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

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2011
Open to Public Inspection
A For the calendar year, or tax year beginning 10-01-2011 and ending 09-30-2012
BCheck if applicable:
CName of organization
OSF Healthcare System
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
800 NE GLEN OAK AVENUE
 
Room/suite
City or town, state or country, and ZIP + 4
PEORIA, IL616033200
D Employer identification number

37-0813229
E Telephone number

G Gross receipts $ 1,877,671,105
F Name and address of principal officer:
Daniel E Baker
800 NE Glen Oak Avenue
Peoria,IL61603
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.osfhealthcare.org
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet0928
K Form of organization:
 
L Year of formation: 1880
M State of legal domicile: IL
Part I
Summary
Activities  & Governance 1 Briefly describe the organization’s mission or most significant activities: OSF Healthcare System is a Catholic Integrated health care delivery system. During FY2012 osf operated 7 hospitals, 1 nursing home, 5 home health agencies, 4 hospices and employeed approximately 590 physicians
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a)..... 3 11
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 6
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ... 5 14,993
6 Total number of volunteers (estimate if necessary) .... 6 1,793
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 6,000,284
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b  
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 20,962,768 53,637,086
9 Program service revenue (Part VIII, line 2g) ......... 1,679,394,636 1,752,743,785
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 35,856,767 36,513,922
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 28,146,582 32,275,538
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 1,764,360,753 1,875,170,331
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 2,211,639 1,895,004
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) 791,991,821 919,657,664
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 100,336 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet4,826,047    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 857,681,591 796,169,733
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 1,651,985,387 1,717,722,401
19 Revenue less expenses. Subtract line 18 from line 12....... 112,375,366 157,447,930
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 2,267,817,172 2,418,704,402
21 Total liabilities (Part X, line 26)............. 1,515,029,132 1,693,780,438
22 Net assets or fund balances. Subtract line 21 from line 20..... 752,788,040 724,923,964
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid preparer use only
Print/type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name Right pointing arrowhead image

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



Phone no.
May the IRS discuss this return with the preparer shown above? See instructions .........bullet
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2011)
Form 990 (2011)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III .........
1
Briefly describe the organization’s mission: OSF HEALTHCARE SYSTEM IS A CATHOLIC INTEGRATED HEALTH CARE DELIVERY SYSTEM WHICH DURING ITS FISCAL YEAR 2012 OPERATED 7 HOSPITALS, 1 NURSING HOME until 2/1/13, 5 HOME HEALTH AGENCIES, 4 HOSPICES, AND EMPLOYED approximately 590 PHYSICIANS. ALL PATIENTS ARE ACCEPTED REGARDLESS OF THEIR ABILITY TO PAY. ALL FACILITIES, SERVICES, PHYSICIANS AND OTHER PROFESSIONAL STAFF OF OSF HEALTHCARE SYSTEM SERVE ALL PATIENTS WITHOUT REGARD TO RACE, RELIGION, AGE, SEX, NATIONAL ORIGIN, PAYER SOURCE OR ABILITY TO PAY. THE BOARD OF DIRECTORS HAS ADOPTED CHARITY CARE POLICIES AND PROCEDURES WHICH APPLY FOR ALL FACILITIES AND SERVICES OF THE CORPORATION. THE AVAILABILITY OF CHARITY CARE IS COMMUNICATED TO PATIENTS IN NUMEROUS WAYS, INCLUDING USE OF FINANCIAL COUNSELORS, PATIENT INFORMATION BROCHURES, AND NOTICES ON PATIENT BILLINGS. CHARITY CARE APPLICATIONS AND INSTRUCTIONS ARE AVAILABLE ON WEBSITES MAINTAINED BY THE CORPORATION AND UPON A REQUEST MADE TO ANY OF THE CORPORATION'S FACILITIES OR OFFICES. OSF
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 597,321,092 including grants of $ 1,800,066 ) (Revenue $ 858,564,414 )
Inpatient services - SEE Schedule O
4b (Code:   ) (Expenses $ 468,492,064 including grants of $   ) (Revenue $ 670,837,699 )
Outpatient Services - SEE Schedule O
4c (Code:   ) (Expenses $ 240,763,556 including grants of $   ) (Revenue $ 88,570,927 )
Physician Services - SEE Schedule O
4d Other program services (Describe in Schedule O.)
(Expenses $ 217,340,558 including grants of $ 94,938 ) (Revenue $ 163,793,268 )
4e Total program service expensesMediumBullet$ 1,523,917,270
Form 990 (2011)
Form 990 (2011)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment........
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part II
Click to see attachment.........................
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part IIIClick to see attachment........................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part IClick to see attachment....................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment
...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IV
Click to see attachment
...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
Yes
 
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Part I.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II..
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III..
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II..........
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H..... Click to see attachment
20a
Yes
 
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statement to this return? Note. All Form 990 filers that operated one or more hospitals must attach audited financial statements. Click to see attachment
20b
Yes
 
Form 990 (2011)
Form 990 (2011)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.. Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III..... Click to see attachment
22
Yes
 
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................ Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
Yes
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?
......................
24c
 
No
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I......
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II
.........................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III.........
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV .........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV
...................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV..
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I
...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
Yes
 
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2........... Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2011)
Form 990 (2011)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V .........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
700
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
14,993
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note.
All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2011)
Form 990 (2011)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI .........
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
If the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
1a
11
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
6
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
Yes
 
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? .................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ............
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ..........
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
Yes
 
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes? ....
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form?
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done ....................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes," to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
Yes
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
IL
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
MR DANIEL BAKER
800 NE GLEN OAK AVE
PEORIA,IL61603
(309) 655-3638
Form 990 (2011)
Form 990 (2011)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII .........
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

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

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

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

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title
(B)
Average hours per week (describe hours for related organizations in Schedule O)
(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee)
(D)
Reportable compensation from the organization (W- 2/1099-MISC)
(E)
Reportable compensation from related organizations (W- 2/1099-MISC)
(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) GERALD J MCSHANE MD
Pres/CEO OSFMG, board member
40.0 X           523,501 0 49,298
(2) JAMES W GIRARDY MD
BOARD MEMBER
3.0 X           26,566 0 0
(3) KEVIN D SCHOEPLEIN
Vice Chairperson; CEO
40.0 X   X       1,014,672 0 561,494
(4) SISTER AGNES JOSEPH WILLIAMS OSF
Assistant Secretary
40.0 X   X       0 4,480 0
(5) SISTER DIANE MARIE MCGREW OSF
PRESIDENT/TREASURER
40.0 X   X       0 4,480 0
(6) SISTER JUDITH ANN DUVALL OSF
Chairperson
40.0 X   X       0 4,480 0
(7) SISTER MARIA ELENA PADILLA OSF
Board Member
40.0 X           0 0 0
(8) SISTER ROSE THERESE MANN OSF
Board Member
40.0 X           0 0 0
(9) SISTER THERESA ANN BRAZEAU OSF
Secretary
40.0 X   X       0 4,480 0
(10) SUSAN CAMPBELL
Senior VP, Board Member
40.0 X           286,751 0 48,635
(11) VANCE C PARKHURST
Senior Vice President
40.0 X           357,489 0 49,710
(12) DANIEL EBAKER
Senior VP, Board Member
40.0     X       538,332 0 222,122
(13) DANIEL R FASSETT MD
Physician, Neurosurgery
40.0         X   1,551,442 0 24,043
(14) FINN REIDER AMBLEMD
Physician, Neurosurgery
40.0         X   1,040,622 0 42,216
(15) JEFFREY D KLOPFENSTEIN MD
Physician, Neurosurgery
40.0         X   1,339,347 0 34,680
(16) SYED M HUSSAIN MD
Physician, Vascular Surgery
40.0         X   1,033,643 0 37,443
(17) TRAVIS D RICHARDSON MD
Physician, Orthopedics
40.0         X   1,137,689 0 24,616
Form 990 (2011)
Form 990 (2011)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title
(B)
Average hours per week (describe hours for related organizations in Schedule O)
(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee)
(D)
Reportable compensation from the organization (W- 2/1099-MISC)
(E)
Reportable compensation from related organizations (W- 2/1099-MISC)
(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) JAMES MOORE
Vice Chairperson; CEO Retired
.1           X 1,385,662 0 0
























1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 10,235,716 17,920 1,094,257
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet883
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address
(B)
Description of services
(C)
Compensation
UNIV OF IL COLLEGE OF MEDICINE
PO BOX 4196
SPRINGFIELD,IL627084196
TEACHING PHYSICIANS 18,817,065
HINSHAW CULBERTSON LLP
8142 Solutions Center Dr
CHICAGO,IL606778001
LEGAL 6,802,321
ASSOC ANESTHESIOLOGISTS SC
8600 N STATE RT 91 SUITE 250
PEORIA,IL616159452
Anesthesiology Svs 2,777,291
ROCKFORD ANESTHESIOLOGISTS ASSOC
2202 HARLEM RD STE 200
LOVES PARK,IL611112754
Anesthesiology Svs 1,704,850
CENTRAL IL PATHOLOGY SC
PO BOX 9190
PEORIA,IL616129190
PATHOLOGY SERVICES 1,349,461
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet58
Form 990 (2011)
Form 990 (2011)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue
(B)
Related or
exempt
function
revenue
(C)
Unrelated
business
revenue
(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 15,571,298
e Government grants (contributions)1e 19,604,379
f All other contributions, gifts, grants, and
similar amounts not included above
1f
18,461,409
g Noncash contributions included in lines 1a-1f:$  
h Total. Add lines 1a-1f.......MediumBullet 53,637,086
 Program Service Revenue Business Code
2a NET PATIENT SERVICE REVENUE 900,099 1,747,157,470 1,747,157,470    
b LAB 621,500 3,915,931   3,915,931  
c COLLECTION FEE 900,099 4,400   4,400  
d AFFILIATED PURCHASING PROGRAM 561,499 1,575,411   1,575,411  
e INTEREST 900,099 41,758   41,758  
f All other program service revenue . 48,815   48,815  
g Total. Add lines 2a–2f........MediumBullet 1,752,743,785
 Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 36,453,794     36,453,794
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties............MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents 2,365,146  
b Less: rental expenses 2,500,774  
c Rental income or (loss) -135,628  
d Net rental income or (loss).......MediumBullet -135,628     -135,628
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory   60,128
b Less: cost or other basis and sales expenses    
c Gain or (loss)   60,128
d Net gain or (loss)..........MediumBullet 60,128     60,128
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a TUITION 900,099 10,211,097 10,211,097    
b INCOME FROM JOINT VENTURES 900,099 6,120,796 6,120,796    
c PHYSICIANS/RNS/STAFF CONTRACT SERVICES 900,099 4,391,610 4,391,610    
d All other revenue .... 11,687,663 8,299,020 413,969 2,974,674
e Total. Add lines 11a–11d ......MediumBullet 32,411,166
12 Total revenue. See Instructions....MediumBullet 1,875,170,331 1,776,179,993 6,000,284 39,352,968
Form 990 (2011)
Form 990 (2011)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Check if Schedule O contains a response to any question in this Part IX. .........
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII.
(A)
Total expenses
(B)
Program service expenses
(C)
Management and general expenses
(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 1,800,066 1,800,066
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 94,938 94,938
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 .... 3,081,090   3,081,090  
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 711,279,464 649,679,710 60,023,732 1,576,022
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 52,664,123 46,567,799 6,096,324  
9 Other employee benefits ....... 104,032,672 96,782,784 7,249,888  
10 Payroll taxes ........... 48,600,315 44,172,500 4,427,815  
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 3,999,961 2,228,259 1,771,702  
c Accounting ........... 535,918 338,200 197,718  
d Lobbying ........... 0      
e Professional fundraising. See Part IV, line 17.. 0  
f Investment management fees ...... 0      
g Other .......... 65,903,969 58,331,905 7,571,614 450
12 Advertising and promotion .... 7,225,005 6,870,895 258,406 95,704
13 Office expenses ....... 9,840,338 8,811,297 996,188 32,853
14 Information technology ...... 18,497,359 2,623,786 15,873,573  
15 Royalties .. 0      
16 Occupancy ........... 15,321,161 14,639,052 674,629 7,480
17 Travel ............ 5,743,556 4,524,526 1,199,186 19,844
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 2,688,391 1,892,853 776,826 18,712
20 Interest ........... 42,616,001 247,762 42,368,239  
21 Payments to affiliates ....... -63,180,731 -55,412,970 -7,768,111 350
22 Depreciation, depletion, and amortization ..... 76,191,295 62,380,358 13,810,937  
23 Insurance .............. 20,946,488 20,873,918 72,570  
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 SUPPLIES 264,392,742 263,653,241 354,789 384,712
b EQUIP RENTAL & MAINT 149,390,282 137,226,797 11,787,399 376,086
c BAD DEBT 82,075,923 82,075,923    
d MEDICAID FEES 34,493,208 34,493,208    
e
f All other expenses 59,488,867 39,020,463 18,154,570 2,313,834
25 Total functional expenses. Add lines 1 through 24f 1,717,722,401 1,523,917,270 188,979,084 4,826,047
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720). 1,478,645 1,317,714 159,709 1,222
Form 990 (2011)
Form 990 (2011)
Page 11
Part X Balance Sheet
(A)
Beginning of year
(B)
End of year
Assets 1 Cash—non-interest-bearing .......... 0 1 0
2 Savings and temporary cash investments ....... 105,037,151 2 88,078,588
3 Pledges and grants receivable, net ......... 7,224,184 3 9,660,264
4 Accounts receivable, net ......... 332,073,347 4 437,391,995
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 .............. 19,336,204 8 20,605,960
9 Prepaid expenses and deferred charges ............ 6,570,936 9 6,604,229
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 1,911,724,814
b Less: accumulated depreciation. ..... 10b 1,089,388,655 812,776,075 10c 822,336,159
11 Investments—publicly traded securities .......... 627,988,373 11 687,533,607
12 Investments—other securities. See Part IV, line 11 ...... 0 12 0
13 Investments—program-related. See Part IV, line 11 .. 39,575,545 13 35,193,736
14 Intangible assets ......... 6,631,798 14 6,631,798
15 Other assets. See Part IV, line 11 ........... 310,603,559 15 304,668,066
16 Total assets. Add lines 1 through 15 (must equal line 34)... 2,267,817,172 16 2,418,704,402
Liabilities 17 Accounts payable and accrued expenses . 137,154,631 17 150,349,952
18 Grants payable .......... 0 18 0
19 Deferred revenue .......... 0 19 0
20 Tax-exempt bond liabilities .......... 832,282,449 20 845,650,526
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..... 545,592,052 25 697,779,960
26 Total liabilities. Add lines 17 through 25..... 1,515,029,132 26 1,693,780,438
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets ..... 693,251,306 27 683,656,289
28 Temporarily restricted net assets ..... 47,706,091 28 28,093,608
29 Permanently restricted net assets ..... 11,830,643 29 13,174,067
Organizations that do not follow SFAS 117, check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ..... 752,788,040 33 724,923,964
34 Total liabilities and net assets/fund balances ..... 2,267,817,172 34 2,418,704,402
Form 990 (2011)
Form 990 (2011)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI .........
1
Total revenue (must equal Part VIII, column (A), line 12) ...
1
1,875,170,331
2
Total expenses (must equal Part IX, column (A), line 25) ....
2
1,717,722,401
3
Revenue less expenses. Subtract line 2 from line 1 ...
3
157,447,930
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
752,788,040
5
Other changes in net assets or fund balances (explain in Schedule O) ...
5
-185,312,006
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) ....
6
724,923,964
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII .........
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?....
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant? If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O. ...........................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
Yes
 
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
Yes
 
Form 990 (2011)
Additional Data


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

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

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

37-0813229
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization? ................
11g(i)
 
 
(ii) a family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
(i)
Name of supported organization
(ii)
EIN
(iii)
Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv)
Is the organization in col. (i) listed in your governing document?
(v)
Did you notify the organization in col. (i) of your support?
(vi)
Is the organization in col. (i) organized in the U.S.?
(vii)
Amount of support?
Yes No Yes No Yes No
Total                  

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

Additional Data


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

37-0813229
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




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

Page 2
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
OSF Healthcare System
 
Employer identification number

37-0813229
Part I
Contributors (see Instructions). Use duplicate copies of Part I if additional space is needed.
     
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED




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

     
 
   

$  




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

     
 
   

$  




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

     
 
   

$  




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

     
 
   

$  




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

     
 
   

$  




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

Page 3
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
OSF Healthcare System
 
Employer identification number

37-0813229
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
OSF Healthcare System
 
Employer identification number

37-0813229
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet $  

Use duplicate copies of Part III if additional space is needed
(a) No.
from
Part I
(b)
Purpose of gift
(c)
Use of gift
(d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I
(b)
Purpose of gift
(c)
Use of gift
(d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I
(b)
Purpose of gift
(c)
Use of gift
(d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I
(b)
Purpose of gift
(c)
Use of gift
(d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Additional Data


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

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

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

37-0813229
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

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

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

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

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










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

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

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


Schedule C (Form 990 or 990-EZ) 2011
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
Yes
No
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
Yes
 
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
Yes
 
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
Yes
 
601,764
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? ..........................
 
No
 
j
Total. Add lines 1c through 1i ...............................
601,764
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
No
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2 are answered “No” OR (b) Part III-A, line 3 is answered “Yes”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ...........................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, Part II-A; line 5; and Part ll-B, line 1.
Also, complete this part for any additional information.
Identifier Return Reference Explanation
Mailing Expenses Part II-B, Line 1d The only cost of mailing related to lobbying expenses related to the cost of stamps. The total expenditures related to mailing is minor and the actual dollar amount is not readily available.
Legislative Contacts Part II-B, Line 1g Schedule C, Part II-B, Line 1g includes lobbying expenses paid to various national health associations as part of dues and subscriptions in the amount of $161,764. It also includes direct contact with legislators, their staffs, government officials, and legislative bodies relating to physician payment reform, medicare rural extenders, hospital and home care protection, SGR issue resolution, and maintaining hospital reimbursement rates. This amounted to $440,000.
Schedule C (Form 990 or 990EZ) 2011

Additional Data


Software ID:  
Software Version:  

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

37-0813229
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .......    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) ...    
4 Aggregate value at end of year .......    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................
9
In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958), relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 52283D
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIV.
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current Year (b)Prior Year (c)Two Years Back (d)Three Years Back (e)Four Years Back
1a Beginning of year balance .... 17,139,873 7,390,433 5,655,845 2,718,442
b Contributions ........ 2,735,884 10,371,045 1,551,108 2,914,621
c Net investment earnings, gains, and losses ... 3,093,976 -557,661 526,674 32,954
d Grants or scholarships ..... -71,508 -63,944 -343,194 -10,172
e Other expenditures for facilities
and programs ........
-33,103      
f Administrative expenses ....        
g End of year balance ...... 22,865,122 17,139,873 7,390,433 5,655,845
2
Provide the estimated percentage of the year end balance (line 1g) held as:
a
Board designated or quasi-endowment SchDMd Bullet61.580 %
b
Permanent endowment SchDMd Bullet35.110 %
c
Temporarily restricted endowment SchDMd Bullet3.310 %
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
No
(ii) related organizations ........................
3a(ii)
 
No
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   16,688,385 16,688,385
b Buildings ................   994,939,468 425,668,581 569,270,887
c Leasehold improvements ............   8,164,832 6,602,864 1,561,968
d Equipment ................   831,058,499 638,915,091 192,143,408
e Other .................   60,873,630 18,202,119 42,671,511
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 822,336,159
Schedule D (Form 990) 2011

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








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








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) BOND INSURANCE FEES 7,799,280
(2) WORKERS' COMP ESCROW DEPOSITS 5,275,012
(3) THIRD PARTY WITHHOLDINGS 13,637,676
(4) DUE FROM FOUNDATION 7,372,345
(5) ASSETS - LIMITED OR RESTRICTED 41,267,674
(6) FUNDS LIMITED AS TO USE 202,836,091
(7) OTHER ACCOUNTS 26,479,988


Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 304,668,066
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Book value
Federal Income Taxes 0
ESTIMATED SELF INSURANCE LIABI 138,324,651
RETIRE OBLIG - ASBESTOS 2,959,600
ACCRUED PENSION LIABILITY 414,264,000
MARKET VALUATION OF SWAP 56,932,780
THIRD PARTY SETTLEMENT PAYABLE 82,668,563
DEFERRED COMPENSATION 2,630,366



Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 697,779,960
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1  
2 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
SUPPLEMENTAL INFORMATION   OSF adopted ASC Subtopic 740-10, Accounting for Uncertainty in Income Taxes - an interpretation of FASB statment No. 109. The interpretation 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, OSF 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 September 30, 2011 and 2012, OSF does not have a liablity for unrecognized tax benefits.
Part V, Line 4   The organization's endowment funds are used to provide scholarships to nursing students, acquire equipment and support programs of various medical departments of the OSF Healthcare System hospitals.
Schedule D (Form 990) 2011

Additional Data


Software ID:  
Software Version:  




SCHEDULE H (Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
OSF Healthcare System
 
Employer identification number

37-0813229
Part I
Charity Care and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a....
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Did the organization use FPG to determine eligibility for providing discounted care? If "Yes," indicate which of the
following was the family income limit for eligibility for discounted care: ............
3b
Yes
 
c
If the organization did not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

4

Yes

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

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount?......
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care?...............
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year?...........
6a
Yes
 
b
If "Yes," did the organization make it available to the public? ...............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance
and Means-Tested Government Programs
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) ..
    77,457,258   77,457,258 4.740 %
b Medicaid (from Worksheet 3, column a) .....     257,400,636 221,639,700 35,760,936 2.190 %
c Costs of other means-tested government programs (from Worksheet 3, column b) .            
dTotal Financial Assistance and
Means-Tested Government Programs .....
    334,857,894 221,639,700 113,218,194 6.930 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) ....
    1,288,193 117,289 1,170,904 0.070 %
f Health professions education
(from Worksheet 5) ..
    54,576,370 21,793,030 32,783,340 2.000 %
g Subsidized health services
(from Worksheet 6) ..
    33,807,326 16,124,886 17,682,440 1.080 %
h Research (from Worksheet 7)     1,389,616 128,248 1,261,368 0.080 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) ....     1,723,692   1,723,692 0.110 %
jTotal Other Benefits ...     92,785,197 38,163,453 54,621,744 3.340 %
kTotal. Add lines 7d and 7j. ..     427,643,091 259,803,153 167,839,938 10.270 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue
(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy     23,621   23,621  
8 Workforce development            
9 Other            
10 Total     23,621   23,621  
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense........
2
25,002,874
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy .....
3
 
4
Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
449,317,154
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
537,565,329
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
-88,248,175
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures
(see instructions)
(a) Name of entity (b) Description of primary
activity of entity
(c) Organization's
profit % or stock
ownership %
(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership%
(e) Physicians'
profit % or stock
ownership %
1NONE
 
       
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest)
How many hospital facilities did the organization operate during the tax year?7
Name and address
Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe)
1 Saint Francis Medical Center
530 NE Glen Oak Avenue
Peoria,IL61637
X X X X   X X    
2 St Anthony Medical Center
5666 East State Street
Rockford,IL61108
X X   X   X X    
3 St Joseph Medical Center
2200 East Washington Street
Bloomington,IL61701
X X         X    
4 St Mary Medical Center
3333 North Seminary Street
Galesburg,IL61401
X X         X    
5 St Francis Hospital
3401 Ludington Street
Escanaba,MI49829
X       X   X    
6 SAINT JAMES HOSPITAL
2500 W REYNOLDS STREET
PONTIAC,IL61764
X X         X    
7 OSF HOLY FAMILY MEDICAL CENTER
1000 W HARLEM AVENUE
MONMOUTH,IL61462
X       X   X    
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

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

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 600.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20 Yes  
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 Yes  
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

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

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 600.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20 Yes  
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 Yes  
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
St Joseph Medical Center
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):3

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 600.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20 Yes  
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 Yes  
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
St Mary Medical Center
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):4

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 350.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20 Yes  
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 Yes  
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
St Francis Hospital
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):5

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 350.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20 Yes  
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 Yes  
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
SAINT JAMES HOSPITAL
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):6

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 350.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20 Yes  
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 Yes  
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
OSF HOLY FAMILY MEDICAL CENTER
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):7

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 350.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20 Yes  
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 Yes  
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?39
Name and address Type of Facility (describe)
1 Glen Avenue Diagnostic Center
4911 Executive Drive Main Level S
Peoria,IL61614
Maternal Fetal Diagnostics
2 Outpatient Rehabilitation
Randolph Building Suite 100 NERan
Peoria,IL61606
Rehab
3 Outpatient Audiology
Randolph Building Suite 100 NERan
Peoria,IL61606
Audiology
4 PM&R Associates
Randolph Building Suite 100 NERan
Peoria,IL61606
Rehab
5 Center for Industrial Rehab
506 High Point Lane
East Peoria,IL61611
Rehab
6 Out Patient Rehabilitation
Pennsylvania Medical Building 200 E
Peoria,IL61603
Rehab
7 Pekin Cancer Treatment Center
603 Thirteenth Street
Pekin,IL61554
EKG, Echo cardiology, Nuclear stress test, Vascular ultrasound, Treadmill stress T
8 ObstetricsGynecology Clinic
320 E Armstrong
Peoria,IL61603
OB/GYNE Services
9 Internal Medicine
320 E Armstrong
Peoria,IL61603
Ambulatory Internal Medicine
10 Pediatric Ambulatory Clinic
320 E Armstrong
Peoria,IL61603
Ambulatory Pediatric Medicine
11 Saint Clare Family Health Center
10 Saint Clare Court
Washington,IL61571
Lab, EKG, Radiology
12 OSF Center for Health
8600-8800 Rt 91 North
North Peoria,IL61615
Diagnostic Imaging/Lab/Voice & Swallowing Services
13 OSF Saint Francis Riverplex
600 N E Water Street
Peoria,IL61602
Rehab
14 OSF Saint Francis Heart Hospital
5405 N Knoxville Avenue
Peoria,IL61614
Nuclear Med, CT Scan, Vascular ultrasound, Echo cardiology, Chest X-Ray, Stress test
15 OSF Heart Hospital Diagnostic Center
610 Park Avenue
Pekin,IL615544650
EKG, Nuclear stress test, Vascular ultrasound, Echo cardiology, Chest X-Ray,Stress
16 OSF SF Radiation Oncology
8948 N Wood Sage Road
Peoria,IL61615
Radiation oncology
17 OSF Saint Francis Morton Health Center
435 Maxine Dr
Morton,IL61550
Radiology, Lab, EEG, EKG, Sleep lab
18 Saint Francis Medical INI Rehabilitation
Five Points Washington 360 Wilmor R
Washington,IL615711252
Rehab
19 OSF Saint Francis Center for Health Glen
5114 Glen Park Place
Peoria,IL616144686
Diagnostic Imaging/Lab
20 Southridge Laboratory
4423 Manchester Drive
Rockford,IL61109
Diagnostic Lab
21 Outpatient Rehabilitation Services
5510 E State Street
Rockford,IL61108
Rehab
22 Diabetes Education Center
5510 E State Street
Rockford,IL61108
Education
23 Wound Healing Center State and Roxbury
5668 E State Street
Rockford,IL61108
Hyperbaric Oxygen Therapy
24 Rockford Cardiovascular Associates
444 Roxbury Road
Rockford,IL61107
Cardiac and Pulmonary Rehab / Radiology and Diagnostic Services / Sleep Center
25 OSF Center for Health-Rock Cut Crossing
9951 Rock Cut Crossing
Loves Park,IL611111999
Diagnostic Imaging/Lab
26 Illinois Neurological Institute at OSF
535 Roxbury Road
Rockford,IL61108
No procedures are done at this location at this time
27 OSF St Francis Hospital and Medical Gro
N 15995 Main St
Powers,MI49870
Diagnostic Lab
28 St Francis Hospital- Powers Clinic
N 15995 Main St
Powers,MI49870
Diagnostic X-Ray
29 OSF St Francis Hospital Medical Group
128 Michigan
Gladstone,MI49837
Diagnostic X-Ray/Lab
30 OSF St Francis Hospital Medical Group
3409 Ludington St
Escanaba,MI49829
Diagnostic X-Ray/Lab
31 St Francis Hospital- Rehab Services
704 Superior Avenue
Gladstone,MI49837
Rehab
32 OSF Saint James Rehabilitation
106 South First Street
Fairbury,IL61739
Rehab
33 OSF Saint James Rehabilitation
105 John Street
Dwight,IL60420
Rehab
34 Center for Health at Ft Jesse
2200 Ft Jesse Road
Normal,IL61761
Physical Therapy; Occupational Therapy; Audiology; Industrial Rehab; Pain Clinic; Wound Care
35 OSF St Joseph Medical Center-College Av
1701 East College Avenue
Bloomington,IL61704
Diagnostic Imaging
36 OSF St Joseph Medical Center - Rehabili
1701 East College Avenue
Bloomington,IL61704
Rehab
37 Eastland Medical Plaza I
1505 Eastland Avenue
Bloomington,IL61704
Rehab
38 OSF Holy Family Clinic
1000 West Harlem Ave
Monmouth,IL61462
cardiology, general, neru, pediatric, podiatry sleep center
39 Outpatient Medical Imaging
3375 North Seminary St
Galesburg,IL61401
mammo, ultrasound, bone density, limited x-ray
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 9, 10, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Identifier ReturnReference Explanation
PART I, LINE 3C:   THE CORPORATION PROVIDES FREE CARE AND DISCOUNTED CARE TO HOSPITAL PATIENTS AND ALL OTHER PATIENTS IN THE FOLLOWING WAYS: - FREE CHARITY CARE FOR PATIENTS WHOSE FAMILY INCOME IS LESS THAN 200% OF FEDERAL POVERTY GUIDELINES (FPG) FOR THEIR FAMILY SIZE. - DISCOUNTED CHARITY CARE ON A SLIDING SCALE FOR PATIENTS WHOSE FAMILY INCOME IS BETWEEN 200% AND 600% OF FPG FOR THEIR FAMILY SIZE. - CATASTROPHIC CHARITY CARE REGARDLESS OF INCOME OR ASSET LEVELS FOR MEDICALLY NECESSARY SERVICES WHICH EXCEED 25% OF ANNUAL FAMILY INCOME. NO PATIENT PAYS MORE THAN 25% OF ANNUAL FAMILY INCOME IN A 12-MONTH PERIOD REGARDLESS OF INCOME OR ASSET LEVELS. - 20% DISCOUNT FOR ALL UNINSURED PATIENTS WHO ARE NOT OTHERWISE ELIGIBLE FOR FREE, DISCOUNTED, OR CATASTROPHIC CHARITY CARE. - ALL PATIENTS RECEIVE THE GREATEST DISCOUNT AVAILABLE UNDER ANY OF THESE PROGRAMS. NO ASSET TESTS ARE USED. - EXCEPT AS OTHERWISE NOTED, THESE POLICIES APPLY BOTH TO UNINSURED PATIENTS AND TO INSURED PATIENTS WITH RESPECT TO THE PATIENT RESPONSIBILITY AMOUNT.
PART I, LINE 7:   COSTS REPORTED ON LINES 7 a, b, and c ARE CALCULATED USING THE RATIO OF PATIENT CARE COST-TO-CHARGES DERIVED FROM WORKSHEET 2. COSTS REPORTED ON LINES 7 e,f,g,h, and i ARE COSTS DERIVED FROM GENERAL LEDGER ACCOUNTS AND HOSPITAL DEPARTMENT COST CENTER REPORTS WHICH INCLUDE BOTH DIRECT AND INDIRECT COSTS LESS REVENUE. LINE 7g REPRESENTS ALL PAYERS EXCLUDING MEDICARE, MEDCAID AND SELF-PAY.
PART I, LINE 7G:   NET COSTS (TOTAL EXPENSE LESS REVENUE) OF THIRTEEN PHYSICIAN CLINICS ARE INCLUDED AS SUBSIDIZED HEALTH SERVICES ON PART I, LINE 7g. SUCH NET COSTS TOTAL $5,666,600.
PART I, LINE 7, COLUMN F:   BAD DEBT EXPENSE IN THE AMOUNT OF $82,075,923 IS INCLUDED ON FORM 990, PART IX, LINE 24c, COLUMN (A), BUT WAS SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGES IN SCHEDULE H, PART I, LINE 7, COLUMN (F).
PART III, LINE 4:   IN GENERAL, AND IN ACCORDANCE WITH MEDICARE REGULATIONS, PATIENT ACCOUNT BALANCES ARE WRITTEN OFF TO BAD DEBT EXPENSE AFTER REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED AND THE ACCOUNT HAS BEEN SENT TO A COLLECTION AGENCY OR LAW FIRM. Patients' accounts receivable are reduced by an allowance for uncollectible accounts. In evaluating the collectibility of patients' accounts receivable, OSF analyzes its past history and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for uncollectible accounts and provision for bad debts. Management regularly reviews data about these major payor sources of revenue in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with services provided to patients who have third-party coverage, OSF analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for bad debts, if necessary. For receivables associated with patient responsibility(which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), the patients are screened against the OSF charity care policy and uninsured discount policy. For any remaining patient responsibility balance, OSF records a provision for bad debts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the standard rates(or the discounted rates if negotiated) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts. Bad debt expense of $82,075,923 on Form 990, Part IX, Line 24c is based upon accrual accounting required by generally accepted accounting principles. This amount consequently differs from the bad debt expense of $25,002,874 on Schedule H, Part III, Line 2 which requires the organization to report aggregate bad debt at cost. BAD DEBT EXPENSE REPORTED ON PART III, LINE 2 IS therefore CALCULATED BY MULTIPLYING GROSS CHARGES WRITTEN OFF TO BAD DEBT EXPENSE TIMES THE RATIO OF PATIENT CARE COST-TO-CHARGES DERIVED FROM WORKSHEET 2. DISCOUNTS, INCLUDING ANY APPLICABLE THIRD PARTY PAYER CONTRACTUAL ALLOWANCES AND ANY CHARITY CARE DISCOUNTS (VALUED AT GROSS CHARGES), ARE APPLIED TO PATIENT ACCOUNT GROSS CHARGES TO DETERMINE THE ACCOUNT BALANCE BEFORE PATIENT PAYMENTS. THE AGGREGATE AMOUNT OF ALL PATIENT PAYMENTS IS THEN APPLIED TO THE ACCOUNT BALANCE. WHEN DETERMINATION IS MADE THAT NO FURTHER AMOUNTS CAN BE COLLECTED IN ACCORDANCE WITH THE CORPORATION'S BAD DEBT POLICY, THE REMAINING BALANCE IS WRITTEN OFF TO BAD DEBT EXPENSE. THE CORPORATION UTILIZES A PRESUMPTIVE CHARITY PROCEDURE FOR ALL PATIENTS WHO FAIL TO PROVIDE FINANCIAL INFORMATION NORMALLY CONSIDERED IN MAKING CHARITY ELIGIBILITY DETERMINATIONS BUT FOR WHOM THE CORPORATION IS ABLE TO OBTAIN COMPARABLE INFORMATION FROM INDEPENDENT SOURCES, INCLUDING CONTRACT SERVICE PROVIDERS WHO COMPILE CREDIT BUREAU AND OTHER INFORMATION. WHEN SUCH INDEPENDENT VERIFICATION OF A PATIENT'S FINANCIAL INFORMATION IS OBTAINED, THE CORPORATION APPLIES THE SAME CHARITY DISCOUNT IT WOULD HAVE PROVIDED IF THE PATIENT HAD COMPLETED A CHARITY APPLICATION AND SUBMITTED SUCH FINANCIAL INFORMATION. SUCH PRESUMPTIVE CHARITY DETERMINATIONS MAY BE MADE AT ANY TIME THE NECESSARY FINANCIAL INFORMATION BECOMES AVAILABLE TO THE CORPORATION, AND PATIENTS ARE NOTIFIED IN WRITING OF THE CHARITY DISCOUNT AMOUNTS SO DETERMINED AND APPLIED. THEREFORE, THE CORPORATION DOES NOT BELIEVE THAT BAD DEBT EXPENSE REPORTED ON PART III, LINE 3 INCLUDES ANY AMOUNTS THAT REASONABLY COULD BE ATTRIBUTABLE TO PATIENTS WHO WOULD LIKELY QUALIFY UNDER THE CORPORATION'S CHARITY CARE POLICY.
PART III, LINE 8:   100% OF THE MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT. OSF IS COMMITTED TO SERVING PATIENTS, REGARDLESS OF ABILITY TO PAY OR IF THE PAYMENTS TO BE RECEIVED WILL BE LESS THAN THE COST TO PROVIDE THE SERVICE, WHICH IS THE CASE FOR MEDICARE AND MEDICAID PATIENTS. THE MEDICARE ALLOWABLE COSTS ON LINE 6 PART III HAVE BEEN CALCULATED BY MULTIPLYING MEDICARE CHARGES BY THE PATIENT CARE COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2. THE AMOUNT IS COMPARED TO TOTAL MEDICARE PAYMENTS RECEIVED INCLUDING DSH AND IME PAYMENTS. THIS SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT SINCE IT REFLECTS UNREIMBURSED COSTS TO THE HEALTH SYSTEM FOR PROVIDING MEDICAL SERVICES TO THE MEDICARE RESIDENTS OF THE COMMUNITY.
PART III, LINE 9B   THE CORPORATION HAS A FAIR BILLING/COLLECTION POLICY WHICH APPLIES FOR ALL PATIENTS. THE POLICY INCLUDES: - REQUIRED INFORMATION PROVIDED IN BILLS TO PATIENTS (INCLUDING A REQUIREMENT THAT INFORMATION BE PROVIDED ON HOW THE PATIENT MAY APPLY FOR CHARITY CARE). - PROCESS FOR PATIENTS TO INQUIRE ABOUT OR DISPUTE A BILL, INCLUDING TOLL-FREE TELEPHONE NUMBER, ADDRESS, CONTACT NAME, AND E-MAIL ADDRESS. - REQUIREMENTS FOR TIMELY RESPONSE TO PATIENT INQUIRIES. - CONDITIONS WHICH MUST BE SATISFIED AND VERIFIED BY AN AUTHORIZED HOSPITAL REPRESENTATIVE BEFORE THE ACCOUNT OF AN UNINSURED PATIENT MAY BE SENT TO A COLLECTION AGENCY OR ATTORNEY. - THE CORPORATION'S HOSPITALS ARE REQUIRED TO OFFER A REASONABLE PAYMENT PLAN (BASED ON STATE WAGE GARNISHMENT LIMITS) TO UNINSURED PATIENTS. - LEGAL ACTION FOR NON-PAYMENT OF A PATIENT BILL MAY NOT BE INITIATED UNTIL AN AUTHORIZED HOSPITAL OFFICIAL HAS DETERMINED THAT ALL CONDITIONS IN THE CORPORATION'S POLICY (INCLUDING ALL OF THE FOREGOING POLICY PROVISIONS) HAVE BEEN SATISFIED FOR INITIATING LEGAL ACTION. - LEGAL ACTION MAY NOT BE PURSUED AGAINST UNINSURED PATIENTS WHO HAVE DEMONSTRATED THAT THEY HAVE NEITHER SUFFICIENT INCOME NOR ASSETS TO MEET THEIR FINANCIAL OBLIGATIONS - EVEN IF SUCH PATIENTS ARE NOT ELIGIBLE FOR CHARITY CARE ASSISTANCE. - THE CORPORATION SHALL NOT FILE A JUDGMENT LIEN AGAINST THE PRIMARY RESIDENCE OF ANY DEBTOR (EXCEPTIONS MAY BE APPROVED IN RARE CASES BY SENIOR OFFICERS OF THE CORPORATION ONLY). - THE CORPORATION SHALL NOT OBTAIN A BODY ATTACHMENT AGAINST ANY PATIENT OR GUARANTOR. - THE CORPORATION SHALL NOT ENGAGE IN ANY EXTRAORDINARY COLLECTION ACTIONS, SUCH AS SUBMITTING REPORTS TO CREDIT AGENCIES BEFORE REASONABLE ATTEMPTS TO DETERMINE ELIGIBILITY FOR CHARITY CARE ASSISTANCE HAVE BEEN COMPLETED.
Explained the basis for calculating amounts charged to patients: Part V - LINE 11H Saint Francis Medical Center, St. Anthony Medical Center, St. Joseph Medical Center, St. Mary Medical Center, Saint James Hospital, OSF Holy Family Medical Center: Please refer to the response to Schedule H, Part I, Line 3C for a description of how the above mentioned facilities explained the basis for calculating amounts charged to patients.
Actions the hospital facility took before involving a collections agency Part V, Line 17E Saint Francis Medical Center, St. Anthony Medical Center, St. Joseph Medical Center, St. Mary Medical Center, Saint James Hospital, OSF Holy Family Medical Center: Please refer to the response to Schedule H, Part III, Line 9B for a description of actions the above mentioned facilities took before initiating any of the collection actions checked in Schedule H, Part V, line 16.
amounts billed to uninsured or underinsured individuals: part v, line 19d Saint Francis Medical Center, St. Anthony Medical Center, St. Joseph Medical Center, St. Mary Medical Center, Saint James Hospital, OSF Holy Family Medical Center: THE HOSPITAL DETERMINED THE AMOUNTS BILLED TO INDIVIDUALS WHO DID NOT HAVE INSURANCE COVERING EMERGENCY OR OTHER MEDICALLY NECESSARY CARE IN THE FOLLOWING WAYS. THE AMOUNT BILLED TO THE INDIVIDUAL WAS THE LOWEST AMOUNT DETERMINED UNDER ANY OF THE FOLLOWING METHODS WHICH APPLY TO THE INDIVIDUAL: - FOR ILLINOIS RESIDENTS WHO INCUR GROSS CHARGES IN EXCESS OF $300 FOR ANY ONE INPATIENT ADMISSION OR OUTPATIENT ENCOUNTER, WHO APPLY FOR FINANCIAL ASSISTANCE, AND WHO'S FAMILY INCOME IS 600% OR LESS OF THE FEDERAL POVERTY GUIDELINE FOR THEIR FAMILY SIZE, THE AMOUNT BILLED IS CALCULATED BY MULTIPLYING GROSS CHARGES TIMES THE HOSPITAL'S COST TO CHARGE RATIO DETERMINED FROM ITS MOST RECENTLY FILED MEDICARE COST REPORT AND THEN MULTIPLYING THAT PRODUCT TIMES 135%. - THE AMOUNT BILLED FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE TO ANY UNINSURED PATIENT WHO APPLIES AND DOES NOT OTHERWISE QUALIFY FOR FINANCIAL OR CHARITY ASSISTANCE IS LIMITED TO 80% OF GROSS CHARGES. - THE MAXIMUM AMOUNT BILLED FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE TO ANY PATIENT WHO APPLIES FOR FINANCIAL ASSISTANCE DOES NOT EXCEED 25% OF FAMILY INCOME. -The maximum charge to any patient who qualifies for financial assistance under the hospital's charity policy will not exceed the average dollar amount which would be payable(including any patient or plan participant responsibility amount) for the same services under the terms of the three contracts in effect between the OSF facility providing medical care and private insurance companies on the first day of the fiscal year in which the patient's discharge occurs and which result in the lowest payment amounts. No insurance company contract which includes provisions for interim payments subject to later reconciliation shall be included in the calculation of the maximum charge. The amount billed to a patient eligible for charity assistance under this policy will be less than the amount of the gross charges. St. Francis Hospital: THE HOSPITAL DETERMINED THE AMOUNTS BILLED TO INDIVIDUALS WHO DID NOT HAVE INSURANCE COVERING EMERGENCY OR OTHER MEDICALLY NECESSARY CARE IN THE FOLLOWING WAYS. THE AMOUNT BILLED TO THE INDIVIDUAL WAS THE LOWEST AMOUNT DETERMINED UNDER ANY OF THE FOLLOWING METHODS WHICH APPLY TO THE INDIVIDUAL: - THE MAXIMUM AMOUNT BILLED FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE TO ANY PATIENT WHO MEETS THE ELIGIBILITY CRITERIA OF THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY DOES NOT EXCEED 25% OF FAMILY INCOME. DESCRIPTION AND REQUIRMENTS OF FINANCIAL ASSISTANCE POLICY ARE FOUND IN OSF HEALTHCARE SYSTEM POLICY AC-31. - THE AMOUNT BILLED FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE TO ANY UNINSURED PATIENT WHO APPLIES BUT DOES NOT OTHERWISE QUALIFY FOR FINANCIAL OR CHARITY ASSISTANCE IS LIMITED TO 92.5% OF GROSS CHARGES.
charges for medical care: part v, line 20 Saint Francis Medical Center, St. Anthony Medical Center, St. Joseph Medical Center, St. Mary Medical Center, Saint James Hospital, OSF Holy Family Medical Center, St. Francis Hospital: CHARGES TO PATIENTS WHO WERE ELIGIBLE FOR ASSISTANCE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY WERE DETERMINED IN THE MANNERS DESCRIBED FOR PART I, LINE 3C AND PART V, LINE 19D ABOVE. IT IS POSSIBLE, ALTHOUGH UNUSUAL, THAT A PATIENT WHO WAS ELIGIBLE FOR FINANCIAL ASSISTANCE COULD HAVE BEEN CHARGED MORE THAN THE AMOUNTS GENERALLY BILLED TO INDIVIDUALS WHO HAD INSURANCE COVERING SUCH CARE.
patients charged amount equal to the gross charge for services provided: part v, line 21 Saint Francis Medical Center, St. Anthony Medical Center, St. Joseph Medical Center, St. Mary Medical Center, Saint James Hospital, OSF Holy Family Medical Center: THE HOSPITAL CHARGED ITS PATIENTS AN AMOUNT EQUAL TO GROSS CHARGES IN THE FOLLOWING CIRCUMSTANCES: - PATIENTS RECEIVING ELECTIVE MEDICAL SERVICES OTHER THAN EMERGENCY OR OTHER MEDICALLY NECESSARY CARE, SUCH AS ELECTIVE COSMETIC SURGERY PERFORMED TO IMPROVE ONE'S APPEARANCE AND NOT RELATED TO A TRAUMA OR DISFIGURATION. - UNINSURED PATIENTS WHO DID NOT QUALIFY FOR FINANCIAL OR CHARITY ASSISTANCE AND WHO FAILED TO REQUEST THE 20% DISCOUNT OFFERED BY THE HOSPITAL TO ALL SUCH PATIENTS WHO REQUEST THE DISCOUNT. [THE HOSPITAL'S BILLING SYSTEM IS NOT CAPABLE OF AUTOMATICALLY APPLYING THIS DISCOUNT]. - PATIENTS WHOSE MEDICAL BILLS ARE THE RESPONSIBILITY OF A THIRD PARTY PURSUANT TO A CLAIM BROUGHT BY THE PATIENT AGAINST THE THIRD PARTY, SUCH ANOTHER DRIVER IN AN AUTO ACCIDENT. St. Francis Hospital: THE HOSPITAL CHARGED ITS PATIENTS AN AMOUNT EQUAL TO GROSS CHARGES IN THE FOLLOWING CIRCUMSTANCES: - PATIENTS RECEIVING ELECTIVE MEDICAL SERVICES OTHER THAN EMERGENCY OR OTHER MEDICALLY NECESSARY CARE, SUCH AS ELECTIVE COSMETIC SURGERY PERFORMED TO IMPROVE ONE'S APPEARANCE AND NOT RELATED TO A TRAUMA OR DISFIGURATION. - UNINSURED PATIENTS WHO DID NOT QUALIFY FOR FINANCIAL OR CHARITY ASSISTANCE AND WHO FAILED TO REQUEST THE 7.5% DISCOUNT OFFERED BY THE HOSPITAL TO ALL SUCH PATIENTS WHO REQUEST THE DISCOUNT. [THE HOSPITAL'S BILLING SYSTEM IS NOT CAPABLE OF AUTOMATICALLY APPLYING THIS DISCOUNT]. - PATIENTS WHOSE MEDICAL BILLS ARE THE RESPONSIBILITY OF A THIRD PARTY PURSUANT TO A CLAIM BROUGHT BY THE PATIENT AGAINST THE THIRD PARTY, SUCH ANOTHER DRIVER IN AN AUTO ACCIDENT. Schedule H - Part VI - 2 - Needs Assessment: The corporation commenced work during its fiscal year 2012 on conducting a community health needs assessment for each of its hospitals, as required by section 501(r)(3) of the code. That work effort continued into the corporation's fiscal year 2013. The final community health needs assessment for each of the corporation's hospitals was approved and adopted by the corporation's board of directors on July 29, 2013.
Schedule H - Part VI - 3 - Patient Education of Eligibility for assistance   THE CORPORATION INFORMS AND EDUCATES PATIENTS AND PERSONS WHO ARE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER GOVERNMENT PROGRAMS AND THE CORPORATION'S CHARITY ASSISTANCE POLICY IN THE FOLLOWING WAYS: - SIGNS ARE POSTED IN PATIENT REGISTRATION AREAS (INCLUDING EMERGENCY DEPARTMENT REGISTRATION) INFORMING PATIENTS OF THE AVAILABILITY OF CHARITY ASSISTANCE AND THE AVAILABILITY OF FINANCIAL ASSISTANCE REPRESENTATIVES. - PRINTED BROCHURES ARE DISTRIBUTED TO PATIENTS AT REGISTRATION INFORMING THEM OF THE AVAILABILITY OF CHARITY ASSISTANCE (FOR BOTH INSURED AND UNINSURED PATIENTS), FINANCIAL ASSISTANCE REPRESENTATIVES (INCLUDING CONTACT INFORMATION), AND UNINSURED PATIENT DISCOUNTS. - A NOTICE OF AVAILABILITY OF THE CORPORATION'S CHARITY CARE AND UNINSURED PATIENT DISCOUNT POLICIES IS PROMINENTLY AVAILABLE ON THE CORPORATION'S WEB SITE (AND SEPARATE WEB SITES OF ITS HOSPITAL FACILITIES). THE APPLICATION FORM WITH INSTRUCTIONS IS AVAILABLE FOR DOWNLOAD. - A NOTE REGARDING THE AVAILABILITY OF CHARITY AND FINANCIAL ASSISTANCE (TOGETHER WITH CONTACT PHONE NUMBERS) APPEARS ON EVERY PATIENT BILL AND STATEMENT. - FINANCIAL ASSISTANCE COUNSELORS ARE AVAILABLE IN PERSON AND BY PHONE TO ASSIST PATIENTS IN COMPLETING CHARITY AND FINANCIAL ASSISTANCE APPLICATIONS AND IN DETERMINING ELIGIBILITY AND APPLYING FOR GOVERNMENT PROGRAM BENEFITS, INCLUDING MEDICAID. - THE CORPORATION'S CHARITY CARE POLICY IS FILED WITH THE ILLINOIS ATTORNEY GENERAL AND IS AVAILABLE TO THE PUBLIC.
Schedule H - Part VI - 4 - Community Information   Saint Francis Medical Center is located in Peoria County in Illinois and serves those in the counties of Peoria, Tazewell, and Woodford. Peoria County is a metropolitan statistical area and its population in 2010 was 186,494. For Peoria County, the median household income in 2010 was $49,819 and the percent of persons below poverty level was 15.4%. Tazewell County is a metropolitan statistical area and its population in 2010 was 135,394. For Tazewell County, the median household income in 2010 for was $54,078 and the percent of persons below poverty level was 8.5%. Woodford County is a metropolitan statistical area and its population in 2010 was 38,664. For Woodford County, the median household income in 2010 was $65,342 and the percent of persons below poverty level was 7.2%. Saint Anthony Medical Center is located in Winnebago County. Winnebago County is a metropolitan statistical area and its population in 2010 was 295,266. For Winnebago County, the median household income in 2010 was $45,611 and the percent of persons below poverty level was 12.7%. St. Joseph Medical Center is located in McLean County in Illinois. McLean County is a metropolitan statistical area and its population in 2010 was 169,572. For McLean County, the median household income in 2010 was $58,365 and the percent of persons below poverty level was 11%. Saint James-John W. Albrecht Medical Center is located in Livingston County in Illinois. Livingston County is a metropolitan statistical area and its population in 2010 was 38,950. For Livingston County, the median household income in 2010 was $53,745 and the percent of persons below poverty level was 11.0%. St. Mary Medical Center is located in Knox County in Illinois. Knox County is a metropolitan statistical area and its population in 2010 was 52,919. For Knox County, the median household income in 2010 was $38,535 and the percent of persons below poverty level was 15.5%. Holy Family Medical Center is located in Warren County in Illinois. Warren County is a metropolitan statistical area and its population in 2010 was 17,707. For Warren County, the median household income in 2010 was $42,773 and the percent of persons below poverty level was 13.4%. St. Francis Hospital is located in Delta County in Michigan. Delta County is a metropolitan statistical area and its population in 2010 was 37,069. For Delta County, the median household income in 2010 was $40,496 and the percent of persons below poverty level was 12.7%.
COMMUNITY BUILDING ACTIVITIES:   THE CORPORATION'S COMMUNITY BUILDING ACTIVITIES PROMOTE THE HEALTH OF THE COMMUNITIES SERVED IN THE FOLLOWING WAYS: - WELLNESS SCREENINGS AND FIRST AID STATIONS AT COMMUNITY EVENTS SUCH AS STATE FAIRS AND SENIORS CONVENTIONS. - CORPORATE EXECUTIVES VOLUNTEER TO SERVE ON BOARDS AND COMMITTEES OF COMMUNITY ORGANIZATIONS SUCH AS UNITED WAY AND OTHERS. - TRANSPORTATION VOUCHERS ARE GIVEN TO INDIGENT PERSONS FOR THEIR PERSONAL TRANSPORTATION NEEDS (OTHER THAN TO OR FROM THE CORPORATION'S FACILITIES).
Schedule H - Part VI - 5 - PROMOTION OF COMMUNITY HEALTH:   THE CORPORATION'S SPONSORING ORGANIZATION IS A RELIGIOUS CONGREGATION OF THE ROMAN CATHOLIC CHURCH KNOWN AS THE SISTERS OF THE THIRD ORDER OF ST. FRANCIS. IN ACCORDANCE WITH CANON LAW OF THE ROMAN CATHOLIC CHURCH AND FEDERAL TAX LAW APPLICABLE TO SUPPORTING ORGANIZATIONS, A MAJORITY OF THE MEMBERS OF THE BOARD OF DIRECTORS OF THE CORPORATION ARE PROFESSED MEMBERS OF THE SPONSORING RELIGIOUS CONGREGATION. EACH HOSPITAL OPERATED BY THE CORPORATION HAS A COMMUNITY ADVISORY BOARD CONSISTING OF MEMBERS OF THE COMMUNITY WHO ARE NOT DIRECTORS, OFFICERS, OR CONTRACTORS OF THE CORPORATION. EXCEPT FOR HOSPITAL DEPARTMENTS WHICH HAVE BEEN CLOSED, OR IN WHICH CLINICAL PRIVILEGES HAVE BEEN RESTRICTED, FOR CLINICAL OR QUALITY OF CARE REASONS BY ACTIONS OF THE HOSPITAL'S MEDICAL STAFF AND THE BOARD OF DIRECTORS, THE CORPORATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITIES. THE CORPORATION'S SURPLUS FUNDS WERE USED DURING ITS FISCAL YEAR ENDED SEPTEMBER 30, 2012 FOR IMPROVEMENTS IN PATIENT CARE, MEDICAL EDUCATION, AND RESEARCH IN THE FOLLOWING WAYS: - CAPITAL EXPENDITURES OF APPROXIMATELY $98,753,262 WERE MADE DURING THE FISCAL YEAR FOR CONSTRUCTION AND RENOVATION OF PATIENT CARE FACILITIES AND ACQUISITION OF MEDICAL EQUIPMENT AND OTHER EQUIPMENT USED IN PATIENT CARE AND RELATED SUPPORT SERVICES. - THE CORPORATION INCURRED NET COSTS (EXPENSES MINUS REVENUES) OF APPROXIMATELY $26,131,047 DURING THE FISCAL YEAR FOR ACCREDITED PHYSICIAN RESIDENCY PROGRAMS AND NET COSTS OF APPROXIMATELY $5,216,791 FOR UNDERGRADUATE AND GRADUATE NURSING EDUCATION PROGRAMS. SEE SCHEDULE O, FORM 990, PART III, LINE 4D FOR A DESCRIPTION OF SUCH PROGRAMS. - THE CORPORATION INCURRED NET COSTS (EXPENSES MINUS REVENUES) OF APPROXIMATELY $1,261,367 DURING THE FISCAL YEAR FOR CLINICAL RESEARCH PROGRAMS AND ACTIVITIES. ALL OF THE CORPORATION'S HOSPITALS MEET THE REQUIREMENTS OF REVENUE RULING 69-545 BY: - OPERATING EMERGENCY DEPARTMENTS WHICH ARE STAFFED 24 HOURS PER DAY BY QUALIFIED PHYSICIANS AND OTHER MEDICAL PERSONNEL AND WHICH ARE OPEN TO ALL PERSONS WITHOUT REGARD TO ABILITY TO PAY. - HAVING MEDICAL STAFFS WHICH ARE OPEN TO ALL QUALIFIED PHYSICIANS, MID-LEVEL PROVIDERS, PODIATRISTS, AND DENTISTS IN THE COMMUNITY (EXCEPT WHERE RESTRICTED IN RARE CASES FOR CLINICAL QUALITY REASONS BY ACTION OF THE MEDICAL STAFF AND THE BOARD OF DIRECTORS). - ACCEPTING MEDICARE, MEDICAID AND OTHER GOVERNMENT PROGRAM PATIENTS. - ACCEPTING ALL PATIENTS, INCLUDING UNINSURED PATIENTS, WITHOUT REGARD TO THEIR ABILITY TO PAY. - USING SURPLUS FUNDS TO IMPROVE THEIR FACILITIES, EQUIPMENT, PATIENT CARE, MEDICAL TRAINING, EDUCATION, AND RESEARCH AS DESCRIBED ABOVE. THE FOLLOWING PROVIDES A SUMMARY OF SERVICES FOR EACH OSF HOSPITAL: Saint Francis Medical Center ("Saint Francis Medical Center") is a 609 licensed bed tertiary acute care teaching hospital located near downtown Peoria, Illinois. Saint Francis Medical Center operates several hospital-based outpatient facilities in and around Peoria, Illinois. In addition to its regular hospital accreditation, Saint Francis Medical Center has received disease specific certification from The Joint Commission for its primary stroke network and its myocardial infarction and acute coronary syndrome programs. The University of Illinois College of Medicine at Peoria, founded in 1970, maintains its primary teaching affiliation with Saint Francis Medical Center and has established 11 fully accredited residency programs and 2 fully accredited fellowship programs at Saint Francis Medical Center. Currently, 196 residents and fellows are in training at Saint Francis Medical Center. In addition to providing the full range of primary, secondary and tertiary services, Saint Francis Medical Center provides certain specialized services, including Level I (highest level) trauma services, life flight helicopter transport services (using the helicopters owned by OSF Aviation), adult and pediatric open heart surgery, pancreas and kidney transplantation services, neurosurgery and neurology, Level III (highest level) perinatal services, radiation oncology (including gamma knife and the Varian Trilogy unit), and specialized services of the Children's Hospital of Illinois (which is operated as a part of Saint Francis Medical Center). Saint Anthony Medical Center ("Saint Anthony") is a 254 licensed bed acute care hospital located on the east side of Rockford, Illinois. Saint Anthony provides primary, secondary and tertiary care. Saint Anthony provides certain specialized services, including Level 1(highest level) Trauma services, helicopter services (using helicopters owned by OSF Aviation), adult open heart surgery, a regional burn unit, neurosurgery, and neurology, and radiation oncology (including varian true beam and stereotactic radio-surgery). St. Joseph Medical Center ("St. Joseph") in Bloomington, Illinois, and OSF Saint James-John W. Albrecht Medical Center ("Saint James") in Pontiac, Illinois are located approximately 35 miles apart and serve partially overlapping markets. St. Joseph is a 137 licensed acute care bed and 12 bed skilled nursing care hospital located on the east side of Bloomington, Illinois. St. Joseph provides primary, secondary and tertiary care, including open heart surgery. Saint James has 42 licensed acute care beds which are also Medicare swing bed approved. This hospital facility is located on the west side of Pontiac, Illinois, near Interstate 55. Saint James is the only acute care hospital located in Livingston County, Illinois. St. Mary Medical Center ("St. Mary") in Galesburg, Illinois, and OSF Holy Family Medical Center ("Holy Family") in Monmouth, Illinois are located approximately 19 miles apart and serve partially overlapping markets. Residents of Monmouth and its surrounding areas frequently travel to Galesburg to receive health care services. St. Mary is a 90 licensed bed acute care hospital located on the northeast side of Galesburg, Illinois. In addition to primary and secondary care, including diagnostic cardiac catheterization services, St. Mary has designations from the State of Illinois as a Level II Trauma Center, a Trauma Network Resource Hospital, a Level II perinatal center and a Hemophilia Emergency Treatment Center. Holy Family is a 23 licensed acute bed facility located in Monmouth, Illinois. All of its acute beds are also Medicare approved swing beds. St. Francis Hospital ("St. Francis Hospital") is a 25 licensed bed critical access hospital located on the west side of Escanaba, Michigan. As the only hospital in Delta County, Michigan, St. Francis Hospital provides a range of inpatient and outpatient hospital, diagnostic, therapeutic and ancillary services.
AFFILIATED HEALTH CARE SYSTEM ROLES:   THE CORPORATION IS PART OF AN AFFILIATED HEALTH CARE SYSTEM (THE "OSF SYSTEM") WHICH PROVIDES INTEGRATED HEALTH CARE SERVICES THROUGHOUT CENTRAL ILLINOIS, PARTS OF NORTHERN ILLINOIS, AND PARTS OF THE UPPER PENNINSULA OF MICHIGAN. THE OSF SYSTEM INCLUDES THE OTHER CORPORATIONS LISTED BELOW, ALL OF WHICH ARE CONTROLLED, DIRECTLY OR INDIRECTLY, BY THE SISTERS OF THE THIRD ORDER OF ST. FRANCIS (THE "CONGREGATION"). ALL AFFILIATED CORPORATIONS (WHETHER TAXABLE OR EXEMPT) APPLY AND FOLLOW THE CHARITY CARE POLICY OF THE CORPORATION AND ARE OPERATED IN FURTHERANCE OF THE MISSION OF THE CONGREGATION TO PROVIDE COMPREHENSIVE, INTEGRATED, QUALITY CARE, INCLUDING PREVENTIVE, PRIMARY, ACUTE, CONTINUOUS AND REHABILITATIVE HEALTH SERVICES TO THE COMMUNITIES SERVED BY THE CORPORATION AND THE OSF SYSTEM. SPECIAL EMPHASIS IS PLACED ON MEETING THE PHYSICAL, SPIRITUAL, EMOTIONAL, AND SOCIAL NEEDS OF EVERYONE WHO IS CARED FOR IN THE OSF SYSTEM REGARDLESS OF RACE, COLOR, RELIGION AND ABILITY TO PAY. THE AFFILIATED CORPORATIONS ARE: - THE SISTERS OF THE THIRD ORDER OF ST. FRANCIS, WHICH HOLDS THE ASSETS OF THE RELIGIOUS CONGREGATION AND DIRECTS ALL OTHER CORPORATIONS IN THE AFFILIATED HEALTH CARE SYSTEM THROUGH BOARD REPRESENTATION AND THE EXERCISE OF RESERVED POWERS. - OSF SAINT FRANCIS, INC., WHICH PROVIDES HOME INFUSION AND DURABLE MEDICAL EQUIPMENT SERVICES, MOBILE MEDICAL IMAGING SERVICES, MEDICAL EQUIPMENT MAINTENANCE AND REPAIR SERVICES, MEDICAL STAFFING SERVICES, BILLING SERVICES, AND OTHER SERVICES IN SUPPORT OF THE AFFILIATED HEALTH CARE SYSTEM. - OSF AVIATION, LLC, WHICH IS AN FAA PART 135 CERTIFIED CARRIER PROVIDING EMS HELICOPTER SERVICES THROUGHOUT CENTRAL ILLINOIS AND PARTS OF NORTHERN ILLINOIS. - OSF LIFELINE AMBULANCE, LLC, WHICH PROVIDES GROUND AMBULANCE TRANSPORTATION SERVICES IN PARTS OF NORTHERN ILLINOIS. - OSF MULTISPECIALTY GROUP - PEORIA, LLC, WHICH PROVIDES PEDIATRIC CARDIOLOGY PHYSICIAN SERVICES IN CENTRAL ILLINOIS. - ILLINOIS NEUROLOGICAL INSTITUTE - PHYSICIANS, LLC, WHICH PROVIDES PHYSICIAN NEUROSURGERY SERVICES IN CENTRAL ILLINOIS. - HEARTCARE MIDWEST, LTD., WHICH PROVIDES CARDIOLOGY AND CARDIOVASCULAR SURGERY PHYSICIAN SERVICES IN CENTRAL ILLINOIS. - CARDIOVASCULAR INSTITUTE AT OSF, LLC, WHICH PROVIDES CARDIOLOGY AND CARDIOVASCULAR SURGERY PHYSICIAN SERVICES IN PARTS OF NORTHERN ILLINOIS. - OSF MULTISPECIALTY GROUP - EASTERN REGION, LLC, WHICH PROVIDES PRIMARY AND SPECIALTY PHYSICIAN SERVICES IN PARTS OF CENTRAL ILLINOIS. - ILLINOIS PATHOLOGIST SERVICES, LLC, WHICH PROVIDES PROFESSIONAL PATHOLOGY SERVICES IN PARTS OF NORTHERN ILLINOIS. - ILLINOIS SPECIALTY PHYSICIAN SERVICES AT OSF, LLC, WHICH PROVIDES PULMONOLOGY AND CRITICAL CARE PHYSICIAN SERVICES IN CENTRAL ILLINOIS. - OSF PERINATAL ASSOCIATES, LLC, WHICH PROVIDES MATERNAL FETAL MEDICINE PHYSICIAN SERVICES IN CENTRAL ILLINOIS. - OSF MULTISPECIALTY GROUP - WESTERN REGION, LLC, WHICH PROVIDES PRIMARY AND SPECIALTY PHYSICIAN SERVICES IN WESTERN ILLINOIS. - OSF CHILDREN'S MEDICAL GROUP- CONGENITAL HEART CENTER, LLC WHICH PROVIDES PEDIATRIC CARE FOR CARDIOVASCULAR ILLNESSES IN NORTHERN ILLINOIS. - PREFERRED EMERGENCY PHYSICIANS OF ILLINOIS, LLC WHICH PROVIDES PHYSICIAN COVERAGE FOR EMERGENCY DEPARTMENTS. - CENTER FOR HEALTH AMBULATORY SURGERY CENTER, LLC, WHICH PROVIDES AMBULATORY SURGERY SERVICES IN CENTRAL ILLINOIS. - EASTLAND MEDICAL PLAZA SURGICENTER, LLC, WHICH PROVIDES AMBULATORY SURGERY SERVICES IN CENTRAL ILLINOIS. - FORT JESSE IMAGING CENTER, LLC, WHICH PROVIDES MEDICAL IMAGING SERVICES IN CENTRAL ILLINOIS. - SLEEP CENTER OF CENTRAL ILLINOIS, LLC, WHICH PROVIDES MEDICAL TREATMENT FOR SLEEP DISORDERS IN CENTRAL ILLINOIS.
ALL STATES WHICH ORGANIZATION FILES A COMMUNITY BENEFIT REPORT:   IL, MI
Schedule H (Form 990) 2011
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
OSF Healthcare System
 
Employer identification number
37-0813229
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed
......................... lBullet
(a) Name and address of organization
or government
(b) EIN (c) IRC Code section
if applicable
(d) Amount of cash grant (e) Amount of non-cash
assistance
(f) Method of valuation
(book, FMV, appraisal,
other)
(g) Description of
non-cash assistance
(h) Purpose of grant
or assistance
(1) Heartland Community Health1701 W Garden Street
Peoria,IL61605
37-1270794 501(c)(3) 750,000       support of clinic operations
(2) Quality Quest for Heart of Illinois416 Main St Ste 717
Peoria,IL61602
26-3896631 501(c)(3) 200,000       SUPPORT OF ORG OPERATIONS
(3) Five Points Washington360 N Wilmor Road
Washington,IL61571
36-4141385 501(c)(3) 100,000       SUPP EFFORT TO INC WELLNESS
(4) Peoria Riverfront Museum1125 West Lake Avenue
Peoria,IL61614
27-2920016 501(c)(3) 500,000       SUPPORT OPER FOR COMM EDU
(5) Illinois Heart & Lung Foundation1302 Franklin Ave
Normal,IL61761
37-1400057 501(c)(3) 6,000       SUPP WOMMENS HEALTH NIGHT PROG
(6) Catholic Charities USAPO Box 7044
ROCKFORD,IL61125
36-2181998 501(C)(3) 50,000       SUPP FEEDING CHILDREN PROG
(7) Peoria Park District2218 N Prospect Road
Peoria,IL61603
37-1368760 501(C)(3) 100,000       SUPP PROG TO ENCOURAGE EXERCISE










2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
7
3
Enter total number of other organizations listed in the line 1 table ......................... . Bullet Image
0
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2011

Schedule I (Form 990) 2011
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients
(c)Amount of
cash grant
(d)Amount of
non-cash assistance
(e)Method of valuation (book,
FMV, appraisal, other)
(f)Description of non-cash assistance
(1) SCHOLARSHIPS 88 94,938      













Part IV
Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.
Identifier Return Reference Explanation
SUPPLEMENTAL INFORMATION   Procedures for Monitoring Grants Part I, Line 2 THE CORPORATION MONITORS THE USE OF GRANT FUNDS IN THE UNITED STATES IN A VARIETY OF WAYS. FOR EDUCATIONAL SCHOLARSHIPS, THE CORPORATION TRACKS AND REVIEWS THE STUDENT'S GRADES AND SUCCESSFUL COURSE COMPLETION EACH SEMESTER. IN SOME CASES, THE CORPORATION'S CHIEF FINANCIAL OFFICER OR OTHER REPRESENTATIVE OF THE CORPORATION SERVES ON THE BOARD OF DIRECTORS OR ON THE FINANCE COMMITTEE OF THE GRANTEE ORGANIZATION AND RECEIVES DIRECT INFORMATION REGARDING USE OF GRANT FUNDS IN SUCH CAPACITY. IN OTHER CASES, THE CORPORATION RECEIVES WRITTEN REPORTS AND/OR FINANCIAL STATEMENTS FROM THE GRANTEE ORGANIZATION WHICH INCLUDE INFORMATION REGARDING USE OF GRANT FUNDS. Requirements for Saint Francis Medical Center Scholarship All scholarships are approved by the scholarship committee. Nursing Minimum Requirements: - GPA 2.5/4.0 scale - Two favorable academic references from clinical instructors - Two favorable employer references - Completed scholarship application form - Acceptance of the scholarship requires the student to secure and start in an OSF Saint Francis Medical Center RN staff position within 60 days of graduation and remain employed in a 72-80 hours/pay for two years following completion of the 90 day unit nursing orientation. Radiology, Radiation Therapist & Sonography Minimum Requirements: - GPA 2.5/4.0 scale - Two favorable academic references from clinical instructors - Two favorable employer references - Completed scholarship application form - Acceptance of the scholarship requires the student to secure and start in an OSF Saint Francis Medical Center Diagnostic Radiology Technologist staff position within 30 days of graduation and remain employed for two years following completion of the department orientation. Pharmacy Minimum Requirements: - Interview - GPA 2.5/4.0 or 3.125/5.0 scale - Two favorable academic references from clinical instructors - Two favorable employer references - Completed scholarship application form - Acceptance of the scholarship requires the student to secure and start in an OSF Saint Francis Medical Center R.Ph. position within 30 days of graduation and remain employed for two years or three years, depending on the monies received, following completion of the Pharmacy orientation. Respiratory Therapy Minimum Requirements: For External Candidates: - Meet all Illinois Central College's (ICC) minimum requirements for admission - GPA 3.0/4.0 scale - Pass a Wonderlic Test score of a 3 on the verbal section and a 2 on the math portion - Two favorable academic references from clinical instructors - Two favorable employer references - A brief 1-2 page typed essay explaining interest and desire to enroll the scholarship program - Interview For OSF Saint Francis Medical Center Employees: - Meet all Illinois Central College's (ICC) minimum requirements for admission - GPA 3.0/4.0 scale - Pass a Wonderlic Test score of a 3 on the verbal section and a 2 on the math portion - Must not be on any current formal levels of discipline - Two favorable supervisor/manager or director references - A brief 1-2 page typed essay explaining interest and desire to enroll the scholarship program - Interview Merit Scholarship Requirement: - GPA 3.4/4.0 scale - Dean's List in the semester previous to posting on students account Institutional Scholarship Requirement: - College of Nursing student in good academic standing and in financial need President's Scholarship Requirement: - GPA 3.55/4.0 scale Requirements for Saint Anthony Medical Center Scholarships Scholarships are awarded based on 50% academics, 30% financial need, and 20% community service. The awards are approved by the Saint Anthony College of Nursing Financial Aid Committee. The Alumni Memorial Scholarship are awarded based on 60% academics, 30% financial need, and 10% community service. Minimum requirements for all scholarships: - GPA 2.5/4.0 scale - Resume - Two favorable letters of recommendation, at least one from a clinical instructor - A brief typed essay explaining interest and desire to enroll the scholarship program Requirements for Holy Family Medical Center Scholarships - Application for assistance from OSF Holy Family Medical Center signifies a desire to work at OSF HFMC at the completion of the educational course work. - Meeting deadlines is the responsibility of the applicant. All application materials must reach OSF HFMC by April 1. Awards will be made by May 31. - Funds may only be used for health care-related coursework at the bachelor's degree level or below. - Recipients must reside in Warren or Henderson County, Illinois, be employees of OSF Holy Family Medical Center, or related to employees of OSF HFMC. - The maximum available amount of educational assistance is $3,500 annually. This amount will be distributed for tuition, books, and lab fees. Funds may not be used for living expenses or transportation - Each disbursement of funds requires the recipient sign a "Student Loan Promissory Note" which is forgiven when the student borrower becomes employed at OSF HFMC at completion of the educational program within specified time constraints. This means each request for funds requires a personal appearance by the student. (According to tax law, disbursements are taxable income.) - When funds have been distributed for a given semester, additional funds will not be paid until OSF HFMC has been furnished with a copy of prior semester grades, giving proof of successful completion of course work. A cumulative 3.0 grade point average or higher is required. - Recipients must reapply annually if they desire funds for subsequent years. While funds for subsequent years are not guaranteed, serious consideration will be given to those students who have excelled academically. - Receipt of educational assistance does not guarantee the recipient will be offered employment at the completion of the educational program. An appropriate position may not be available at that time. If an appropriate position is available, the recipient must accept the position or be prepared to repay any funds received. - With mutual agreement, the requirement to accept a position at OSF HFMC may be met by accepting employment at other OSF facilities.
Schedule I (Form 990) 2011


Additional Data


Software ID:  
Software Version:  


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

37-0813229
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all the expenses described above? If "No," complete Part III to explain....
1b
Yes
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....
2
Yes
 
3
Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ...............
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2011

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

Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and column (E) for that individual.
(A) Name (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits
(E) Total of columns
(B)(i)-(D)
(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) DANIEL R FASSETT MD (i)
(ii)
473,500
0
1,060,907
0
17,035
0
24,043
0
12
0
1,575,497
0
0
0
(2) FINN REIDER AMBLEMD (i)
(ii)
698,447
0
305,000
0
37,175
0
27,004
0
15,230
0
1,082,856
0
0
0
(3) GERALD J MCSHANE MD (i)
(ii)
395,061
0
68,673
0
59,767
0
37,500
0
11,877
0
572,878
0
0
0
(4) JAMES MOORE (i)
(ii)
111,824
0
1,179,429
0
94,409
0
0
0
0
0
1,385,662
0
0
0
(5) JEFFREY D KLOPFENSTEIN MD (i)
(ii)
473,501
0
851,648
0
14,198
0
20,000
0
14,692
0
1,374,039
0
0
 
(6) KEVIN D SCHOEPLEIN (i)
(ii)
774,705
0
141,989
0
97,978
0
545,173
0
16,373
0
1,576,218
0
0
0
(7) SUSAN CAMPBELL (i)
(ii)
205,606
0
28,687
0
52,458
0
37,282
0
11,405
0
335,438
0
0
 
(8) SYED M HUSSAIN MD (i)
(ii)
297,846
0
685,844
0
49,953
0
22,763
0
14,691
0
1,071,097
0
0
 
(9) TRAVIS D RICHARDSON MD (i)
(ii)
684,759
0
416,879
0
36,051
0
15,008
0
9,620
0
1,162,317
0
0
 
(10) VANCE C PARKHURST (i)
(ii)
268,667
0
35,015
0
53,807
0
38,357
0
11,432
0
407,278
0
0
 
(11) DANIEL EBAKER (i)
(ii)
410,341
0
51,874
0
76,117
0
208,368
0
13,806
0
760,506
0
0
0





Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
Schedule J, Part I, Line 1a   THE CORPORATION REIMBURSES CERTAIN EXECUTIVES FOR SOCIAL CLUB DUES PAID BY SUCH EXECUTIVES. ELIGIBILITY FOR CLUB DUES REIMBURSEMENT IS DETERMINED BY THE HUMAN RESOURCES COMMITTEE OF THE BOARD OF DIRECTORS AND IS TAKEN INTO CONSIDERATION BY THE COMMITTEE IN DETERMINING FAIR MARKET COMPENSATION. SEE FORM 990 - SCHEDULE O - PART VI - LINES 15A AND 15B FOR AN EXPLANATION OF THE ROLE OF THE HUMAN RESOURCES COMMITTEE AND THE MANNER IN WHICH FAIR MARKET COMPENSATION IS DETERMINED. CLUB DUES ARE NOT ELIGIBLE FOR REIMBURSEMENT IF THE CLUB IN QUESTION DISCRIMINATES ON THE BASIS OF RACE, RELIGION, SEX, NATIONAL ORIGIN, OR OTHER PROHIBITED FACTORS. DUES REIMBURSEMENT IS TREATED AND REPORTED AS TAXABLE COMPENSATION. Schedule J, Part I, Line 3 See explanation in Schedule O, Part VI, Line 15a for details regarding the process to establish the compensation of the organization's CEO. Schedule J, Part I, Line 4b OSF healthcare System has a deferred compensation plan for select key executives. This plan was developed to assist with attracting and retaining certain key executives in the corporation. The plan is designed to encourage the participants to stay until a certain retirement date. If the participants terminate prior to their target retirement date, they forfeit what is in the plan.
Schedule J (Form 990) 2011

Additional Data


Software ID:  
Software Version:  
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.

OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
OSF Healthcare System
 
Employer identification number
37-0813229
Part I
Bond Issues
(a) Issuer Name (b) Issuer EIN (c) CUSIP # (d) Date Issued (e) Issue Price (f) Description of Purpose (g) Defeased (h) On
Behalf of
Issuer
(i) Pool
financing
Yes No Yes No Yes No
A Illinois Finance Authority
 
86-1091967 45200B8E1 08-29-2007 461,801,780 See Schedule O   X   X   X
B Illinois Finance Authority
 
86-1091967 45200FWD7 03-31-2009 249,074,230 See Schedule O   X   X   X
C Illinois Finance Authority
 
86-1091967   08-18-2009 70,000,000 See Schedule O   X   X   X
D Illinois Finance Authority
 
86-1091967 45200f3r8 06-29-2010 158,535,888 SEE SCHEDULE O   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . 0 0 0 0
2 Amount of bonds legally defeased . . . . . . . . . . 0 0 0 0
3 Total proceeds of issue . . . . . . . . . . . . . 461,801,780 249,074,230 70,000,000 158,535,888
4 Gross proceeds in reserve funds . . . . . . . . 24,898,348 12,276,530 0 15,337,813
5 Capitalized interest from proceeds . . . . . . . . . . 0 0 0 0
6 Proceeds in refunding escrows . . . . . . . . . . . 127,425,737 233,334,384 0 115,936,745
7 Issuance costs from proceeds . . . . . . . . . . . 12,165,772 3,240,846 0 2,080,292
8 Credit enhancement from proceeds . . . . . . . . . . 0 0 0 0
9 Working capital expenditures from proceeds . . . . . . . 0 0 0 0
10 Capital expenditures from proceeds . . . . . . . . . . 285,706,088 0 70,000,000 28,000,000
11 Other spent proceeds . . . . . . . . . . . 0 0 0 0
12 Other unspent proceeds . . . . . . . . . . . 0 0 0 0
13 Year of substantial completion . . . . . . . . . . . 2010 2010 2010
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . . X   X     X X  
15 Were the bonds issued as part of an advance refunding issue? . . . .   X   X   X   X
16 Has the final allocation of proceeds been made? . . . . . . X   X   X   X  
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . X   X   X   X  
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .   X   X   X   X
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .   X   X   X   X
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2011
Schedule K (Form 990) 2011
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . .   X   X   X   X
b If ‘Yes’ to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . .                
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . .   X   X   X   X
d If ‘Yes’ to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? .                
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . SchKMediumBullet 0.00000% 0.00000% 0.00000% 0.00000%
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet 0.00000% 0.00000% 0.00000% 0.00000%
6 Total of lines 4 and 5 . . .. . . . . . . . . 0.00000% 0.00000% 0.00000% 0.00000%
7 Does the bond issue meet the private security or payment test? . . . X   X   X   X  
8 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
X   X   X   X  
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . .   X   X   X   X
2 Is the bond issue a variable rate issue? X   X   X     X
3a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue? X     X   X   X
b Name of provider . . . . . . . . Merrill Lynch
 
0
 
0
 
 
 
c Term of hedge . . . . . . . .        
d Was the hedge superintegrated? . . . .   X            
e Was a hedge terminated? . . . . . X              
4a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . .   X   X   X   X
b Name of provider . . . . . . 0
 
0
 
0
 
0
 
c Term of GIC . . . . . . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . . .                
5 Were any gross proceeds invested beyond an available temporary period? . . . . . . X     X   X   X
6 Did the bond issue qualify for an exception to rebate? .   X   X   X   X
7 Has the organization established written procedures to monitor the requirements of section 148? . . .   X   X   X   X
Schedule K (Form 990) 2011

Schedule K (Form 990) 2011
Page 3
Part V
Procedures To Undertake Corrective Action
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? . . . . . . . . . . . . . .
Part VI
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
Schedule K (Form 990) 2011

Additional Data


Software ID:  
Software Version:  

SCHEDULE O
(Form 990 or 990-EZ)

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

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

37-0813229
Identifier Return Reference Explanation
FORM 990 - PART III - LINE 4A: INPATIENT SERVICES: OSF HEALTHCARE SYSTEM OWNS AND OPERATES ACUTE CARE HOSPITALS IN ESCANABA, MICHIGAN; ROCKFORD, ILLINOIS; PONTIAC, ILLINOIS; BLOOMINGTON, ILLINOIS; PEORIA, ILLINOIS; GALESBURG, ILLINOIS; AND MONMOUTH, ILLINOIS; AND OWNed AND OPERATEd ONE LONG-TERM CARE FACILITY IN PEORIA HEIGHTS, ILLINOIS until it was sold on February 1, 2013. AS OF THE CLOSE OF THE REPORTING PERIOD ON SEPTEMBER 30, 2012, THESE EIGHT FACILITIES HAD A COMBINED TOTAL OF 1,396 LICENSED INPATIENT AND RESIDENT BEDS AND OPERATED A COMBINED TOTAL OF 1,363 STAFFED INPATIENT AND RESIDENT BEDS. THEY HAD COMBINED TOTALS OF 60,044 INPATIENT AND RESIDENT DISCHARGES AND 307,806 INPATIENT AND RESIDENT DAYS, INCLUDING 10,077 NEWBORN INPATIENT DAYS. THE SEVEN ACUTE CARE HOSPITALS COLLECTIVELY SERVED 48 COUNTIES. THEY HAD A COMBINED TOTAL OF APPROXIMATELY 2,133 PHYSICIANS ON THEIR MEDICAL STAFFS; INCLUDING APPROXIMATELY 1,271 PHYSICIANS ON THEIR ACTIVE OR ASSOCIATE MEDICAL STAFFS. TWO OF THE HOSPITALS ARE SOLE COMMUNITY HOSPITALS AND two are CRITICAL ACCESS HOSPITALs. THE CORPORATION'S HOSPITALS OFFER A BROAD RANGE OF INPATIENT SERVICES. THREE OF THE HOSPITALS PROVIDE OPEN HEART SURGERY SERVICES, TWO OFFER LEVEL II NEONATAL SERVICES, ONE OFFERS LEVEL III NEONATAL SERVICES (HIGHEST LEVEL), AND ONE OFFERS KIDNEY AND PANCREAS ORGAN TRANSPLANT SERVICES. THE CORPORATION HAS ORGANIZED AND OPERATES COMPREHENSIVE CARDIAC AND STROKE CARE NETWORKS IN CENTRAL AND NORTHERN ILLINOIS AND OPERATES THE ONLY COMPREHENSIVE CHILDREN'S HOSPITAL IN CENTRAL ILLINOIS
FORM 990 - PART III - LINE 4B: OUTPATIENT SERVICES: THE SEVEN ACUTE CARE HOSPITALS OWNED AND OPERATED BY OSF HEALTHCARE SYSTEM COLLECTIVELY PROVIDED 1,009,030 OUTPATIENT VISITS DURING THE REPORTING PERIOD ENDED SEPTEMBER 30, 2012, INCLUDING 50,937 OUTPATIENT SURGERY VISITS BUT EXCLUDING EMERGENCY DEPARTMENT VISITS. THE CORPORATION'S HOSPITALS OFFER A BROAD RANGE OF OUTPATIENT THERAPEUTIC AND DIAGNOSTIC SERVICES, INCLUDING OUTPATIENT SURGERY AND ADVANCED MEDICAL IMAGING.
FORM 990 - PART III - LINE 4C: Physcian Services PHYSICIANS EMPLOYED BY OSF HEALTHCARE SYSTEM PROVIDED 967,351 OFFICE VISITS (NOT INCLUDING SERVICES PROVIDED TO HOSPITAL INPATIENTS AND OUTPATIENTS) AT OFFICES IN 74 SEPARATE LOCATIONS THROUGHOUT CENTRAL AND NORTHERN ILLINOIS AND THE UPPER PENINSULA OF MICHIGAN.
FORM 990 - PART III - LINE 4D: Home Health Services: (EXPENSES $48,589,211 INCLUDING GRANTS OF $NONE)(REVENUE $43,818,098) THE five HOME HEALTH AGENCIES OWNED AND OPERATED BY THE CORPORATION COLLECTIVELY SERVE 32 COUNTIES IN ILLINOIS AND MICHIGAN, ENROLLED 24,518 HOME HEALTH PATIENTS, AND PROVIDED 179,135 HOME HEALTH VISITS DURING THE REPORTING PERIOD ENDED SEPTEMBER 30, 2012. THE Four HOSPICE PROGRAMS OWNED AND OPERATED BY THE CORPORATION COLLECTIVELY SERVE 35 COUNTIES IN ILLINOIS AND MICHIGAN, ENROLLED 1,862 HOSPICE PATIENTS, AND PROVIDED 94,474 HOSPICE DAYS DURING THE REPORTING PERIOD ENDED SEPTEMBER 30, 2012.
FORM 990 - PART III - LINE 4D: EMERGENCY DEPARTMENT SERVICES: (EXPENSES $73,333,883 INCLUDING GRANTS OF $ NONE) (REVENUE $88,819,744) ALL OF THE SEVEN ACUTE CARE HOSPITALS OF THE CORPORATION PROVIDE 24-HOUR EMERGENCY DEPARTMENT SERVICES. ALL ARE STAFFED BY PHYSICIANS WHO ARE PREDOMINANTLY (BUT NOT ENTIRELY) CERTIFIED IN EMERGENCY MEDICINE BY NATIONAL SPECIALTY BOARDS. THE EMERGENCY DEPARTMENTS OF THE CORPORATION'S ACUTE CARE HOSPITALS PROVIDED 207,850 PATIENT VISITS DURING THE REPORTING PERIOD ENDED SEPTEMBER 30, 2012.
FORM 990 - PART III - LINE 4D: RESIDENCY PROGRAMS: (EXPENSES $42,368,717 INCLUDING GRANTS OF $ NONE) (REVENUE $100,324) OSF HEALTHCARE SYSTEM HAS ENTERED INTO A MAJOR AFFILIATION AGREEMENT WITH THE UNIVERSITY OF ILLINOIS PROVIDING SIGNIFICANT FINANCIAL AND TEACHING SUPPORT FOR PHYSICIAN RESIDENCY AND FELLOWSHIP PROGRAMS SPONSORED BY THE UNIVERSITY. THE CORPORATION EMPLOYED 201 RESIDENTS AND FELLOWS IN THESE PROGRAMS DURING THE REPORTING PERIOD.
FORM 990 - PART III - LINE 4D: COLLEGES OF NURSING PROGRAMS: (EXPENSES $11,270,296 INCLUDING GRANTS OF $94,938) (REVENUE $10,611,057) TWO OF THE CORPORATION'S HOSPITALS OPERATE ACCREDITED COLLEGES OF NURSING WHICH AWARD BACCALAUREATE, MASTERS, AND DOCTORATE DEGREES. THERE WERE 2,013 ENROLLEES IN THESE PROGRAMS DURING THE THREE SEMESTERS FALLING WITHIN THE REPORTING PERIOD (FALL 2011, SPRING 2012, AND SUMMER 2012)
FORM 990 - PART III - LINE 4D: TRAUMA SERVICES (LEVEL 1): (EXPENSES $8,751,802 INCLUDING GRANTS OF $ NONE) (REVENUE $1,232,982) TWO OF THE CORPORATION'S SEVEN HOSPITALS HAVE BEEN DESIGNATED AS LEVEL I (HIGHEST LEVEL) TRAUMA CENTERS, AND TWO HAVE BEEN DESIGNATED AS LEVEL II TRAUMA CENTERS. LEVEL I TRAUMA CENTERS ARE CONTINUOUSLY STAFFED WITH IN-HOUSE TRAUMA SURGEONS, ANESTHESIA PROVIDERS, AND OTHER SPECIALIZED HEALTH CARE PROFESSIONALS IN ORDER TO PROVIDE IMMEDIATE TRAUMA SURGERY AND OTHER TREATMENT SERVICES TO TRAUMA PATIENTS. THE EXPENSES ABOVE REFLECT THESE STAFFING COSTS. LEVEL I TRAUMA CENTERS ALSO HAVE SPECIAL RESPONSIBILITIES FOR FORMING AND CARRYING OUT AREA-WIDE DISASTER PREPAREDNESS AND EMERGENCY RESPONSE PLANS AND FOR COORDINATING AREA-WIDE TRAUMA SERVICES IN THE EVENT OF MAJOR DISASTERS.
FORM 990 - PART III - LINE 4D: EMS FLIGHT & GROUND TRANSPORT SERVICES: (EXPENSES $19,464,792 INCLUDING GRANTS OF $ NONE) (REVENUE $12,869,567) THE CORPORATION PROVIDES EMERGENCY HELICOPTER TRANSPORT SERVICES TO PATIENTS IN NORTHERN AND CENTRAL ILLINOIS USING A FLEET OF FOUR EMS CONFIGURED HELICOPTERS. 2,396 EMS HELICOPTER PATIENT TRANSPORTS WERE PROVIDED DURING THE REPORTING PERIOD ENDED SEPTEMBER 30, 2012. A SUBSIDIARY OF THE CORPORATION PROVIDES GROUND AMBULANCE PATIENT TRANSPORT SERVICES IN NORTHERN ILLINOIS. 7,810 GROUND AMBULANCE PATIENT TRANSPORTS PLUS 3,334 WHEELCHAIR PATIENT TRANSPORTS WERE PROVIDED DURING THE REPORTING PERIOD ENDED SEPTEMBER 30, 2012.
FORM 990 - PART III - LINE 4D: COMMUNITY CLINIC, Outreach, and Other Educational PROGRAMS: (EXPENSES $6,679,145 INCLUDING GRANTS OF $ NONE) (REVENUE $2,284,015) OSF COMMUNITY PRENATAL CLINIC - BLOOMINGTON, ILLINOIS: THIS CLINIC SERVES UNINSURED AND UNDERINSURED PREGNANT WOMEN IN THE BLOOMINGTON-NORMAL, ILLINOIS COMMUNITIES AND SURROUNDING AREA. THE CLINIC PROVIDES SPANISH-SPEAKING STAFF TO ASSIST PATIENTS WHO HAVE LANGUAGE BARRIERS. PRENATAL SERVICES AND DELIVERIES WERE PROVIDED TO 48 WOMEN DURING THE REPORTING PERIOD ENDED SEPTEMBER 30, 2012. OSF SISTERS COMMUNITY HEALTHCARE CLINICS - PEORIA, ILLINOIS: THIS CLINIC IS A PRIMARY CARE HOSPITAL BASED RESIDENCY CLINIC WHERE UNINSURED AND UNDERINSURED PATIENTS OF ALL AGES ARE SEEN BY RESIDENT PHYSICIANS UNDER THE DIRECTION OF AN ATTENDING PHYSICIAN. PROFESSIONAL SERVICES INCLUDE ADULT INTERNAL MEDICINE, PEDIATRIC AMBULATORY CARE, AND OBSTETRICS/GYNECOLOGY. OTHER SERVICES INCLUDE X-RAY, LABORATORY, SONOGRAPHY, COUMADIN MANAGEMENT, ADULT AND PEDIATRIC SOCIAL SERVICES, AND FINANCIAL ADVISORY SERVICES. 23,332 PATIENT VISITS WERE PROVIDED DURING THE REPORTING PERIOD ENDED SEPTEMBER 30, 2012. PARISH NURSING PROGRAM - PEORIA, ILLINOIS: THIS PROGRAM PROVIDES PROFESSIONAL SUPERVISION AND CLINICAL SUPPORT FOR VOLUNTEER NURSES WHO FURNISH MEDICAL SCREENING, EDUCATION AND NURSING SERVICES TO MEMBERS OF CHURCH CONGREGATIONS IN AND AROUND PEORIA, ILLINOIS. PERINATAL OUTREACH PROGRAM - PEORIA, ILLINOIS: THIS PROGRAM PROVIDES PROFESSIONAL EDUCATION AND TRAINING TO CLINICIANS IN COMMUNITY HOSPITALS THROUGHOUT CENTRAL ILLINOIS REGARDING CLINICALLY APPROPRIATE MANAGEMENT AND REFERRAL OF WOMEN WITH HIGH RISK PREGNANCIES. 1,038 HOURS OF EDUCATION AND TRAINING WERE PROVIDED DURING THE REPORTING PERIOD ENDED SEPTEMBER 30, 2012. COMMUNITY TRAINING CENTER - ROCKFORD, ILLINOIS AND PEORIA, ILLINOIS: THE COMMUNITY TRAINING CENTERS PROVIDE TRAINING TO THE PUBLIC SO THEY ARE PREPARED TO DO BASIC LIFE SUPPORT IN AN EMERGENCY. CLASSES INCLUDE CPR CERTIFICATION AND TRAINING FOR THE AMERICAN HEART ASSOCIATION CERTIFICATIONS SUCH AS BASIC LIFE SUPPORT AND ADVANCED LIFE. PARAMEDICAL EDUCATION - ROCKFORD, ILLINOIS: THIS PROGRAM PROVIDES BASIC AND CONTINUING EDUCATION AT VARIOUS EMERGENCY MEDICAL TECHNICIAN (EMT) LEVELS TO OVER 2,500 EMTS WHO SERVE IN THEIR HOME COMMUNITIES. EMT EDUCATION - PEORIA, ILLINOIS: THIS INCLUDES CLASSES PROVIDED TO THE AMBULANCE AND RESCUE SQUADS OF THE CENTRAL ILLINOIS AREA FOR THE TRAINING AND UPDATING OF THE EMPLOYEES AND VOLUNTEERS OF THE SQUADS. THIS SERVICE PROVIDES HUNDREDS OF HOURS OF ONGOING TRAINING THROUGHOUT THE REGION TO FIRST RESPONDERS. MEDICAL TECH EDUCATION - ROCKFORD, ILLINOIS AND PEORIA, ILLINOIS: AT PEORIA THIS IS A YEAR LONG PROGRAM FOR SCIENCE MAJOR STUDENTS THAT WILL BECOME TECHNICIANS IN A HOSPITAL LAB. THIS IS A REQUIRED PROGRAM FOR THE STUDENTS TO COMPLETE THE BACHELOR'S DEGREE AND BE ABLE TO FUNCTION IN THE LAB. THERE ARE USUALLY TEN STUDENTS PER YEAR. ROCKFORD'S CLINICAL LAB HAS AN EXCLUSIVE AFFILIATION WITH THE NORTHERN ILLINOIS UNIVERSITY CLINICAL LABORATORY SCIENCE PROGRAM. THE LAB SERVES AS A CLINICAL TRAINING SITE FOR FOUR STUDENTS ANNUALLY WHO COMPLETE A 33-WEEK CLINICAL ROTATION WHERE THEY ARE ONSITE FOR 24 HOURS EACH WEEK. RADIOLOGY TECH EDUCATION - PEORIA, ILLINOIS: THIS IS A TWO YEAR PROGRAM FOR STUDENTS THAT WISH TO BECOME IMAGING TECHNICIANS IN ANY OF SEVERAL AREAS (DIAGNOSTIC, MRI, CT, SONS, ETC). UPON GRADUATION THE STUDENT IS ABLE TO PROVIDE THE PROCEDURES IN A CLINICAL SETTING. THERE ARE APPROXIMATELY TWENTY STUDENTS PER YEAR. DIETETIC EDUCATION - PEORIA, ILLINOIS: THIS IS A YEAR LONG PROGRAM THAT IS REQUIRED FOR A STUDENT TO BECOME A REGISTERED DIETITIAN. THE STUDENTS ARE PROVIDED TRAINING IN THE PREPARATION OF DIETS, COUNSELING, RESEARCH, AND EXPOSURE TO THE OPERATIONS OF A FOOD SERVICE AREA. THERE ARE APPROXIMATELY TEN STUDENTS PER YEAR. OTHER PROGRAM SERVICES (EXPENSES $6,882,712 INCLUDING GRANTS OF $ NONE) (REVENUE $4,057,481) Form 990 - Part VI - Line 1a: By adopting certain provisions of the corporate bylaws, the board of directors has delegated broad authority to the executive committee of the board. The bylaws provide that the executive committee shall be authorized to take such action as may be necessary on behalf of the corporation during periods when the board of directors is not in session. FORM 990 - PART VI - LINE 4 On April 30, 2012, OSF Healthcare System (OSF) became the sole corporate member of Ottawa Regional Hospital & Healthcare Center d/b/a OSF Saint Elizabeth Medical Center (SEMC) an Illinois not-for-profit corporation. SEMC owns all of the capital stock of Ottawa Regional Healthcare Affiliates, Inc. and Ottawa Regional Hospital Auxiliary. SEMC is the sole member of Ottawa Regional Hospital Foundation and has a 57% ownership in Radiation Oncology of Northern Illinois, LLC (RONI). RONI is consolidated by SEMC. Ottawa Regional Healthcare Affiliates, Inc. (ORHA) is an Illinois for-profit corporation, was incorporated in 2008, and is wholly owned by SEMC. ORHA is a holding company and does not itself operate any businesses. ORHA is the sole stockholder of Ottawa Regional Medical Center, Inc. (ORMC) and Ottawa Regional Cardinal Sleep Center, LLC (ORCSC) and 50% owner of Ottawa Regional DMC, LLC (DME). ORHA has not made any initial capital contributions to ORCSC and DME and there have been no operations within these entities at September 30, 2012.
FORM 990 - PART VI - LINE 6 & 7A:   OSF HEALTHCARE SYSTEM HAS NO CORPORATE STOCK OR STOCKHOLDERS. ITS SOLE MEMBER IS THE SISTERS OF THE THIRD ORDER OF ST. FRANCIS, AN ILLINOIS NOT FOR PROFIT CORPORATION, WHICH IS CONTROLLED BY MEMBERS OF A RELIGIOUS CONGREGATION OF THE CATHOLIC CHURCH ALSO KNOWN AS THE SISTERS OF THE THIRD ORDER OF ST. FRANCIS. THE GOVERNING BOARD OF THE SISTERS OF THE THIRD ORDER OF ST. FRANCIS, AN ILLINOIS NOT FOR PROFIT CORPORATION AND THE SOLE MEMBER OF OSF HEALTHCARE SYSTEM, HOLDS RESERVED POWERS TO ELECT AND REMOVE ALL OF THE MEMBERS OF THE BOARD OF DIRECTORS OF OSF HEALTHCARE SYSTEM.
FORM 990 - PART VI - LINE 7B:   AS GOVERNED BY CANONICAL AND CIVIL GUIDELINES PERTAINING TO ROMANCATHOLIC CHURCH PROPERTIES AND AS PROVIDED IN THE BYLAWS, CERTAIN TRANSACTIONS OF OSF HEALTHCARE SYSTEM MAY BE AUTHORIZED ONLY BY VOTE OF THE GOVERNING BOARD OF THE SISTERS OF THE THIRD ORDER OF ST. FRANCIS, WHICH VOTE IS TO BE TAKEN ONLY AFTER CONSIDERING THE ADVICE OF THE BOARD OF DIRECTORS OF OSF HEALTHCARE SYSTEM. THESE TRANSACTIONS ARE AS FOLLOWS: - TO ESTABLISH THE PHILOSOPHY AND MISSION ACCORDING TO WHICH THE CORPORATION OPERATES. - TO AMEND THE CORPORATION'S ARTICLES OF INCORPORATION AND BYLAWS. - TO ELECT AND REMOVE WITH OR WITHOUT CAUSE THE DIRECTORS OF THE CORPORATION. - TO MERGE OR DISSOLVE THE CORPORATION. - TO LEASE, SELL, ENCUMBER OR OTHERWISE ALIENATE REAL PROPERTY OF THE CORPORATION. - TO APPROVE ANY TRANSFER, LEASE, SALE OR ENCUMBRANCE OF PERSONAL PROPERTY OF THE CORPORATION EXCEPT IN THE ORDINARY COURSE OF BUSINESS. - TO APPROVE ANY BORROWING OR DEBT FINANCING IN EXCESS OF A SPECIFIED LIMIT (CURRENTLY $1,000,000) ESTABLISHED BY RESOLUTION OF THE MEMBER. - TO APPOINT (OR APPROVE THE APPOINTMENT OF) OR REMOVE THE CORPORATION'S CHAIRPERSON, CHIEF EXECUTIVE OFFICER, PRESIDENT, REGIONAL PRESIDENT/CHIEF EXECUTIVE OFFICERS, AND THE LOCAL PRESIDENT/CHIEF EXECUTIVE OFFICER OF EACH HEALTH CARE FACILITY AND OPERATING DIVISION OWNED, OPERATED OR CONTROLLED BY THE CORPORATION. - TO APPROVE STRATEGIC PLANS, MANAGEMENT OBJECTIVES AND CAPITAL ANDOPERATING BUDGETS OF THE CORPORATION. - TO APPROVE ANY PURCHASE OR OTHER ACQUISITION IN EXCESS OF A SPECIFIED LIMIT (CURRENTLY $1,000,000) ESTABLISHED BY RESOLUTION OF THE MEMBER. - TO REQUIRE A CERTIFIED AUDIT OF THE CORPORATION'S FINANCES AND TO APPOINT THE CERTIFIED PUBLIC ACCOUNTANT TO PERFORM THE AUDIT. - TO APPROVE THE ENGAGEMENT OF ANY OUTSIDE LEGAL COUNSEL TO REPRESENT THE CORPORATION ON A REGULAR BASIS AND THE DISMISSAL OF ANY CURRENT LEGAL COUNSEL REPRESENTING THE CORPORATION ON A REGULAR BASIS. - TO GIVE PRELIMINARY APPROVAL PRIOR TO THE DEVELOPMENT OF, AND TO GIVE FINAL APPROVAL PRIOR TO THE EXECUTION OF, ALL DOCUMENTS TO WHICH THE CORPORATION IS OR WILL BE A PARTY AND WHICH RELATE TO THE CREATION, FORMATION, ORGANIZATION, OR TERMINATION OF ANY OTHER LEGAL ENTITY (WHETHER A CORPORATION, LIMITED LIABILITY COMPANY, PARTNERSHIP, OR ANY OTHER ENTITY) IN WHICH THE CORPORATION WILL HAVE ANY OWNERSHIP INTEREST, MEMBERSHIP INTEREST, POWER TO ELECT OR APPOINT BOARD MEMBERS OR OFFICERS, OR ANY OTHER FORMAL PARTICIPATION ARRANGEMENT, WHETHER ACTING ALONE OR IN CONJUNCTION WITH ANY OTHER PERSON OR ENTITY.
FORM 990 - PART VI - LINE 9:   JAMES W. GIRARDY, M.D. 5666 East State Street ROCKFORD, IL 61108 JAMES MOORE 4405 W. LONGMEADOW CT. PEORIA, IL 61615
FORM 990 - PART VI - LINE 11B:   THE INITIAL DRAFT FORM 990 AND ALL REQUIRED SCHEDULES ARE PREPARED USING A MULTI-DISCIPLINARY PROCESS WHICH INCLUDES CORPORATE FINANCE AND ACCOUNTING, CORPORATE LEGAL, CORPORATE COMPLIANCE, AND CORPORATE MARKETING AND COMMUNICATIONS PERSONNEL WHO FOCUS INITIALLY ON SPECIFIC PORTIONS OF THE RETURN. THE COMPLETED DRAFT FORM 990 AND ALL SCHEDULES ARE THEN REVIEWED BY THIS SAME MULTI-DISCIPLINARY TEAM TO ENSURE ACCURACY AND INTEGRATION OF THE INDIVIDUAL PARTS AND SCHEDULES. IN ADDITION, THE INFORMATION AND SCHEDULES OF THE RETURN ARE SENT TO THE CORPORATION'S OUTSIDE AUDITORS, KPMG LLP FOR REVIEW AND COMMENT. KPMG REVIEWS THE INFORMATION AND SCHEDULES AND PREPARES AND SIGNS THE FINAL RETURN. COMMENTS FROM THE MULTI-DISCIPLINARY TEAM AND FROM THE AUDITORS ARE INCORPORATED INTO A PROPOSED FINAL VERSION OF FORM 990 AND ALL SCHEDULES. THIS PROPOSED FINAL VERSION IS THEN SENT VIA E-MAIL TO ALL OFFICERS AND MEMBERS OF THE BOARD OF DIRECTORS FOR THEIR REVIEW PRIOR TO FILING. ANY APPROPRIATE CHANGES REQUESTED BY THE OFFICERS AND DIRECTORS ARE THEN INCORPORATED INTO THE FINAL FORM 990 AND ALL SCHEDULES FOR FILING.
FORM 990 - PART VI - LINE 12C:   DISCLOSURES BY OFFICERS, DIRECTORS AND TRUSTEES, AS WELL AS KEY EMPLOYEES AND EMPLOYEES CHARGED WITH PURCHASING, PROCUREMENT AND CONTRACTING DECISION-MAKING ARE MADE THROUGH AN ELECTRONIC REPORTING SYSTEM. DISCLOSURES ARE RECEIVED AND REVIEWED BY THE CORPORATE COMPLIANCE DIVISION. IF A POTENTIAL CONFLICT OF INTEREST IS IDENTIFIED, THEN THE DISCLOSING EMPLOYEE IS NOTIFIED OF THE POTENTIAL CONFLICT AND MAY BE ASKED FOR ADDITIONAL INFORMATION ABOUT THE INTEREST. THE CORPORATE COMPLIANCE DIVISION DETERMINES WHETHER A PLAN TO MANAGE A POSSIBLE OR ACTUAL CONFLICT OF INTEREST IS NEEDED, DISCUSSES THE MANAGEMENT PLAN WITH THE EMPLOYEE AND MONITORS THE EMPLOYEE'S COMPLIANCE WITH THE PLAN. PLANS TO MANAGE CONFLICTS ARE TRACKED THROUGH THE ELECTRONIC DISCLOSURE SYSTEM.
FORM 990 - PART VI - LINE 15A:   THE BOARD OF DIRECTORS HAS ESTABLISHED A BOARD COMMITTEE KNOWN AS THE HUMAN RESOURCES COMMITTEE WHOSE MEMBERS ARE ALL PROFESSED MEMBERS OF THE RELIGIOUS CONGREGATION KNOWN AS THE SISTERS OF THE THIRD ORDER OF ST. FRANCIS WHO HAVE TAKEN A VOW OF POVERTY. HENCE, THEY DO NOT PERSONALLY BENEFIT FROM DECISIONS OF THE COMMITTEE. THE CHIEF EXECUTIVE OFFICER ("CEO") IS NOT A MEMBER OF THE COMMITTEE. THE PERFORMANCE OF THE CEO AND HIS ACHIEVEMENT OF ANNUAL GOALS IS EVALUATED EACH YEAR BY THE FULL BOARD OF DIRECTORS, AND THIS PERFORMANCE REVIEW IS PROVIDED TO THE COMMITTEE. THE COMMITTEE ALSO OBTAINS COMPENSATION SURVEY DATA AND RECOMMENDATIONS FROM A NATIONALLY RECOGNIZED INDEPENDENT COMPENSATION CONSULTANT. BASED ON ALL OF THESE FACTORS, THE COMMITTEE SETS THE BASE SALARY AND BENEFITS OF THE CEO AND APPROVES THE EXECUTIVE COMPENSATION PLAN APPLICABLE TO THE CEO. PRIOR TO PAYMENT OF ANY BONUS OR INCENTIVE COMPENSATION, THE TOTAL COMPENSATION FOR THE CEO, INCLUDING BASE SALARY, BENEFITS, AND PROPOSED BONUS OR INCENTIVE COMPENSATION, IS AGAIN REVIEWED BY A NATIONALLY RECOGNIZED COMPENSATION CONSULTANT TO ENSURE THAT NO "EXCESS BENEFIT" AMOUNT IS PAID OR FURNISHED.
FORM 990 - PART VI - LINE 15B:   THE BOARD OF DIRECTORS HAS ESTABLISHED A BOARD COMMITTEE KNOWN AS THE HUMAN RESOURCES COMMITTEE WHOSE MEMBERS ARE ALL PROFESSED MEMBERS OF THE RELIGIOUS CONGREGATION KNOWN AS THE SISTERS OF THE THIRD ORDER OF ST. FRANCIS WHO HAVE TAKEN A VOW OF POVERTY. HENCE, THEY DO NOT PERSONALLY BENEFIT FROM DECISIONS OF THE COMMITTEE. THE COMMITTEE DETERMINES WHICH OFFICERS, KEY EMPLOYEES AND OTHER EMPLOYEES ARE ELIGIBLE TO PARTICIPATE IN THE EXECUTIVE COMPENSATION PLAN. BASED ON PERFORMANCE REVIEWS BY THE SUPERVISORS OF SUCH PERSONS AND COMPENSATION SURVEY DATA AND RECOMMENDATIONS FROM A NATIONALLY KNOWN INDEPENDENT COMPENSATION CONSULTANT, THE COMMITTEE APPROVES ANY EXECUTIVE COMPENSATION PLAN APPLICABLE TO KEY EMPLOYEES AND ESTABLISHES THE BASE SALARY AND BENEFITS FOR PLAN PARTICIPANTS. PRIOR TO PAYMENT OF ANY BONUS OR INCENTIVE COMPENSATION, THE TOTAL COMPENSATION FOR EACH KEY EMPLOYEE, INCLUDING BASE SALARY, BENEFITS, AND PROPOSED BONUS OR INCENTIVE COMPENSATION, IS AGAIN REVIEWED BY A NATIONALLY RECOGNIZED COMPENSATION CONSULTANT TO ENSURE THAT NO "EXCESS BENEFIT" AMOUNT IS PAID OR FURNISHED. SOME KEY EMPLOYEES LISTED IN PART VII ARE PRACTICING PHYSICIANS WHO ARE LISTED AS KEY EMPLOYEES AS A RESULT OF THE COMPENSATION THEY RECEIVE AND NOT DUE TO ANY EXECUTIVE OR MANAGEMENT POSITION WHICH THEY HOLD. SUCH PHYSICIANS GENERALLY ARE NOT PARTICIPANTS IN THE EXECUTIVE COMPENSATION PLAN, AND THEIR COMPENSATION, INCLUDING BASE SALARY, BENEFITS, AND ANY APPLICABLE BONUS OR INCENTIVE COMPENSATION, IS ESTABLISHED IN ACCORDANCE WITH NATIONALLY RECOGNIZED PHYSICIAN COMPENSATION SURVEYS AND IS SET FORTH IN WRITTEN EMPLOYMENT AGREEMENTS WHICH ARE APPROVED BY THE BOARD OF DIRECTORS OR ITS EXECUTIVE COMMITTEE.
FORM 990 - PART VI - LINE 18:   OSF HEALTHCARE SYSTEM MAKES ITS FORM 990, ITS FORM 990-T, AND DOCUMENTATION OF ITS EXEMPT STATUS UNDER SECTION 501(C)(3) OF THE CODE AVAILABLE FOR PUBLIC INSPECTION AND COPYING UPON REQUEST IN ACCORDANCE WITH SECTION 6104 OF THE INTERNAL REVENUE CODE. NAMES AND ADDRESSES OF CONTRIBUTORS ARE NOT DISCLOSED. REQUESTS MAY BE MADE IN PERSON, IN WRITING, OR BY TELEPHONE. REQUESTS MADE IN PERSON ARE ACCEPTED AT THE CORPORATE OFFICE AND AT EACH HOSPITAL FACILITY OF THE CORPORATION. REQUESTS MADE IN WRITING OR BY TELEPHONE TO ANY FACILITY OR LOCATION OF THE CORPORATION ARE FORWARDED TO THE CORPORATE FINANCE AND ACCOUNTING DIVISION, WHICH THEN PROVIDES COPIES OF THE REQUESTED DOCUMENTS IN THE MANNER REQUESTED (IF SUCH DELIVERY METHOD IS AVAILABLE TO THE CORPORATION).
FORM 990 - PART VI - LINE 19:   THE CORPORATION MAKES ITS ARTICLES OF INCORPORATION, CORPORATE BYLAWS, AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC UPON REQUEST. ALL REQUESTS ARE FORWARDED TO THE CORPORATE LEGAL DIVISION, WHICH THEN PROVIDES COPIES OF THE REQUESTED DOCUMENTS IN THE MANNER REQUESTED (IF SUCH DELIVERY METHOD IS AVAILABLE TO THE CORPORATION). IN ADDITION, THE CORPORATION'S ARTICLES OF INCORPORATION ARE PUBLICLY AVAILABLE FROM THE OFFICE OF THE ILLINOIS SECRETARY OF STATE OR FROM THE RECORDER OF DEEDS IN WOODFORD COUNTY, ILLINOIS, SITE OF THE CORPORATION'S REGISTERED OFFICE. FINANCIAL STATEMENTS OF THE CORPORATION ARE PUBLICLY AVAILABLE ON THE ELECTRONIC MUNICIPAL MARKET ACCESS (EMMA) WEBSITE OF THE MUNICIPAL SECURITIES RULEMAKING BOARD (MSRB)AND FROM THE ILLINOIS ATTORNEY GENERAL AS PART OF THE CORPORATIONS COMMUNITY BENEFIT REPORT. FORM 990 - PART VII - Section A: Reportable compensation in Part VII was determined from a review of payroll queries from the Organization's and related organization's payroll and general ledger modules, yearly payroll reports, and W-2 filings.
FORM 990 - PART XI - LINE 5: OTHER CHANGES IN FUND BALANCE INCLUDE: CHANGE IN UNREALIZED MARKET VALUE OF SWAPS (4,017,477) NET ASSETS RELEASED FROM RESTRICTION (29,093,369) UNREALIZED GAIN/LOSS 45,222,754 UNREALIZED GAIN/LOSS - RESTRICTED 1,842,997 INCREASE IN PERMANETLY RESTRICTED ASSETS 9,005,812 REVERSAL OF MINIMUM PENSION LIABILITY (130,781,385) SFI & SUBSIDIAIRY INCOME (407,191) CHANGE IN MARKET VALUE OF TRUSTEE ACCOUNTS 4,163,325 MINORiTY INTEREST (2,823,822) INVESTMENT IN HEALTHCARE MIDWEST (17,227,232) EQUITY TRANSFERS (37,337,192) EARLY EXTINGUISHMENT OF DEBT (11,340,591) TRANSFER TO PARENT (200,000) TRANSFER TO OTTAWA (12,318,635) ------------ TOTAL CHANGES IN NET ASSETS OR FUND BALANCE (185,312,006)
SCHEDULE K - PART I - BOND ISSUES   ILLINOIS FINANCE AUTHORITY - 08/29/2007 Cusip# 45200B8E1 THE CORPORATION USED THE PROCEEDS OF THE SERIES 2007 BONDS, TOGETHER WITH CERTAIN OTHER AVAILABLE FUNDS, INCLUDING PROCEEDS FROM THE SALE OF THE AUCTION BONDS AND THE variable RATE BONDS, TO (I) FINANCE OR REFINANCE THE COST OF THE ACQUISITION, CONSTRUCTION AND EQUIPPING OF THE PROJECT; (II) PAY CAPITALIZED INTEREST WITH RESPECT TO A PORTION OF THE SYSTEMWIDE BONDS; (III) FUND DEBT SERVICE RESERVE FUNDS FOR CERTAIN OF THE SYSTEMWIDE BONDS; (IV) REFINANCE THE PRIOR INDEBTDEDNESS DESCRIBED BELOW AND (V) PAY CERTAIN EXPENSES INCURRED IN CONNECTION WITH THE ISSUANCE OF THE SYSTEMWIDE BONDS AND THE REFINANCING. ILLINOIS FINANCE AUTHORITY - 03/31/2009 Cusip# 45200FWD7, 4500FWG0, 45200FWE5, 45200FWF2 THE CORPORATION USED THE PROCEEDS OF THE SYSTEMWIDE BONDS, TOGETHER WITH CERTAIN OTHER AVAILABLE FUNDS, TO (I) REFINANCE AND REDEEM THE PRIOR BONDS DESCRIBED BELOW; (II) FUND A DEBT SERVICE RESERVE FUND FOR THE SERIES 2009 BONDS; AND (III) PAY CERTAIN EXPENSES INCURRED IN CONNECTION WITH THE ISSUANCE OF THE SYSTEMWIDE BONDS AND THE REFINANCING. ILLINOIS FINANCE AUTHORITY - 08/18/2009 NO CUSIP# THE CORPORATION USED THE PROCEEDS OF THE SERIES 2009EFG TO PAY OR REIMBURSE THE CORPORATION FOR THE PROJECTS. ILLINOIS FINANCE AUTHORITY - 06/29/2010 CUSIP# 45200F3R8 THE CORPORATION USED THE PROCEEDS OF THE SERIES 2010A BONDS, TOGETHER WITH CERTAIN OTHER AVAILABLE FUNDS, TO (i) REFINANCE AND REDEEM ON OR ABOUT AUGUST 2, 2010, THE ILLINOIS HEALTH FACILITY AUTHORITY VARIABLE DEMAND REVENUE BONDS, SERIES 1985B (REVOLVING FUND POOLED FINANCING PROGRAM) AND ILLINOIS FINANCE AUTHORITY VARIABLE RATE REVENUE BONDS, SERIES 2001 IN THE AMOUNT OF $75,000,000 AND $46,050,000, RESPECTIVELY, ON OR ABOUT SEPTEMBER 17, 2010, THE ILLINOIS FINANCE AUTHORITY REVENUE BONDS, SERIES 2007D IN THE AMOUNT OF $20,050,000; (ii) PAY OR REIMBURSE THE CORPORATION FOR THE PROJECT; (iii) FUND A DEBT SERVICE RESERVE FUND FOR THE SERIES 2010A BONDS; AND PAY CERTAIN EXPENSES INCURRED IN CONNECTION WITH THE ISSUANCE OF THE SERIES 2010A BONDS AND THE REFINANCING OF THE SERIES 1985B BONDS, THE SERIES 2001 BONDS AND THE SERIES 2007D BONDS. The Corporation used the proceeds of the Series 2012 bonds to (i) pay or reimburse the corporation or ottawa regional hospital & healthcare center for the costs of the project, (ii) advance refund all of the illinois finance authority revenue bonds, series 2004, (iii) current refund a portion of the illinois finance authority insured variable rate demand revenue bonds, series 2007f, (iv) currently refund all of the illinois finance authority variable rate demand revenue bonds, series 2007g, (v) advance refund a portion of the illinois finance authority revenue bonds, series 2009a, (vi) currently refund all of the illinois finance authority revenue bonds, series 2009f, (vii) refinance the pnc bank loan, and (viii) pay certain expenses incurred in connection with the issuance of the bonds and the refunding of the prior bonds and pnc bank loan.
SCHEDULE K - PART II - LINE 7 BOND ISSUANCE COSTS BOND ISSUANCE COST CREDIT ENHANCEMENT TOTAL A $3,319,397 $8,846,375 $12,165,772 B $3,114,169 $126,677 $3,240,846 C $0 $0 $0 D $2,080,292 $0 $2,080,292 E $2,402,586 $0 $2,402,586
SCHEDULE R - PART I - (B) PRIMARY ACTIVITY:   OSF LIFELINE AMBULANCE, LLC OWNS ten AMBULANCES AND FOUR WHEEL CHAIR VANS CONFIGURED AND EQUIPPED FOR PATIENT TRANSPORT AND PROVIDES GROUND AMBULANCE SERVICES IN NORTHERN ILLINOIS.
SCHEDULE R - PART II - (B) PRIMARY ACTIVITY:   THE SISTERS OF THE THIRD ORDER OF ST. FRANCIS IS THE SOLE MEMBER OF THE CORPORATION AND IS ENGAGED IN ACTIVITIES RELATED TO GOVERNANCE OF THE CORPORATION. OSF HEALTHCARE FOUNDATION RAISES FUNDS TO SUPPORT THE ACTIVITIES OF THE CORPORATION. St. Francis Community clinic provides free comprehensive health care services to the indigent population of the area. Ottawa regional hospital & healthcare center operates an acute care hospital in Ottawa that provides efficient and quality healthcare services consistent with the needs of the commnunity. Ottawa regional hospital foundation supports and encourages healthcare services in furtherance of the support of and in assistance to Ottawa Regional Hospital & Healthcare Center through providing financial and fundraising assistance. Ottawa regional hospital auxiliary operates to promote and advance the welfare of Ottawa regional hospital & healthcare center. Ottawa regional hospital & healthcare liability loss fund provides a vehicle for self-insuring risks arising from the operation and maintenance of the Ottawa regional hospital & healthcare center. OSF multi-specialty group has been organized to support the mission of OSF healthcare system in future years through the provision of quality healthcare services related to comprehensive inpatient and outpatient care. it has not yet commenced operations. OSF Heart & Vascular Institute has been organized to support the mission of OSF healthcare system in future years through the provision of quality healthcare services related to cardiovascular care and treatment. It has not yet commenced operations. Children's hospital of Illinois Medical group has been organized to support the mission of OSF healthcare system in future years through the provision of quality of healthcare services related to comprehensive inpatient and outpatient care for children. It has not yet commenced operations. Illinois Neuroscience Institute has been organized to support the mission of OSF healthcare system in future years through the provision of quality healthcare services related to research center for diagnosis and treatment of brain disorders. it has not yet commenced operations.
SCHEDULE R - PART III - (B) PRIMARY ACTIVITY:   CENTER FOR HEALTH AMBULATORY SURGERY CENTER, LLC OPERATES AMULTISPECIALTY AMBULATORY SURGICAL CENTER IN PEORIA, ILLINOIS. STATE AND ROXBURY, LLC OPERATES A REAL ESTATE MANAGEMENT ORGANIZATION IN ROCKFORD, ILLINOIS. EASTLAND MEDICAL PLAZA SURGICENTER, LLC OPERATES A MULTISPECIALTY AMBULATORY SURGERY TREATMENT CENTER IN BLOOMINGTON, ILLINOIS. FORT JESSE IMAGING CENTER, LLC OPERATES A STAND-ALONE MEDICAL IMAGING CENTER IN BLOOMINGTON, ILLINOIS. SLEEP CENTER OF CENTRAL ILLINOIS, LLC OPERATES A STAND-ALONE SLEEP DISORDER DIAGNOSTIC CENTER IN BLOOMINGTON, ILLINOIS. Radiation Oncology of Northern Illinois, LLC operates a radiation oncology center. Ottawa regional cardinal sleep center, LLC was created to be a sleep diagnostic center. It has not yet commenced operations.
SCHEDULE R - PART IV - (B) PRIMARY ACTIVITY:   OSF SAINT FRANCIS, INC. PROVIDES HEALTHCARE RELATED SERVICES SUCH AS MEDICAL PRACTICE MANAGEMENT, RETAIL PHARMACIES, MOBILE MEDICAL SYSTEMS, DURABLE MEDICAL EQUIPMENT, HOME THERAPEUTICS, REAL ESTATE RENTAL AND EQUIPMENT TECHNOLOGY SERVICES. HEARTCARE MIDWEST, LTD. IS A PHYSICIAN GROUP OF CARDIOVASCULAR SPECIALISTS SERVING CENTRAL ILLINOIS. CARDIOVASCULAR INSTITUTE AT OSF, LLC IS A PHYSICIAN GROUP OF CARDIOVASCULAR SPECIALISTS SERVING NORTHERN ILLINOIS. ILLINOIS PATHOLOGIST SERVICES, LLC PROVIDES PATHOLOGY SERVICES INNORTHERN ILLINOIS. OSF MULTISPECIALTY GROUP - EASTERN REGION, LLC IS A MULTISPECIALTY CLINIC SERVING EASTERN ILLINOIS, OFFERING SERVICES IN ADULT MEDICINE, BEHAVIORAL FAMILY MEDICINE, GENERAL SURGERY, NEUROLOGY, OBSTETRICS, GYNECOLOGY, PEDIATRICS, PHYSIATRY, PULMONOLOGY, RADIOLOGY AND UROLOGY. OSF MULTISPECIALTY GROUP - PEORIA, LLC PROVIDES PEDIATRIC CARE FOR CARDIOVASCULAR ILLNESSES. ILLINOIS NEUROLOGICAL INSTITUTE - PHYSICIANS, LLC PROVIDES A FULL SPECTRUM OF ADULT AND PEDIATRIC CARE FOR ILLNESSES AFFECTING THE BRAIN, SPINAL CORD, AND PERIPHERAL NERVES. ILLINOIS SPECIALTY PHYSICIAN SERVICES AT OSF, LLC PROVIDES PULMONOLOGY AND CRITICAL CARE SERVICES IN CENTRAL ILLINOIS. OSF PERINATAL ASSOCIATES, LLC PROVIDES MATERNAL FETAL MEDICINE PHYSICIAN SERVICES IN CENTRAL ILLINOIS. OSF Multispecialty group - western region, LLC is a multispecialty clinic serving western Illinois, offering services in a wide variety of general and specialty medical categories. OSF CHILDREN'S MEDICAL GROUP - CONGENITAL HEART CENTER, LLC PROVIDES PEDIATRIC CARE FOR CARDIOVASCULAR ILLNESS IN NORTHERN ILLINOIS. PREFERRED EMERGENCY PHYSICIANS OF ILLINOIS, LLC PROVIDES PHYSICIAN COVERAGE FOR EMERGENCY DEPARTMENTS. Ottawa regional healthcare affiliates, inc. is a holding company for Ottawa regional cardinal sleep centr, llc and ottawa regional medical center, inc. Ottawa regional medical center, inc. provides outpatient medical and diagnostic services.
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:GERALD J. MCSHANE, M.D. TITLE:Pres/CEO OSFMG, board member HOURS:5
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:KEVIN D SCHOEPLEIN TITLE:Vice Chairperson; CEO HOURS:5
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SISTER AGNES JOSEPH WILLIAMS, OSF TITLE:Assistant Secretary HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SISTER DIANE MARIE MCGREW, OSF TITLE:PRESIDENT/TREASURER HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SISTER JUDITH ANN DUVALL, OSF TITLE:Chairperson HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SISTER ROSE THERESE MANN, OSF TITLE:Board Member HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SISTER THERESA ANN BRAZEAU, OSF TITLE:Secretary HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:VANCE C. PARKHURST TITLE:Senior Vice President HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DANIEL E.BAKER TITLE:Senior VP, Board Member HOURS:5
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DANIEL R. FASSETT, MD ** TITLE:Physician, Neurosurgery HOURS:40
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:FINN REIDER AMBLE,MD ** TITLE:Physician, Neurosurgery HOURS:40
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JEFFREY D. KLOPFENSTEIN, MD ** TITLE:Physician, Neurosurgery HOURS:40
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SYED M. HUSSAIN, MD ** TITLE:Physician, Vascular Surgery HOURS:40
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JAMES MOORE TITLE:Vice Chairperson; CEO Retired HOURS:
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2011

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)

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

OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
OSF Healthcare System
 
Employer identification number

37-0813229
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) OSF Lifeline Ambulance LLC
318 Roxbury Road
Rockford,IL61107
20-0080542
Schedule O IL -1,119,546 948,611 OSF
 










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


(b)
Primary activity


(c)
Legal domicile (state
or foreign country)

(d)
Exempt Code section



(e)
Public charity status
(if section 501(c)(3))

(f)
Direct controlling
entity

(g)
Section 512(b)(13) controlled organization
Yes No
(1) Sisters of The Third order of St Franci

800 NE Glen OAK Ave

Peoria,IL61603
37-1259286
Schedule O IL 501(c)(3) Ln11 TypeII NA
 
 
No
(2) OSF Healthcare Foundation

800 NE Glen OAk Ave

Peoria,IL61603
37-1259284
Schedule O IL 501(c)(3) Ln11 TypeII NA
 
 
No
(3) St Francis Community Clinic

530 NE Glen Oak Ave

Peoria,IL61603
37-0661235
Schedule O IL 501(c)(3) Ln7 sis 3rd osf
 
 
No
(4) Ottawa Regional Hospital & Healthcare Ce

1100 East Norris Drive

Ottawa,IL61350
36-2604009
Schedule O IL 501(c)(3) Ln3 OSF
 
 
No
(5) Ottawa Regional Hospital Foundation

1100 East Norris Drive

Ottawa,IL61603
36-4007569
Schedule O IL 501(c)(3) LN11A TYPE1 orhhc
 
 
No
(6) Ottawa Regional Hospital Auxiliary

1100 East Norris Drive

Ottawa,IL61603
36-3854788
Schedule O IL 501(c)(3) LN11C Tpiii NA
 
 
No
(7) Ottawa Regional Hospital & Healthcare Ce

1100 East Norris Drive

Ottawa,IL61603
36-0361265
Schedule O IL 501(c)(3) LN11A TYPE1 orhhc
 
 
No
(8) OSF Multi-Specialty Group

800 NE Glen Oak Avenue

Peoria,IL61603
38-3852646
Schedule O IL 501(c)(3) LN11A TYPE1 OSF
 
 
No
(9) OSF Heart & Vascular Institute

800 NE Glen Oak Avenue

Peoria,IL61603
35-2422385
Schedule O IL 501(c)(3) LN11A TYPE1 OSF
 
 
No
(10) Children's Hospital of Illinois Medical

800 NE Glen Oak Avenue

Peoria,IL61603
32-0353954
Schedule O IL 501(c)(3) LN11A TYPE1 OSF
 
 
No
(11) Illinois Neuroscience Institute

800 NE Glen Oak Avenue

Peoria,IL61603
36-4709999
Schedule O IL 501(c)(3) LN11A TYPE1 OSF
 
 
No
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



(b)
Primary activity




(c)
Legal
domicile
(state or foreign
country)


(d)
Direct controlling
entity



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

(f)
Share of total income




(g)
Share of end-of-year
assets



(h)
Disproprtionate allocations?




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



(k)
Percentage
ownership


Yes No Yes No
(1) Center for Health Ambulatory Surgery Cen

8800 Route 91 North
Peoria,IL61615
20-5557171
Schedule O IL OSF
 
Related 2,791,115 2,265,027   No     No 60.250 %
(2) State and Roxbury LLC

5668 E State Street
Rockford,IL61108
26-1728983
Schedule O IL OSF
 
Related -56,238 1,872,798   No     No 51.000 %
(3) Eastland Medical Plaza Surgicenter LLC

1505 Eastland Drive
Bloomington,IL61701
37-1400643
Schedule O IL OSF
 
Related 3,434,227 5,753,329   No     No 50.000 %
(4) Fort Jesse Imaging Center LLC

220 Ft Jesse Road Suite B
Normal,IL61761
46-0515604
Schedule O IL OSF
 
Related 303,558 232,943   No     No 50.100 %
(5) Sleep Center of Central Illinois LLC

2204 Eastland Drive Suite 100
Bloomington,IL61704
81-0581886
Schedule O IL OSF
 
Related 263,464 205,345   No     No 50.050 %
(6) Radiation Oncology of Northern Illinois

1200 Starfire Drive
Ottawa,IL61350
75-3247165
Schedule O IL ORHHC
 
Related 455,880 1,173,554   No     No 57.000 %
(7) Ottawa Regional Cardinal Sleep Center

1601 Mercury Circle Suite 2
Ottawa,IL61350
Schedule O IL ORHHC
 
Related 0 0   No     No 100.000 %
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of related organization



(b)
Primary activity



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


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

(f)
Share of total income



(g)
Share of
end-of-year
assets

(h)
Percentage
ownership


(1) OSF Saint Francis Inc
800 NE Glen Oak Ave
Peoria,IL61603
36-3484677
Schedule O IL OSF
 
C 312,355 144,307,094 100.000 %
(2) Heartcare Midwest LTD
5405 N Knoxville Avenue
Peoria,IL61614
37-0996868
Schedule O IL OSF
 
c -17,227,232 5,758,710 100.000 %
(3) Cardiovascular Institute at OSF LLC
444 Roxbury Road
Rockford,IL61107
26-4225726
Schedule O IL OSF
 
C -7,594,715 2,243,688 100.000 %
(4) Illinois Pathologist Services LLC
5666 East State Street
Rockford,IL61108
80-0439081
Schedule O IL OSF
 
C 165,715 434,835 100.000 %
(5) OSF Multispecialty Group-Eastern Region
1701 E College Avenue
Bloomington,IL61704
30-0561892
Schedule O IL OSF
 
C -12,929,274 3,686,709 100.000 %
(6) OSF Multispecialty Group-Peoria LLC
530 NE Glen Oak Avenue
Peoria,IL61637
26-2800379
Schedule O IL OSF
 
C 2,566,953 219,464 100.000 %
(7) Ill Neurological Institute-Phy LLC
719 N William Kumpf Blvd
Peoria,IL61605
26-3109118
Schedule O IL OSF
 
C -4,988,556 699,144 100.000 %
(8) Ill Spec Phy Svcs at OSF LLC
1001 Main Street Suite 200
Peoria,IL61606
80-0462209
Schedule O IL OSF
 
C -3,461,233 320,429 100.000 %
(9) OSF Perinatal Associates LLC
4911 Executive Drive Suite 200
Peoria,IL61614
80-0498373
Schedule O IL OSF
 
C -1,678,863 77 100.000 %
(10) OSF Multispecialty Group-Western Region
3315 North Seminary Street
Galesburg,IL61401
80-0608541
Schedule O IL OSF
 
C -5,959,111 752,174 100.000 %
(11) OSF Children's Medical Group - Congenita
5701 Strathmoor Drive Suite 1
Peoria,IL61603
90-0714643
Schedule O IL OSF
 
C -880,007 35,360 100.000 %
(12) Preferred Emergency Physicians of Illino
800 NE Glen Oak Avenue
Peoria,IL61603
90-0749855
Schedule O IL OSF
 
C 207,343 191,198 100.000 %
(13) Ottawa Regional Healthcare Affiliates
1100 East Norris Drive
Ottawa,IL61350
26-3937519
Schedule O IL ORHHC
 
C -991,344 2,898,024 100.000 %
(14) Ottawa Regional Medical Center Inc
1614 East Norris Drive
Ottawa,IL61350
27-1036071
Schedule O IL ORHHC
 
C 0 0 100.000 %
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III or IV.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
Yes
 
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
Yes
 
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
Yes
 
k Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1k
Yes
 
l Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization
(b)
Transaction
type(a-r)
(c)
Amount involved
(d)
Method of determining amount involved
(1) Center for Health Ambulatory Surgery Center

a(iv) 707,401  
(2) Eastland Medical Plaza Surgicenter LLC

a(iv) 567,317  
(3) Heartcare Midwest Ltd

a(iv) 236,703  
(4) OSF Multispecialty Group - Peoria LLC

a(iv) 233,810  
(5) OSF Perinatal Associates LLC

a(iv) 128,912  
(6) Illinois Neurological Institute - Physicians

a(iv) 22,659  
(7) OSF Saint Francis Inc

a(iv) 395,632  
(8) Illinois Pathologist Services LLC

a(iv) 11,628  
(9) OSF Multispecialty Group-Western Region LLC

a(iv) 3,035  
(10) OSF Children's Medical Group - Congenital Hea

a(iv) 31,477  
(11) OSF Multispecialty Group-Peoria LLC

b 2,079,492  
(12) Illinois Neurological Institute - Physicians

b 4,820,000  
(13) Cardiovascular Institute at OSF LLC

b 7,850,000  
(14) OSF Multispecialty Group-Eastern Region LLC

b 11,000,000  
(15) Illinois Specialty Physician Services at OSF

b 3,672,000  
(16) OSF Multispecialty Group-Western Region LLC

b 5,895,000  
(17) OSF Perinatal Associates LLC

b 1,306,200  
(18) OSF Children's Medical Group - Congenital Hea

b 714,500  
(19) HeartCare Midwest Ltd

b 18,700,000  
(20) State and Roxbury LLC

d 500,000  
(21) Ottawa Regional Hospital & Healthcare Center

d 750,000  
(22) OSF Saint Francis Inc

j 5,654,183  
(23) Cardiovascular Institute at OSF LLC

j 544,495  
(24) State and Roxbury LLC

j 325,873  
(25) Heartcare Midwest Ltd

j 217,089  
(26) Ottawa Regional Hospital & Healthcare Center

j 3,588  
(27) OSF Saint Francis Inc

k 7,909,307  
(28) Heartcare Midwest Ltd

k 266,787  
(29) OSF Multispecialty Group-Eastern RegionLLC

k 13,681,330  
(30) Cardiovascular Institute at OSF LLC

k 9,321,646  
(31) Illinois Pathologist Services LLC

k 1,217,369  
(32) Illinois Specialty Physician Services at OSF

k 5,271,627  
(33) OSF Perinatal Associates LLC

k 1,952,133  
(34) OSF Multispecialty Group-Peoria LLC

k 3,360,647  
(35) Illinois Neurological Institute - Physicians

k 8,304,418  
(36) OSF Multispecialty Group-Western Region LLC

k 9,301,277  
(37) OSF Children's Medical Group - Congenital Hea

k 936,197  
(38) Preferred emergency physicians of illinois

k 3,316,900  
(39) ottawa regional hospital & healthcare center

k 1,620,399  
(40) OSF Saint Francis Inc

L 82,217,077  
(41) OSF Saint Francis Inc

o 2,251,111  
(42) Heartcare Midwest Ltd

o 1,958,709  
(43) OSF Multispecialty Group-Eastern Region LLC

o 20,370,436  
(44) Cardiovascular Institute at OSF LLC

o 7,693,281  
(45) Illinois Pathologist Services LLC

o 764,940  
(46) Illinois Specialty Physician Services at OSF

o 3,406,554  
(47) OSF Perinatal Associates LLC

o 1,304,044  
(48) OSF Multispecialty Group-Peoria LLC

o 2,801,439  
(49) Illinois Neurological Institute - Physicians

o 5,975,360  
(50) OSF Multispecialty Group-Western Region LLC

o 10,982,818  
(51) OSF Children's Medical Group - Congenital Hea

o 1,126,165  
(52) Preferred emergency physicians of illinois l

o 557,521  
(53) ottawa regional hospital & healthcare center

o 6,650  
(54) Eastland Medical Plaza Surgicenter LLC

r 3,067,145  
(55) Sleep Center of Central Illinois LLC

r 245,245  
(56) Fort Jesse Imaging Center LLC

r 397,205  
(57) Center for Health Ambulatory Surgery Center

r 3,341,775  
(58) OSF Multispecialty Group-Peoria LLC

r 1,431,000  
(59) Illinois Neurological Institute - Physicians

r 9,755,000  
(60) Cardiovascular Institute at OSF LLC

r 1,866,973  
(61) OSF Multispecialty Group-Eastern Region LLC

r 1,250,000  
(62) Illinois Specialty Physician Services at OSF

r 4,014,000  
(63) OSF Perinatal Associates LLC

r 1,671,000  
(64) Illinois Pathologist Services LLC

r 2,060,000  
(65) OSF Multispecialty Group-Western Region LLC

r 13,500,000  
(66) OSF Saint Francis Inc

r 115,016,447  
(67) osf children's medical group-congenital heart

r 714,000  
(68) preferred emergency physicians of illinois l

r 3,241,000  
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity
(b)
Primary activity
(c)
Legal domicile
(state or foreign
country)
(d)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

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




(g)
Share of
end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership


Yes No Yes No Yes No






























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


Software ID:  
Software Version: