TY 2011 Form 990

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) MARK WARGO MD SECRETARY/MBR. B.O.D.	1.0	X	X		0	0	0
(2) STEVEN BROADUS CHAIRPERSON, B.O.D.	1.0	X	X		0	0	0
(3) WILLIAM E EHLING MD MBR. BOARD OF DIRECTORS	1.0	X			0	0	0
(4) PATRICK GIBBONS MBR. BOARD OF DIRECTORS	1.0	X			0	0	0
(5) SR MARYbeth CULNAN OSF MBR. BOARD OF DIRECTORS	1.0	X			0	0	0
(6) SHERYL KUZMA MBR. BOARD OF DIRECTORS	1.0	X			0	0	0
(7) JIMMIE LANSFORD secretary, B.O.D.	1.0	X	X		0	0	0
(8) EVERETT J SOLON vice chair, B.O.D.	1.0	X	X		0	0	0
(9) JOANNE FENTON PRESIDENT/CEO	40.0	X	X		0	211,185	36,241
(10) Sr Maureen Fagan OSF MBR. Board of Directors	1.0	X			0	0	0
(11) William Franklin Mbr. board of directors	1.0	X			0	0	0
(12) ANN CARR TREASURER	.25		X		0	225,813	215,561
(13) KEVIN KAST Division CEO	1.0		X		0	403,490	180,530
(14) KAREN CLARK CHIEF FINANCIAL OFFICER	40.0		X		154,117	0	134,821
(15) KIMBERLY LANDERS DIR. PAT. CARE SERVICES	40.0		X		132,217	0	111,422
(16) PARVEEN CHAND CHIEF OPERATING OFFICER	40.0		X		154,789	0	19,349
(17) CATHERINE CHAPMAN Director Pharmacy	40.0			X	123,913	0	44,999

(A) Name and business address	(B) Description of services	(C) Compensation
Emergency Medical Experts LTD 1401 South Prairie Avenue CHICAGO,IL60605	Emergency MD	1,652,889
Anesthesia Pain Services LLC 1800 E Lake Shore Dr DECATUR,IL62521	Anesthesia MD	1,235,228
Immediate Care Experts LLC 1401 South Prairie Avenue CHICAGO,IL60605	Immediate Care MD	1,115,587
TGC LLC PO Box 130 HIGHLAND,MD20777	Consulting	184,689
Executive Health Resources Inc PO Box 822688 PHILADELPHIA,PA191822688	Compliance Services	160,133
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 43

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.	(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to governments and organizations in the United States. See Part IV, line 21	0
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	0
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16	0
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	449,375	0	449,375	0
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	0
7	Other salaries and wages	16,600,787	12,852,694	3,748,093	0
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	1,269,576	982,934	286,642	0
9	Other employee benefits .......	3,888,402	3,010,486	877,916	0
10	Payroll taxes ...........	1,280,746	991,582	289,164	0
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	281,280	0	281,280	0
c	Accounting ...........	0	0	0	0
d	Lobbying ...........	0
e	Professional fundraising. See Part IV, line 17..	0
f	Investment management fees ......	0
g	Other ..........	10,667,291	7,718,604	2,948,687	0
12	Advertising and promotion ....	245,109	47,727	197,382	0
13	Office expenses .......	6,987,257	6,354,234	633,023	0
14	Information technology ......	290,373	78,247	212,126	0
15	Royalties ..	0
16	Occupancy ...........	1,142,101	1,047,470	94,631	0
17	Travel ............	75,103	61,365	13,738	0
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	40,276	0	40,276	0
19	Conferences, conventions, and meetings ....	241,131	0	241,131	0
20	Interest ...........	0
21	Payments to affiliates .......	3,477,600	0	3,477,600	0
22	Depreciation, depletion, and amortization .....	4,524,318	3,988,585	535,733	0
23	Insurance ..............	379,778	9,039	370,739	0
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)
a	BAD DEBT EXPENSE	1,678,013	1,678,013	0
b	MISCELLANEOUS	1,158,985	191,496	967,489
c	REFERRAL LAB	662,687	662,687	0
d	DUES AND SUBSCRIPTIONS	110,940	1,103	109,837
e
f	All other expenses
25	Total functional expenses. Add lines 1 through 24f	55,451,128	39,676,266	15,774,862	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet
	1	Cashnon-interest-bearing ..........	1,424	1	1,349
2	Savings and temporary cash investments .......	499,962	2	-421,339
3	Pledges and grants receivable, net .........	0	3	0
4	Accounts receivable, net .........	7,544,058	4	8,015,880
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........	0	5	0
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........	0	6	0
7	Notes and loans receivable, net .............	0	7	0
8	Inventories for sale or use ..............	1,440,093	8	931,503
9	Prepaid expenses and deferred charges ............	518,462	9	477,871
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	79,772,850
b	Less: accumulated depreciation. .....	10b	40,233,458	42,792,432	10c	39,539,392
11	Investments—publicly traded securities ..........	28,971,877	11	26,661,215
12	Investments—other securities. See Part IV, line 11 ......	0	12	0
13	Investments—program-related. See Part IV, line 11 ..	76,000	13	43,791
14	Intangible assets .........	0	14	0
15	Other assets. See Part IV, line 11 ...........	7,217,918	15	7,021,048
16	Total assets. Add lines 1 through 15 (must equal line 34)...	89,062,226	16	82,270,710
	17	Accounts payable and accrued expenses .	10,793,726	17	8,587,515
18	Grants payable ..........	0	18	0
19	Deferred revenue ..........	0	19	0
20	Tax-exempt bond liabilities ..........	12,917,783	20	12,622,783
21	Escrow or custodial account liability. Complete Part IV of Schedule D..	0	21	0
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........	0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	0	23	0
24	Unsecured notes and loans payable to unrelated third parties ....	0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.....	11,405,489	25	17,963,387
26	Total liabilities. Add lines 17 through 25.....	35,116,998	26	39,173,685
		Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....	51,726,068	27	40,831,614
28	Temporarily restricted net assets .....	2,152,138	28	2,184,308
29	Permanently restricted net assets .....	67,022	29	81,103
	Organizations that do not follow SFAS 117, check here 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 .....	53,945,228	33	43,097,025
34	Total liabilities and net assets/fund balances .....	89,062,226	34	82,270,710

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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.

Attach to Form 990 or Form 990-EZ. right arrow

See separate instructions.

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization

ST MARY'S HOSPITAL STREATOR HOSPITAL SISTERS
OF THE 3RD ORDER ST FRANCIS

Employer identification number

36-2169181

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.)

A church, convention of churches, or association of churches. section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in

section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

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.)

An organization organized and operated exclusively to test for public safety. Seesection 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.

Type I

Type II

Type III - Functionally integrated

Type III - Other

By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).

If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box ..................................................

Since August 17, 2006, has the organization accepted any gift or contribution from any of the
following persons?

(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)

Yes

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)

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(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?
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of support?


Total

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2011

Page 2

Part II

Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3..
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public Support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year(or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11	Total support (Add lines 7 through 10).

Gross receipts from related activities, etc. (See instructions.) ..................

First Five Years If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.......................................... right arrow

Section C. Computation of Public Support Percentage

Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f)) .........

Public Support Percentage for 2009 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2011. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ...................... right arrow

33 1/3% support test—2010. If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2011. If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization .................................................. right arrow

10%-facts-and-circumstances test—2010. If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly
supported organization .............................................. right arrow

Private Foundation If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions ................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2011

Page 3

Part III

Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513..
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public Support (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13	Total support (Add lines 9, 10c, 11 and 12.).

Section C. Computation of Public Support Percentage

Public Support Percentage for 2011 (line 8 column (f) divided by line 13 column (f)) .........

Public support percentage from 2010 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f)) ......

Investment income percentage from 2010 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2011. If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .......... right arrow

33 1/3% support tests—2010. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private Foundation If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions ..... right arrow

Schedule A (Form 990 or 990-EZ) 2011

Page 4

Part IV

Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Explanation

Schedule A (Form 990 or 990-EZ) 2011

Additional Data

Software ID:
Software Version:

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Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

OMB No. 1545-0047

2011

Name of organization

ST MARY'S HOSPITAL STREATOR HOSPITAL SISTERS
OF THE 3RD ORDER ST FRANCIS

Employer identification number

36-2169181

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

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

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II.

Special Rules

For a section 501(c)(3) organization filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), and received from any one contributor, during the year, a contribution of the
greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 for use exclusively for religious, charitable,
scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. Complete Parts I, II, and
III.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ that received from any one contributor,
during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did
not total to more than $1,000. If this box is checked, enter here the total contributions that were received during
the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule
applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more
during the year. ......................... Arrow Bullet

Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2, of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 2

Name of organization ST MARY'S HOSPITAL STREATOR HOSPITAL SISTERS OF THE 3RD ORDER ST FRANCIS
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Part I	Contributors (see Instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	RESTRICTED RESTRICTED RESTRICTED RESTRICTED, RESTRICTED RESTRICTED	$RESTRICTED	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 3

Name of organization ST MARY'S HOSPITAL STREATOR HOSPITAL SISTERS OF THE 3RD ORDER ST FRANCIS
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Part II	Noncash Property (see Instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 4

Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Name of organization
ST MARY'S HOSPITAL STREATOR HOSPITAL SISTERS
OF THE 3RD ORDER ST FRANCIS

Employer identification number

36-2169181

Part III

Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet

$
Use duplicate copies of Part III if additional space is needed

(a) No.
from
Part I

(b)
Purpose of gift

(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

(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

(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

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below.
SchCMd Bullet

Attach to Form 990 or Form 990-EZ. SchCMd Bullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public
Inspection

If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, line 35c (Proxy Tax), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

ST MARY'S HOSPITAL STREATOR HOSPITAL SISTERS
OF THE 3RD ORDER ST FRANCIS

Employer identification number

36-2169181

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures .................................... SchCMd Bullet

Volunteer hours ........................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ......... SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ...... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............

Yes No

Was a correction made? .........................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c) except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ................................... SchCMd Bullet

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

Did the filing organization file Form 1120-POL for this year? ..........................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.

For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2011

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......
b	Total lobbying expenditures to influence a legislative body (direct lobbying) .......
c	Total lobbying expenditures (add lines 1a and 1b) ...................
d	Other exempt purpose expenditures ........................
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ......................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2008	(b) 2009	(c) 2010	(d) 2011	(e) Total

2a	Lobbying non-taxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2011

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? .........................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....

Media advertisements? ....................................

Mailings to members, legislators, or the public? .........................

Publications, or published or broadcast statements? .......................

Grants to other organizations for lobbying purposes? .......................

Direct contact with legislators, their staffs, government officials, or a legislative body? ........

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......

Other activities? ..........................

Yes

17,862

Total. Add lines 1c through 1i ...............................

17,862

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 .................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ................

Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2 are answered “No” OR (b) Part III-A, line 3 is answered “Yes”.

Dues, assessments and similar amounts from members .....................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).

Current year .........................................

Carryover from last year ....................................

Total ...........................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................

Taxable amount of lobbying and political expenditures (see instructions) ..............

Part IV

Supplemental Information

Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, Part II-A; line 5; and Part ll-B, line 1.
Also, complete this part for any additional information.

Identifier	Return Reference	Explanation
DESCRIPTION OF OTHER LOBBYING ACTIVITIES	Schedule C, Part II, Question 1i	St. Mary's Hospital ("The Hospital") is a member of the Catholic Health Association ("CHA"), The Illinois Hospital Association ("IHA"), The National Association for Home Care and Hospice, and the American Hospital Association ("AHA"). As a member of these organizations, the hospital pays dues and part of these dues are attributable to lobbying fees paid by the organizations. The amount listed above is the amount attributable to the hospital for its dues paid.

Schedule C (Form 990 or 990EZ) 2011

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet

Attach to Form 990. SchDMd Bullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

ST MARY'S HOSPITAL STREATOR HOSPITAL SISTERS
OF THE 3RD ORDER ST FRANCIS

Employer identification number

36-2169181

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 .......

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? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ....................	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

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)? ....................................

Yes No

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.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:

(i)

Revenues included in Form 990, Part VIII, line 1 ........................ SchDMd Bullet

(ii)

Assets included in Form 990, Part X .............................. SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958), relating to these items:

Revenues included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 52283D

Schedule D (Form 990) 2011

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

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):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.

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?........

Yes No

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.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIV and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21? .....................

Yes No

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	Net investment earnings, gains, and losses ...
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the year end balance (line 1g) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

The percentages in lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIV the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment. See Form 990, Part X, line 10.

Description of property		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	1,234,827		1,234,827
b	Buildings ................	51,627,392	20,539,555	31,087,837
c	Leasehold improvements ............	979,977	708,522	271,455
d	Equipment ................	25,685,221	18,985,381	6,699,840
e	Other .................	245,433		245,433
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				39,539,392

Schedule D (Form 990) 2011

Page 3

Part VII

InvestmentsOther Securities. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)		(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
Other








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

Part VIII

InvestmentsProgram Related. See Form 990, Part X, line 13.

(a) Description of investment type		(b) Book value	(c) Method of valuation: Cost or end-of-year market value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1) VALUATION RESERVE				2,585,000
(2) ASSETS WHOSE USE IS LIMITED				2,265,412
(3) WORKERS COMP HS				1,273,092
(4) A/R NON-PATIENT				445,764
(5) A/R FOUNDATION				13,196
(6) PAY ADJUSTMENT				1,965
(7) OTHER ASSETS				436,619


Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				7,021,048

Part X

Other Liabilities. See Form 990, Part X, line 25.

1.(a) Description of Liability		(b) Book value
Federal Income Taxes		0
ACCRUED BENEFIT LIABILITY		16,132,477
RETIRE OBLIGATION - ASBESTOS		1,829,143
A/R SELF INSURANCE		1,767






Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		17,963,387
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).

Schedule D (Form 990) 2011

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 through 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 must 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 must equal Form 990, Part I, line 18.) ......		5

Part XIV

Supplemental Information

Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.

Identifier	Return Reference	Explanation
ASC SUBTOPIC 740-10		The Obligated Group adopted ASC Subtopic 740-10, Accounting for Uncertainty in Income Taxes - an Interpretation of FASB Statement No. 109. ASC Subtopic 740-10 addresses the determination of how tax benefits claimed or expected to be claimed on a tax return should be recorded in the consolidated financial statements. Under ASC Subtopic 740-10, the Obligated Group must recognize the tax benefit from an uncertain tax position only if it is more likely than not that the tax position will be sustained on examination by the taxing authorities, based on the technical merits of the position. The tax benefits recognized in the consolidated financial statements from such a position are measured based on the largest benefit that has a greater than 50% likelihood of being realized upon ultimate settlement. ASC Subtopic 740-10 also provides guidance on derecognition, classification, interest and penalties on income taxes, and accounting in interim periods, and requires increased disclosures. As of June 30, 2012 and 2011, the Obligated Group does not have a liability for unrecognized tax benefits.

Schedule D (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H (Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

ST MARY'S HOSPITAL STREATOR HOSPITAL SISTERS
OF THE 3RD ORDER ST FRANCIS

Employer identification number

36-2169181

Part I

Charity Care and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a....

Yes

If "Yes," was it a written policy? .......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other 135 %

Did the organization use FPG to determine eligibility for providing discounted care? If "Yes," indicate which of the

following was the family income limit for eligibility for discounted care: ............

Yes

200% 250% 300% 350% 400% Other 215 %

If the organization did not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

Yes

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

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount?......

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care?...............

Did the organization prepare a community benefit report during the tax year?...........

Yes

If "Yes," did the organization make it available to the public? ...............

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

	(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a Financial Assistance at cost (from Worksheet 1) ..		2,344	2,788,181	0	2,788,181	5.190 %
b Medicaid (from Worksheet 3, column a) .....		9,545	7,142,036	3,480,057	3,661,979	6.810 %
c Costs of other means-tested government programs (from Worksheet 3, column b) .
dTotal Financial Assistance and Means-Tested Government Programs .....		11,889	9,930,217	3,480,057	6,450,160	12.000 %
Other Benefits e Community health improvement services and community benefit operations (from (Worksheet 4) ....	17	26,183	300,600	3,355	297,245	0.550 %
f Health professions education (from Worksheet 5) ..	3	39	20,044	0	20,044	0.040 %
g Subsidized health services (from Worksheet 6) ..	1	18	45,963	39,080	6,883	0.010 %
h Research (from Worksheet 7)
i Cash and in-kind contributions for community benefit (from Worksheet 8) ....	18	5,447	67,763	0	67,763	0.130 %
jTotal Other Benefits ...	39	31,687	434,370	42,435	391,935	0.730 %
kTotal. Add lines 7d and 7j. ..	39	43,576	10,364,587	3,522,492	6,842,095	12.730 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2011

Schedule H (Form 990) 2011

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense
1	Physical improvements and housing
2	Economic development
3	Community support	3	500	2,533	0	2,533
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy	1	0	662	0	662
8	Workforce development
9	Other
10	Total	4	500	3,195	0	3,195

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense........

598,619

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy .....

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

Enter total revenue received from Medicare (including DSH and IME).....

19,952,471

Enter Medicare allowable costs of care relating to payments on line 5.....

23,902,113

Subtract line 6 from line 5. This is the surplus or (shortfall)........

-3,949,642

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:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

Yes

Part IV

Management Companies and Joint Ventures

(see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership%	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2011

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest) How many hospital facilities did the organization operate during the tax year?1 Name and address		Other (Describe)
1	St Mary's Hospital 111 Spring Street Streator,IL61364	X	X	X

Schedule H (Form 990) 2011

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)

St Mary's Hospital

Name of Hospital Facility:

Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

				Yes	No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1	During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. .....................		1	Yes
	If “Yes,” indicate what the Needs Assessment describes (check all that apply):
	a	A definition of the community served by the hospital facility
	b	Demographics of the community
	c	Existing health care facilities and resources within the community that are available to respond to the health needs of the community
	d	How data was obtained
	e	The health needs of the community
	f	Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
	g	The process for identifying and prioritizing community health needs and services to meet the community health needs
	h	The process for consulting with persons representing the community’s interests
	i	Information gaps that limit the hospital facility’s ability to assess the community’s health needs
	j	Other (describe in Part VI)
2	Indicate the tax year the hospital facility last conducted a Needs Assessment: 20 11
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	Yes
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		No
5	Did the hospital facility make its Needs Assessment widely available to the public? ...........		5	Yes
	If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
	a	Hospital facility’s website
	b	Available upon request from the hospital facility
	c	Other (describe in Part VI)
6	If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
	a	Adoption of an implementation strategy to address the health needs of the hospital facility’s community
	b	Execution of the implementation strategy
	c	Participation in the development of a community-wide community benefit plan
	d	Participation in the execution of a community-wide community benefit plan
	e	Inclusion of a community benefit section in operational plans
	f	Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
	g	Prioritization of health needs in the community
	h	Prioritization of services that the hospital facility will undertake to meet health needs in its community
	i	Other (describe in Part VI)
7	Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. ....		7		No
Financial Assistance Policy
	Did the hospital facility have in place during the tax year a written financial assistance policy that:
8	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?		8	Yes
9	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........		9	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 135.% If "No," explain in Part VI the criteria the hospital facility used.

Schedule H (Form 990) 2011

Page

Part VFacility Information (continued)

				Yes	No
10	Used FPG to determine eligibility for providing discounted care?.................		10	Yes
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 215.% If "No," explain in Part VI the criteria the hospital facility used.
11	Explained the basis for calculating amounts charged to patients?.................		11	Yes
	If “Yes,” indicate the factors used in determining such amounts (check all that apply):
	a	Income level
	b	Asset level
	c	Medical indigency
	d	Insurance status
	e	Uninsured discount
	f	Medicaid/Medicare
	g	State regulation
	h	Other (describe in Part VI)
12	Explained the method for applying for financial assistance?...................		12	Yes
13	Included measures to publicize the policy within the community served by the hospital facility?.......		13	Yes
	If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
	a	The policy was posted on the hospital facility’s web site
	b	The policy was attached to all billing invoices
	c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
	d	The policy was posted in the hospital facility’s admissions offices
	e	The policy was provided, in writing, to patients upon admission to the hospital facility
	f	The policy was available upon request
	g	Other (describe in Part VI)
Billing and Collections
14	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?.......		14	Yes
15	Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments
	e	Other similar actions (describe in Part VI)
16	Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?..........		16		No
	If “Yes,” check all actions in which the hospital facility or a third party engaged:
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments
	e	Other similar actions (describe in Part VI)
17	Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
	a	Notified patients of the financial assistance policy upon admission
	b	Notified patients of the financial assistance policy prior to discharge
	c	Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
	d	Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
	e	Other (describe in Part VI)

Schedule H (Form 990) 2011

Page

Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
				Yes	No
18	Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..........		18	Yes
	If “No,” indicate why:
	a	The hospital facility did not provide care for any emergency medical conditions
	b	The hospital facility’s policy was not in writing
	c	The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
	d	Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19	Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
	a	The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
	b	The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
	c	The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
	d	Other (describe in Part VI)
20	Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?.........		20		No
	If “Yes,” explain in Part VI.
21	Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?...............................		21		No
	If “Yes,” explain in Part VI.

Schedule H (Form 990) 2011

Page

Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2011

Page

Part VI

Supplemental Information

Complete this part to provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 9, 10, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Identifier	ReturnReference	Explanation
Part I, line 3c		Not applicable as the organization does follow federal poverty guidelines to determine eligibility for providing charity and discounted care to low-income uninsured and underinsured individuals.
Part I, line 6a		SMS does prepare an annual community benefit report in booklet form distributed to the public via mail and is available upon request at St. Mary's Hospital, 111 Spring Street, Streator, IL.
Part I, line 7g		The Adult Day program and Supportive Care program are subsidized services offered at St. Mary's Hospital. The hospital uses Lyons Software ("CBISA") to determine subsidized services. Physician clinics were not included in the subsidized health services.
Part I, line 7, column (f)		The percent of charity care and certain other benefits at cost as a percent of total expenses less bad debt is 12.73%. The amount of bad debt removed when calculating the percentages in Part I, Line 7, column (F) was $1,678,013.
Part I, line 7		SMS uses the Lyons Software (CBISA) which follows the CHA guidelines on reporting Christian care and certain other community benefits at cost. Lyons Software uses the hospital's audited financials for total expenses, bad debt and gross patient charges to calculate the appropriate cost to charge ratio in determining charity care and other community benefits at cost.
Part II		Community building through community support, health improvement advocacy, and workforce development is an important part of St. Mary's commitment to enhancing community-wide health and well-being. St. Mary's is engaged in the community by developing support groups and through coalition building with community outreach events. As part of our commitment to provide our community with the highest quality of care, St. Mary's Hospital participated in a number of health fairs providing free health screenings and educational information. This year St. Mary's colleagues donated their time to travel to several health fairs throughout the Illinois Valley, offering health education and free screenings such as bone density tests, ankle brachial index screenings, blood pressure checks and pulse ox screenings. These health fairs are just one way that our hospital can educate the community and promote early detection and disease prevention, as well as encouraging a healthy lifestyle. Throughout the course of the year St. Mary's Hospital lends our support by sponsoring a variety of events in our community. In February, St. Mary's Hospital was a corporate sponsor of Streator's Taste of Town, a culinary auction event that raises funds for several local organizations in the community. Aside from our sponsorship, our hospital provided volunteers to assist during the event. St. Mary's Hospital partners with the March of Dimes, an organization that supports research aimed at preventing birth defects, premature birth and infant mortality, to help create awareness about premature births. St. Mary's also sponsored the market place tent at the March for Babies. St. Mary's also takes pride in our partnership with the Streator Area Chamber of Commerce. We attend several of their events that raise money to help build a better community. Some of the annual Chamber events that we participate in include their corporate bowling challenge, dessert auction and golf outing. St. Mary's Hospital is a proud supporter of the American Cancer Society's relay for life. This year the hospital was a $3,000 gold sponsor of Relay for Life. This event represents the hope that those lost to cancer will never be forgotten, that those who face cancer will be supported, and that one-day cancer will be eliminated. In addition to being a gold sponsor, the hospital was able to assist Relay for Life by printing the event programs in-house free of charge, as well as supplying the bottles of water for the night of the event. Beyond our hospital efforts, we also had a group of St. Mary's colleagues who volunteered at the event and distributed health care information and water to the walkers. St. Mary's Hospital is proud to be a sponsor of this great event - one that educates the public about the importance of cancer research and celebrates those whose lives have been affected by cancer. In January, cardiologist Riyaz Nomani, MD gave a presentation to the community at St. Mary's Health Care-Ottawa on the importance of knowing your cholesterol numbers. He educated the group on why they should know their numbers, how to interpret their results and how to lower their risk of cardiovascular disease. One lucky winner received a free copy of the American Heart Association's "Low-Fat, Low Cholesterol" cookbook. St. Mary's Hospital strives to promote and improve the health of the communities it serves by providing a teaching environment for nursing and technical clinical expertise for the regional workforce, recruiting and retaining the professional medical staff to meet the area need, and by providing care through a collaborative approach. Consistent with its exempt purpose, St. Mary's serves as a clinical site for students in the fields of nursing, laboratory, diagnostic imaging, physical therapy, speech and pharmacy. St. Mary's hospital is a community partner with Illinois Valley Community College to provide a clinical training site, professional oversight, and supportive entrance to the nursing field. By providing this medical education, the hospital is contributing to the regional and national workforce in a way that will continue to ensure access and high quality care for the families we serve. St. Mary's hospital supports those students who wish to make a difference in the lives of others by going into the field of health care. Friends of St. Mary's Hospital awarded two $1,000 scholarships for the 2012 Chad Scoles Memorial Scholarship. The scholarship was established in memory of Chad Scoles, son of Dick Scoles, a long-term St. Mary's Hospital employee, and his wife Sally. Chad passed away in 2004 at the age of 21. The scholarship fund was created by two emergency room physicians, Dr. William Sullivan and Dr. Ted Patras.
Part III, Line 4		Since the hospital implemented the Search America process, a much closer representation of the true community benefit is reflected. Self-pay patients are screened for verification of no insurance coverage. Once verification of no coverage has been completed, the guarantors will be screened for charity or uninsured discounts based on income levels. Those guarantors that do not qualify for charity through the screening process will be asked to provide proof of income in the form of a recent pay stub and/or recent tax return to determine the level of uninsured discounting. If no proof of income is provided or a guarantor's income is greater than 301% of the federal poverty level, the appropriate discount according to the established criteria will be applied. That amount of money not collected from those Self-pay patients who are not eligible for charity care is calculated as bad debt.
Part III, Line 8		The hospital continually strives to provide excellent patient care in the most cost effective fashion. Nonetheless, the Medicare program, in many cases, does not provide payment that covers the full cost of the care provided. Since it is the mission of the hospital to respond to community need, hospital management continually advocates for improved Medicare payment so that the cost of quality care to those patients that are not able to afford it is not compromised and is fairly subsidized by all payers. While this shortfall in Medicare payments is not classified as community benefit by the IRS, we nonetheless believe it is an important contribution made by the hospital to the health and well-being of the community. The hospital Medicare shortfall at cost for fiscal year 2012 was $7,388,641.
Part III, line 9b		EVERY EFFORT IS MADE PRIOR TO, DURING AND AFTER PROVISION OF MEDICAL SERVICES TO DETERMINE WHETHER A PATIENT IS ELIGIBLE FOR CHARITY/COMMUNITY CARE AND TO ASSIST THE PATIENT IN COMPLETING THE APPLICATION AND PROVIDING ADEQUATE DOCUMENTATION. IF THE PATIENT QUALIFIED FOR CHARITY/COMMUNITY CARE FOR THE FULL BALANCE OF THEIR ACCOUNT, THE ENTIRE AMOUNT IS WRITTEN OFF TO CHARITY/COMMUNITY CARE AND HENCE NO DEBT COLLECTION IS PURSUED. IF THE PATIENT QUALIFIED FOR CHARITY/COMMUNITY CARE FOR A PORTION OF THEIR ACCOUNT BALANCE, THAT PORTION IS WRITTEN OFF TO CHARITY/COMMUNITY CARE, WITH THE PATIENT BEING RESPONSIBLE FOR THE REMAINDER OF THE BALANCE. ADDITIONALLY, REASONABLE EFFORT WILL BE MADE TO OBTAIN THIRD-PARTY OR GOVERNMENT PAYER REIMBURSEMENT ON BEHALF OF THE PATIENT. IF THOSE EFFORTS ARE NOT FRUITFUL, AN OFFER WILL BE EXTENDED TO THE PATIENT TO MAKE INSTALLMENT PAYMENTS ON THEIR BALANCE. ONLY AT SUCH POINT THAT THE PATIENT DEFAULTS ON INSTALLMENT PAYMENTS OR REFUSES TO COOPERATE WITH THE HOSPITALS EFFORTS TO BE REIMBURSED WILL THE ACCOUNT BE SENT TO COLLECTIONS. FOR ADDITIONAL INFORMATION, SEE RESPONSE TO QUESTION VI, 3.
Part V, Section B, Line 3		St. Mary's Hospital in cooperation with Leede Research, a research firm specializing in health care information programs and tools, completed the 2012 Community Needs Assessment survey process. The goal of the study was to identify population perceptions of community issues and needs that could be combined with other information for a Community Health Needs Assessment. The needs assessment report was used as a basis for the implementation strategy that outlines a plan to address selected needs which would benefit the community and general populations. A Community Needs Steering Committee was established to review the results of the survey and other data. This was a diverse group of twenty-one community leaders from LaSalle, Livingston and Marshall Counties, consisting of health care and physician leaders, political leaders, individuals with expertise in public health, and representatives of underserved, low-income and minority populations.
Part V, SECTION B, Line 7		The St. Mary's Hospital Board of Directors approved an implementation strategy based on the CHNA during the reporting year (FY2012); however, the identified needs are being addressed in the current year (FY2013). Using the data from the CHNA, the steering committee identified four priority areas for the community: obesity, family violence, substance abuse/alcohol, and education. St. Mary's Hospital will focus on two of the four major needs - obesity and family violence - because they best match our core competencies and would offer us the best opportunity to affect the most change. Since St. Mary's Hospital does not have a specific substance/alcohol abuse program and is not an educational institution, we will collaborate with other organizations to support their efforts in these areas. The implementation strategy consists of plans to expand St. Mary's Hospital Lean 2 Green program and also develop community gardens, both aimed at reducing obesity and focusing the community on a healthier lifestyle. In addition, St. Mary's Hospital is currently engaging in a process with other community organizations to assess how the hospital could support local resources already in place for domestic violence.
Part V, section b, Line 13g		Brochures giving notice of the hospitals Christian Care Policy will be available to the public in the Emergency Department, Collection and Registration areas. Information outlining the program is also available on patient statements and upon request. Patient statements shall include but not be limited to the following: Request that the patient inform the hospital if the patient has health insurance coverage, Medicare, Medicaid or other insurance.
Part V, section b, Line 19d		WE ASK EACH PATIENT TO FILL OUT A FORM IN ORDER TO DETERMINE THEIR ELIGIBILITY UNDER THE ILLINOIS UNINSURED ACT. IF THE PATIENT FAILS TO FILL OUT THE FORM, FINANCIAL COUNSELORS WILL SEEK TO DETERMINE PATIENT ELIGIBILITY BY SEEKING APPROPRIATE INFORMATION IN THE SEARCH AMERICA PROGRAM. WE ALSO REVIEW THE PATIENTS' ACCOUNTS TO ENSURE THEY ARE NOT CHARGED MORE THAN 25% OF THEIR ANNUAL GROSS INCOME. ONCE THE CHARGES FOR A SELF-PAY BALANCE EXCEED 25% OF THE PATIENTS' ANNUAL GROSS INCOME, THE REMAINING BALANCE IS ADJUSTED OFF TO CHRISTIAN CARE.
Needs assessment		The Community Health Needs and associated implementation strategy will be used to guide our efforts in FY2013 and is available at http://www.stmaryshospital.org on the Check Up 2012 and Implementation Strategy link. For prior years, we used other methods to identify community need. For example, historic encounters are reviewed for trends and demographic information is reviewed annually during our strategic planning process. Indigent levels, educational levels, housing costs, unemployment and uninsured children are all considered in the planning process. Physician demand analysis is ongoing. SMS engages in conversations with the community to ascertain those services that are in demand and which ones are out-migrating. Those conversations are held informally and sometimes formally. As areas are identified a business plan and proforma are done to validate the need.
Patient education of eligibility for assistance		The Registration Department provides brochures to patients upon registration regarding the Payment Assistance Program available to them at St. Mary's Hospital. The brochures are also supplied in waiting and ancillary areas for easy access by the patient contact numbers for several agencies are listed in the brochure, as well as information about how to read and understand the billing information on payment assistance, billing procedures and explanation of Medicare forms are available on the organization's web site. The organization has a representative on site to assist patients who may be eligible for Medicaid assistance through the Illinois Department of Public Assistance. They work with patients to determine if they may be eligible, and if so, assist in pulling together the necessary application for submission. Patients are also provided a Fair Billing Act notification at the point of registration regarding separate physician billing they can expect to receive, plus information about the patient's financial responsibility if their insurance plan is out of network. One-on-one conversations to educate patients about financial assistance often stem from patients receiving a statement or a pre-collection letter. At that point, the customer service representative or cashier, or other qualified staff, will inform/educate the caller about financial assistance options. The first pre-collection letter reminds the patient their account is in delinquent status. It also informs them they may be eligible for financial assistance through the organization's charity care program. The letter provides direct contact information to begin the application process for charity care. The Search America is now being utilized after failed attempts made by the hospital to work out payment arrangements. That system accesses credit and other information and allows us to see the probability of a patient being able to pay their bill. After assessing that information, the hospital makes a determination whether to grant charity or continue collection efforts.
Community Information		According to the 2010 Census, the demographic make-up of the city of Streator is 85.2% White, 10.4% Latino, 2.5% African American, and 1.9% from other races. The number of persons below poverty level for the city of Streator is 14.8%, which is above the LaSalle County level of 10.8% and the Illinois state level of 12.6%. In addition, St. Mary's has provided charity benefits for 2,344 uninsured persons and transportation benefits to 238 underserved persons.
Promotion of Community Health		St. Mary's Hospital offers hope to our community in the tradition of the Hospital Sisters of St. Francis. As a healing ministry of the Catholic Church and an affiliate of the Hospital Sisters Health System (HSHS), St. Mary's is committed to delivering high quality, compassionate, and cost-effective health care services to all. The hospital was founded over 125 years ago to bring a healing presence and improve the health of our community, especially for people who are sick, poor, and disadvantaged St. Mary's is a small, rural hospital with 68 staffed beds. Because of the hospital's purpose and tradition, it is organized to promote the health of Streator, Illinois and surrounding areas. The hospital is governed by a Board of Directors, the majority of which is comprised of persons who reside in the organization's primary service area and who are neither employees nor contractors of the hospital (nor family members thereof). The Board ensures that St. Mary's is responding to community need. During the last year, for example, the Board reviewed the Community Health Needs Assessment and approved an implementation strategy for addressing selected needs. Also consistent with its exempt purpose, St. Mary's has an open medical staff with privileges available to all qualified physicians in the area. In addition, the hospital operates an emergency department that is open 24 hours to all persons regardless of their ability to pay. As a not-for-profit hospital, St. Mary's reinvests surplus funds into the mission of the organization and health of the community rather than distributing them as profits to shareholders or individuals. Funds not committed to ongoing operations are generally used to upgrade facilities, secure new technologies, improve patient care, and support initiatives designed to promote health and ensure access for all. For example, St. Mary's is currently working with its parent organization, Hospital Sisters Health System, to continuously enhance quality and improve coordination of care both inside the hospital and with a growing number of physician partners. Supported by investments in information technology, this "care integration" strategy is designed to better coordinate care, improve health outcomes, create new efficiencies, and help ensure that patients (especially those with chronic conditions) get well and stay well. Affordable healthcare for uninsured and underinsured patients St. Mary's Hospital devotes significant resources to access for patients who cannot afford care, along with other community benefits. In fiscal year 2012, St. Mary's provided over $14.2 million in community benefit services, including charity care at cost, unpaid costs of Medicaid and other public programs, and a range of diverse programs designed to enhance access and improve community health. Additionally, during this period, St. Mary's provided $6.4 million (at cost) in uncompensated care to patients that qualified for charity care or public assistance and over $7.3 million (at cost) in excess of Medicare payment for health care services. St. Mary's Hospital participates in multiple government-sponsored health care programs, including Medicaid, Medicare, Champus and Tricare. The range of benefits provided by St. Mary's flows from our mission and long-standing commitment to our community. In many cases, these programs would be unlikely to exist without the leadership role played by St. Mary's, and they often relieve a burden that would otherwise be carried by government. To further improve the health status of the community and/or access for underserved populations, St. Mary's offered free educational nutritional programs throughout the year. St. Mary's clinical dietitian taught a series of educational nutrition programs designed to help people take better care of themselves and to better manage their cholesterol and diabetes. This included a free cholesterol screening and educational program for the community at St. Mary's Health Care - Ottawa, on how to incorporate Therapeutic Lifestyle Changes (TLC). TLC is a set of tools that helps participants get results. Participants of the program received an easy-to-read booklet designed to help make the lifestyle changes that will lower blood cholesterol and reduce the risk for heart disease. In addition, St. Mary's clinical dietitian gave tips on how to follow the TLC diet, increase physical activity and manage weight for those who have a cholesterol level above normal. During Diabetes Awareness Month, St. Mary's Hospital offered a free holiday diabetes education program, led again by the registered dietitian. The topic was Dining with Diabetes-Holiday survival skills to help you manage your diabetes. Participants enjoyed food samples and took home some healthy holiday recipes. As a way to show thanks and appreciation to local Veterans, St. Mary's Hospital offered a series of free health screenings for anyone who had or was currently serving our military. The screenings that were provided were able to help determine if one might be at risk for developing heart disease, diabetes, osteoporosis, vascular disease and/or chronic obstructive pulmonary disease. The screenings offered included a Heart Smart cholesterol and glucose screening, Bone Density screening, Ankle-Brachial Index screening, Pulse Oximetry screening and a Body Mass Index screening. Other Community Benefits Based on the assessment of community needs described under #2 above, St. Mary's has focused on the following priorities: obesity and family violence. These major needs in our community best match the hospital's core competencies and would offer the best opportunity to affect the most change in the communities we serve. To target obesity in the communities served, St. Mary's Hospital focused on exercise, nutrition and healthy lifestyles. Every January, St. Mary's Hospital offers their Lean to Green (L2G) program, designed to help St. Mary's colleagues and community members realize that healthy eating and fitness are year round activities. In the style of the popular television show, "The Biggest Loser", L2G is designed to be a fun and exciting way to encourage hospital colleagues and community members to achieve and maintain a healthy lifestyle with weight loss as the motivator. Lean to Green also serves as a maintenance program for those who don't need to lose weight but would still like to improve their overall fitness. This year we had 116 participants complete the 12-week weight loss program and those participants lost a total of 1,995 pounds or 5.14 percent of their original body weight. In conjunction with the Lean to Green program, St. Mary's Hospital offered weekly handouts related to nutrition and exercise. In the coming year, these activities will be modified or supplemented to focus on the priority needs identified by the FY2012 community health needs assessment process. Another area of focus for St. Mary's is environment sustainability. St. Mary's hosted an electronic recycling and used medical equipment drive open to all colleagues and the community in honor of earth day. Vintage Tech Recyclers, Inc. as on site with a truck collecting various electronic items to be recycled and the used medical equipment was donated to HSHS Mission Outreach in Springfield, Illinois. Because of our event, we were able to recycle 38,397 pounds of electronics that otherwise would end up in our landfills. In addition to the electronics recycling drive, St. Mary's Pharmacy set up a medication disposal drive to help preserve our water supply. The pharmacy collected 95.4 pounds of expired or unwanted medications that individuals wished to safely discard. St. Mary's is committed to facilitating access for populations with special needs. Transportation options in Streator are severely limited. Not only is there no public transportation system, there is not even a taxi company. This leaves many people, especially the elderly or disabled, at the mercy of others' kindness. St. Mary's Hospital recognized this as a very serious problem and responded with the medical transportation program. The program established in 1994, provides free transportation to needy patients, particularly those with disabilities, who had no other way of getting to and from their medical appointments. The program provides transportation to seniors, children, expectant mothers and individuals with special needs. Transportation is made with the participant's safety in mind with a qualified staff to assist individuals with boarding and disembarking in vans maintained to Illinois Department of Transportation Standards. Enhancing the Health of Our Community In the coming year, many of the above activities will be continued or strengthened as St. Mary's begins to focus on the priority needs identified during the FY1012 Community Health Needs Assessment process. As outlined in a board-approved "implementation strategy," in addition to expansion of St. Mary's Lean 2 Green program t
Affiliated health care system		St. Mary's Hospital Streator is an affiliate of Hospital Sisters Health System (HSHS), a health care ministry that includes 13 hospitals, scores of community-based health centers and clinics, and more than 2,000 physician partners across Illinois and Wisconsin. The Mission of HSHS is to reveal and embody Christ's healing love for all people through our high quality Franciscan health care ministry. We live our Mission by healing those who seek our care, as well as through our Community Benefit initiatives. Working collaboratively with others in the 12 communities we serve, our Community Benefit efforts are successfully expanding access to care, improving the health status of residents, and furthering medical education and knowledge. Across HSHS, we collectively provided $174.2 million in Community Benefits (or 9.7% of total hospital expenses) in FY2012. Included in this amount was $43.1 million provided for Charity Care and $97.9 million for unreimbursed care provided under the Medicaid program. In addition, HSHS hospitals committed significant resources to care for Medicare patients. The cost of providing services to primarily elderly beneficiaries of the Medicare program - in excess of governmental and managed care contract payments - was $168.4 million. HSHS hospitals also recorded $106.6 million in uncollectible accounts. Beyond the dollars invested in our Community Benefit programs, HSHS also continues to reinvest any surplus revenue from operations and investments into new medical technology, facility infrastructure and health care services in our communities. By doing do, we ensure we are able to meet the ongoing demand for high quality, efficient and easily accessible health care. Recognizing that the health care delivery model in the U.S. is evolving, HSHS remains focused on implementing our Care Integration strategy. Care Integration coordinates the delivery of care around the needs of each patient. During FY2012, we made significant progress with this strategy as we further implemented interoperable health information technologies, expanded the number of Medical Homes, and strengthened our alignment with physicians. Greater access to care As a Franciscan health care ministry, HSHS is deeply committed to serving those who are most in need. We not only provide care to every patient who walks through our doors, but also reach out beyond the walls of our hospitals and clinics to care for the individual. Our efforts to ensure residents in the communities we serve receive the right care at the right time often involve partnering with others to achieve this goal. Across our two-state system, there are numerous examples of HSHS collaborating with other organizations to enhance access to care for those in need. In western Wisconsin, St. Joseph's Hospital in Chippewa Falls works closely with the Chippewa Health Improvement Partnership (CHIP) to support the Open Door Clinic. The free medical clinic provides health care for those without insurance coverage. This past year, the clinic received a total of 2,216 patient visits, a 25% increase from the prior year. With more than 150 individuals volunteering, the clinic provided over 6,500 hours (including 700 physician hours and 1,500 nursing hours) of service to individuals. The Open Door Clinic is an example of HSHS providing leadership and support to a community-based program designed to meet the needs of those less fortunate. In northeastern Wisconsin, St. Vincent Hospital in Green Bay supports patient care for the uninsured at the NEW Community Clinic by paying a nurse's salary and offering free and discounted laboratory and radiology services. More than 70% of patients who use the clinic report the care they received helped keep them out of the Emergency Department. St. Nicholas Hospital in Sheboygan proactively reaches out to local Hmong and Hispanic organizations to ensure these populations can participate in free screenings and health education programs. Through this ongoing outreach initiative, St. Nicholas engaged more than 350 people last year, and in many cases was able to identify critical health conditions early and provide appropriate follow-up care. A Woman's Place at St. Mary's Hospital Medical Center in Green Bay reaches out to Hispanic neighbors to provide health and wellness education, health screenings, resources and referral services. Last year A Woman's Place touched the lives of more than 7,000 women through health screenings, educational events, classes and its resource center. In southeast Illinois, area residents can get help filling a prescription through the long-term collaboration between St. Anthony's Memorial Hospital in Effingham and Catholic Charities. Last year, St. Anthony's helped underwrite the cost of prescription medications for more than 430 residents. In southwest Illinois, St. Joseph's Hospital in Highland recognized many rural residents did not have a reliable means of transportation and partnered with generous individuals in the community to offer a free transportation service. The "Friends' Van," fully supported by the Friends of St. Joseph's Hospital, provides free rides to medical, dental and other personal appointments within a 20-mile radius of Highland. In FY2012, the Friends Van transported 2,050 individuals for a total of 12,561 miles. In addition to programs such as these, HSHS makes sure that those who need financial assistance for care receive it. Our Charity Care program covers 100% of hospital charges for individuals and families who earn less than 200% of the federal poverty level. HSHS Charity Care programs have a sliding scale, in some instances providing up to a 60% discount on charges for those earning up to 600% of the federal poverty level. Counselors are available in our hospitals to explain our charity care policies to patients, provide them with assistance in filling out a simple application form, or help them enroll in publicly funded health care programs. Better community health As part of our mission to embody Christ's healing love, we understand that we have a responsibility to improve the overall quality of life in our communities by supporting initiatives that promote health and wellness. We recognize we are most successful when we work together with a wide array of public and private organizations that share our commitment to improving lives. By doing so, we maximize our efforts and reduce the duplication of services. HSHS hospitals also understand we need to listen closely to the residents of the communities we serve to ensure the health care needs of all are being met. To that end, each of our 13 hospitals completed Community Health Needs Assessments (CHNA) during FY2012. The information gathered from these assessments is being used to help us develop new, and enhance existing, programs and services that best address the needs of the community. Among the many priority needs identified from the CHNAs include metabolic and cardiovascular disease management, adequate food and nutrition, and mental health. HSHS hospitals are addressing these and other needs by proactively offering educational opportunities, preventative screenings, and new or enhanced clinical services. To address metabolic disease management, St. Francis Hospital in Litchfield, Illinois, partners with Montgomery County Health Department to provide screening for diabetes and renal disease. St. Francis Hospital teams up with Macoupin County Health Department to provide Diabetes Self-Management classes. St. Joseph's Hospital in Breese, Illinois coordinates several community education seminars and health fairs on cardiovascular disease and healthy eating each year. Over 3,000 residents participated in these health events last year. Recognizing the importance of proper food and nutrition to overall health, St. John's Hospital in Springfield initiated the Destination Dinner program which teaches families how to cook healthy, from-scratch meals, and eat together as a family. Families meet quarterly to learn new cooking skills. They also learn how to prepare a meal for a family of four on a budget of $8.00. In addition to raising awareness about how to eat healthy on a limited budget, the program brings families together around the dinner table, which research shows promotes healthy relationships, increased academic performance and decreased risk for substance abuse and risky sexual behavior. Sacred Heart Hospital in Eau Claire, Wisconsin addressed the need for access to mental health services for children and adolescents by opening an outpatient behavioral health clinic. Sacred Heart has also adopted screening tools for behavioral and mental health risk factors for use at affiliated clinics. The goal is to better identify mental health issues and provide earlier intervention. Sacred Heart Hospital is also working with the Chippewa Valley Free Clinic (CVFC) to develop expanded provider coverage for CVFC patients who require mental health services. St.
STATE FILING OF COMMUNITY BENEFIT REPORT	990 SCHEDULE H, PART VI	IL,

Schedule H (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet

Attach to Form 990. SchJMediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

ST MARY'S HOSPITAL STREATOR HOSPITAL SISTERS
OF THE 3RD ORDER ST FRANCIS

Employer identification number

36-2169181

Part I

Questions Regarding Compensation

Yes

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.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all the expenses described above? If "No," complete Part III to explain....

Yes

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? ....

Yes

Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

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:

Receive a severance payment or change-of-control payment? ...............

Yes

Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? ........

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.

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:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

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:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

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 ............

Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 50053T

Schedule J (Form 990) 2011

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and column (E) for that individual.

(A) Name		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(A) Name		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(1) JOANNE FENTON	(i) (ii)	0 170,753	0 0	0 40,432	0 23,600	0 13,241	0 248,026	0 0
(2) ANN CARR	(i) (ii)	0 180,382	0 0	0 45,431	0 197,622	0 18,652	0 442,087	0 15,440
(3) KEVIN KAST	(i) (ii)	0 368,854	0 0	0 34,636	0 158,181	0 23,169	0 584,840	0 40,460
(4) KAREN CLARK	(i) (ii)	154,092 0	0 0	25 0	126,238 0	9,196 0	289,551 0	0 0
(5) KIMBERLY LANDERS	(i) (ii)	98,099 0	7,319 0	26,799 0	98,431 0	13,395 0	244,043 0	0 0
(6) LARRY JONES	(i) (ii)	0 0	0 0	153,856 0	0 0	0 0	153,856 0	0 0
(7) PARVEEN CHAND	(i) (ii)	154,494 0	0 0	295 0	0 0	19,998 0	174,787 0	0 0
(8) CATHERINE CHAPMAN	(i) (ii)	123,353 0	0 0	560 0	38,470 0	7,061 0	169,444 0	0 0
(9) Jeanne A Washko	(i) (ii)	113,639 0	168 0	464 0	105,997 0	19,100 0	239,368 0	0 0

Schedule J (Form 990) 2011

Page 3

Part III

Supplemental Information

Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.

Identifier	Return Reference	Explanation
severance payment	Schedule J, Part I, Line 4a	Larry Jones received a severance payment in the amount of $152,231 during the tax year. This amount has been included in Larry's reportable compensation on Schedule J and Form 990, Part VII.
joanne fenton	Schedule J, Part I, Line 4b	joanne fenton participated in a serp plan during the year in the amount of $23,600.
kevin kast	Schedule J, Part I, Line 4b	kevin kast participated in a serp plan during the year in the amount of $79,410.
ann m. carr	schedule j, part i, line 4b	ann m. carr participated in a serp plan during the year in the amount of $33,655.

Schedule J (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

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. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

ST MARY'S HOSPITAL STREATOR HOSPITAL SISTERS
OF THE 3RD ORDER ST FRANCIS

Employer identification number

36-2169181

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?
1(a) Name of disqualified person	(b) Description of transaction	Yes	No

Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image

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?
(a) Name of interested person and purpose	To	From	(c)Original principal amount	(d)Balance due	Yes	No	Yes	No	Yes	No






Total ............... $

Part III

Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b)Relationship between interested person and the organization	(c)Amount of grant or type of assistance

For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2011

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?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) Georgene Lansford	Spouse of Director	93,220	Employment		No
(2) Kara Hughes	Sister of Officer	60,981	Employment		No
(3) Jeannine Solon	Spouse of Director	53,941	Employment		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
BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS	FORM 990 SCHEDULE L, PART IV	THERE ARE TWO ST. MARY'S HOSPITAL COLLEAGUES WHO ARE SPOUSES OF OFFICERS. ONE EMPLOYEE IS THE SISTER OF A DIRECTOR. ALL PERSONS LISTED ON SCHEDULE L, PART IV WERE HIRED IN ACCORDANCE WITH THE HOSPITAL HIRING POLICY AT COMPARATIVE INDUSTRY MARKET COMPENSATION.

Schedule L (Form 990 or 990-EZ) 2011

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization

ST MARY'S HOSPITAL STREATOR HOSPITAL SISTERS
OF THE 3RD ORDER ST FRANCIS

Employer identification number

36-2169181

Identifier	Return Reference	Explanation
Organization's mission	FORM 990 PART III, Line 1	To continue Christ's healing ministry through service to the sick, the aged, the poor and the terminally ill, regardless of race, creed, sex, handicaps, religion, age, sexual orientation, marital, military discharge, or financial status. The values of compassion, justice, reverence for life, and individual dignity are fostered. Health services that improve or maintain the quality of life are supported. The Sisters, Administration, Medical Staff and employees practice this mission by identifying with the core values of the Hospital Sisters Health System - Respect, Care, Competence and Joy. FORM 990, PART III, LINE 3 ST. MARY'S HOSPITAL DISCONTINUED ITS SKILLED NURSING UNIT ON AUGUST, 2011 AND DISCONTINUED ITS ADULT DAY PROGRAM ON SEPTEMBER 30, 2011. FORM 990, PART 111, LINE 4 THREE LARGEST PROGRAMS INPATIENT AND OUTPATIENT CARE SERVICES WITH DIRECT EXPENSES OF $3,164,558 INCLUDES MEDICAL SURGICAL, WOMEN'S HEALTH, AND INTENSIVE CARE ACUTE INPATIENT AND OBSERVATION PATIENT SERVICES AS WELL AS NURSERY INPATIENT CARE. THESE SERVICES PROVIDED 7,782 ACUTE PATIENT DAYS, PROVIDED SERVICES FOR 1,320 OBSERVATION PATIENTS AND 421 NURSERY DAYS. IMAGING SERVICES WITH DIRECT EXPENSES OF $3,818,048 INCLUDE ROUTING DIAGNOSTIC, ANGIOGRAPHY, ULTRASOUND, MRI, CT, AND NUCLEAR MEDICINE SERVICES. DIAGNOSTIC IMAGING CONDUCTED 19,975 IP/OP PROCEDURES; ANGIOGRAPHY CONDUCTED 1,932 IP/OP PROCEDURES; ULTRASOUND CONDUCTED 7,303 IP/OP PROCEDURES; MRI CONDUCTED 1,347 IP/OP PROCEDURES; CT 4,499 IP/OP PROCEDURES AND NUCLEAR MEDICINE CONDUTED 1,348 IP/OP PROCEDURES. THE IMAGING DEPARTMENTS PROVIDE NECESSARY INPATIENT AND OUTPATIENT SERVICES TO THE COMMUNITY WE SERVE. SURGICAL SERVICES WITH DIRECT EXPENSES OF $3,588,156 INCLUDED BOTH INPATIENT AND OUTPATIENT SERVICES. SURGERY PERFORMED A TOTAL OF 3,201 SURGICAL PROCEDUDRES. 582 OF THOSE SERVICES WERE PROVIDED FOR INPATIENTS AND 2,619 FOR OUTPATIENTS. THE SURGERY DEPARTMENT MEETS THE NEEDS OF THE COMMUNITY BY PROVIDING BOTH EMERGENT AND ELECTIVE SURGERY ON AN INPATIENT AND OUTPATIENT BASIS. PROGRAM SERVICE ACCOMPLISHMENTS - FORM 990 PART III, LINE 4A THE COMMUNITY BENEFIT CONTRIBUTION OF ST. MARY'S HOSPITAL INCLUDES PROGRAMS AND ACTIVITIES THAT IMPROVE ACCESS TO HEALTH CARE AND IMPROVE HEALTH IN OUR COMMUNITIES. IN ORDER TO PORTRAY THE FULL BREADTH OF OUR CONTRIBUTION, OUR COMMUNITY BENEFIT INFORMATION IS DESCRIBED BELOW: SECTION 1: QUALITATIVE DESCRIPTION OF COMMUNITY BENEFIT - DESCRIBES THE HOSPITAL'S COMMUNITY BENEFIT MISSION, HOW THE MISSION IS TRANSLATED INTO A PROACTIVE APPROACH DESIGNED TO MEET COMMUNITY HEALTH NEEDS, HOW THE HOSPITAL MEETS TAX-EXEMPT REQUIREMENTS, AND A DESCRIPTION OF COMMUNITY BENEFIT PROGRAMS AND SERVICES THAT HIGHLIGHT THE HOSPITAL'S IMPACT ON COMMUNITY HEALTH. SECTION 2: QUANTITATIVE DESCRIPTION OF COMMUNITY BENEFIT - DESCRIBES THE HOSPITAL'S COMMUNITY BENEFIT CONTRIBUTION IN FINANCIAL TERMS PRESENTING THE AMOUNT OF CHARITY CARE, THE UNPAID SHORTFALL FROM GOVERNMENT HEALTH CARE FOR THE INDIGENT, AND THE NET EXPENSE OF COMMUNITY BENEFIT SERVICES. SECTION 1 - QUALITATIVE DESCRIPTION OF COMMUNITY BENEFIT 1.ORGANIZATIONAL COMMITMENT TO PROVIDING COMMUNITY BENEFIT- ST. MARY'S HOSPITAL MISSION IS TO CONTINUE CHRIST'S HEALING MINISTRY THROUGH SERVICE TO THE SICK, THE AGED, THE POOR AND THE TERMINALLY ILL REGARDLESS OF RACE, CREED, SEX, HANDICAPS, AGE, RELIGION, SEXUAL ORIENTATION, MARITAL, MILITARY-DISCHARGE OR FINANCIAL STATUS. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF ST. MARY'S HOSPITAL, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES AND FURTHER THAT OUR MISSION IS TO SERVE THE COMMUNITY WITH RESPECT TO PROVIDING HEALTHCARE SERVICES AND HEALTHCARE EDUCATION. A. ST. MARY'S HOSPITAL IS LOCATED IN STREATOR ILLINOIS AND SERVES A PRIMARY SERVICE AREA OF APPROXIMATELY 113,921 RESIDENTS; WITH A SECONDARY SERVICE AREA OF APPROXIMATELY 90,254 RESIDENTS. ST. MARY'S HOSPITAL HAS BEEN DESIGNATED AS A MEDICARE DEPENDENT HOSPITAL MEETING THE CRITERIA OF AT LEAST 60 PERCENT OF INPATIENT DAYS OR DISCHARGES COVERED BY MEDICARE. THIS GREATER DEPENDENCE ON MEDICARE MAKES THE HOSPITAL MORE FINANCIALLY VULNERABLE TO PROSPECTIVE PAYMENT. ST. MARY'S HOSPITAL HAS IDENTIFIED TRANSPORTATION AS A NEED OF OUR SERVICE AREA. THE INCREASE IN THE ELDERLY POPULATION WHO ARE STILL IN THEIR HOMES AND DO NOT HAVE TRANSPORTATION TO OBTAIN MEDICAL NEEDS HAS INCREASED IN THIS SERVICE AREA. THE HOSPITAL HAS PROVIDED TRANSPORTATION BENEFITS TO 238 UNDERSERVED PERSONS AND IS WORKING IN CONJUNCTION WITH THE INTERAGENCY COORDINATING COMMITTEE ON TRANSPORTATION FOR LASALLE COUNTY TO ADDRESS THIS GROWING NEED. BASED ON THE ASSESSMENT OF COMMUNITY NEEDS, ST. MARY'S HAS FOCUSED ON THE FOLLOWING PRIORITIES: OBESITY AND FAMILY VIOLENCE. THESE MAJOR NEEDS IN OUR COMMUNITY BEST MATCH THE HOSPITAL'S CORE COMPETENCIES AND WOULD OFFER THE BEST OPPORTUNITY TO AFFECT THE MOST CHANGE IN THE COMMUNITIES WE SERVE. TO TARGET OBESITY IN THE COMMUNITIES SERVED, ST. MARY'S HOSPITAL FOCUSED ON EXERCISE, NUTRITION AND HEALTHY LIFESTYLES. EVERY JANUARY, ST. MARY'S HOSPITAL OFFERS THEIR LEAN TO GREEN (L2G) PROGRAM, DESIGNED TO HELP ST. MARY'S COLLEAGUES AND COMMUNITY MEMBERS REALIZE THAT HEALTHY EATING AND FITNESS ARE YEAR ROUND ACTIVITIES. IN THE STYLE OF THE POPULAR TELEVISION SHOW, "THE BIGGEST LOSER", L2G IS DESIGNED TO BE A FUN AND EXCITING WAY TO ENCOURAGE HOSPITAL COLLEAGUES AND COMMUNITY MEMBERS TO ACHIEVE AND MAINTAIN A HEALTHY LIFESTYLE WITH WEIGHT LOSS AS THE MOTIVATOR. LEAN TO GREEN ALSO SERVES AS A MAINTENANCE PROGRAM FOR THOSE WHO DON'T NEED TO LOSE WEIGHT BUT WOULD STILL LIKE TO IMPROVE THEIR OVERALL FITNESS. THIS YEAR WE HAD 116 PARTICIPANTS COMPLETE THE 12-WEEK WEIGHT LOSS PROGRAM AND THOSE PARTICIPANTS LOST A TOTAL OF 1,995 POUNDS OR 5.14 PERCENT OF THEIR ORIGINAL BODY WEIGHT. IN CONJUNCTION WITH THE LEAN TO GREEN PROGRAM, ST. MARY'S HOSPITAL OFFERED WEEKLY HANDOUTS RELATED TO NUTRITION AND EXERCISE. ST. MARY'S HOSTED AN ELECTRONIC RECYCLING AND USED MEDICAL EQUIPMENT DRIVE OPEN TO ALL COLLEAGUES AND THE COMMUNITY IN HONOR OF EARTH DAY. VINTAGE TECH RECYCLERS, INC. AS ON SITE WITH A TRUCK COLLECTING VARIOUS ELECTRONIC ITEMS TO BE RECYCLED AND THE USED MEDICAL EQUIPMENT WAS DONATED TO HSHS MISSION OUTREACH IN SPRINGFIELD, ILLINOIS. BECAUSE OF OUR EVENT, WE WERE ABLE TO RECYCLE 38,397 POUNDS OF ELECTRONICS THAT OTHERWISE WOULD END UP IN OUR LANDFILLS. IN ADDITION TO THE ELECTRONICS RECYCLING DRIVE, ST. MARY'S PHARMACY SET UP A MEDICATION DISPOSAL DRIVE TO HELP PRESERVE OUR WATER SUPPLY. THE PHARMACY COLLECTED 95.4 POUNDS OF EXPIRED OR UNWANTED MEDICATIONS THAT INDIVIDUALS WISHED TO SAFELY DISCARD. B. ST. MARY'S HOSPITAL HAS A CHARITY PROGRAM IN PLACE TO OFFER FINANCIAL ASSISTANCE TO PERSONS WITHOUT THE ABILITY TO PAY FOR NECESSARY MEDICAL TREATMENT. ST. MARY'S PROVIDES BROCHURES IN THE EMERGENCY DEPARTMENT, PATIENT REGISTRATION DEPARTMENT AND FROM THE PATIENT FINANCIAL REPRESENTATIVES GIVING NOTICE OF THE HOSPITAL'S CHARITY ASSISTANCE POLICY. INFORMATION OUTLINING THE PROGRAM IS ALSO AVAILABLE ON PATIENT STATEMENTS AND UPON REQUEST. 2. ORGANIZATIONAL DESCRIPTION FOR TAX EXEMPTION- ST. MARY'S HOSPITAL OPERATES AN EMERGENCY DEPARTMENT THAT IS OPEN 24 HOURS TO ALL PERSONS REGARDLESS OF THEIR ABILITY TO PAY. THE HOSPITAL HAS AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA. ST. MARY'S HOSPITAL SERVES AS A CLINICAL SITE FOR STUDENTS IN THE FIELDS OF NURSING, LABORATORY, DIAGNOSTIC IMAGING, PHYSICAL THERAPY, SPEECH AND PHARMACY. ST. MARY'S HOSPITAL PARTICIPATES IN THE GOVERNMENT-SPONSORED HEALTH CARE PROGRAMS FOR MEDICAID, MEDICARE, CHAMPUS AND TRICARE. 3. DESCRIPTION OF COMMUNITY BENEFIT PROGRAMS- ST. MARY'S HOSPITAL OPERATES AN ADULT DAY PROGRAM WHICH PROVIDES MEALS, TRANSPORTATION, AND SOCIAL STIMULATION FOR SENIORS WHO LIVE AT HOME BUT DO NOT HAVE A CARETAKER AVAILABLE DURING THE DAY. THE ADULT DAY CENTER IS FOR ADULTS WHO ARE MINIMALLY PHYSICALLY IMPAIRED, SOCIALLY ISOLATED OR DISABLED. THE PROGRAM PROVIDES DAILY ACTIVITIES WHICH MAY INCLUDE MUSIC, ART, CRAFTS AND EXERCISE PROVIDED BY PROFESSIONALLY TRAINED AND QUALIFIED INDIVIDUALS. NO PARTICIPANT IS REFUSED SERVICE BECAUSE OF AN INABILITY TO PAY. ST. MARY'S HOSPITAL IS AWARE OF THE NEED IN THE COMMUNITY FOR TRANSPORTATION TO AND FROM MEDICAL SERVICES. IN AN EFFORT TO ALLEVIATE THIS NEED, THE HOSPITAL PROVIDES A MEDICAL TRANSPORTATION PROGRAM WHICH INCLUDES FREE VAN SERVICE TO MEDICAL APPOINTMENTS FOR PATIENTS WITH SPECIAL NEEDS AND NO MEANS OF TRANSPORTATION. THIS SERVICE INCLUDES TRANSPORTATION TO PHYSICIAN OFFICE AND ALL OUTPATIENT SERVICES AFFILIATED WITH ST. MARY'S HOSPITAL. TRANSPORTATION IS MADE WITH THE PARTICIPANTS SAFETY IN MIND WITH A QUALIFIED STAFF TO ASSIST INDIVIDUALS WITH BOARDING AND DISEMBARKING IN VANS MAINTAINED TO ILLINOIS DEPARTMENT OF TRANSPORTATION STANDARDS.
STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS CONTINUED	FORM 990 PART III,	ST. MARY'S HOSPITAL HAS RECOGNIZED THE NEED FOR COMPREHENSIVE MANAGEMENT OF THE PHYSICAL, PSYCHOSOCIAL, AND SPIRITUAL NEEDS OF PATIENTS WITH COMPLICATED OR SERIOUS ILLNESSES. IN RESPONSE TO THIS NEED, THE HOSPITAL OFFERS THE SERVICES OF THE SUPPORTIVE CARE TEAM. THIS TEAM UTILIZES A TEAM OF PROFESSIONALS AS A CONSULT WITH THE PRIMARY PHYSICIAN. A PHYSICIAN, NURSE, SOCIAL WORKER, AND CHAPLAIN AIM TO RELIEVE SUFFERING AND IMPROVE QUALITY OF LIFE, REGARDLESS OF THE PROGNOSIS AND TREATMENT. THE PRIMARY FOCUS OF CARE IS TO IDENTIFY PATIENT AND FAMILY GOALS AND MANAGE SYMPTOMS FOR A BETTER QUALITY OF LIFE. THIS SERVICE IS OFFERED FREE OF CHARGE AND OFFERS COORDINATION OF CARE BASED ON PATIENT AND FAMILY GOALS, TIME INTENSIVE PATIENT-FAMILY COMMUNICATION INCLUDING DIFFICULT DECISION MAKING, EXPERTISE IN SYMPTOM MANAGEMENT SUCH AS PAIN, ANXIETY, NAUSEA, DIFFICULTY BREATHING, APPETITE LOSS, BOWEL PATTERNS, EMOTIONAL DISTRESS AND SLEEP DISTURBANCES AND A HIGH LEVEL PATIENT AND FAMILY SATISFACTION WITH THEIR PHYSICIAN, HEALTH CARE TEAM AND HOSPITAL. 4. LINKS TO ADDITIONAL COMMUNITY BENEFIT INFORMATION- ST. MARY'S HOSPITAL CHRISTIAN CARE POLICY, REQUEST FOR FINANCIAL ASSISTANCE, FINANCIAL ELIGIBILITY CRITERIA TABLE AND COMMUNITY BENEFITS REPORT IS ATTACHED. SECTION 2 - QUANTIFIABLE COMMUNITY BENEFIT THE FINANCIAL INFORMATION IN THIS REPORT WAS PREPARED IN ACCORDANCE WITH THE CATHOLIC HEALTH ASSOCIATION'S (CHA) COMMUNITY BENEFIT REPORTING GUIDELINES. THESE GUIDELINES RECOMMEND THE FOLLOWING: "REPORT CHARITY CARE AT COST, NOT CHARGES. "DO NOT INCLUDE BAD DEBT, CONTRACTUAL ALLOWANCES, AND QUICK PAY DISCOUNTS AS PART OF CHARITY CARE EXPENSE. "DO NOT COUNT MEDICARE SHORTFALL AS A COMMUNITY BENEFIT. "REPORT THE NET EXPENSE FOR COMMUNITY BENEFIT SERVICES, I.E., THE TOTAL COMMUNITY BENEFIT EXPENSE MINUS ANY ASSOCIATED REVENUE FROM PATIENTS, PAYERS, AND OTHER EXTERNAL SOURCES. THE CHA REPORTING GUIDELINES REFLECT A CONSERVATIVE APPROACH TO REPORTING QUANTIFIABLE COMMUNITY BENEFIT. THE GOAL OF THE REPORTING GUIDELINES IS TO PRODUCE COMMUNITY BENEFIT FINANCIAL REPORTS THAT REFLECT TRUE COSTS AND THAT DESCRIBE COMMUNITY BENEFIT ACTIVITIES THAT INCREASE ACCESS TO HEALTH CARE AND IMPROVE COMMUNITY HEALTH. CATEGORY A, COMMUNTIY HEALTH IMPROVEMENT SERVICES- EDUCATION, CLINICAL, AND SUPPORT SERVICES WERE PROVIDED TO 26,183 PEOPLE, AT A COST OF 300,600, FOR A TOTAL BENEFIT AMOUNT OF 297,245. A1 - COMMUNITY HEALTH EDUCATION: COMMUNITY HEALTH EDUCATION BENEFIT PROGRAMS, SERVED 24,366 PERSONS AT A COST OF 91,430. THERE WERE NO OFFSETTING REVENUES FOR A TOTAL BENEFIT AMOUNT OF 90,132. A2 - COMMUNITY BASED CLINICAL SERVICES: COMMUNITY HEALTH EDUCATION BENEFIT PROGRAMS SERVED 1,534 PERSONS AT A COST OF 67,675, WITH NO OFFSETTING REVENUES FOR A TOTAL BENEFIT AMOUNT OF 67,675. A3 - HEALTH CARE SUPPORT SERVICES: COMMUNITY HEALTH EDUCATION BENEFIT PROGRAMS SERVED 283 PERSONS AT A COST OF 300,600 WITH OFFSETTING REVENUES OF 1,995 FOR A TOTAL BENEFIT AMOUNT OF 297,245. CATEGORY B, COMMUNTIY HEALTH IMPROVEMENT SERVICES- 20,044 IN SCHOLARSHIPS AND FUNDING FOR EDUCATION WAS PROVIDED. CATEGORY C, LOW OR NEGATIVE MARGIN PROGRAMS SERVED 18 PEOPLE AT A COST OF 45,963, WITH OFFSETTING REVENUES OF 237,859 FOR A TOTAL BENEFIT AMOUNT OF 6,883. CATEGORY E, FINANCIAL AND IN-KIND CONTRIBUTIONS TOTALED 67,763 SERVING 5,447 PEOPLE. E1 - CASH DONATIONS TOTALED 5500. E3 - IN-KIND DONANTIONS: IN-KIND DONATIONS SERVED 5,447 PERSONS AT A COST OF 62,263 WITH NO OFFSETTING REVENUES FOR A TOTAL BENEFIT AMOUNT OF 62,263. CATEGORY F - COMMUNITY BUILDING ACTIVITIES, INCLUDED SUPPORT SYSTEM ENHANCEMENTS AT A COST OF 3,195. A TOTAL OF 43 COMMUNITY BENEFIT ACTIVITIES WERE COMPLETED, AT A COST OF 437,565 WITH OFFSETTING REVENUES OF 42,435 FOR A TOTAL BENEFIT AMOUNT OF 395,130. TAX EXEMPT BONDS FORM 990, PART IV, QUESTION 4 ST. MARY'S - STREATOR HOLDS A LIABILITY ON ITS BOOKS FOR TAX-EXEMPT BONDS, WHICH IS AN ALLOCATION FROM ITS SOLE CORPORATE MEMBER, HOSPITAL SISTERS SERVICES, INC. AS A RESULT, THIS QUESTION WAS ANSWERED NO, AND SCHEDULE K WILL BE COMPLETED ON THE HOSPITAL SISTERS SERVICES, INC. FORM 990.
RIGHTS OF MEMBERS TO ELECT GOVERNING BODY	FORM 990 PART VI, LINES 6 & 7A	THE SENIOR GOVERNING BODY OF ST. MARY'S HOSPITAL STREATOR (THE "CORPORATION") IS THE MEMBER OF THE CORPORATION, WHICH IS HOSPITAL SISTERS HEALTH SERVICES, INC. ("HSSI"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. PURSUANT TO SECTION 2.3 OF THE CORPORATION'S BYLAWS, HSSI HAS THE RIGHT TO APPOINT AND REMOVE THE CORPORATION'S BOARD OF DIRECTORS, CHAIRPERSON OF THE BOARD AND PRESIDENT.
MEMBER RESERVED POWERS	FORM 990 PART VI, LINE 7B	RESPONSIBILITY FOR THE POLICY AND OPERATIONS OF ST. MARY'S HOSPITAL STREATOR (THE "CORPORATION") IS VESTED IN ITS BOARD OF DIRECTORS, EXCEPT WITH RESPECT TO SPECIFIC POWERS RESERVED IN THE CORPORATION'S BYLAWS TO THE CORPORATION'S MEMBER, HOSPITAL SISTERS HEALTH SERVICES, INC. ("HSSI"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE MEMBER OF HSSI IS HOSPITAL SISTERS HEALTH SYSTEM ("HSHS"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE MEMBERS OF HSHS ARE THE INDIVIDUAL SISTERS WHO FROM TIME TO TIME ARE THE DULY ELECTED PROVINCIAL SUPERIOR AND PROVINCIAL COUNCILORS, RESPECTIVELY OF THE AMERICAN PROVINCE OF THE HOSPITAL SISTERS OF ST. FRANCIS ("AMERICAN PROVINCE"). THE AMERICAN PROVINCE IS THE UNITED STATES ORGANIZATION OF THE CONGREGATION OF THE HOSPITAL SISTERS OF THE THIRD ORDER REGULAR OF ST. FRANCIS, A RELIGIOUS INSTITUTE OF THE ROMAN CATHOLIC CHURCH. THE GOVERNANCE AND OPERATIONS OF THE CORPORATION ARE SUBJECT TO HSSI'S RIGHT TO EXERCISE THESE RESERVED POWERS WITH RESPECT TO THE CORPORATION AND ORGANIZATIONS OF WHICH THE CORPORATION IS EITHER, DIRECTLY OR INDIRECTLY, A CONTROLLING MEMBER OR A CONTROLLING SHAREHOLDER ("AFFILIATES"). HSSI'S RIGHT TO EXERCISE CERTAIN OF THESE RESERVED POWERS IS, IN TURN, SUBJECT TO THE APPROVAL OF HSHS AND HSHS' MEMBERS. THE RESERVED POWERS INCLUDE ALL RIGHTS GRANTED TO HSSI BY LAW AND THE RIGHT TO: (A) ADOPT, APPROVE AMENDMENTS TO, OR AMEND ANY STATEMENT OF PHILOSOPHY, MISSION, MISSION INTEGRATION OR VALUES OR ANY NAME, LOGO, OR MARK OF THE CORPORATION OR OF ANY AFFILIATE; (B) ADOPT, APPROVE AMENDMENTS TO, OR AMEND THE ARTICLES OF INCORPORATION OF THE CORPORATION OR OF ANY AFFILIATE; (C) ADOPT, APPROVE AMENDMENTS TO, OR AMEND THE BYLAWS OF THE CORPORATION OR OF ANY AFFILIATE; (D) APPOINT AND REMOVE THE BOARD OF DIRECTORS, ANY ONE OR MORE OF THE DIRECTORS OF THE CORPORATION OR OF ANY AFFILIATE, AND THE CHAIRPERSON AND PRESIDENT OF THE CORPORATION OR OF ANY AFFILIATE; (E) APPROVE THE RECOMMENDATION OF THE BOARD OF DIRECTORS TO APPOINT OR REMOVE THE BOARD OF DIRECTORS, ANY ONE OR MORE DIRECTORS OF THE CORPORATION OR OF ANY AFFILIATE, OR THE CHAIRPERSON AND PRESIDENT OF THE CORPORATION OR OF ANY AFFILIATE. (F) WITH RESPECT TO THE CORPORATION OR ANY AFFILIATE, APPROVE THE PURCHASE, SALE, ALIENATION, EXCHANGE, LEASE OR ENCUMBRANCE OF ANY REAL PROPERTY OF THE CORPORATION OR OF ANY AFFILIATE, WHICH PROPERTY HAS A VALUE IN EXCESS OF LIMITS SET FROM TIME TO TIME BY HSSI; (G) APPROVE THE OPERATING AND CAPITAL BUDGETS OF THE CORPORATION OR OF ANY AFFILIATE, AND ANY DEVIATIONS BY THE CORPORATION OR OF ANY AFFILIATE FROM SUCH BUDGETS IN AN AMOUNT OR PERCENTAGE SPECIFIED BY HSSI FROM TIME TO TIME; (H) APPROVE THE STRATEGIC PLAN AND GOALS OF THE CORPORATION OR OF ANY AFFILIATE; (I) APPROVE THE SALE OF SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION OR OF ANY AFFILIATE; (J) APPROVE THE MERGER OR DISSOLUTION OF THE CORPORATION OR OF ANY AFFILIATE; (K) ADOPT OR AMEND THE PLAN FOR MINISTRY EDUCATION AND GOVERNANCE FOR THE CORPORATION AND ITS AFFILIATES; (L) APPROVE THE CORPORATION'S MISSION ACCOUNTABILITY REPORTS AND THOSE OF ANY AFFILIATE; (M) APPROVE THE FINANCIAL POLICIES AND PROCEDURES OF THE CORPORATION OR OF ANY AFFILIATE AND APPROVE ANY DEVIATIONS FROM SUCH POLICIES AND PROCEDURES BY THE CORPORATION OR ANY AFFILIATE; AND (N) ADOPT POLICIES TO IMPLEMENT THE RESERVED POWERS OF HSSI.
FORM 990 REVIEW PROCESS	FORM 990 PART VI, LINE 11b	THE HOSPITAL EMPLOYS KPMG TO ASSIST IN THE OVERALL preparation and REVIEW AND ELECTRONIC SUBMISSION OF ITS FORM 990. KPMG PROVIDES GUIDANCE IN IDENTIFYING CRITICAL ERRORS IN THE RETURN SUBMISSION AND FEEDBACK ON QUANTITATIVE AND QUALITATIVE RESPONSES. ADDITIONALLY, THE HOSPITAL CFO PERFORMS A THOROUGH REVIEW OF THE RETURN AND REVIEWS IT WITH THE HOSPITAL CEO AND/OR SENIOR LEADERS BEFORE PRESENTING IT IN ITS ENTIRETY TO THE HOSPITAL BOARD FOR QUESTIONING AND REVIEW PRIOR TO THE RETURN'S SIGNING AND SUBMISSION TO THE IRS.
CONFLICT OF INTEREST POLICY	FORM 990 PART VI, LINE 12C	THE ORGANIZATION IS SUBJECT TO THE CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY ("POLICY") OF HOSPITAL SISTERS HEALTH SYSTEM, AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. A REVISED CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY HAVE BEEN IMPLEMENTED SINCE JANUARY, 2009 TO MANAGE CONFLICTS OF INTEREST USING A SYSTEM-WIDE PROTOCOL FOR DISCLOSURE STATEMENTS. IN ACCORDANCE WITH THE ORGANIZATON'S CONFLICT OF INTEREST POLICY, ALL COVERED PERSONS HAVE A DUTY TO COMPLY WITH THE CONFLICT OF INTEREST POLICY FOR ANY CONTRACT, TRANSACTION, RELATIONSHIP OR ACTIVITY CONTEMPLATED, ENTERED INTO OR CONDUCTED AT HSHS OR ITS AFFILIATES. THE POLICY DEFINES COVERED PERSONS AS BOARD MEMBERS, BOARD COMMITTEE MEMBERS, OFFICERS, BOARD DESIGNEES, SENIOR MANAGEMENT, MEMBERS OF ANY COMMITTEE THAT OVERSEES THE APPROVAL OF PHARMACEUTICALS AND MEDICAL DEVICES, ANY OTHER INDIVIDUAL WHO HOLDS A POSITION OF TRUST. ON AN ANNUAL BASIS, HSHS DISCLOSES A COPY OF THE CONFLICT OF INTEREST POLICY (AND ALL CORRESPONDING PROCEDURES, GUIDELINES, FORMS AND TOOLS) TO ALL COVERED PERSONS AND ADVISES ALL COVERED PERSONS IN WRITING OF ANY SUBSTANTIVE CHANGES TO THIS POLICY AND SUCH RELATED MATERIALS. COVERED PERSONS ARE REQUIRED TO REVIEW AND COMPLETE THE CORRESPONDING CONFLICT OF INTEREST STATEMENT. THE SYSTEM OFFICE VICE PRESIDENT - SYSTEM RESPONSIBILITY, VICE PRESIDENT - RISK & COMPLIANCE OR MEMBERS OF THE AUDIT AND INTEGRITY COMMITTEE ("COMMITTEE") ARE AVAILABLE TO ANSWERS ANY QUESTIONS A COVERED PERSON MAY HAVE. IN ADDITION, IF, AT ANY TIME AFTER SUBMITTING AN ANNUAL CONFLICT OF INTEREST STATEMENT, A COVERED PERSON BECOMES AWARE OF AN INTEREST THAT HE OR SHE WOULD HAVE HAD TO DISCLOSE AT THE ANNUAL INTERVAL, THE COVERED PERSON IS REQUIRED PROMPTLY TO DISCLOSE THE INTEREST TO THE COMMITTEE USING THE HSHS CONFLICT OF INTEREST DISCLOSURE STATEMENT. COMPLETED CONFLICT OF INTEREST STATEMENTS ARE SUBMITTED TO THE COMMITTEE, WHICH IS RESPONSIBLE FOR IDENTIFYING, ASSESSING, AND MANAGING CONFLICTS OF INTEREST THAT ARISE IN THE COURSE OF CONDUCTING THE AFFAIRS OF HSHS AND ITS AFFILIATES. IF THE COMMITTEE DETERMINES THAT A CONFLICT OF INTEREST EXISTS, THE CONFLICT OF INTEREST POLICY REQUIRES HSHS NOT TO ENGAGE IN OR ENTER INTO A PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT OR ACTIVITY UNLESS THE COMMITTEE OR, WHERE NECESSARY, THE BOARD OF DIRECTORS (ACTING THROUGH ITS DISINTERESTED MEMBERS), HAS INVESTIGATED ALTERNATIVES TO THE PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT OR ACTIVITY AND, IN THE ABSENCE OF ALTERNATIVES THAT ARE IN THE BEST INTERESTS OF HSHS, HAS DETERMINED: 1. THAT, REGARDLESS OF WHETHER THE COVERED PERSON PARTICIPATES IN THE IMPLEMENTATION OF THE PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY; 2. THE CONTRACT, TRANSACTION, ARRANGEMENT OR ACTIVITY IS IN THE BEST INTERESTS OF HSHS; 3. THE CONTRACT, TRANSACTION, ARRANGEMENT OR ACTIVITY IS FAIR AND REASONABLE FROM THE PERSPECTIVE OF HSHS; AND 4. HSHS CANNOT OBTAIN A MORE ADVANTAGEOUS CONTRACT, TRANSACTION, ARRANGEMENT OR ACTIVITY WITH REASONABLE EFFORTS UNDER THE CIRCUMSTANCES. IN DETERMINING WHETHER A CONTRACT, TRANSACTION OR ARRANGEMENT IS FAIR AND REASONABLE TO HSHS, THE COMMITTEE SHALL CONSIDER, WHERE APPLICABLE: 1. APPRAISALS OR OTHER INDEPENDENT VALUATIONS OF THE FAIR MARKET VALUE OF THE CONTRACT, TRANSACTION OR ARRANGEMENT; 2. INFORMATION REGARDING COMPARABLE CONTRACTS, TRANSACTIONS OR ARRANGEMENTS BETWEEN UNRELATED PARTIES; 3. OFFERS FROM COMPARABLE COMPETING ENTITIES; AND/OR 4. STUDIES OF COMPARABLE COMPENSATION ARRANGEMENTS. IN ANY CASE IN WHICH THE COMMITTEE FINDS, AFTER TAKING THE STEPS DESCRIBED ABOVE, THAT HSHS SHOULD PARTICIPATE IN A PROPOSED TRANSACTION OR ARRANGEMENT DESPITE THE EXISTENCE OF A CONFLICT OF INTEREST, THE COMMITTEE SHALL DEVELOP, IMPLEMENT, MONITOR, AND ENFORCE COMPLIANCE WITH, A CONFLICT MANAGEMENT PLAN FOR MANAGING THE CONFLICT OF INTEREST AS IT CONSIDERS NECESSARY FOR SUCH FINDINGS TO REMAIN VALID THROUGHOUT THE LIFE OF THE CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT OR ACTIVITY. ALL CONFLICT MANAGEMENT PLANS SHALL: 1. STATE THAT THE COMMITTEE WILL OVERSEE, MONITOR AND ENFORCE COMPLIANCE WITH THE PLAN THROUGHOUT THE COURSE OF THE STUDY AND SPECIFY MEANS FOR DOING SO, INCLUDING, WITHOUT LIMITATION, THAT THE APPROPRIATE INDIVIDUALS MUST PROVIDE THE COMMITTEE WITH WRITTEN REPORTS PERTAINING TO COMPLIANCE WITH THE CONFLICT MANAGEMENT PLAN, THAT THE COMMITTEE SHALL HAVE THE RIGHT TO AUDIT THE STUDY FOR SUCH COMPLIANCE AND THE RIGHT TO IMPOSE SANCTIONS FOR NON-COMPLIANCE; 2. STATE THAT THE PLAN MUST BE SHARED WITH COVERED PERSON WHOSE INTERESTS IT WAS DEVELOPED TO MANAGE; 3. STATE THAT THE PLAN MUST BE SHARED WITH, AND PERIODIC REPORTS ON COMPLIANCE WITH THE PLAN MUST BE PROVIDED TO, THE BOARD, SENIOR MANAGEMENT AND/OR GOVERNMENT AGENCIES; AND 4. PROVIDE FOR SUCH OTHER MANAGEMENT STEPS AND MECHANISMS THE COMMITTEE CONSIDERS NECESSARY AND APPROPRIATE. IN ADDITION TO THE COMMITTEE, THE SYSTEM OFFICE VICE PRESIDENTS OF SYSTEM RESPONSIBILITY AND RISK & COMPLIANCE MAY RETAIN SUCH INDEPENDENT ADVISORS OR EXPERTS AS DEEMED NECESSARY TO ASSIST IN MAKING ITS DETERMINATIONS AND DECISIONS. IF THE COMMITTEE DETERMINES THAT THE CONTEMPLATED TRANSACTION, RELATIONSHIP ARRANGEMENT OR ACTIVITY CANNOT PROCEED DUE TO A CONFLICT OF INTEREST, THE COMMITTEE SHALL INFORM THE APPLICABLE COVERED PERSON OR DECISION-MAKING BODY OF SUCH DETERMINATION WITHIN ONE WEEK OF THE COMMITTEE MEETING AT WHICH THE CONTEMPLATED TRANSACTION WAS DISCUSSED. THE COMMITTEE SHALL DOCUMENT ITS REJECTION OF THE CONTEMPLATED TRANSACTION IN THE COMMITTEE'S MEETING MINUTES.
WHISTLEBLOWER POLICY	FORM 990 PART VI, LINE 13	PROVISIONS WITHIN THE CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY PROVIDE PROTECTIONS FOR WHISTLEBLOWER TYPE ACTIVITIES.
COMPENSATION PROCESS	FORM 990 PART VI, LINE 15	THE COMPENSATION COMMITTEE (COMMITTEE) IS COMPRISED OF INDEPENDENT MEMBERS OF THE BOARD OF DIRECTORS. THE COMMITTEE DEVELOPS A COMPENSATION PHILOSOPHY FOR THE SYSTEM AND ALL AFFILIATES. THE COMMITTEE SELECTS AND HIRES THE INDEPENDENT COMPENSATION CONSULTANT TO DEVELOP COMPARABILITY DATA AND ADVISE THE COMMITTEE DURING ITS DELIBERATIONS REGARDING ALL ELEMENTS OF TOTAL COMPENSATION FOR ALL DISQUALIFIED INDIVIDUALS. INTEGRATED HEALTHCARE STRATEGIES (IHS), THE CONSULTANTS UTILIZED BY THE COMMITTEE, USE DATA FROM MULTIPLE TAX-EXEMPT PEER GROUP SOURCES TO DETERMINE SALARY RANGES, INCENTIVE OPPORTUNITY RANGES AND BENEFITS FOR THE DISQUALIFIED INDIVIDUALS. IHS THEN ASSISTS THE COMMITTEE IN PREPARING CONTEMPORANEOUS DOCUMENTATION OF ALL ACTIONS. EACH COMMITTEE MEETING IS CONDUCTED WITH THE INTENT TO CREATE A REBUTTABLE PRESUMPTION OF REASONABLENESS FOR ALL ELEMENTS OF EXECUTIVE TOTAL COMPENSATION FOR THE DISQUALIFIED INDIVIDUALS. THE CHAIRMAN MAKES THIS DECLARATION AND ALSO INQUIRES IF THERE ARE ANY CONFLICTS OF INTEREST BY ANY ATTENDEES. ANY CONFLICTS ARE DISCLOSED AND THE COMMITTEE THEN ACTS IN A MANNER TO AVOID ANY CONFLICTED INDIVIDUAL PARTICIPATING IN ANY MANNER WHERE A CONFLICT MIGHT EXIST. AT THE END OF THE MEETING, THE COMMITTEE PREPARES CONTEMPORANEOUS MINUTES THAT RECORD ALL ACTIONS TAKEN DURING THE MEETING.
DOCUMENTS AVAILABLE TO THE PUBLIC	FORM 990 PART VI, LINE 19	BOARD-APPROVED FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE GENERAL PUBLIC AT THIS TIME.
POOLED INVESTMENT ACCOUNT	FORM 990 PART X, LINE 11	St. Mary's Hospital's cash reserves ARE INVESTED IN A POOLED INVESTMENT ACCOUNT MAINTAINED BY HOSPITAL SISTERS HEALTH SYSTEM (HSHS). PARTICIPATION IN THE POOLED INVESTMENT FUND IS LIMITED TO THE 501(C)(3) HOSPITALS AND HEALTH SERVICES ORGANIZATIONS SPONSORED BY HSHS. THE POOLED ACCOUNT CONSISTS OF CASH, EQUITY AND DEBT SECURITIES THAT ARE PUBLICLY TRADED. IN ACCORDANCE WITH THE PROVISIONS OF STATEMENT OF FINANCIAL ACCOUNTING STANDARDS (SFAS) NO. 124, "ACCOUNTING FOR CERTAIN INVESTMENTS HELD BY NOT-FOR-PROFIT ORGANIZATIONS", INVESTMENTS IN EQUITY SECURITIES WITH READILY DETERMINABLE FAIR VALUES AND ALL INVESTMENTS IN DEBT SECURITIES ARE REPORTED AT FAIR VALUE ON THE BALANCE SHEET. INCOME, REALIZED AND UNREALIZED GAINS AND LOSSES ARE POOLED AND ALLOCATED TO THE PARTICIPANTS. INDIVIDUAL COMPONENTS OF ASSETS AND REVENUE ARE NOT IDENTIFIED TO THE INDIVIDUAL HOSPITAL PARTICIPANTS.
Other changes in net assets	Form 990, Part XI, Line 5	UNREALIZED LOSS (2,287,250) NET ASSETS REALISED FORM RESTRICTION - PP&E 27,483 TEMPORARILY RESTRICTED NET INCOME (32,882) PERMANENTLY RESTRICTED NET INCOME 14,081 RECOGNITION OF CHANGES IN PENSION FUNDED STATUS (6,507,053) PROCEEDS FROM RESTRICTED GRANT USED TO ACQUIRE EQUIPMENT 195,290 TRANSFER TO/FROM AFFILIATES (2,798,001) ------------- TOTAL (11,388,332) =============
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:SR. MARYbeth CULNAN, OSF TITLE:MBR. BOARD OF DIRECTORS HOURS:59
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:ANN CARR TITLE:TREASURER HOURS:60

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2011

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

ST MARY'S HOSPITAL STREATOR HOSPITAL SISTERS
OF THE 3RD ORDER ST FRANCIS

Employer identification number

36-2169181

Part I

Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)

(a) Name, address, and EIN of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity
(1) Springfield Health Partners LLC 4936 Laverna Road Springfield,IL62707 37-1364419	Healthcare	IL	0	0	hshs mg
(2) Kiara Clinical Integration Network LLC 4936 Laverna Road Springfield,IL62707 26-1417684	Healthcare	IL	0	0	HSSI
(3) PHYSICIANS CLINICAL INTEGRATION NETWORK 4936 Laverna Road Springfield,IL62707 31-1668647	Healthcare	IL	0	0	KCIN

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
(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	Yes	No
(1) HOSPITAL SISTERS HEALTH SYSTEM 4936 LAVERNA ROAD SPRINGFIELD,IL62707 37-1058692	HEALTHCARE	IL	501(c)(3)	11A	NA		No
(2) HOSPITAL SISTERS SERVICES INC 4936 LAVERNA ROAD SPRINGFIELD,IL62707 37-1163402	HEALTHCARE	IL	501(c)(3)	11A	NA		No
(3) HOSPITAL SISTERS OF ST FRANCIS FDTN 4936 LAVERNA ROAD SPRINGFIELD,IL62707 37-1186514	HEALTHCARE	IL	501(c)(3)	11A	NA		No
(4) HSHS HEALTH CARE PLAN TRUST FUND 4936 LAVERNA ROAD SPRINGFIELD,IL62707 37-1137724	HEALTHCARE	IL	501(c)(9)	N/A	NA		No
(5) ST ANTHONY'S HOSPITAL 503 N MAPLE STREET EFFINGHAM,IL62401 37-0661233	HEALTHCARE	IL	501(c)(3)	3	NA		No
(6) ST ELIZABTH'S HOSPITAL 211 SOUTH THIRD STREET BELLEVILLE,IL62220 37-0663567	HEALTHCARE	IL	501(c)(3)	3	NA		No
(7) ST FRANCIS HOSPITAL 1215 FRANCISCAN DRIVE LITCHFIELD,IL62056 37-0661236	HEALTHCARE	IL	501(c)(3)	3	NA		No
(8) ST JOHN'S HOSPITAL 800 EAST CARPENTER STREET SPRINGFIELD,IL62769 37-0661238	HEALTHCARE	IL	501(c)(3)	3	NA		No
(9) ST JOSEPH'S HOSPITAL 9515 HOLY CROSS LANE BREESE,IL62230 37-1208459	HEALTHCARE	IL	501(c)(3)	3	NA		No
(10) ST JOSEPH'S HOSPITAL 1515 MAIN STREET HIGHLAND,IL62249 37-0663568	HEALTHCARE	IL	501(c)(3)	3	NA		No
(11) ST JOSEPH'S HOSPITAL 2661 COUNTY HIGHWAY 1 CHIPPEWA FALLS,WI54729 39-0810545	HEALTHCARE	WI	501(c)(3)	3	NA		No
(12) ST MARY'S HOSPITAL 1800 E LAKE SHORE DRIVE DECATUR,IL62521 37-0661244	HEALTHCARE	IL	501(c)(3)	3	NA		No
(13) SACRED HEART HOSPITAL 900 WEST CLAIREMONT AVE EAU CLAIRE,WI54701 39-0807060	HEALTHCARE	WI	501(c)(3)	3	NA		No
(14) ST MARY'S MEDICAL CENTER 1726 SHAWANO AVENUE GREEN BAY,WI54303 39-0818682	HEALTHCARE	WI	501(c)(3)	3	NA		No
(15) ST NICHOLAS HOSPITAL 3100 SUPERIOR AVENUE SHEBOYGAN,WI53081 39-0808480	HEALTHCARE	WI	501(c)(3)	3	NA		No
(16) ST VINCENT HOSPITAL 835 S VAN BUREN GREEN BAY,WI54301 39-0817529	HEALTHCARE	WI	501(c)(3)	3	NA		No
(17) Hospital Sisters Healthcare West Inc 2661 COUNTY HIGHWAY I CHIPPEWA FALLS,WI54729 51-0157933	HEALTHCARE	WI	501(c)(3)	11A	NA		No
(18) HSHS SELF INSURANCE TRUST FUND 4936 LAVERNA ROAD SPRINGFIELD,IL62707 37-1120626	INSURANCE	IL	501(c)(3)	11A	NA		No
(19) HSHS Medical Group Inc 3215 Executive Park Drive SPRINGFIELD,IL62703 26-3956318	HEALTHCARE	IL	501(c)(3)	11A	NA		No
(20) HSHS Wisconsin Medical Group Inc 3215 Executive Park Drive springfield,IL62703 26-4515959	HEALTHCARE	WI	501(c)(3)	11A	NA		No
(21) Orange Cross Ambulance Inc 919 ASHLAND AVENUE SHEBOYGAN,WI53081 39-1860942	HEALTHCARE	WI	501(c)(3)	9	ST NICHOLAS		No
(22) WISCONSIN UPPER PENINSULA ONCOLOGY MGMT 835 S VAN BUREN GREEN BAY,WI54301 39-1677100	HEALTHCARE	WI	501(c)(3)	3	ST VINCENT		No
(23) UNITY LIMITED PARTNERSHIP 2366 OAK RIDGE CIRCLE DE PERE,WI54115 39-1750729	HEALTHCARE	WI	501(c)(3)	9	HSSI		No

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2011

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) Memorial and St Elizabeth's Healthcare 4000 North Illinois Street Swansea,IL62226 37-1312961	HealthCare	IL	St Elizabeth's	related	0	0		No	0		No	0 %
(2) Prairie Heart Institute - Carbondale 800 East Carpenter Street Springfield,IL62769 37-1321197	HealthCare	IL	St John's	related	0	0		No	0		No	0 %
(3) Northeast Wisconsin Radiation Therapy Se 1821 S Webster Avenue STE 300 Green Bay,WI543079047 26-3749065	HealthCare	WI	HSSI	related	0	0		No	0		No	0 %
(4) Pain Center of Wisconsin 4131 W Loomis Road STE 300 Greenfield,WI53221 26-3155343	HealthCare	WI	St Vincent	related	0	0		No	0		No	0 %
(5) Prevea Ventures LLC 2710 EXECUTIVE DRIVE Green Bay,WI54304 20-3775127	HealthCare	WI	HSSI	related	0	0		No	0		No	0 %
(6) Surgery Center of Sheboygan LLC 3141 Saemann Avenue Sheboygan,WI53081 26-0822209	Healthcare	WI	St Nicholas	related	0	0		No	0		No	0 %
(7) Carpenter Street Hotel LLC 525 North Sixth Street Springfield,IL62702 36-4128127	Hotel	IL	LaSante Inc	related	0	0		No	0		No	0 %
(8) Springfield Urgent Care Real Estate LLC PO Box 19456 Springfield,IL627949456 03-0413258	Rent. Real Es	IL	LaSante Inc	related	0	0		No	0		No	0 %

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)
(1) Kiara Inc 4936 Laverna ROAd Springfield,IL62707 37-1163401	HealthCare	IL	HSHS	C Corp
(2) LaSante Wisconsin Inc 4936 Laverna ROAd Springfield,IL62707 39-1572196	HealthCare	IL	Kiara Inc	C Corp
(3) LaSante Inc 4936 Laverna ROAd Springfield,IL62707 37-1163400	HealthCare	IL	Kiara Inc	C Corp
(4) Prairie Cardiovascular 619 East Mason STE 4P57 Springfield,IL62701 37-1071858	HealthCare	IL	Kiara Inc	C Corp
(5) Prevea Health Services 2710 EXECUTIVE DRIVE Green Bay,WI54304 39-1839351	HealthCare	WI	HSSI	C Corp
(6) Prevea Clinic Inc 2710 EXECUTIVE DRIVE Green Bay,WI54304 39-1839349	HealthCare	WI	HSSI	C Corp
(7) Prevea Health Network 2710 EXECUTIVE DRIVE Green Bay,WI54304 39-2000537	HealthCare	WI	HSSI	C Corp
(8) RENAISSANCE QUALITY INSURANCE PO Box 1159 Grand Caymans KY1-1102 CJ 98-0669953	Insurance	CJ	HSSI	C Corp

Schedule R (Form 990) 2011

Page 3

Part V

Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)

Note. Complete line 1 if any entity is listed in Parts II, III or IV.

Yes

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 . . . . . . . . . . . . . . . . . . . . . . .

b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

g Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

j Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

k Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .

l Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .

Yes

m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .

n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

q Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

r Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

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) PRARIE CARDIOVASCULAR	I	19,092	fmv
(1)
(2)
(3)
(4)
(5)
(6)

Schedule R (Form 990) 2011

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2011

Page 5

Part VII

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule R (see instructions).

Identifier	Return Reference	Explanation
transactions with related organizations	schedule r, part v, line 2	The transactions reported on line 1 and not specifically identified on line 2 are between related 501(c)(3) public charities. accordingly they are not reported in this section.

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: TO CONTINUE CHRIST'S HEALING MINISTRY THROUGH SERVICE TO THE SICK, THE AGED, THE POOR, AND THE TERMINALLY ILL.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a).....	3	10
4	Number of independent voting members of the governing body (Part VI, line 1b) ....	4	7
5	Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...	5	619
6	Total number of volunteers (estimate if necessary) ....	6	119
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ..	7a	16
b	Net unrelated business taxable income from Form 990-T, line 34 ..	7b	-156

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	95,740	65,053
9	Program service revenue (Part VIII, line 2g) .........	56,252,478	53,476,524
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	2,288,999	1,897,769
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	774,533	551,911
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	59,411,750	55,991,257
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	28,746,450	23,488,886
16a	Professional fundraising fees (Part IX, column (A), line 11e).....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f)....	34,367,167	31,962,242
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	63,113,617	55,451,128
19	Revenue less expenses. Subtract line 18 from line 12.......	-3,701,867	540,129
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	89,062,226	82,270,710
21	Total liabilities (Part X, line 26).............	35,116,998	39,173,685
22	Net assets or fund balances. Subtract line 21 from line 20.....	53,945,228	43,097,025

Sign Here

	Signature of officer	Date

	Type or print name and title.


4a	(Code: ) (Expenses $ 39,676,266 including grants of $ ) (Revenue $ 53,476,524 )
	See Schedule O - Community Benefit Report

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 expenses$ 39,676,266

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	955,193	840,488	888,891

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)			(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
(A) Name and Title
(18) Jeanne A Washko Pharmacist	40.0	X		114,271	0	124,611
(19) RENA A MATHESIUS PHARMACIST	40.0	X		122,030	0	21,357
(20) LARRY JONES CHIEF MEDICAL OFFICER	40.0		X	153,856	0	0

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512, 513, or 514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d		65,053
e	Government grants (contributions)1e

f	All other contributions, gifts, grants, and similar amounts not included above1f
g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			65,053
			Business Code
2a	NET PATIENT SERVICE REVENUE		900,099	53,476,524	53,476,508	16
b
c
d
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			53,476,524
3	Investment income (including dividends, interest
	and other similar amounts).....			638,313			638,313
4	Income from investment of tax-exempt bond proceeds..			0
5	Royalties............			0
		(i) Real	(ii) Personal
6a	Gross rents
b	Less: rental expenses
c	Rental income or (loss)
d	Net rental income or (loss).......
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	1,264,221	12,955
b	Less: cost or other basis and sales expenses		17,720
c	Gain or (loss)	1,264,221	-4,765
d	Net gain or (loss)..........			1,259,456			1,259,456
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..			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...			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..			0
Miscellaneous Revenue			Business Code
11a	MISC. HEALTHCARE REVENUE		532,000	501,487			501,487
b	GIFT SHOP		453,220	50,424			50,424
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			551,911
12	Total revenue. See Instructions....			55,991,257	53,476,508	16	2,449,680


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing ..........			1,424	1	1,349
2	Savings and temporary cash investments .......			499,962	2	-421,339
3	Pledges and grants receivable, net .........			0	3	0
4	Accounts receivable, net .........			7,544,058	4	8,015,880
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........			0	5	0
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........			0	6	0
7	Notes and loans receivable, net .............			0	7	0
8	Inventories for sale or use ..............			1,440,093	8	931,503
9	Prepaid expenses and deferred charges ............			518,462	9	477,871
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	79,772,850
b	Less: accumulated depreciation. .....	10b	40,233,458	42,792,432	10c	39,539,392
11	Investments—publicly traded securities ..........			28,971,877	11	26,661,215
12	Investments—other securities. See Part IV, line 11 ......			0	12	0
13	Investments—program-related. See Part IV, line 11 ..			76,000	13	43,791
14	Intangible assets .........			0	14	0
15	Other assets. See Part IV, line 11 ...........			7,217,918	15	7,021,048
16	Total assets. Add lines 1 through 15 (must equal line 34)...			89,062,226	16	82,270,710
17	Accounts payable and accrued expenses .			10,793,726	17	8,587,515
18	Grants payable ..........			0	18	0
19	Deferred revenue ..........			0	19	0
20	Tax-exempt bond liabilities ..........			12,917,783	20	12,622,783
21	Escrow or custodial account liability. Complete Part IV of Schedule D..			0	21	0
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........			0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..			0	23	0
24	Unsecured notes and loans payable to unrelated third parties ....			0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.....			11,405,489	25	17,963,387
26	Total liabilities. Add lines 17 through 25.....			35,116,998	26	39,173,685
	Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....			51,726,068	27	40,831,614
28	Temporarily restricted net assets .....			2,152,138	28	2,184,308
29	Permanently restricted net assets .....			67,022	29	81,103
	Organizations that do not follow SFAS 117, check here 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 .....			53,945,228	33	43,097,025
34	Total liabilities and net assets/fund balances .....			89,062,226	34	82,270,710