unreimbursed costs for Medicare Community Outreach for Persons who are Poor Project Cure Collection of Medical Supplies and Equipment is palletized and shrink wrapped for donation Social Assistance Prescriptions This program provides medications at the time of discharge for low-income patients Cab Vouchers for Low Income Patients Community Outreach for the Broader Community Community Contributions PAHS Hospitals are proud to contribute to the local charities and organizations that help to meet their mission and care for the people or their community. New Life Education Classes PAHS provides numerous child birthing preparation, sibling preparation, and exercise classes. Safety Safari Provides safety information to children in the community. Community Education Provides education regarding disease processes, safety and promoting health in the community. Family Education Women's Services offers a variety of classes for the community, including CPR, Lactation and others. Vim and Vigor Magazine Free community health and wellness magazine. Published quarterly. Diabetes Awareness Classes In these classes, Diabetics and their families learn to manage diabetes through nutrition, exercise, foot care, medications and the ins and outs of monitoring blood sugar. Body of Knowledge - Community Talks A series of public lectures that cover various topics from cardiology and heart health to orthopedic surgery to new treatments for Parkinson's Disease. Educational Programs for Clinical Professionals The Porter Hospital Transplant Program conducts numerous programs and seminars designed to educate the greater community on the latest advancements in transplant medicine. Ask-a Nurse Calls Free health information and physician referral service for our community. Nurses also assess health conditions from neck pain to a fever, and give free professional advice on what action to take next. This program provides information and registration for hospital classes and events Student Precepting Supervising healthcare related students from various local and regional colleges and vocational schools. Curious George Hospital Tours This program is geared to children aged 4-10. Based on the story "Curious George goes to the Hospital" and involves taking tours of all the departments that George visited. The tour compliments the hospitals focus on creating a healing environment. Children see a hospital as a less scary, helpful place.
Part VI, Item 3   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 charity care policy. Information concerning financial assistance is included on Centura's website. The website not only lists phone numbers for patients to call to discuss financial assistance, but also includes Centura's policy for charity care and its policies related to uninsured patients. In addition, at the time of registration, uninsured patients are screened to determine if the patients qualify for any Federal, State or County programs. Uninsured patients are also sent a letter requesting that the patient call to determine eligibility for various assistance programs, including charity.
Part VI, Item 6   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. Portercare Adventist Health System is operated as part of Centura Health Corporation ("Centura"). Centura and its affiliated organizations are dedicated to extending the healing ministry of Christ by caring for those who are ill and by nurturing the health of the people in our communities. Specifically, Centura has launched a system-wide strategic plan to improve the quality, consistency, availability, and affordability of health care to communities throughout Colorado. The three main components of this strategy are (1) to continue investing in technology advancements that improve the quality, costs, and coordination of care including the establishment of electronic health records linking our physicians, clinics, hospitals, long-term facilities and home care services; (2) providing wellness care, thereby potentially reducing health care costs by helping patients to maintain good health, growing the level of support and outreach provided to rural communities, and increasing access, affordability and quality of health care; and (3) coordinate and develop systems of care, looking to each facility and entity in Centura to share best practices and improve overall efficiency and communication system-wide from birth to home care.
Schedule H (Form 990) 2010
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
PORTERCARE ADVENTIST HEALTH SYSTEM
 
Employer identification number
84-0438224
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) Doctors Care191 E Orchard Rd Ste 102NE
Littleton,CO80121 		84-1150815 501(c)(3) 20,000        
(2) PARKER TASK FORCE20118 E Mainstreet Unit D
Parker,CO80138 		74-2494265 501(c)(3) 5,150        
(3) Denver Botanic Gardens909 York Street
Denver,CO80206 		84-0440359 501(c)(3) 6,666        
(4) Colorado Women's Chamber of Commerce1624 Market Street Suite 340
Denver,CO80202 		32-0248696 501(c)(3) 6,725        
(5) Arthritis Foundation2280 S Albion Street
Denver,CO80222 		38-3826066 501(c)(3) 16,000        
(6) Campion Academy300 SW 42nd Street
Loveland,CO80537 		84-0459259 501(c)(3) 5,396 12,500 FMV Sports Equipment  
(7) Littleton Firefighters FND3465 Witford Dr
Highland Ranch,CO80126 		84-1502497 501(c)(3) 8,000        
(8) Colorado Police & Fire Athletic Association10495 South Progress Way Suite 104
Parker,CO80134 		74-2416051 501(c)(3) 6,000        
(9) Women's Crisis CenterPO Box 367
Castle Rock,CO80104 		74-2385006 501(c)(3) 10,000        
(10) Colorado Wellness Connection4960 E Mineral Circle
Centennial,CO80122 		84-1504515 501(c)(3) 8,006        
(11) Clinica Campesina (Family Health Services)1345 Plaza Court North Suite 1A
Lafayette,CO80026 		84-0743432 501(c)(3) 165,504        
(12) University of Denver2201 S Gaylord St
Denver,CO80208 		84-0404231 501(c)(3) 54,868        
(13) The Community Foundation1123 Spruce St
Boulder,CO80302 		84-1171836 501(c)(3) 10,000        
(14) New Day Christian Seventh Day Adventist905 N Hwy 83
Franktown,CO80116 		84-0719073 501(c)(3) 11,250        
(15) Union College3800 S 48th Street
Lincoln,NE68506 		47-0405319 501(c)(3) 10,000        
(16) ACS Community Lift5045 W 1st Ave
Denver,CO80219 		84-0527826 501(c)(3) 60,000        
(17) Mile High Academy711 E Yale Ave
Denver,CO80210 		84-0525223 501(c)(3) 15,000        
(18) Glacier View Ranch8748 Overland Rd
Ward,CO80481 		84-0968738 501(c)(3) 42,180        
(19) Rocky Mountain Adventist Healthcare Foundation7995 E Prentice Ave Suite 204
Greenwood Village,CO80111 		84-0745018 501(c)(3) 654,389        
2
Enter total number of section 501(c)(3) and government organizations ......................... Bullet Image
20
3
Enter total number of other organizations ................................ . Bullet Image
 
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2010

Schedule I (Form 990) 2010
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance













Part IV
Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.
Identifier Return Reference Explanation
Schedule I Part I Q2 Procedures for monitoring the use of grants Grants are made at the discretion of the facility CEOs. The CEOs make requests for funding, which CAN BE EITHER a donation to A SPECIFIC entity OR an invoice for a specific expense. Most all recipients of monies are 501(c)(3) entities. As such, they ensure that all monies received are used for their intended purpose only.
Schedule I (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
PORTERCARE ADVENTIST HEALTH SYSTEM
 
Employer identification number

84-0438224
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
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
Yes
 
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in 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) ROBERT HENDERSCHEDT (i)
(ii)		  
573,822 		 
166,156 		 
221,069 		 
1,092,715 		 
27,815 		 
2,081,577 		 
 
(2) TERRY SHAW (i)
(ii)		  
805,019 		 
233,100 		 
58,537 		 
171,790 		 
47,246 		 
1,315,692 		 
 
(3) RICHARD REINER (i)
(ii)		  
805,019 		 
232,471 		 
136,463 		 
162,106 		 
46,413 		 
1,382,472 		 
 
(4) RANDY HAFFNER (i)
(ii)		 436,276
  		168,857
  		23,240
  		170,936
  		20,215
  		819,524
  		 
 
(5) JOHN SACKETT (i)
(ii)		 274,622
  		99,250
  		7,405
  		77,481
  		19,274
  		478,032
  		 
 
(6) KENNETH BACON (i)
(ii)		 323,602
  		95,221
  		19,418
  		120,367
  		17,307
  		575,915
  		 
 
(7) STEVEN CHEN (i)
(ii)		 241,468
  		65,370
  		469
  		36,992
  		8,999
  		353,298
  		 
 
(8) CHERYL CURRY (i)
(ii)		 179,405
  		39,002
  		557
  		17,569
  		15,736
  		252,269
  		 
 
(9) ANDREW GAASCH (i)
(ii)		 174,319
  		50,284
  		285
  		10,216
  		14,084
  		249,188
  		 
 
(10) DAVID SMITH (i)
(ii)		 176,230
  		36,911
  		522
  		13,850
  		4,404
  		231,917
  		 
 
(11) TODD FOLKENBERG (i)
(ii)		 231,694
  		57,982
  		498
  		28,512
  		14,892
  		333,578
  		 
 
(12) JOHN PRALL (i)
(ii)		 1,219,865
  		 
  		1,623
  		12,564
  		14,522
  		1,248,574
  		 
 
(13) DAVID VANSICKLE (i)
(ii)		 1,001,250
  		63,268
  		764
  		20,228
  		14,363
  		1,099,873
  		 
 
(14) DAVID SCHRIER (i)
(ii)		 751,303
  		15
  		2,493
  		22,678
  		14,535
  		791,024
  		 
 
(15) BERNARD GUIOT (i)
(ii)		 739,449
  		 
  		1,251
  		20,228
  		1,645
  		762,573
  		 
 
(16) Robert Bess (i)
(ii)		 681,372
  		 
  		6,344
  		20,228
  		14,482
  		722,426
  		 
 
(17) KARSTEN RANDOLPH (i)
(ii)		 221,592
  		53,464
  		425
  		32,344
  		15,806
  		323,631
  		 
 
(18) TERRY FORDE (i)
(ii)		 284,595
  		93,457
  		18,018
  		75,995
  		17,713
  		489,778
  		40,040
 
(19) MICHAEL BLAIR (i)
(ii)		  
  		 
  		149,760
  		 
  		 
  		149,760
  		 
 
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
BENEFITS PROVIDED TO EXECUTIVES 990 SCH J, PART I, Q. 1A SENIOR VPs AND HOSPITAL CEOs ARE PAID THROUGH CENTURA HEALTH CORP AND ARE ELIGIBLE FOR THE FOLLOWING BENEFITS: TRAVEL FOR COMPANIONS, HEALTH OR SOCIAL CLUB DUES, AND REIMBURSEMENT UP TO $10,000 FOR PERSONAL SERVICES SUCH AS TAX, FINANCIAL, AND ESTATE PLANNING SERVICES, ALONG WITH TAX GROSS-UP PAYMENTS FOR ANY REIMBURSEMENTS INCLUDED IN TAXABLE COMPENSATION. ALL BENEFITS ARE PROVIDED PURSUANT TO A WRITTEN POLICY GOVERNING PAYMENT AND REIMBURSEMENT, SUBSTANTIATION IS REQUIRED FOR ALL EXPENSES SUBMITTED FOR REIMBURSEMENT, AND REIMBURSEMENTS ARE INCLUDED IN TAXABLE COMPENSATION WHERE APPROPRIATE.
METHODS USED TO ESTABLISH CEO COMPENSATION 990 SCH J, PART I, Q.3 PAHS's ceo is paid by centura health corporation (centura). OUTSIDE CONSULTANTS ARE ENGAGED TO PROVIDE RECOMMENDATIONS TO CENTURA'S COMPENSATION COMMITTEE REGARDING THE COMPENSATION OF FACILITY CEOS. THE CONSULTANT'S RECOMMENDATIONS ARE THEN PRESENTED TO AND APPROVED BY THE COMPENSATION COMMITTEE.
POST-TERMINATION PAYMENTS 990 SCH J, PART I, Q. 4A CENTURA HAS A DEFINED SEVERANCE POLICY. SEVERANCE PAYMENTS ARE DETERMINED BASED ON A COMBINATION OF THE INDIVIDUAL'S POSITION WITHIN THE ORGANIZATION AND YEARS OF SERVICE. SEVERANCE AGREEMENTS INCLUDE LIMITATIONS WITH RESPECT TO WORKING FOR COMPETING FACILITIES AND OTHER REQUIREMENTS THAT CAN CAUSE FORFEITURE OF THE SEVERANCE BENEFIT. IN ADDITION, THE AGREEMENTS RELEASE CENTURA FROM LITIGATION AND FUTURE CLAIMS AGAINST THE ORGANIZATION. THE FOLLOWING RECEIVED SEVERANCE PAYMENTS DURING THE CALENDAR YEAR 2010: MICHAEL BLAIR - $149,760
NON-QUALIFIED RETIREMENT PLAN 990 SCH J, PART I, Q. 4B CENTURA OFFERS A NON-QUALIFIED RETIREMENT PLAN IN WHICH SENIOR EXECUTIVES (SENIOR VPS AND ABOVE) ARE PROVIDED A 10% OF SALARY ALLOWANCE TO PURCHASE INSURANCE PRODUCTS OR CONTRIBUTED INTO THE DEFERRED COMPENSATION PLAN. IN ADDITION, A PENSION RESTORATION BENEFIT IS PROVIDED WHICH CREDITS PARTICIPANTS WITH A BENEFIT WHICH IS CALCULATED BASED ON THE EXCESS OF THE PARTICIPANT'S COMPENSATION OVER THE MAXIMUM ALLOWED FOR PENSION CONTRIBUTIONS. AMOUNTS DEFERRED ARE NOT REPORTED AS TAXABLE INCOME UNTIL/UNLESS A TRIGGERING EVENT OCCURS. THIS DEFERRED COMPENSATION PLAN HAS A SUBSTANTIAL RISK OF FORFEITURE PROVISION AND AN ELECTED VESTING SCHEDULE. THE FOLLOWING RECEIVED CONTRIBUTIONS TO A NON-QUALIFIED PLAN for the calendar year 2010: KENNETH BACON $71,632; STEVEN CHEN $5,932; TODD FOLKENBERG $2,917; TERRY FORDE $40,036; RANDALL HAFFNER $102,304; KARSTEN RANDOLPH $3,608; JOHN SACKETT $42,477. DURING 2010 THE FOLLOWING DISTRIBUTIONS WERE MADE BY PAHS FROM THE DEFERRED COMPENSATION PLAN: TERRY FORDE: $40,040 In addition, three of the board members are compensated by Adventist Health System Sunbelt Healthcare Corp and in recognition of the contribution that each executive makes to the success of AHS, AHS provides to eligible executives participation In the AHS Executive FLEX Benefit Program (the Plan). The purpose of the Plan IS to offer eligible executives an opportunity to elect from among a variety of supplemental benefits, Including deferred compensation benefits taxable under Internal Revenue Code (IRC) Section 457(f), to Individually tailor a benefits program appropriate to each executive's needs. The Plan provides eligible participants a pre-determined benefits allowance credit that IS equal to a percentage of the executive's base pay from which IS deducted the cost of mandatory and elective employee benefits. The pre-determined benefits allowance credit percentage IS approved by the AHS Board Strategy & Compensation Committee, an Independent committee of the Board of Directors of AHSSHC. Any funds that remaIn after the cost of mandatory and elective benefits are subtracted from the pre-determined benefits annual amount are contributed, at the employee's option, to either an IRC 457(f) deferred compensation account or to an IRC 457(b) eligible deferred compensation plan. The Plan documents define an employee who IS eligible to participate In the Plan to generally Include the Chief Executive Officers of AHS entities and Vice Presidents of all AHS entities whose base salary IS at least $196,000. In 2010, the Plan provided for a class year vesting schedule (2 years for each class year) with respect to amounts accumulated In the executive's 457(f) deferred compensation account. Distributions could also be made from the executive's 457(f) deferred compensation account upon attainment of age 65 or upon an Involuntary separation. The account is forfeited by the executive upon a voluntary separation. In addition to the Plan, AHS has Instituted a defined benefit, non-tax-qualified deferred compensation plan for certain executives who have provided lengthy service to AHS and/or to other Seventh-Day Adventist Church hospital or health care Institutions. Participation In the plan IS offered to AHS executives on a prorata schedule beginning with 20 years of service as an employee of AHS and/or another hospital or health care Institution controlled by the Seventh-Day Adventist Church and who satisfy certain other qualifying criteria. This supplemental executive retirement plan (SERP) was designed to provide eligible executives with the economic equivalent of an annual Income beginning at normal retirement age equal to 60% of the average of the participant's three highest years of base salary from AHS active employment Inclusive of Income from all other Seventh-Day Adventist Church healthcare employer-financed retirement Income sources and investment income earned on those contributions through social security normal retirement age as defined in the plan. 457(f) Employer Contributions for 2010 were: Robert Henderschedt $107,010; Richard Reiner $165,263; Terry Shaw $158,447. SERP Payments for 2010 were: Robert Henderschedt $119,583; Richard Reiner $61,356.
NON-FIXED PAYMENTS 990 SCH J, PART I, Q. 7 PARTICIPANTS IN CENTURA'S INCENTIVE COMPENSATION PLANS INCLUDE DIRECTORS AND ABOVE. PAYOUTS ARE BASED ON METRICS ESTABLISHED AND APPROVED BY CENTURA'S COMPENSATION COMMITTEE. THE METRICS INCLUDE QUANTIFIABLE MEASURES PERTAINING TO FINANCIAL PERFORMANCE, SAFETY AND QUALITY AND ASSOCIATE SATISFACTION WITH EACH METRIC WEIGHTED IN DETERMINING THE OVERALL SCORE. THE INCENTIVE COMPENSATION PAYOUT IS CALCULATED BASED ON THE CUMULATIVE SCORE FOR ALL METRICS AND THE PAYOUT IS BASED ON A COMBINATION OF THE SCORE, THE INDIVIDUAL'S BASE COMPENSATION AMOUNT AND POSITION (E.G. DIRECTOR, VICE PRESIDENT).
REPORTABLE INDIVIDUALS COMPENSATED BY UNRELATED ORGANIZATIONS 990 SCH J, PART II All key employees and hospital CEO's are compensated by Centura Health Corporation, who manages the daily activities of Portercare Adventist Hospitals under a Joint Operating Agreement dated December 8, 1995 between the Adventist Healthcare System and Catholic Health Initiatives. As such, their salaries are paid to them by Centura, an unrelated org, for services rendered in their capacity as key employees or officers of PAHS. All of their reportable compensation is disclosed on Form 990, Schedule J, Part II, Row (i) and 990, Part VII, Column (D) as reporting org compensation. In addition, the CEO and CFO of Pahs were appointed as such by the PAHS board of directors. while they are officers of these entities, a very small portion of their time is directly related to the operations of PAHS. They are compensated by Centura, which is charged with managing the facilities. Their respective compensation is not reported on the filing org's 990 but in fact is reported in full on Part VII and Schedule J of Centura Health Corporation's Form 990.
Schedule J (Form 990) 2010

Additional Data


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

84-0438224
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Description of transaction (c) Corrected?
Yes No





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

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.
(a) Name of interested person and purpose (b) Loan to or from the organization? (c)Original principal amount (d)Balance due (e) In default? (f) Approved by board or committee? (g)Written agreement?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b)Relationship between interested person and the organization (c)Amount of grant or type of assistance
For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2010
Schedule L (Form 990 or 990-EZ) 2010
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) HEALTHCARE SUPPORT SERVICES KEY ON PAHS/BOARD ON HSS 2,496,854 HSS IS A VENDOR OF PAHS   No
(2) TAMMY SMITH SPOUSE OF KEY EMPLOYEE 86,172 EMPLOYEE COMPENSATION   No
(3) STEPHANIE TRAVER DAUGTHER OF KEY EMPLOYEE 57,700 EMPLOYEE COMPENSATION   No
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
Schedule L (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  




SCHEDULE O
(Form 990 or 990-EZ)

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

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

84-0438224
Identifier Return Reference Explanation
Executive Committee Composition and Authority 990, Part VI, Q 1a Pursuant to Article IV of the Bylaws of Portercare Adventist Health System, The Board of Trustees may, by resolution or resolutions passed by a majority of the Trustees thereof, appoint an Executive Committee or such other committees for any purpose and delegate to such committees any of the powers and authority of the Board of Trustees as is permitted by law. Colorado law precludes a committee of the Board from (i) authorizing distributions; (ii) approving or proposing to the Member actions that Articles 121-137 of Title 7 of the Colorado Revised Statutes require to be approved by the Member; (iii) amending the Corporation's Amended and Restated Articles of Incorporation; (iv) adopting, amending or repealing the Bylaws; (v) approving a plan of merger not requiring approval of the Member; or (vi) approving a sale, lease, exchange or other disposition of all, or substantially all, of its property, with or without good will, otherwise than in the usual and regular course of business subject to approval of the Member. Such committees shall have the power to act only in intervals between meetings of the Board of Trustees and shall at all times be subject to the control of the Board of Trustees. The Board of Trustees, or if the Board does not act, the committees, shall establish rules and regulations for meetings and shall meet at such times as are deemed necessary, provided that a reasonable notice of all meetings shall be given to committee members. No act of a committee shall be valid unless approved by the vote or written consent of a majority of its members. Committees shall keep regular minutes of proceedings and report the same to the Board from time to time as the Board may require.
Members or Stockholders 990 Part VI Line 6 The sole corporate member of PAHS is Adventist Health System Sunbelt Healthcare Corporation (AHS), a Florida nonprofit corporation.
Electing Directors 990 Part VI Line 7a The sponsor, AHS, has the power to appoint or remove the members of the governing body.
Governing Powers 990 Part VI Line 7b The sponsor, AHS, acting through the board of trustees, maintains all rights permitted to be exercised by directors of a Colorado corporation except as limited by the organizations' articles, bylaws, or affiliation agreement with Catholic Health Initiatives, (CHI). The agreement of both AHSSHC and CHI is required for certain significant decisions involving Centura Facilities.
Process used to review Form 990 Form 990, Part VI, Q 11B A draft of the Form 990 is provided to management, including the CFO, for review. The return is e-mailed to the entire board for review prior to filing. After presentation to the board, the tax department files the return with the appropriate federal agencies, making any non-substantive changes necessary to effect e-filing. Any such changes are not re-submitted to the board.
PROCEDURES FOR MONITORING AND ENFORCING THE COI POLICY Form 990, Part VI, Q 12C PORTERCARE ADVENTIST HEALTH SYSTEM HAS ADOPTED CENTURA HEALTH's CONFLICT OF INTEREST POLICY: This policy applies to all interested persons defined as management (including the president, executive vice presidents, senior vice presidents, vice presidents, directors, and managers), supply chain management and respiratory therapy associates and board and board committee members of Centura Health (Centura). All interested persons owe a duty of loyalty and fidelity to the organization. This duty requires that they exercise the best care, skill and judgment for the benefit of Centura. A conflict of interest exists when the interested person and/or his/her immediate relations has a financial or other interest in a matter, which may influence the interested person's judgment when acting and exercising their fiduciary duties on behalf of Centura. Centura acknowledges that conflicts of interest may occasionally present themselves and that neither the elimination from the board or management of all persons who might potentially have any such conflict nor the avoidance of all transactions involving a conflict of interest would necessarily serve the best interests of Centura. Nonetheless, each interested person should avoid conflicts of interest and refrain from attempting to influence the decisions of management and/or the board on matters in which such interested person has a financial or other interest. It is, therefore, the policy of Centura to avoid the participation of any interested person in the consideration of a matter or decision that poses a conflict of interest or the appearance of a conflict of interest, for that interested person. Further, it is the policy of Centura that all interested persons be required to disclose any conflicts of interest, or possible conflicts of interest that might potentially affect their judgment in making decisions on behalf of Centura by completing a Conflict of Interest Disclosure Statement ("Disclosure Statement") annually. This policy is not intended to inhibit investments or activities unless such investments or activities would be harmful to Centura and/or its affiliates. This Policy is intended to supplement but not replace any applicable state laws governing conflicts of interests applicable to nonprofit and charitable organizations. 1. CONFLICT OF INTEREST POLICY 1.1 CONSISTENT WITH CENTURA INTEGRITY STANDARDS, IT IS POLICY THAT EACH BOARD OF TRUSTEE MEMBER, CORPORATE OFFICER, AND KEY EMPLOYEE ACT AT ALL TIMES IN A MANNER THAT IS CONSISTENT WITH CENTURA'S MISSION AND VALUES BASED SERVICE TO THE COMMUNITY AND EXERCISE CARE THAT HE OR SHE DOES NOT HAVE ANY PERSONAL INTEREST WHICH MIGHT CONFLICT WITH OR APPEAR TO CONFLICT WITH THE INTEREST OF CENTURA OR WHICH MIGHT INFLUENCE THEIR JUDGMENT OR ACTIONS IN PERFORMING THEIR DUTIES. 1.1.1 IN CONNECTION WITH AN ACTUAL OR POSSIBLE TRANSACTION OR ARRANGEMENT INVOLVING CENTURA, ANY BOARD MEMBER, CORPORATE OFFICER, OR KEY EMPLOYEE WHO HAS A DIRECT OR INDIRECT FINANCIAL INTEREST MUST DISCLOSE AND BE GIVEN THE OPPORTUNITY TO SHARE ALL MATERIAL FACTS WITH THE BOARD CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. 1.1.2 BOARD MEMBERS, CORPORATE OFFICERS, AND KEY EMPLOYEES ARE ALSO REQUIRED TO DISCLOSE ANY POSSIBLE CONFLICTS ON AN ANNUAL BASIS THROUGH THE CONFLICT OF INTEREST QUESTIONNAIRE. 2. PROCEDURE FOR DISCLOSING AND REVIEWING TRANSACTION OR ARRANGEMENT CONFLICT OF INTERESTS: 2.1 BOARD MEMBERS, CORPORATE OFFICERS, AND KEY EMPLOYEES THAT HAVE A FINANCIAL INTEREST IN ANY ACTUAL OR POSSIBLE TRANSACTION INVOLVING CENTURA ARE REQUIRED TO DISCLOSE THE FINANCIAL INTEREST. 2.1.1 IN ORDER TO DETERMINE IF A CONFLICT OF INTEREST EXISTS, THE INDIVIDUAL WHO IS CONSIDERED TO HAVE A FINANCIAL INTEREST MAY MAKE A PRESENTATION AT THE BOARD OR BOARD COMMITTEE MEETING. AFTER SUCH PRESENTATION, THE INDIVIDUAL SHALL LEAVE THE MEETING FOR DISCUSSION AND A VOTE ON THE ISSUE. 2.1.2 AFTER EXERCISING DUE DILLEGENCE, THE BOARD OR BOARD COMMITTEE SHALL DETERMINE WHETHER CENTURA CAN OBTAIN A MORE ADVANTAGEOUS TRANSACTION WITH REASONABLE EFFORTS FROM ANOTHER PERSON OR ENTITY. IF A MORE ADVANTAGEOUS TRANSACTION IS NOT REASONABLY ATTAINABLE, THE BOARD OR BOARD COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED MEMBERS WHETHER THE TRANSACTION IS IN CENTURA'S BEST INTEREST AND IS FAIR. 3. PROCEDURE FOR DISCLOSING AND REVIEWING OTHER CONFLICT OF INTERESTS: 3.1 BOARD MEMBERS, CORPORATE OFFICERS, AND KEY EMPLOYEES SHALL ALSO DISCLOSE IN ADVANCE TO CENTURA LEADERS ANY NON-TRANSACTIONAL ACTIONS OR RELATIONSHIPS THAT HAVE THE POTENTIAL TO CREATE A CONFLICT OF INTEREST. 3.1.1 THE BOARD OR BOARD COMMITTEE SHALL CAREFULLY REVIEW AND SCRUTINIZE ANY CONFLICT OF INTEREST. BY A MAJORITY VOTE OF THE DISINTERESTED MEMBERS, THE BOARD SHALL TAKE WHATEVER ACTION IS DEEMED APPROPRIATE WITH RESPECT TO THE BOARD MEMBER, CORPORATE OFFICER, OR KEY EMPLOYEE UNDER THE CIRCUMSTANCES, INCLUDING POSSIBLE CORRECTIVE ACTION, IN ORDER TO BEST PROTECT THE INTERESTS OF CENTURA. 3.1.2 ON AN ANNUAL BASIS, BOARD MEMBERS, CORPORATE OFFICERS, AND KEY EMPLOYEES WILL ALSO BE SENT AN EMAIL REQUESTING THEY COMPLETE THE BOARD MEMBER AND CORPORATE OFFICER CONFLICT OF INTEREST QUESTIONNAIRE BY THE SPECIFIED DUE DATE IN THE EMAIL. 3.1.3 THE CORPORATE RESPONSIBILITY DEPARTMENT SHALL NOTIFY THE CHAIRPERSON OF THE BOARD OF ANY POTENTIAL CONFLICTS AND THE CHAIRPERSON, OR DESIGNEE, SHALL PERFORM FURTHER INVESTIGATION AS HE OR SHE DEEMS APPROPRIATE. 4. RECORD OF PROCEEDINGS: 4.1 THE MINUTES OF THE BOARD AND BOARD COMMITTEE SHALL CONTAIN: 4.1.1 THE NAMES OF PERSONS WHO DISCLOSED OR OTHERWISE WERE FOUND TO HAVE A FINANCIAL INTEREST AND THE NATURE OF THE FINANCIAL INTEREST. 4.1.2 THE NAMES OF PERSONS WHO WERE PRESENT FOR DISCUSSIONS AND VOTES RELATING TO ANY FINANCIAL INTEREST, THE CONTENT OF THE DISCUSSION, INCLUDING ANY ALTERNATIVES, AND A RECORD OF THE BOARD OR BOARD COMMITTEE DECISION. 5. VIOLATIONS OF THE CONFLICTS OF INTEREST POLICY: 5.1 IF THE BOARD OR BOARD COMMITTEE HAS REASONABLE CAUSE TO BELIEVE THAT AN INDIVIDUAL HAS FAILED TO DISCLOSE EITHER AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST, OR ALL MATERIAL FACTS SURROUNDING AN ACTUAL OR POSSIBLE CONFLICT, THE INDIVIDUAL WILL BE GIVEN A CHANCE TO EXPLAIN. 5.1.1 AFTER HEARING THE RESPONSE, THE BOARD WILL CONDUCT SUCH ADDITIONAL INVESTIGATION AS APPROPRIATE. IF THE BOARD DETERMINES THAT THE INDIVIDUAL HAS IN FACT FAILED TO DISCLOSE AS REQUIRED BY THE CONFLICT OF INTEREST POLICY, THE BOARD SHALL TAKE APPROPRIATE DISCIPLINARY OR CORRECTIVE ACTION.
Process for Determining Compensation 990 Part VI Line 15a & 15b OUTSIDE CONSULTANTS ARE ENGAGED TO PROVIDE RECOMMENDATIONS TO CENTURA'S COMPENSATION COMMITTEE REGARDING THE COMPENSATION OF FACILITY CEOS AND CENTURA SENIOR EXECUTIVES. THE CONSULTANT'S RECOMMENDATIONS ARE THEN PRESENTED TO, considered by, AND APPROVED BY THE COMPENSATION COMMITTEE. CENTURA'S HUMAN RESOURCES DEPARTMENT PERFORMS ANALYSES OF THE MARKET TO DETERMINE COMPENSATION RANGES FOR THE REMAINDER OF CENTURA ASSOCIATES WHICH ARE REVIEWED AND APPROVED BY CENTURA'S SENIOR LEADERSHIP.
Joint Venture Policy 990 Part VI Line 16 Portercare Adventist Health System HAS NOT FORMALLY ADOPTED A WRITTEN POLICY OR WRITTEN PROCEDURE REGARDING JOINT VENTURES. HOWEVER, ADVENTIST HEALTH SYSTEM'S ("AHS") SYSTEM-WIDE JOINT VENTURE MODEL OPERATING AGREEMENT INCORPORATES CONTROLS OVER THE VENTURE SUFFICIENT TO ENSURE THAT (1) THE EXEMPT ORGANIZATIONS AT ALL TIMES RETAINS CONTROL OVER THE VENTURE SUFFICIENT TO ENSURE THAT THE PARTNERSHIP FURTHERS THE EXEMPT PURPOSE OF THE ORGANIZATION; (2) IN ANY PARTNERSHIP IN WHICH THE EXEMPT ORGANIZATION IS A PARTNER, ACHIEVEMENT OF EXEMPT PURPOSES IS PRIORITIZED OVER MAXIMIZATION OF PROFITS FOR THE PARTNERS; (3) THE PARTNERSHIP DOES NOT ENGAGE IN ANY ACTIVITIES THAT WOULD JEOPARDIZE THE EXEMPT ORGANIZATION'S EXEMPTION; (4) RETURNS OF CAPITAL, ALLOCATIONS, AND DISTRIBUTIONS MUST BE MADE IN PROPORTION TO THE PARTNERS' RESPECTIVE OWNERSHIP INTERESTS; AND (5) ALL CONTRACTS ENTERED INTO BY THE PARTNERSHIP WITH THE EXEMPT ORGANIZATION MUST BE AT ARM'S-LENGTH, WITH PRICES SET AT FAIR MARKET VALUE.
Availability of Governing documents, COI Policy, Financial Statements 990, Part VI, Q 19 The organization's governing documents are available on the COLORADO Secretary of State's website. The conflict of interest policy AND FINANCIAL STATEMENTS ARE not available to the public.
Estimate of Hours Devoted to Related Organizations 990 Part VII Three of the four organization's voting board members are employed by Adventist Health System (AHS), a related organization. Compensation reported on Form 990, Part VII was paid to the board members by AHS in exchange for the fulfillment of their duties as full-time, 60 hour-per-week employees. ADDITIONALLY, COMPENSATION PAID TO EMPLOYEES OF CENTURA HEALTH CORPORATION WAS PAID TO THEM IN EXCHANGE FOR THE FULFILLMENT OF THEIR DUTIES AS FULL TIME, 40+ HOUR-PER-WEEK EMPLOYEES.
Form 990 Part XI Line 5 OTHER CHANGES IN NET ASSETS OR FUND BALANCE NET UNREALIZED GAINS/(LOSSES) $29,243 PRIOR PERIOD ADJUSTMENT $503,809 TRANSFERS TO AFFILIATES ($5,545,489) INTERCOMPANY WRITE-OFFS ($11,377,660) OTHER CHANGES $202,822 GAAP ADJUSTMENT $4,646,417 ============================================================== TOTAL ($11,540,860)
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
PORTERCARE ADVENTIST HEALTH SYSTEM
 
Employer identification number

84-0438224
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) Adventist Bolingbrook Hospital

500 Remington Blvd

Bolingbrook,IL60440
65-1219504 		Hospital ops IL   3 AHSS
 
 
 
(2) Adventist Care Centers - Courtland Inc

730 Courtland Street

Orlando,FL32804
20-5774723 		Elderly care FL   9 SHCC
 
 
 
(3) Adventist GlenOaks Hospital

701 Winthrop Avenue

Glendale Heights,IL60139
36-3208390 		Hospital ops IL   3 AHSS
 
 
 
(4) Adventist Health Mid-America Inc

9100 W 74th Street

Shawnee Mission,KS66204
52-1347407 		Health care KS   11a AHSS
 
 
 
(5) Adventist Health Partners Inc

1000 Remington Blvd Ste 200

Bolingbrook,IL60440
36-4138353 		Out-patient IL   3 AHSMM
 
 
 
(6) Adventist Health System Affiliated Benef

111 N Orlando Avenue

Winter Park,FL32789
26-6422966 		Health care FL   11a AHSSHC
 
 
 
(7) Adventist Health System Sunbelt Healthca

111 N Orlando Avenue

Winter Park,FL32789
59-2170012 		Mngmt serv FL   11a NA
 
 
 
(8) Adventist Health SystemGeorgia Inc

1035 Red Bud Road

Calhoun,GA30701
58-1425000 		Hospital ops GA   3 AHSSHC
 
 
 
(9) Adventist Health SystemSunbelt Inc

111 N Orlando Avenue

Winter Park,FL32789
59-1479658 		Hospital ops FL   3 AHSSHC
 
 
 
(10) Adventist Health SystemTexas Inc

602 Courtland Street

Orlando,FL32804
74-2578952 		Inactive TX   9 AHSSHC
 
 
 
(11) Adventist Hinsdale Hospital

120 North Oak Street

Hinsdale,IL60521
36-2276984 		Hospital ops IL   3 AHSS
 
 
 
(12) AHS Midwest Management Inc

1000 Remington Blvd Ste 200

Bolingbrook,IL60440
36-3354567 		Health clinic IL   11a AHSS
 
 
 
(13) AHSCentral Texas Inc

1301 Wonder World Drive

San Marcos,TX78666
74-2621825 		Office space TX   11c AHSSHC
 
 
 
(14) Apopka Health Care Properties Inc

305 E Oak Street

Apopka,FL32703
51-0605694 		lease GA   11c SHCC
 
 
 
(15) Battle Creek Adventist Hospital

1000 Remington Blvd Ste 200

Bolingbrook,IL60440
38-1359189 		Hospital ops MI   3 AHSS
 
 
 
(16) Bert Fish Medical Center Inc

401 Palmetto Street

New Smyrna Beach,FL32168
36-2276984 		HOSPITAL OPS FL   9 AHSSHC
 
 
 
(17) Bolingbrook Hospital Foundation

1000 Remington Blvd Ste 200

Bolingbrook,IL60440
90-0494445 		Fundraising IL   7 MHF
 
 
 
(18) Bradford Heights Health & Rehab Center

950 Highpoint Drive

Hopkinsville,KY42240
20-5782342 		Elderly care KY   9 SHCC
 
 
 
(19) Burleson Nursing & Rehab Center Inc

301 Huguley Blvd

Burleson,TX76028
20-5782243 		Elderly care TX   9 SHCC
 
 
 
(20) Caldwell Health Care Properties Inc

1333 West Main

Princeton,KY42445
51-0605680 		Lease GA   11c SHCC
 
 
 
(21) Central Texas Medical Center Foundation

1301 Wonder World Drive

San Marcos,TX78666
74-2259907 		Fundraising TX   7 AHSS
 
 
 
(22) Chickasaw Health Care Properties Inc

250 S Chickasaw Trail

Orlando,FL32825
51-0605681 		Lease GA   11c SHCC
 
 
 
(23) Chippewa Valley Hospital & Oakview Care

1220 Third Avenue West

Durand,WI54736
39-1365168 		Hospital ops WI   3 AHSS
 
 
 
(24) Cobb Medical Associates LLC

3949 South Cobb Drive SE

Smyrna,GA30080
58-2617089 		Physi Practi GA   3 EA
 
 
 
(25) Courtland Health Care Properties Inc

730 Courtland Street

Orlando,FL32804
51-0605682 		Lease GA   11c SHCC
 
 
 
(26) Creekwood Place Nursing & Rehab Center

683 E Third Street

Russellville,KY42276
20-5782260 		Elderly care KY   9 SHCC
 
 
 
(27) Dairy Road Health Care Properties Inc

7350 Dairy Road

Zephyrhills,FL33540
51-0605684 		lease GA   11c SHCC
 
 
 
(28) East Orlando Health & Rehab Center Inc

250 S Chickasaw Trail

Orlando,FL32825
20-5774748 		Elderly care FL   9 SHCC
 
 
 
(29) Emory-Adventist Inc

3949 South Cobb Drive

Smyrna,GA30080
58-2171011 		Hospital ops GA   3 AHSS
 
 
 
(30) Fletcher Hospital Inc

100 Hospital Drive

Hendersonville,NC28792
56-0543246 		Hospital ops NC   3 AHSSHC
 
 
 
(31) FLNC Inc

3355 E Semoran Blvd

Apopka,FL32703
20-5774761 		Elderly care FL   9 SHCC
 
 
 
(32) Florida Hospital College of Health Scien

671 Lake Winyah Drive

Orlando,FL32803
59-3069793 		School ops FL   2 AHSS
 
 
 
(33) Florida Hospital DeLand Auxiliary Inc

701 West Plymouth Avenue

Deland,FL32720
59-3425543 		Support serv FL   11c MHWV
 
 
 
(34) Florida Hospital Waterman Inc

1000 Waterman Way

Tavares,FL32778
59-3140669 		Hospital ops FL   3 AHSSHC
 
 
 
(35) Florida Hospital Wesley Chapel Inc

2528 Bruce B Downs Blvd CR 581 S

Wesley Chapel,FL33543
20-3965753 		Inactive FL   11c AHSSHC
 
 
 
(36) Florida Hospital Zephyrhills Inc

7050 Gall Blvd

Zephyrhills,FL33541
59-2108057 		Hospital ops FL   3 AHSS
 
 
 
(37) Florida Physicians Medical Group Inc

900 Winderley Place

Maitland,FL32751
59-3214635 		Physi Practi FL   3 AHSS
 
 
 
(38) Foundation for Shawnee Mission Medical C

9100 W 74TH ST

Shawnee Mission,KS66204
48-0868859 		Fundraising KS   11a SMMC
 
 
 
(39) GlenOaks Hospital Foundation

701 Winthrop Avenue

Glendale Heights,IL60139
36-3926044 		Physi Practi IL   7 MHF
 
 
 
(40) Hays Memorial Hospital Association of Se

1301 Wonder World Drive

San Marcos,TX78667
74-1362785 		Emp Leasing TX   11b AHSSHC
 
 
 
(41) Helen Ellis Memorial Hospital Auxiliary

1395 S Pinellas Ave

Tarpon Springs,FL34689
59-2106043 		Fundraising FL   11a TSHF
 
 
 
(42) Hinsdale Hospital Foundation

7 Salt Creek Lane Suite 203

Hinsdale,IL60521
52-1466387 		Fundraising IL   7 MHF
 
 
 
(43) In-Motion Rehab Inc

602 Courtland Street Ste 200

Orlando,FL32804
20-8023411 		Therapy Serv KS   11b SHCC
 
 
 
(44) Jellico Community Hospital Inc

188 Hospital Lane

Jellico,TN37762
62-0924706 		Hospital ops TN   3 AHSSHC
 
 
 
(45) La Grange Memorial Hospital Foundation

5101 S Willow Springs Rd

La Grange,IL60525
30-0247776 		Fundraising IL   7 MHF
 
 
 
(46) Memorial Health Systems Foundation Inc

770 West Granada Blvd

Ormond Beach,FL32174
31-1771522 		Fundraising FL   7 MHS
 
 
 
(47) Memorial Health Systems Inc

301 Memorial Medical Parkway

Daytona Beach,FL32117
59-0973502 		Hospital ops FL   3 AHSS
 
 
 
(48) Memorial Hospital - Flagler Inc

60 Memorial Medical Parkway

Palm Coast,FL32164
59-2951990 		Hospital ops FL   3 MHS
 
 
 
(49) Memorial Hospital - West Volusia Inc

701 West Plymouth Avenue

Deland,FL32720
59-3256803 		Hospital ops FL   3 MHS
 
 
 
(50) Memorial Hospital Inc

210 Marie Langdon Drive

Manchester,KY40962
61-0594620 		Hospital ops KY   3 AHSSHC
 
 
 
(51) Merriam Health Care Properties Inc

9700 West 62nd Street

Merriam,KS66203
36-4595806 		Lease KS   11c SHCC
 
 
 
(52) Metroplex Adventist Hospital Inc

2201 S Clear Creek Road

Killeen,TX76549
74-2225672 		Hospital ops TX   3 AHSSHC
 
 
 
(53) Metroplex Clinic Physicians Inc

2201 S Clear Creek Road

Killeen,TX76549
11-3762050 		Physi serv TX   3 MAH
 
 
 
(54) Midwest Health Foundation

120 North Oak Street

Hinsdale,IL60521
35-2230515 		Support serv IL   11b NA
 
 
 
(55) Mills Health & Rehab Center Inc

500 Beck Lane

Mayfield,KY42066
20-5782320 		Elderly care KY   9 SHCC
 
 
 
(56) Mission Strategies Inc

602 Courtland Street Ste 200

Orlando,FL32804
20-5982365 		Support serv KS   11b SHCC
 
 
 
(57) Missouri Adventist Health Inc

9100 W 74th Street

Shawnee Mission,KS66204
43-1224729 		Support serv MO   11d AHMA
 
 
 
(58) North Regional EMS Inc

188 Hospital Lane

Jellico,TN37762
26-2653616 		EMS Serv TN   9 JCH
 
 
 
(59) Ormond Beach Memorial Hospital Auxiliary

301 Memorial Medical Parkway

Daytona Beach,FL32117
59-1721962 		Support serv FL   11c MHS
 
 
 
(60) Overland Park Nursing & Rehab Center In

6501 West 75th Street

Overland Park,KS66204
20-5774821 		Elderly care KS   9 SHCC
 
 
 
(61) Paragon Health Care Properties Inc

950 Highpoint Drive

Hopkinsville,KY42240
51-0605686 		lease GA   11c SHCC
 
 
 
(62) Portercare Adventist Health System

2525 S Downing Street

Denver,CO80210
84-0438224 		Hospital ops CO   3 AHSSHC
 
 
 
(63) Portland Nursing & Rehab Center Inc

215 Highland Circle Drive

Portland,TN37148
20-5774842 		Elderly care TN   9 SHCC
 
 
 
(64) Princeton Health & Rehab Center Inc

1333 West Main

Princeton,KY42445
20-5782272 		Elderly care KY   9 SHCC
 
 
 
(65) Princeton Professional Services Inc

601 E Rollins Street

Orlando,FL32803
59-1191045 		healthcare FL   9 AHSSHC
 
 
 
(66) Quality Circle for Healthcare Inc

111 N Orlando Avenue

Winter Park,FL32789
26-3789368 		healthcare FL   11c AHSSHC
 
 
 
(67) Resource Personnel Inc

602 Courtland Street Ste 200

Orlando,FL32804
20-8040875 		admn supp FL   11b SHCC
 
 
 
(68) Rocky Mountain Adventist Healthcare Foun

2525 South Downing Street

Denver,CO80210
84-0745018 		Fundraising CO   7 PAHS
 
 
 
(69) Rollins Bedford Corporation

602 Courtland Street Ste 200

Orlando,FL32804
37-0908840 		Inactive FL   11b SHCC
 
 
 
(70) Russellville Health Care Properties Inc

683 East Third Street

Russellville,KY42276
51-0605691 		Lease GA   11c SHCC
 
 
 
(71) San Marcos Health Care Properties Inc

1900 Medical Parkway

San Marcos,TX78666
51-0605693 		Lease GA   11c SHCC
 
 
 
(72) San Marcos Nursing & Rehab Center Inc

1900 Medical Parkway

San Marcos,TX78666
20-5782224 		Elderly care TX   9 SHCC
 
 
 
(73) Shawnee Mission Health Care Inc

6501 West 75th Street

Overland Park,KS66204
48-0952508 		lease KS   11c SHCC
 
 
 
(74) Shawnee Mission Medical Center Inc

9100 W 74th Street

Shawnee Mission,KS66204
48-0637331 		Hospital ops KS   3 AHMA
 
 
 
(75) South Central Nursing Homes Properties

111 N Orlando Avenue

Winter Park,FL32789
59-3686109 		Mgmt Supp GA   11d SC
 
 
 
(76) South Central Nursing Homes Inc

602 Courtland Street

Orlando,FL32804
61-1242373 		Mgmt Supp KY   11d SC
 
 
 
(77) South Central Properties III Inc

111 N Orlando Avenue

Winter Park,FL32789
59-3692860 		Real Estate GA   N/A SCNHP
 
 
 
(78) South Central Properties IV Inc

111 N Orlando Avenue

Winter Park,FL32789
59-3692862 		Real Estate GA   N/A SCNHP
 
 
 
(79) South Central Properties VI Inc

111 N Orlando Avenue

Winter Park,FL32789
59-3692857 		Real Estate GA   N/A SCNHP
 
 
 
(80) South Central Properties Inc

111 N Orlando Avenue

Winter Park,FL32789
59-3651692 		Real Estate GA   N/A SCNHP
 
 
 
(81) South Central Inc

602 Courtland Street

Orlando,FL32804
59-3689740 		Mgmt Supp GA   11c NA
 
 
 
(82) South Pasco Health Care Properties Inc

38250 A Avenue

Zephyrhills,FL33542
51-0605679 		Lease GA   11c SHCC
 
 
 
(83) Southwest Volusia Health Services Inc

1055 Saxon Blvd

Orange City,FL32763
59-3281591 		Med Off Bldg FL   11a SVHC
 
 
 
(84) Southwest Volusia Healthcare Corporation

1055 Saxon Blvd

Orange City,FL32763
59-3149293 		Hospital ops FL   3 AHSS
 
 
 
(85) Specialty Physicians of Central Texas I

1301 Wonder World Drive

San Marcos,TX78666
20-8814408 		Physi serv TX   3 AHSS
 
 
 
(86) Spring View Health & Rehab Center Inc

718 Goodwin Lane

Leitchfield,KY42754
20-5782288 		Elderly care KY   9 SHCC
 
 
 
(87) Sunbelt Health & Rehab Center - Apopka

305 East Oak Street

Apopka,FL32703
20-5774856 		Elderly care FL   9 SHCC
 
 
 
(88) Sunbelt Health Care Centers Inc

602 Courtland Street Ste 200

Orlando,FL32804
58-1473135 		Mgmt Serv TN   11b AHSSHC
 
 
 
(89) SunSystem Development Corporation

111 N Orlando Avenue

Winter Park,FL32789
59-2219301 		Fundraising FL   7 AHSSHC
 
 
 
(90) Tarrant County Health Care Properties I

301 Huguley Blvd

Burleson,TX76028
51-0605677 		lease GA   11c SHCC
 
 
 
(91) Taylor Creek Health Care Properties Inc

718 Goodwin Lane

Leitchfield,KY42754
51-0605678 		lease GA   11c SHCC
 
 
 
(92) The Volunteer Auxiliary of Florida Hospi

60 Memorial Medical Parkway

Palm Coast,FL32164
59-2486582 		Support serv FL   11c MHF
 
 
 
(93) Trinity Nursing & Rehab Center Inc

9700 West 62nd Street

Merriam,KS66203
20-5774890 		Elderly care KS   9 SHCC
 
 
 
(94) West Kentucky Health Care Properties In

500 Beck Lane

Mayfield,KY42066
51-0605676 		lease GA   11c SHCC
 
 
 
(95) Zephyr Haven Health & Rehab Center Inc

38250 A Avenue

Zephyrhills,FL33542
20-5774930 		Elderly care FL   9 SHCC
 
 
 
(96) Zephyrhills Health & Rehab Center Inc

7350 Dairy Road

Zephyrhills,FL33540
20-5774967 		Elderly care FL   9 SHCC
 
 
 
(97) Helen Ellis Memorial Hospital Foundation

1395 S Pinellas Ave

Tarpon Springs,FL34689
59-3690149 		Fundraising FL   11a TSHF
 
 
 
(98) Tarpon Springs Hospital Foundation

1395 S Pinellas Ave

Tarpon Springs,FL34689
59-0898901 		Hospital Ops FL   3 UCH
 
 
 
(99) University Community Hospital Auxiliary

3100 E Fletcher Ave

Tampa,FL33613
23-7011345 		Support Svs FL   11c UCH
 
 
 
(100) University Community Hospital Foundation

3100 E Fletcher Ave

Tampa,FL33613
59-2554889 		Fundraising FL   11a UCH
 
 
 
(101) University Community Hospital Spec Care

3100 E Fletcher Ave

Tampa,FL33613
59-3231322 		Inactive FL   11 UCH
 
 
 
(102) University Community Hospital Inc

3100 E Fletcher Ave

Tampa,FL33613
59-1113901 		Hospital Ops FL   3 AHSSHC
 
 
 
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) Appalachian Therapy Services LLC

100 Hospital Drive
Hendersonville,NC28792
20-2463851 		Therapy staff NC FH INC
  		                 
(2) Clear Creek MOB Ltd

2201 S Clear Creek Rd
Killeen,TX76549
74-2609195 		Real Estate TX CC MOB INC
  		                 
(3) Florida Hospital DMERT LLC

2450 Maitland Center Pkwy Ste 200
Maitland,FL32751
20-2392253 		Med Equipment FL PPS Inc
  		                 
(4) Florida Hospital Home Infusion

2450 Maitland Center Pkwy Ste 200
Maitland,FL32751
59-3142824 		home infusion FL PPS FHW Inc
  		                 
(5) San Marcos MRI LP

1330 Wonder World Drive Ste 202
San Marcos,TX78666
77-0597972 		Imaging & tes TX AHSSunbelt
  		                 
(6) Shawnee Mission Open MRI LLC

9100 W 74th Street Box 2923
Shawnee Misison,KS66201
27-0011796 		Imaging & tes KS SMMC Inc
  		                 
(7) Shawnee Mission Pain Center LLC

9100 W 74th Street
Shawnee Misison,KS66204
20-8642766 		Pain mgt serv KS SMMC Inc
  		                 
(8) Shawnee Mission Prairie Star Surgery Cen

23401 Prairie Star Parkway
Lenexa,KS66227
36-4634843 		Surgical cent KS SMMC Inc
  		                 
(9) Shawnee Mission Surgery Center LLC

PO Box 2923
Shawnee Misison,KS66201
48-1243914 		Surgical serv KS SMMC Inc
  		                 
(10) Skyland MRI LLC

100 Hospital Drive
Hendersonville,NC28792
04-3646559 		Imaging & tes NC FH Inc
  		                 
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) Adventist Health Sys Sunbelt Healthcare
111 N Orlando Avenue
Winter Park,FL32789
58-1318939 		Admin of SIBP FL AHSSHC
  		TRUST      
(2) AHS Services Inc
11801 South Freeway
Fort Worth,TX76028
75-2049583 		Med Equip TX AHSS Inc
  		C CORP      
(3) Apopka Medical Plaza Condominium Associa
601 East Rollins Street
Orlando,FL32803
59-3000857 		Condo Assoc FL AHSS Inc
  		C CORP      
(4) Altamonte Medical Plaza Condominium Asso
601 East Rollins Street
Orlando,FL32803
59-2855792 		Condo Assoc FL AHSS Inc
  		C CORP      
(5) Arapahoe Medical Building I Inc (630
2525 S Downing Street
Denver,CO80210
84-1574506 		RE Leasing CO PAHS
  		C CORP 12,511 320,787 100.000 %
(6) Arapahoe Medical Building II Inc (630
2525 S Downing Street
Denver,CO80210
84-1574507 		RE Leasing CO PAHS
  		C CORP 12,511 268,314 100.000 %
(7) CC MOB Inc
2201 S Clear Creek Road
Killeen,TX76549
74-2616875 		RE Leasing TX MAH Inc
  		C CORP      
(8) Central Texas Medical Associates
1301 Wonder World Drive
San Marcos,TX78666
74-2729873 		Physician cli TX AHSS Inc
  		C CORP      
(9) Central Texas Provider's Network
1301 Wonder World Drive
San Marcos,TX78666
74-2827652 		Physi Hosp Or TX AHSS Inc
  		C CORP      
(10) Florida Hospital Flagler Medical Office
60 Memorial Medical Parkway
Palm Coast,FL32164
26-2158309 		Condo Assoc FL MHF Inc
  		C CORP      
(11) Florida Hospital Healthcare System Inc
602 Courtland Street
Orlando,FL32804
59-3215680 		PHO/TPA FL AHSS Inc
  		C CORP      
(12) Florida Medical Plaza Condo Association
601 East Rollins Street
Orlando,FL32803
59-2855791 		Condo Assoc FL AHSS Inc
  		C CORP      
(13) Florida Memorial Health Network Inc
770 W Granada Blvd Ste 317
Ormond Beach,FL32174
59-3403558 		Physi Hosp Or FL MHS Inc
  		C CORP      
(14) Helen Ellis Memorial Hospital Real Estat
1395 S Pinellas Ave
Tarpon Springs,FL34689
59-3375731 		RE Rental FL TS Hosp Foundtn
  		C CORP      
(15) Harvard Park East Inc
2525 S Downing Street
Denver,CO80210
84-1574365 		RE Leasing CO PAHS
  		C CORP 12,318 10,272 100.000 %
(16) Kissimmee Multispecialty Clinic
201 Hilda Street Suite 30
Kissimmee,FL34741
59-3539564 		Condo Assoc FL AHSS Inc
  		C CORP      
(17) Huguley Alliance Foundation
11801 South Freeway
Fort Worth,TX76115
75-2642209 		Inactive TX AHSS Inc
  		C CORP      
(18) Huguley Medical Associates Inc
11801 South Freeway
Burleson,TX76028
75-2547668 		Physician cli TX AHSS Inc
  		C CORP      
(19) Metroplex Adventist Hospital CRNA
2201 S Clear Creek Road
Killeen,TX76549
26-0760794 		Support Hosp TX MAH Inc
  		C CORP      
(20) Midwest Management Services Inc
9100 West 74th Street
Shawnee Mission,KS66204
48-0901551 		RE Rental KS AHMA Inc
  		C CORP      
(21) North American Health Services Inc & S
111 N Orlando Avenue
Winter Park,FL32789
62-1041820 		Lessor co. TN AHSSHC
  		C CORP      
(22) Ormond Professional Condo Association (4
770 W Granada Blvd Ste 101
Ormond Beach,FL32174
59-2694434 		Condo Assoc FL MHS Inc
  		C CORP      
(23) Park Ridge Property Owner's Association
1 Park Place Naples Road
Fletcher,NC28732
03-0380531 		Condo Assoc NC FH Inc
  		C CORP      
(24) Porter Affiliated Hlth Services Inc db
2525 S Downing Street
Denver,CO80210
84-0956175 		Healthcare CO PAHS
  		C CORP     100.000 %
(25) Porter Medical Plaza Inc (630 Year En
2525 S Downing Street
Denver,CO80210
84-1574369 		RE Leasing CO PAHS
  		C CORP 12,039 23,185 100.000 %
(26) San Marcos Regional MRI Inc
1301 Wonder World Drive
San Marcos,TX78666
77-0597968 		Holding co TX AHSS Inc
  		C CORP      
(27) The Garden Retirement Community Inc
602 Courtland Street Ste 200
Orlando,FL32804
59-3414055 		RE Rental FL SHCC Inc
  		C CORP      
(28) Reflections Commercial Condo Assoc
875 Sterthaus Ave
Ormond Beach,FL32174
59-3519055 		Condo Assoc FL MHS Inc
  		C Corp      
(29) Southeast Volusia Medical Services Inc
401 Palmetto St
New Smyrna Beach,FL32168
59-3287185 		Inactive FL BFMC Inc
  		C Corp      
(30) University Community Health Insurance Co
C/O AON Ins Managers PO BOX 69GT
Grand Cayman    
CJ
Captive Insurance CJ UCH
  		C Corp      
(31) UCH Services Inc
3100 East Fletcher Ave
Tampa,FL33613
59-3508454 		Managment Co FL UCH
  		C Corp      
(32) West Coat Medical Group Inc
1395 S Pinellas Ave
Tarpon Springs,FL34689
59-3537305 		Physician Clinics FL TSH Foundation
  		C Corp      
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
Yes
 
c Gift, grant, or capital contribution from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Performance of services or membership or fundraising solicitations for other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations by other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Sharing of facilities, equipment, mailing lists, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of paid employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Reimbursement paid to other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid by other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Other transfer of cash or property to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
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) RM Adventist Healthcare Foundation

 c 1,330,813  
(2) RM Adventist Healthcare Foundation

 o 1,539,986  
(3) RM Adventist Healthcare Foundation

 b 654,389  
(4) Adventist Health System Sunbelt HC Corp

 q 5,339,711  
(5) Adventist Health System Sunbelt HC Corp

 L 5,176,456  
(6) Adventist Health System Sunbelt HC Corp

 o 2,881,085  
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: