TY 2011 Form 990

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) KENNETH HAMPTON Trustee	1.00	X			0	0
(2) DENNIS MICHAELIS Secretary	1.00	X			0	0
(3) MS DEBORAH K KEEL Trustee	1.00	X			0	0
(4) HAL M WHITAKER Treasurer	1.00	X			0	0
(5) STEVEN T CATES Trustee	1.00	X			0	0
(6) TODD MOFFATT MD Trustee	1.00	X			0	0
(7) SR JOANNE M VASA DC Trustee	1.00	X			0	0
(8) SR DOROTHEA MOLL DC Trustee	1.00	X			0	0
(9) SR MARIE THERESE SEDGWICK DC Chairman	40.00	X			0	0
(10) DR RONALD J EPPS VICE CHAIR	1.00	X			0	0
(11) KENT A KEAHEY President & CEO	40.00	X	X		1,001,977	15,752
(12) BRETT ESROCK SR VP / COO	40.00		X		227,784	6,111
(13) KAREN RICHARDSON Sr VP/CFO	40.00		X		241,629	39,372
(14) SR CECILE MATUSHEK VP MISSION AFFAIRS	40.00			X	108,594	565
(15) JANA WHITAKER VP MARKETING & VOLUNTEER SERVICES	40.00			X	83,327	10,909
(16) CHARLES SIVESS VP HUMAN RESOURCES	40.00			X	148,895	28,658
(17) MICHAEL OLMSTEAD VP LONG TERM CARE	40.00			X	111,949	12,907

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(F) Estimated amount of other compensation from the organization and related organizations
(18) VICKY CAMPBELL VP HOME CARE	40.00	X			151,897	11,253
(19) JOE HOPKINS VP MENTAL HEALTH	40.00	X			154,279	27,356
(20) ROBERT BUCK VP CLINICAL SUPPORT SVC	40.00	X			171,746	19,085
(21) EVERTT TINDELL VP CLINIC OPS	40.00	X			164,410	12,828
(22) JONATHAN FORD VP WORKPLACE SPIRITUALITY	40.00	X			173,246	42,248
(23) ANNETTE AYERS SR VP NRSG SVCS	40.00	X			193,096	10,234
(24) BRENDA DAVIS VP CLINICAL SUPPORT SERVICES	40.00	X			214,683	4,582
(25) TIMOTHY BARRETT SVP - CMO	40.00	X			299,948	35,881
(26) LUCI HANSSON PHARMACISTS	40.00		X		152,193	5,866
(27) LARRY LEFEVRE PHARMACISTS	40.00		X		159,231	5,928
(28) SAMUEL E ABERNATHY PHARMACIST	40.00		X		164,188	8,805
(29) KRISTIN CRAIG CRNA	40.00		X		155,416	10,476
(30) TONY WELCH CRNA	40.00		X		155,056	3,192
(31) ODIS NICHOLS FORMER COO / SR VP	0.00			X	129,312	1,500

(A) Name and business address	(B) Description of services	(C) Compensation
WACO SURGICAL GROUP 6600 FISH POND RD WACO,TX767102621	MEDICAL CONSULTING	740,378
NAVVIS CONSULTING LLC 15945 CLAYTON ROAD STE360 BALLWIN,MO63011	CONSULTING	680,872
MCLENNAN COUNTY MEDICAL EDUCATION & RESEARCH 1600 PROVIDENCE DR WACO,TX767072291	RESIDENT MEDICAL SVC	923,530
MCLENNAN COUNTY HOSPITALISTS PO BOX 23548 WACO,TX767023548	HOSPITALISTS	1,181,283
MCLENNAN COUNTY EMERGENCY PHYSICIANS PO BOX 23548 WACO,TX767023548	EMERGENCY PHYSICIANS	8,777,413
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 25

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	5,901,915	5,901,915
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	0
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16	0
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	3,636,634		3,636,634
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	146,706		146,706
7	Other salaries and wages	89,504,577	77,941,353	11,563,224
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	1,717,564	1,580,159	137,405
9	Other employee benefits .......	13,401,350	11,927,202	1,474,148
10	Payroll taxes ...........	6,884,446	6,127,157	757,289
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	484,072		484,072
c	Accounting ...........	255,483		255,483
d	Lobbying ...........	0
e	Professional fundraising. See Part IV, line 17..	0
f	Investment management fees ......	0
g	Other ..........	31,500,229	24,428,158	7,072,071
12	Advertising and promotion ....	1,361,479	10,039	1,351,440
13	Office expenses .......	51,968,261	49,169,748	2,798,513
14	Information technology ......	0
15	Royalties ..	0
16	Occupancy ...........	3,400,602	3,384,102	16,500
17	Travel ............	839,501	352,362	487,139
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0
19	Conferences, conventions, and meetings ....	0
20	Interest ...........	1,971,799		1,971,799
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization .....	11,921,086	10,132,923	1,788,163
23	Insurance ..............	112,927		112,927
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	NON RECURRING LOSS PPE	1,105,635	1,105,635
b	EQUIPMENT RENT & MAINT.	1,581,500	1,469,939	111,561
c	MAINTENANCE & REPAIRS	3,879,767	1,560,093	2,319,674
d	OTHER EXPENSES	5,178,607	2,711,906	2,466,701
e
f	All other expenses	-4,422,364	-5,549,421	1,127,057
25	Total functional expenses. Add lines 1 through 24f	232,331,776	192,253,270	40,078,506	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet
	1	Cashnon-interest-bearing ..........		1	0
2	Savings and temporary cash investments .......	18,074,285	2	12,815,151
3	Pledges and grants receivable, net .........		3	0
4	Accounts receivable, net .........	34,126,285	4	36,328,385
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........		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 ..........		6	0
7	Notes and loans receivable, net .............	2,177,213	7	1,125,196
8	Inventories for sale or use ..............	4,046,227	8	3,990,290
9	Prepaid expenses and deferred charges ............	1,127,545	9	993,064
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	236,019,457
b	Less: accumulated depreciation. .....	10b	123,360,531	112,221,955	10c	112,658,926
11	Investments—publicly traded securities ..........		11	0
12	Investments—other securities. See Part IV, line 11 ......		12	0
13	Investments—program-related. See Part IV, line 11 ..		13	0
14	Intangible assets .........	3,286,277	14	3,211,894
15	Other assets. See Part IV, line 11 ...........	124,641,434	15	141,037,837
16	Total assets. Add lines 1 through 15 (must equal line 34)...	299,701,221	16	312,160,743
	17	Accounts payable and accrued expenses .	21,556,744	17	19,980,534
18	Grants payable ..........		18
19	Deferred revenue ..........	4,938,374	19	4,792,314
20	Tax-exempt bond liabilities ..........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D..		21
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........		22
23	Secured mortgages and notes payable to unrelated third parties ..	53,368,857	23	52,984,920
24	Unsecured notes and loans payable to unrelated third parties ....		24
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.....	21,718,144	25	23,155,059
26	Total liabilities. Add lines 17 through 25.....	101,582,119	26	100,912,827
		Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....	197,443,470	27	210,639,277
28	Temporarily restricted net assets .....	675,632	28	608,639
29	Permanently restricted net assets .....		29
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund .....		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances .....	198,119,102	33	211,247,916
34	Total liabilities and net assets/fund balances .....	299,701,221	34	312,160,743

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SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.

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

See separate instructions.

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization

PROVIDENCE HEALTH SERVICES OF WACO
dba PROVIDENCE HEALTHCARE NETWORK

Employer identification number

74-1109636

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

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

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

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

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

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

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

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

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

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

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

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

receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of

its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses

acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

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

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

Type I

Type II

Type III - Functionally integrated

Type III - Other

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

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

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

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

Yes

and (iii) below, the governing body of the the supported organization? ................

11g(i)

(ii) a family member of a person described in (i) above? ......................

11g(ii)

(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................

11g(iii)

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

(i) Name of supported organization	(ii) EIN	(iv) Is the organization in col. (i) listed in your governing document?		(v) Did you notify the organization in col. (i) of your support?		(vi) Is the organization in col. (i) organized in the U.S.?		(vii) Amount of support?
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of support?


Total

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2011

Page 2

Part II

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

Section A. Public Support

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

Section B. Total Support

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

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

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

Section C. Computation of Public Support Percentage

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

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

16a

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

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

17a

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

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

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

Schedule A (Form 990 or 990-EZ) 2011

Page 3

Part III

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

Section A. Public Support

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

Section B. Total Support

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

Section C. Computation of Public Support Percentage

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

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

Section D. Computation of Investment Income Percentage

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

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

19a

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

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

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

Schedule A (Form 990 or 990-EZ) 2011

Page 4

Part IV

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

Facts And Circumstances Test

Explanation

Schedule A (Form 990 or 990-EZ) 2011

Additional Data

Software ID:	11000144
Software Version:	2011v1.5

- TIN:

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

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

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

OMB No. 1545-0047

2011

Name of organization

PROVIDENCE HEALTH SERVICES OF WACO
dba PROVIDENCE HEALTHCARE NETWORK

Employer identification number

74-1109636

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

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

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

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

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

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

Special Rules

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

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

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

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

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

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

Page 2

Name of organization PROVIDENCE HEALTH SERVICES OF WACO dba PROVIDENCE HEALTHCARE NETWORK
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Part I	Contributors (see Instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	RESTRICTED RESTRICTED RESTRICTED RESTRICTED, RESTRICTED RESTRICTED	$RESTRICTED	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 3

Name of organization PROVIDENCE HEALTH SERVICES OF WACO dba PROVIDENCE HEALTHCARE NETWORK
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Part II	Noncash Property (see Instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 4

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

Name of organization
PROVIDENCE HEALTH SERVICES OF WACO
dba PROVIDENCE HEALTHCARE NETWORK

Employer identification number

74-1109636

Part III

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

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

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

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

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

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

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

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

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

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

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

Additional Data

Software ID:	11000144
Software Version:	2011v1.5

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

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

Complete if the organization is described below.
SchCMd Bullet

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

See separate instructions.

OMB No. 1545-0047

2011

Open to Public
Inspection

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

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

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

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

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

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

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

Name of the organization

PROVIDENCE HEALTH SERVICES OF WACO
dba PROVIDENCE HEALTHCARE NETWORK

Employer identification number

74-1109636

Part I-A

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

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

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

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

Part I-B

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

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

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

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

Yes No

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

Yes No

If "Yes," describe in Part IV.

Part I-C

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

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

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

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

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

Yes No

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

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

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2011

Page 2

Part II-A

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

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

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

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

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

2a	Lobbying non-taxable amount

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

c	Total lobbying expenditures

d	Grassroots nontaxable amount

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

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2011

Page 3

Part II-B

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

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

(a)

Yes

(b)

Amount

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

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

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

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

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

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

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

Yes

14,400

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

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

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

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

14,400

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

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

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

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

Part III-A

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

Yes

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

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

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

Part III-B

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

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

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

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

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

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

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

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

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

Part IV

Supplemental Information

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

Identifier	Return Reference	Explanation
Part II-B, Line 1i	Part II-B, Line 1i - Other Activities Description	Lobbying expenses represent the portion of dues paid to national and state hospital associations that is specifically allocable to lobbying.

Schedule C (Form 990 or 990EZ) 2011

Additional Data

Software ID:	11000144
Software Version:	2011v1.5

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

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

Attach to Form 990. SchDMd Bullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

PROVIDENCE HEALTH SERVICES OF WACO
dba PROVIDENCE HEALTHCARE NETWORK

Employer identification number

74-1109636

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .......
2	Aggregate contributions to (during year) ...
3	Aggregate grants from (during year) ...
4	Aggregate value at end of year .......

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............

Yes No

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

Yes No

Part II

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

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

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

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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


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

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

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

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

Yes No

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

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

Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................

Yes No

In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.

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

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

(i)

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

(ii)

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

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

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

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

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

Cat. No. 52283D

Schedule D (Form 990) 2011

Page 2

Part III

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

Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

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

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

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

Yes No

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


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

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

Yes No

If “Yes,” explain the arrangement in Part XIV.

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current Year	(b)Prior Year	(c)Two Years Back
1a	Beginning of year balance ....	1,080,106	965,247	873,361
b	Contributions ........	38,475	32,020	31,644
c	Net investment earnings, gains, and losses ...	-46,644	84,587	95,476
d	Grants or scholarships .....			-28,144
e	Other expenditures for facilities and programs ........	-3,578	-1,748	-7,090
f	Administrative expenses ....
g	End of year balance ......	1,068,359	1,080,106	965,247

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

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

100.000 %

Temporarily restricted endowment SchDMd Bullet

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

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

Yes

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

3a(i)

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

3a(ii)

Yes

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

Yes

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 .................	3,056,088	6,950,353		10,006,441
b	Buildings ................		145,163,039	68,953,933	76,209,106
c	Leasehold improvements ............		5,521,239	3,986,808	1,534,431
d	Equipment ................		74,305,766	50,419,790	23,885,976
e	Other .................		1,022,972		1,022,972
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......					112,658,926

Schedule D (Form 990) 2011

Page 3

Part VII

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

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








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

Part VIII

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

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









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

Part IX

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

(a) Description				(b) Book value
(1) SETTLEMENTS FROM 3RD PARTIES				8,119,026
(2) RESTRICTED DONATIONS				608,639
(3) OTHER ASSETS				74,725
(4) INVESTMENT IN COMMUNITY HOSPICE OF TX				7,084,376
(5) INVESTMENT IN ASC JV - FISHPOND				1,593,960
(6) HSD-EXCESS OPERATING FUND				65,519,041
(7) HSD - PENSION PREFUNDING INVESTMENT				4,444,941
(8) DEFERRED COMPENSATION ASSET				5,374,520

Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				141,037,837

Part X

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

1.(a) Description of Liability		(b) Book value
Federal Income Taxes
THIRD PARTY SETTLEMENTS		1,301,835
Rounding		4
PENSION & OTHER POST-RETIREMENT BENEFITS		8,631,468
OTHER NON CURRENT LIABILITIES		3,226,951
OTHER LIABILITIES		2,643,393
GENERAL & PROFESSIONAL TRUST FUND LIAB		1,976,888
DEFERRED COMPENSATION LIABILITY		5,374,520


Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		23,155,059
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).

Schedule D (Form 990) 2011

Page 4

Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1	Total revenue (Form 990, Part VIII, column (A), line 12) ....................	1
2	Total expenses (Form 990, Part IX, column (A), line 25) .....................	2
3	Excess or (deficit) for the year. Subtract line 2 from line 1 .............	3
4	Net unrealized gains (losses) on investments ..........................	4
5	Donated services and use of facilities .............................	5
6	Investment expenses ...................................	6
7	Prior period adjustments ..................................	7
8	Other (Describe in Part XIV.) .................................	8
9	Total adjustments (net). Add lines 4 through 8 .........................	9
10	Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 .........	10

Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIV.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1.....................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIV.) ...........	4b
c	Add lines 4a and 4b.......................		4c
5	Total Revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1	Total expenses and losses per audited financial statements .............		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a
b	Prior year adjustments ..............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIV.) ............	2d
e	Add lines 2a through 2d......................		2e
3	Subtract line 2e from line 1.....................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIV.) ............	4b
c	Add lines 4a and 4b.......................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIV

Supplemental Information

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

Identifier	Return Reference	Explanation
Part X	Part X : FIN48 Footnote	Effective FY07, Providence Health Services of Waco adopted ASC 740. The adoption of ASC 740 did not have a material impact on Providence Health Services of Waco's consolidated financial position or results of operations. The financial statements of Providence Health Services of Waco were audited on a consolidated basis, as part of the consolidated financial statements of Ascension Health. An audit committee has been delegated the responsibility to oversee the audited financial statements and the selection of the independent accountants that audited the financial statements.
Part XI, Line 8	Part XI, Line 8: Other Changes in Net Assets or Fund Balances	$0 DEFERRED PENSION $649613 OTHER $118004 EQUITY CONTRIBUTION - PHA $ -5775000 EQUITY CONTRIBUTION - AH $ -3797503 OTHER PENSION $ -7397106 UNREALIZED GAIN/LOSS $ -7979749 OTHER $ -0
Part V, Line 4	Part V, Line 4: Intended uses of the endowment fund.	All endowment funds are held by Providence Foundation, a related organization. The funds are administered for the benefit of Providence Health Services of Waco, including the funding of various programs and services. These programs and services are detailed in the narrative provided for Part III, Line 4a, Program Service Accomplishments.

Schedule D (Form 990) 2011

Additional Data

Software ID:	11000144
Software Version:	2011v1.5

- TIN:

SCHEDULE G (Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information Regarding
Fundraising or Gaming Activities

Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19,or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right 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
PROVIDENCE HEALTH SERVICES OF WACO
dba PROVIDENCE HEALTHCARE NETWORK

Employer identification number

74-1109636

Part I

Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17.

Indicate whether the organization raised funds through any of the following activities. Check all that apply.

a	Mail solicitations	e	Solicitation of non-government grants
b	Internet and e-mail solicitations	f	Solicitation of government grants
c	Phone solicitations	g	Special fundraising events
d	In-person solicitations

Did the organization have a written or oral agreement with any individual (including officers, directors, trustees

or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?

Yes

If “Yes,” list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization. Form 990-EZ filers are not required to complete this table.

(i) Name and address of individual or entity (fundraiser)	(ii) Activity	(iii) Did fundraiser have custody or control of contributions?		(iv) Gross receipts from activity	(v) Amount paid to (or retained by) fundraiser listed in col. (i)	(vi) Amount paid to (or retained by) organization
	(ii) Activity	Yes	No	(iv) Gross receipts from activity		(vi) Amount paid to (or retained by) organization
Total .................

List all states in which the organization is registered or licensed to solicit funds or has been notified it is exempt from registration or licensing.

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

Cat. No. 50083H

Schedule G (Form 990 or 990-EZ) 2011

Page 2

Part II

Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 on Form 990-EZ, line 6a. List events with gross receipts greater than $5,000.

		(a) Event #1 JEWELRY SALE (event type)	(b) Event #2 PECAN SALE (event type)	(d) Total Events (Add col. (a) through col. (c))
1	Gross receipts . . .	32,039	6,180	38,219
2	Less: Charitable contributions . . .
3	Gross income (line 1 minus line 2) . . .	32,039	6,180	38,219
4	Cash prizes . . .
5	Non-cash prizes . .
6	Rent/facility costs . .
7	Food and beverages . .
8	Entertainment . . .
9	Other direct expenses .	20,057	4,099	24,156
10	Direct expense summary. Add lines 4 through 9 in column (d) ...........			24,156
11	Net income summary. Combine lines 3 and 10 in column (d)............			14,063

Part III

Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.

(a) Bingo

(b) Pull tabs/Instant
bingo/progressive bingo

(c) Other gaming

(d) Total gaming (Add col. (a) through col. (c))

Gross revenue . . . .

Cash prizes . . . .

Non-cash prizes . . .

Rent/facility costs . . .

Other direct expenses . .

Volunteer labor . . .

	Yes
	No

	Yes
	No

	Yes
	No

Direct expense summary. Add lines 2 through 5 in column (d) ........... right arrow

Net gaming income summary. Combine lines 1 and 7 in column (d) .......... right arrow

Enter the state(s) in which the organization operates gaming activities:

Is the organization licensed to operate gaming activities in each of these states? ............

YesNo

If "No," Explain:

10a

Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? .....

YesNo

If "Yes," Explain:

Does the organization operate gaming activities with nonmembers? .................

YesNo

Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity

formed to administer charitable gaming? ..........................

YesNo

Schedule G (Form 990 or 990-EZ) 2011

Page 3

Indicate the percentage of gaming activity operated in:

The organization's facility ......................

13a

An outside facility ........................

13b

Provide the name and address of the person who prepares the organization's gaming/special events books and records:

Name

Address

15a

Does the organization have a contract with a third party from whom the organization receives gaming

revenue? ......................................

YesNo

If "Yes," enter the amount of gaming revenue received by the organization right arrow

$ and the

amount of gaming revenue retained by the third party right arrow

$ .

If "Yes," enter name and address:

Name

Address

Gaming manager information:

Name

Gaming manager compensation right arrow

Description of services provided right arrow

Director/officer Employee Independent contractor

Mandatory distributions:

Is the organization required under state law to make charitable distributions from the gaming proceeds to

retain the state gaming license? ............................

YesNo

Enter the amount of distributions required under state law distributed to other exempt organizations or spent

in the organization's own exempt activities during the tax year right arrow

Part IV

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

Identifier	ReturnReference	Explanation

Schedule G (Form 990 or 990-EZ) 2011

Additional Data

Software ID:	11000144
Software Version:	2011v1.5

- TIN:

SCHEDULE H (Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

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

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

PROVIDENCE HEALTH SERVICES OF WACO
dba PROVIDENCE HEALTHCARE NETWORK

Employer identification number

74-1109636

Part I

Charity Care and Certain Other Community Benefits at Cost

Yes

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

Yes

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

Yes

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

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

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

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

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

Yes

100% 150% 200% Other

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

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

Yes

200% 250% 300% 350% 400% Other

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

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

Yes

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

Yes

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

Yes

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

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

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

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

Financial Assistance and Certain Other Community Benefits at Cost

	(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) ..	22,048,116		22,048,116	9.490 %
b Medicaid (from Worksheet 3, column a) .....	26,536,963	36,904,407	-10,367,444
c Costs of other means-tested government programs (from Worksheet 3, column b) .
dTotal Financial Assistance and Means-Tested Government Programs .....	48,585,079	36,904,407	11,680,672	9.490 %
Other Benefits e Community health improvement services and community benefit operations (from (Worksheet 4) ....	384,179	98,996	285,183	0.120 %
f Health professions education (from Worksheet 5) ..	994,707		994,707	0.430 %
g Subsidized health services (from Worksheet 6) ..	340,160		340,160	0.150 %
h Research (from Worksheet 7)
i Cash and in-kind contributions for community benefit (from Worksheet 8) ....	5,687,571		5,687,571	2.450 %
jTotal Other Benefits ...	7,406,617	98,996	7,307,621	3.150 %
kTotal. Add lines 7d and 7j. ..	55,991,696	37,003,403	18,988,293	12.640 %

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.

		(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development	268,897	268,897	0.120 %
3	Community support	8,497	8,497
4	Environmental improvements
5	Leadership development and training for community members	1,696	1,696
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total	279,090	279,090	0.120 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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

Yes

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

6,635,036

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

1,327,007

Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.

Section B. Medicare

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

83,616,697

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

80,721,466

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

2,895,231

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

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

Yes

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

Yes

Part IV

Management Companies and Joint Ventures

(see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %
1FPSC II LLC	SURGERY CENTER	46.000 %
2COMMUNITY HOSPICE OF TEXAS	HOSPICE SERVICES	25.000 %
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2011

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest) How many hospital facilities did the organization operate during the tax year?2 Name and address		Other (Describe)
2	DePaul Center 301 Londonderry Dr Waco,TX76712	X			Free Standing Psychiatric Hospital
1	Providence Health Center 6901 Medical Parkway Waco,TX76712	X	X	X

Schedule H (Form 990) 2011

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices.

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

DePaul 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		No
	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: 200.0000% If "No," explain in Part VI the criteria the hospital facility used.

Schedule H (Form 990) 2011

Page

Part VFacility Information (continued)

				Yes	No
10	Used FPG to determine eligibility for providing discounted care?.................		10	Yes
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 300.0000% If "No," explain in Part VI the criteria the hospital facility used.
11	Explained the basis for calculating amounts charged to patients?.................		11	Yes
	If “Yes,” indicate the factors used in determining such amounts (check all that apply):
	a	Income level
	b	Asset level
	c	Medical indigency
	d	Insurance status
	e	Uninsured discount
	f	Medicaid/Medicare
	g	State regulation
	h	Other (describe in Part VI)
12	Explained the method for applying for financial assistance?...................		12	Yes
13	Included measures to publicize the policy within the community served by the hospital facility?.......		13	Yes
	If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
	a	The policy was posted on the hospital facility’s web site
	b	The policy was attached to all billing invoices
	c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
	d	The policy was posted in the hospital facility’s admissions offices
	e	The policy was provided, in writing, to patients upon admission to the hospital facility
	f	The policy was available upon request
	g	Other (describe in Part VI)
Billing and Collections
14	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?.......		14	Yes
15	Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments
	e	Other similar actions (describe in Part VI)
16	Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?..........		16		No
	If “Yes,” check all actions in which the hospital facility or a third party engaged:
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments
	e	Other similar actions (describe in Part VI)
17	Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
	a	Notified patients of the financial assistance policy upon admission
	b	Notified patients of the financial assistance policy prior to discharge
	c	Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
	d	Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
	e	Other (describe in Part VI)

Schedule H (Form 990) 2011

Page

Part VFacility Information (continued)

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

Schedule H (Form 990) 2011

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices.

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

Providence Health 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: 200.0000% If "No," explain in Part VI the criteria the hospital facility used.

Schedule H (Form 990) 2011

Page

Part VFacility Information (continued)

				Yes	No
10	Used FPG to determine eligibility for providing discounted care?.................		10	Yes
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 300.0000% If "No," explain in Part VI the criteria the hospital facility used.
11	Explained the basis for calculating amounts charged to patients?.................		11	Yes
	If “Yes,” indicate the factors used in determining such amounts (check all that apply):
	a	Income level
	b	Asset level
	c	Medical indigency
	d	Insurance status
	e	Uninsured discount
	f	Medicaid/Medicare
	g	State regulation
	h	Other (describe in Part VI)
12	Explained the method for applying for financial assistance?...................		12	Yes
13	Included measures to publicize the policy within the community served by the hospital facility?.......		13	Yes
	If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
	a	The policy was posted on the hospital facility’s web site
	b	The policy was attached to all billing invoices
	c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
	d	The policy was posted in the hospital facility’s admissions offices
	e	The policy was provided, in writing, to patients upon admission to the hospital facility
	f	The policy was available upon request
	g	Other (describe in Part VI)
Billing and Collections
14	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?.......		14	Yes
15	Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments
	e	Other similar actions (describe in Part VI)
16	Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?..........		16		No
	If “Yes,” check all actions in which the hospital facility or a third party engaged:
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments
	e	Other similar actions (describe in Part VI)
17	Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
	a	Notified patients of the financial assistance policy upon admission
	b	Notified patients of the financial assistance policy prior to discharge
	c	Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
	d	Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
	e	Other (describe in Part VI)

Schedule H (Form 990) 2011

Page

Part VFacility Information (continued)

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

Schedule H (Form 990) 2011

Page

Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?3
Name and address		Type of Facility (describe)
1	Providence Breast Center 6600 Fish Pond Rd Ste 104 Waco,TX76710	Women's Breast Health Center
2	Providence Home Care 528 Meadow Lake Center Waco,TX76622	Full Service Home Care Facility and Durable Medical Equipment Store
3	Providence Park 300 W State Hwy 6 Waco,TX76712	Long Term Care Facility
4
5
6
7
8
9
10

Schedule H (Form 990) 2011

Page

Part VI

Supplemental Information

Complete this part to provide the following information.

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

Identifier	ReturnReference	Explanation
	Part VI - Additional Information	Part II Community Building Activities:Providence Healthcare Network actively participates year round with several organizations in our community. Our ministry believes that it's essential to support local organizations financially as well as ensuring that our associates are engaged with them actively. By having our associates engaged and on-site at events, we lead by example that living a healthy lifestyle is critical to our community's future. Our associates are passionate about addressing the most basic needs in our community and feel that getting involved allows them a way to affect the most people. We are promoting good, healthy lifestyles in the community that we serve and also live in when actively participating and can better identify other areas of need that need to be addressed. Examples of organizations we are actively involved with as well as programs we initiate that provide direct support to our community are listed below: -American Heart Association-Carter Blood Care-American Cancer Society-March of Dimes-AARP Tax Aide-Food for Families -Mission Waco Toy Drive-Story Book Christmas-National Red Ribbon Week-Leadership WacoPart VI Promotion of Community HealthProvidence Healthcare Network strives to improve the physical, mental, social and spiritual health status of its surrounding community. Along with providing healthcare services to all that require medical attention, our ministry believes that it is crutial to educate the community on the types of behavior that improves their chances of living a healthy life. Providence Healthcare Network has invested significantly in unique, top quality community health improvement/education programs and materials to accomplish its goals which include: -Social service and support counseling for patients and families-Pastoral care-Space for community groups to use at no charge-Annual free health screenings-Employee and Administration active involvement on community boards and associations-Mentoring children through year round partnerships with local elementary schools-Ongoing clinical research to help advance medical care-Ongoing educational programs for internal and external medical/clinical staff-Comprehensive and interactive website-Charitable financial support of many local and national non-profit organizations-Collaboration with health department and other local hospital to identify community needs and address community problems-Free mammograms for uninsured and underinsured women -Trained financial assistance counselors available to identify eligibility for government benefits-Hospital volunteers receive extensive training by AARP to provide free tax preparation to the needy and underserved in our community-Free or no-cost medications provided to those persons that qualify-Flu shots offered at reduced prices for the general community and free to employees and their families-Disaster readiness support provided locally and globally-Year round CPR Life Support Course provided for free to the community -Active Volunteer Services Department providing the opportunity for persons in the community to come together and combine their compassion, skills and talent to make a difference in the lives of our patients and families, employees, physicians and clinical staff Through each of these diverse community outreach support efforts, Providence Healthcare Network provides a significant impact on the overall well-being of the community while increasing access to health care services and reducing health care costs.
	Part VI - Affilated Health Care System Roles and Promotion	Providence Healthcare Network proudly serves as a member of Ascension Health, the nation's largest Catholic and largest nonprofit health system. Since being founded by the Daughters of Charity in 1905 as a ministry to the suffering, Providence Healthcare Network and its affiliated Divisions have been dedicated to providing accessible, safe and quality healthcare to all patients regardless of their ability to pay. Providence is a comprehensive healthcare network that operates several facilities including the Health Center, DePaul Center, Home Care, Durable Medical Equipment, Providence Park and 13 clinics in Waco, Texas. Network wide, in FY12 our Ministry provided more than $19 million in community health services, professional education, subsidized health care, research, financial contributions and other community building activities.
	Part VI - Community Information	Providence Healthcare Network is located in Waco, Texas and serves McLennan County (pop. 233,378) and the six contiguous counties which include Hill (pop. 39,761), Bosque (pop. 20,232), Limestone (pop. 22,287), Falls (pop. 20,452), Bell (pop. 294,101) and Coryell (pop. 98,538). Waco (pop. 126,217), known as the education and consumer center of Texas, is our primary service area and is located along Interstate 35 in Central Texas, equidistant from Dallas/Ft. Worth and Austin (90 miles). Waco is served by two not for profit hospitals, Providence Healthcare Network and Hillcrest Baptist Medical Center.In McLennan County, 27% of households live at or below federal poverty guidelines; median income is $43,063; 14.4% of families are on Medicaid or other assistance; uninsured and underinsured persons comprise 24% of the population; and 25.8% of our county's population is minority and 17.4% speak a language other than English at home, with Spanish being the predominant other language. In FY12, our Ministry served 18,244 patients and provided $22.1 mil in traditional charity care, and $4.8 mil in unpaid costs of public programs.
	Part VI - Patient Education of Eligibility for Assistance	Providence Healthcare Network is prepared to educate and qualify patients for financial assistance as needed. Financial assistance counselors meet with all self pay patients and screen them for potential government benefits. They assist them with the charity care applications as well as work with them to establish eligibility for governmental benefits. Our counselors receive extensive training on how to qualify patients for assistance under federal, state or local government programs. They are also bi-lingual in both English and Spanish. A summary of our charity care policy is provided to patients during the intake and discharge process.
	Part VI - Needs Assessment	Our Community Needs Assessment is conducted every three years, most recently in July 2010. Our Ministry collaborates with Hillcrest Baptist Medical Center and the Waco-McLennan County Public Health District (WMCPHD) to provide a comprehensive and unbiased profile of McLennan County. The survey is jointly funded by all three entities. During the months of August and September 2009, our needs assessment survey was administered to the residents of the Waco-McLennan County Public Health District, Texas. The survey was a third citizen survey conducted by the University of North Texas Survey Research Center (SRC) for the WMCPHD. Many of the questions in the survey were modeled after the Behavioral Risk Factor Surveillance System Questionnaire (BRFSS). Survey questions included:Perceptions of public health preparednessGeneral physical and emotional health statusHealth care access issuesHealth care awareness of several health conditionsBehaviors that affect healthWomen's health issues The needs assessment included a random sample of 24 geographic areas within our county and a telephone survey of 1,000 landline households and 211 cell-phone-only households. The SRC provided statistical analysis of the survey data to help identify local health needs, to determine priority health needs for McLennan County and to assist in developing a plan of action. The 2010 Community Needs Assessment of McLennan County revealed that the majority of respondents (77.3%) are in good or better health as compared to CDC national data. Diabetes was identified as a specific need in the 2010 Community Needs Assessment and our Ministry is taking steps to address this need.
	Part III, Line 9b - Provisions On Collection Practices For Qualified Patients	The organization has a written debt collection policy that also includes a provision on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance. If a patient qualifies for charity or financial assistance certain collection practices do not apply.
	Part III, Line 8 - Explanation Of Shortfall As Community Benefit	Ascension Health and related health ministries follow the Catholic Health Association ("CHA") guidelines for determining community benefit. CHA community benefit reporting guidelines suggest that Medicare shortfall is not treated as community benefit.
	Part III, Line 4 - Bad Debt Expense	The organization is part of the Ascension Health System consolidated audit. The footnote that references bad debt expense in the 2012 consolidated audit is as follows:"The provision for bad debt expense is based upon management's assessment of expected net collections considering economic conditions, historical experience, trends in the health care coverage, and other collection indicators. Periodically throughout the year, management assesses the adequacy of the allowance for uncollectible accounts based upon historical write off experience by payor category, including those amounts not covered by insurance. The results of this review are then used to make any modifications to the provision for bad debt expense to establish an appropriate allowance for uncollectible accounts. After satisfaction of amounts due from insurance and reasonable efforts to collect from the patient have been exhausted, the System follows established guidelines for placing certain past due patient balances with collection agencies, subject to the terms of certain restrictions on collection efforts as determined by the System. Accounts receivable are written off after collection efforts have been followed in accordance with the System's policies." The organization's share of bad debt expense for fiscal year 2012 was $23,581,586 at charges ($6,635,036 at cost).
	Part I, Line 7g - Costs Associated With Physicans Clinics	The organization employs its physicians at physician clinics, so the associated costs and charges relating to those physician services are included in all relevant categories in Part I.
	Part I, Line 7 - Explanation of Costing Methodology	The cost of providing charity care, means tested government programs, and community benefit programs is estimated using internal cost data, and is calculated in compliance with Catholic Health Association ("CHA") guidelines. The organization uses a costing accounting system that addresses all patient segments (for example, inpatient, outpatient, emergency room, private insurance, Medicaid, Medicare, uninsured, or self pay). The best available data was used to calculate the amounts reported in the table. For certain categories in the table, this was a cost accounting system; in other categories, a specific cost-to-charge ratio was applied.
	Part I, Line 3c - Charity Care Eligibility Criteria (FPG Is Not Used)	The organization provides medically necessary care to all patients,regardless of race, color, creed, ethnic origin, gender, disability or economic status. The organization uses a percentage of Federal Poverty Level (FPL) to determine free and discounted care. At a minimum, patients with income less than or equal to 200% of the FPL, which may be adjusted for cost of living utilizing the local wage index compared to national wage index, will be eligible for 100% charity care write off of charges for services that have been provided to them. Also, at a minimum, uninsured patients that do not fall within the 200% FPL may be eligible for a charity care adjustment. An assessment of the patient's personal and financial information based on the United Stated Census Bureau and Internal Revenue Service guidelines is performed by Providence Healthcare Network to determine the charity care discount.

Schedule H (Form 990) 2011

Additional Data

Software ID:	11000144
Software Version:	2011v1.5

- TIN:

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
PROVIDENCE HEALTH SERVICES OF WACO
dba PROVIDENCE HEALTHCARE NETWORK

Employer identification number
74-1109636

Part I

General Information on Grants and Assistance

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

Yes No

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	(h) Purpose of grant or assistance
(1) WACO FOUNDATION900 AUSTIN AVE 9TH FLOOR WACO,TX76701	74-6054628	501(C)(3)	25,000	0	SPECIAL EVENT
(2) SOCT2950 50TH STREET LUBBOCK,TX79413	32-0316424	501(C)(3)	5,658,000	0	COMMUNITY GRANTS
(3) MARCH OF DIMES3000 HERRING AVE STE 4471 WACO,TX76708	75-1815327	501(C)(3)	15,495	0	SPECIAL EVENT
(4) JUNIOR LEAGUE OF WACO2600 Austin Ave Waco,TX76710	74-1255655	501(C)(3)	12,075	0	Special Event
(5) HOTRAC405 LONDONDERRY DR STE 201 Waco,TX76712	74-2707640	501(C)(3)	9,762	0	Special Event
(6) GREATER WACO CHAMBERPO BOX 1220 Waco,TX76703	75-2420690	501(C)(3)	45,719	0	SPECIAL EVENTS
(7) FAMILY HEALTH CENTER1600 PROVIDENCE DR Waco,TX76707	74-2446071	501(C)(3)	11,980	0	SPECIAL EVENT
(8) EXTRACO EVENTS CENTER4601 Bosque Blvd Waco,TX76710	74-1172561	501(C)(3)	11,590	0	Multiple Special Events
(9) DIOCESE OF AUSTIN6225 E HWY 290 AUSTIN,TX78723	74-1542827	501(C)(3)	10,000	0	SPECIAL EVENT
(10) AMERICAN HEART ASSOC10900-B Stonelake Blvd Austin,TX78759	13-5613797	501(C)(3)	78,694	0	Special Events
(11) AMERICAN CANCER SOCIETYN19 W24350 Riverwood Dr Waukesha,WI53188	41-0724036	501(C)(3)	18,600	0	SPECIAL EVENT

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ......................... . Bullet Image

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

Cat. No. 50055P

Schedule I (Form 990) 2011

Page 2

Part III

Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.

(a)Type of grant or assistance	(b)Number of recipients	(c)Amount of cash grant	(d)Amount of non-cash assistance	(e)Method of valuation (book, FMV, appraisal, other)	(f)Description of non-cash assistance

Part IV

Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.

Identifier	Return Reference	Explanation
Grantmaker's Description of How Grants are Used		When grant or sponsorship requests are submitted, each request is reviewed by the marketing team to determine if the request meets one or more of the following criteria:-How does the request fit with our mission of providing charity care to our community?-How does the request support health related issues within our community?-Will this request be financially sustainable from year to year?-Is the organization/company making the request a member of the Greater Waco Chamber of Commerce?For approved requests, the appropriate forms are filled out and signed by the Vice President of Marketing. The documents are then forwarded to accounting for processing. Records are maintained of amounts spent and are regularly reviewed to ensure compliance.

Schedule I (Form 990) 2011

Additional Data

Software ID:	11000144
Software Version:	2011v1.5

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

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

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

Attach to Form 990. SchJMediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

PROVIDENCE HEALTH SERVICES OF WACO
dba PROVIDENCE HEALTHCARE NETWORK

Employer identification number

74-1109636

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

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

Travel for companions Payments for business use of personal residence

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

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

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

Yes

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....

Yes

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

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

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

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

Yes

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

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

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

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

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

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

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

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

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

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Yes

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

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

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

Cat. No. 50053T

Schedule J (Form 990) 2011

Page 2

Part II

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

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

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

(A) Name		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(A) Name		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(1) VICKY CAMPBELL	(i) (ii)	121,046	6,820	24,031		11,253	163,150	23,795
(2) TONY WELCH	(i) (ii)	154,178		878		3,192	158,248
(3) TIMOTHY BARRETT	(i) (ii)	299,792		156	28,500	7,381	335,829
(4) SAMUEL E ABERNATHY	(i) (ii)	163,251		937	2,877	5,928	172,993
(5) ROBERT BUCK	(i) (ii)	164,266	6,798	682	15,000	4,085	190,831
(6) ODIS NICHOLS	(i) (ii)	127,903		1,409		1,500	130,812	30,750
(7) LUCI HANSSON	(i) (ii)	151,927		266	2,674	3,192	158,059
(8) LARRY LEFEVRE	(i) (ii)	159,001		230		5,928	165,159
(9) KRISTIN CRAIG	(i) (ii)	155,202		214		10,476	165,892
(10) KENT A KEAHEY	(i) (ii)	465,373	474,934	61,670	4,900	10,852	1,017,729
(11) KAREN RICHARDSON	(i) (ii)	224,559	16,995	75	32,297	7,075	281,001
(12) JONATHAN FORD	(i) (ii)	137,515	6,798	28,933	30,907	11,341	215,494	28,417
(13) JOE HOPKINS	(i) (ii)	132,593	6,846	14,840	17,295	10,061	181,635	14,340
(14) EVERTT TINDELL	(i) (ii)	157,612	6,798		1,539	11,289	177,238
(15) CHARLES SIVESS	(i) (ii)	141,546	7,210	139	17,444	11,214	177,553
(16) BRETT ESROCK	(i) (ii)	224,952	2,832			6,111	233,895
(17) BRENDA DAVIS	(i) (ii)	214,608		75		4,582	219,265
(18) ANNETTE AYERS	(i) (ii)	183,161	9,772	163		10,234	203,330

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
Sch J, Part I, Line 7	Part I, Line 7: Non-Fixed payments not listed above	Officers of the Providence Health Services of Waco Management Council received a bonus in FY12. A bonus schedule was presented and approved by the board prior to distribution. No formal bonus plan is documented or in use.
Sch J, Part I, Line 1a	Part I, Line 1a: Relevant information in regards to selections on 1a.	Providence Healthcare Network utilizes an Accountable Plan to guide its activities in the reimbursement of business expenses for employees, officers, and board members. The Accountable Plan, in all material respects, conforms to the rules and regulations of the Internal Revenue Service.The CEO is eligible for travel reimbursement for companions, as well as reimbursement of health or social club dues or initiations fees. The benefits are treated as taxable compensation to each eligible person pursuant to the organization's accountable plan.

Schedule J (Form 990) 2011

Additional Data

Software ID:	11000144
Software Version:	2011v1.5

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

PROVIDENCE HEALTH SERVICES OF WACO
dba PROVIDENCE HEALTHCARE NETWORK

Employer identification number

74-1109636

Part I

Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

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

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

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.

(a) Name of interested person and purpose	(b) Loan to or from the organization?		(c)Original principal amount	(d)Balance due	(e) In default?		(f) Approved by board or committee?		(g)Written agreement?
(a) Name of interested person and purpose	To	From	(c)Original principal amount	(d)Balance due	Yes	No	Yes	No	Yes	No






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

Part III

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

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

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

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2011

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) JANA WHITAKER	FAMILY MEMBER	83,327	EMPLOYMENT		No

Part V

Supplemental Information

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

Identifier	Return Reference	Explanation
		PART IV COLUMN (b) FAMILY MEMBER OF HAL M. WHITAKER, BOARD TREASURER.

Schedule L (Form 990 or 990-EZ) 2011

Additional Data

Software ID:	11000144
Software Version:	2011v1.5

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

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

Attach to Form 990 or 990-EZ.

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization

PROVIDENCE HEALTH SERVICES OF WACO
dba PROVIDENCE HEALTHCARE NETWORK

Employer identification number

74-1109636

Identifier	Return Reference	Explanation
	Schedule H, Pt V Sec. B Ln16 Billing & Collections	Providence Health Center and DePaul Center:The following steps were followed and considered reasonable efforts for purposes of Question 16:Notified each individual of the Hospital's Financial Assistance Policy (FAP). This notification began on the date care was provided and ended on the 120th day after the first billing statement was provided to the individual. Individuals were notified of the FAP by methods noted in Question 13. This includes, but is not limited to, the following:-A brief description of eligibility requirements and assistance provided-Direct individuals to our website and physical location of application forms-Provided instructions to obtain free copy of FAP and application by mail-Provided contact information for an individual/nonprofit organization to assist if the individual has questions-Provided statement of translations of FAP as well as plain language summaries-Provided statement that no FAP-eligible individual will be charged more for emergency/medically necessary care than AGBFor individuals who submitted an incomplete FAP, we provided that individual with information relevent to assist them with completion of the FAP.For individuals that submitted a complete FAP, we made and documented a determination as to whether that person was eligible under the facility's FAP.We determined eligibility based on other means such as establishing that the individual is eligible under one or more means tested programs (as noted in Question 11).
	Schedule H, Pt V Sec. B Ln15e Billing & Collections	Providence Health Center and DePaul Center:The following steps were followed and considered reasonable efforts for purposes of Question 15:Notified each individual of the facility's Financial Assistance Policy (FAP). This notification began on the date care was provided and ended on the 120th day after the first billing statement was provided to the individual. Individuals were notified of the FAP as noted in Question 13. This includes, but is not limited to, providing the following:-A brief description of eligibility requirements and assistance provided-Directions on how to access the FAP and application on our website and physical location of application forms-Instructions to obtain free copy of FAP and application by mail-Contact information for an individual/nonprofit organization to assist if the individual has questions-Statement of translations of FAP as well as plain language summaries-Statement that no FAP-eligible individual will be charged more for emergency/medically necessary care than AGBFor individuals who submitted an incomplete FAP, we provided that individual with information relevent to assist them with completion of the FAP.For individuals that submitted a complete FAP, we made and documented a determination as to whether that person was eligible under the facility's FAP.We determined eligibility based on other means such as establishing that the individual is eligible under one or more means tested programs (as noted in Question 11).
	Schedule H Pt V Sec. B Ln 21 Individuals Eligible for Financial Asst.	Providence Health Center and DePaul Center:The following steps were followed and considered reasonable efforts followed for purposes of identifying patients eligible for assistance under the facility's FAP:Notified each individual of the Hospital's Financial Assistance Policy (FAP) as noted in Question 13. This includes, but is not limited to, the following:-Brief description of eligibility requirements and assistance provided-Direct individuals to our website and physical location of application forms-Provided instructions to obtain free copy of FAP and application by mail-Provided contact information for an individual/nonprofit organization to assist if the individual has questions-Provided statement of translations of FAP as well as plain language summaries-Provided statement that no FAP-eligible individual will be charged more for emergency/medically necessary care than AGBThis notification began on the date care was provided and ended on the 120th day after the first billing statement was provided to the individual. For individuals who submitted an incomplete FAP, we provided that individual with information relevant to assist them with completion of the FAP.For individuals that submitted a complete FAP, we made and documented a determination as to whether that person was eligible under the facility's FAP.We determined eligibility based on other means such as establishing that the individual is eligible under one or more means tested programs (as noted in Question 11).
	Schedule H Pt V Sec. B Ln 20 Individuals Eligible for Financial Asst.	Providence Health Center and DePaul Center:The following steps were followed and considered reasonable efforts followed for purposes of identifying patients eligible for assistance under the facility's FAP:Notified each individual of the Hospital's Financial Assistance Policy (FAP). This notification began on the date care was provided and ended on the 120th day after the first billing statement was provided to the individual. Individuals were notified of the FAP by methods noted in Question 13. This includes, but is not limited to, the following:-A brief description of eligibility requirements and assistance provided-Direct individuals to our website and physical location of application forms-Provided instructions to obtain free copy of FAP and application by mail-Provided contact information for an individual/nonprofit organization to assist if the individual has questions-Provided statement of translations of FAP as well as plain language summaries-Provided statement that no FAP-eligible individual will be charged more for emergency/medically necessary care than AGBFor individuals who submitted an incomplete FAP, we provided that individual with information relevant to assist them with completion of the FAP.For individuals that submitted a complete FAP, we made and documented a determination as to whether that person was eligible under the facility's FAP.We determined eligibility based on other means such as establishing that the individual is eligible under one or more means tested programs (as noted in Question 11).
	PHSW dba continued	Providence Health Services of Waco, Inc dba's:Providence Healthcare NetworkProvidence Health CenterDePaul CenterProvidence ParkProvidence Home CareProvidence Breast Health Center
Form 990, Part VI, Line 19	Form 990, Part VI, Line 19: Other Organization Documents Publicly Available	Organization provides governing documents, conflict of interest policy, and financial statements to the public upon request.
Form 990, Part VI, Line 15b	Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees	POLICY:The executive Compensation Committee of the Board of Trustees of Ascension Health has been delegated the responsibility and authority to oversee the Executive Compensation Program, in accordance with the Committee Charter and the Board approved Executive Compensation Responsibility/Authority Matrix. The Committee is charged with overseeing the Program in a manner designed to assure independence, avoid conflicts of interest, ensure reasonableness and market comparability of total compensation, and to otherwise abide by pertinent laws and regulations. The Providence Healthcare Network Wage Plan is reviewed and appropriately revised at least annually, and is maintained as required between reviews.A salary survey is completed in the market for positions at points over the complete range of the wage scale for all levels of employment including key personnel. The proposed wage plan shall be approved by the President and distributed by the Human Resources Department and to Network Administration. Actual employee pay increases are reviewed and approved by Network Administration.
Form 990, Part VI, Line 12c	Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts	PROCEDURES:Duty to Disclose: In connection with any actual or possible conflicts of interest, an interested person must disclose the existence of his or her financial interest and all material facts to the Trustees, or to the members of a committee with board delegated powers, considering the proposed transaction or arrangement. Such disclosure shall be made either through the annual questionnaire required under "Annual Statements" or when a conflict not disclosed on the questionnaire otherwise arises. The annual statements are reviewed by the compliance department to ensure no conflicts of interest exist.
Form 990, Part VI, Line 11	Form 990, Part VI, Line 11: Form 990 Review Process	The review process for the 990 Informational Return:Management, including certain officers, works diligently to complete the Form 990 and attached schedules in a thorough manner. Management presents the Form to the Board, or a designated committee, to review. Prior to filing the return, all Board Members are provided the Form 990 and management team members are available to answer any Board Members questions.
Form 990, Part VI, Line 7b	Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or Shareholders	All actions of the Board of Directors are subject to the review and approval by Ascension Health as the sole corporate member.
Form 990, Part VI, Line 7a	Form 990, Part VI, Line 7a: How Members or Shareholders Elect Governing Body	Providence Health Services of Waco has a single corporate member, Ascension Health, who has the ability to elect members to the governing body of the Providence Health Services of Waco.
Form 990, Part VI, Line 6	Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder	Providence Health Services of Waco has a single corporate member, Ascension Health.
		Client Note 1 - PROVIDENCE HEALTH SERVICES OF WACO 74-1109636FORM 990 - RETURN OF ORGANIZATION EXEMPT FROM INCOME TAXSUPPORTING STATEMENT FYE 6/30/2012PART III, STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTSProvidence Healthcare Network provides a full range of care, including: outpatient care, inpatient care, emergency services, long-term care, mental health care, chemical dependency treatment, pediatric care and senior adult care services and more. Providence Health Alliance Inc. is the part of Providence Healthcare Network that operates thirteen physician clinics that serve Waco and the six surrounding counties. The Providence Clinics accept all payors to provide complete health care for individuals and families. The clinics' team of dedicated health professionals provides a diverse range of services; from routine physicals and preventive medicine, to more complex matters of illness and injury. The clinic specialties include Family Practice, Internal Medicine, Obstetrics/Gynecology, Psychiatry, Psychotherapy and Geriatric (senior adult) Medicine. Providence Healthcare Network also includes Providence Health Services of Waco Inc. (74-1109636) which operates Providence Health Center (acute care), Providence Park (residential, skilled nursing, and long-term care), DePaul Center (psychiatric care) and Providence Home Care. Providence Healthcare Network also includes Providence Foundation, Inc. (74-2683112), which is the fundraising division of Providence Healthcare Network and is responsible for the acquisition of capital equipment and advanced technology. Providence Health Services of Waco, Inc. and Providence Foundation, Inc. file separate IRS Forms 990. The following information pertains to Providence Healthcare Network:This report illustrates the significant degree to which Providence Healthcare Network contributes to the positive health status of the communities it serves. As a member of Ascension Health, the nation's largest Catholic healthcare system, Providence Healthcare Network continues to build and strengthen sustainable collaborative efforts that benefit the health of individuals, families, and society as a whole. Ascension Health directs its governance and management activities toward strong, vibrant, Catholic Health Ministries united in service and healing, and dedicates its resources to spiritually-centered care which sustains and improves the health of the communities it serves. In accordance with Ascension Health's mission of service to those who are poor and vulnerable, each Health Ministry accepts patients regardless of their ability to pay. Providence Healthcare Network has engaged in the following activities to ensure that our mission is accomplished:Unreimbursed Services Provided to the Elderly and the Poor:Providence Healthcare Network provides a substantial portion of its services to the elderly and poor. During the fiscal year ending June 30, 2012, approximately 47.4% of the values of services rendered were to elderly patients under the Medicare program, and approximately 11.2% of the services were provided to patients who were deemed indigent under state, county, or Health Center Guidelines. In the spirit of principles adopted by Ascension Health, Providence Healthcare Network has taken proactive steps to address those issues that will affect accessibility, the financing, and the delivery of healthcare to all persons, especially the uninsured, underinsured, and the underserved. During the fiscal year ending June 30, 2012, the estimated unreimbursed cost of services provided to the elderly, uninsured, and underinsured totaled $22 million before state uncompensated pool reimbursements.Patient Services: Providence Healthcare Network provides the following inpatient and outpatient medical services to the community:Bronchial ThermoplastyCaner CareCardiac Services Cardio-Pulmonary RehabDaVinci SurgeryDiabetes CareDurable Medical EquipmentEducationEmergency CareHome CareHospiceMidwiferyNeuroscienceOrthopedicsPediatric CarePharmacyPhysician clinical ServicesPsychiatric CareRadiologyResearchRehabilitative Services Senior Care: Independent, Assisted, Long-term Care, and Sub-Acute CareSupport GroupsSurgical Weight LossCentral Stroke CenterWound Care CenterWomen & Newborn Center Some of the services listed above operate at a loss in order to ensure that all services are available to meet community health care needs. These include physician clinical services, and certain acute care departments. During the fiscal year ending June 30, 2012, our Health Center treated 18,244 adults and children in the community for a total of 181,812 patient days of service. The Health Center also provided outpatient services including 4,129 outpatient surgery patients, 79,375 emergency and minor care visits, and 29,796 homebound patients, 8,296 psychiatric care visits, and 156,147 physician office visits. Community Outreach Activities:Providence Healthcare Network seeks to improve the physical, mental, social and spiritual health status of its surrounding community. In addition to providing health care services to all individuals who require medical attention, our Ministry has developed the following programs to help achieve its mission:Expanding Awareness, Education, and Health PromotionProvidence Healthcare Network believes that it is essential to educate people regarding the types of behavior that improve their chances of living a healthy life. Providence Healthcare Network has invested significantly in unique, top quality health education programs and materials to accomplish its goals such as: Bariatric Support GroupCancer Support GroupCardiac Support GroupCommunity Cancer Screenings Community Health ScreeningsDePaul Mental Health and Addiction Support GroupsDiabetes Support GroupPulmonary Support GroupWorksite Wellness ProgramWebsite Educational MaterialsAll of the above listed support groups are posted on our website www.providence.net. Additionally, we have several service lines that have dedicated websites in order to provide a convenient way to better educate their patients. Also, several of our service lines highlight preventative educational materials.Providence Surgical Weight Loss Center- We post support groups on the dedicated website www.werechanginglives.com This site provides health resources to help determine whether or not to have surgery and outlines lifestyle changes that must occur when you do. Providence Breast Health Center- This website www.providencebhc.com provides resources that encourage women to be proactive in maintaining their breast health. It includes such information as Facts and Figures and credible links to national organizations with preventative breast cancer information.DePaul Center- Our psychiatric and substance abuse treatment division posts the schedule for monthly education seminars on mental health topics and posts support groups offered to assist in mental health.Providence Stroke Center- Our Stroke website page highlights the signs & symptoms of a stroke, the risk factors and also provides links to other important national organizations that provide additional in-depth preventative information. Joint Camp- Joint Camp is a comprehensive and coordinated effort that involves everyone from admission clerks and lab personnel to nurses and dietary staff. From the very first pre-surgery visit to the actual surgery, and on to recovery, the Joint Camp at Providence provides comprehensive care that patients can trust. Charitable Contributions to Community Organizations:Providence Healthcare Network provides charitable support to many various organizations within our community. Our Mission directs us to serve all persons, particularly the poor and vulnerable, toward improving the health of individuals and communities. We feel it is our calling to support those organizations that serve this same purpose. Listed below are just a few of those organizations that receive charitable contributions from our Ministry:Advocacy Center for CrimeAlzheimer's AssociationAmerican Cancer SocietyAmerican Heart AssociationBaylor UniversityBig Brothers and SistersCare Net Pregnancy CenterCaritas of WacoCompassion MinistriesEmpowerment by Knowledge CoalitionFamily Health Center Family Abuse Center Girl Scouts of AmericaGreater Waco InterfaithGreater Waco Chamber of CommerceGreater Hewitt Chamber of CommerceMarch of DimesMcLennan county Medical SocietyMidway ISDMended HeartsMission of WacoSt Louis Catholic ChurchWaco ISD Education FoundationWaco Senior LeaguesYoung Life Waco Participation in Charitable or Public Benefit Programs:Providence Healthcare Network actively participates year round with several organizations in our community. Listed below are several ways our Ministry gets involved:American Heart Association - As the cause sponsor of the American Heart Association, Providence provides substantial financial support which aides their fight against our country's No. 1 and No. 3 causes of death: heart disease and stro

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:	11000144
Software Version:	2011v1.5

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

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

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

PROVIDENCE HEALTH SERVICES OF WACO
dba PROVIDENCE HEALTHCARE NETWORK

Employer identification number

74-1109636

Part I

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

(a) Name, address, and EIN of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled organization
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1) Ascension Health PO Box 45998 St Louis,MO63145 31-1662309	Healthcare	MO	501(c)(3)	11.a Type 1	N/A		No
(2) Providence Health Alliance 6901 Medical Parkway Waco,TX76712 74-2696970	Physician Practices	TX	501(c)(3)	3.Hospital	Providence Health Services of Waco	Yes
(3) Providence Foundation Inc 6901 Medical Parkway Waco,TX76712 74-2683112	Support charitable purpose of PHSW	TX	501(c)(3)	11.a Type I	Providence Health Services of Waco	Yes

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

Cat. No. 50135Y

Schedule R (Form 990) 2011

Page 2

Part III

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

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

Schedule R (Form 990) 2011

Page 3

Part V

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

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

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

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

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

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

Yes

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

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

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

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

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

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

Yes

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

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

Yes

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

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) Ascension Health	o	3,797,503	COST
(2) Providence Health Alliance	q	5,775,000	COST
(3) Providence Health Alliance	i	823,537	COST
(4) Providence Foundation Inc	o	309,271	COST
(5)
(6)

Schedule R (Form 990) 2011

Page 4

Part VI

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

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

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

Schedule R (Form 990) 2011

Page 5

Part VII

Supplemental Information

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

Identifier	Return Reference	Explanation

Additional Data

Software ID:	11000144
Software Version:	2011v1.5

1	Briefly describe the organization’s mission or most significant activities: Our Catholic health ministry is dedicated to spiritually centered, holistic care which sustains and improves the health of individuals and communities. In furtherance of its mission and in an effort to reduce the government's financial burden, Providence Health Services of Waco provides essential health care services such as outpatient clinics, and emergency room and ambulatory facilities that serve low income patients as well as community services. Providence Foundation provides funding for capital projects in support of this mission.
2	Check this box
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	10
5	Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...	5	3,030
6	Total number of volunteers (estimate if necessary) ....	6	205
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ..	7a	432,544
b	Net unrelated business taxable income from Form 990-T, line 34 ..	7b

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	2,006,597	209,959
9	Program service revenue (Part VIII, line 2g) .........	240,061,738	253,487,160
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	10,344,849	7,375,585
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	7,487,475	8,569,627
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	259,900,659	269,642,331
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	3,596,550	5,901,915
14	Benefits paid to or for members (Part IX, column (A), line 4).....		0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	109,580,125	115,291,277
16a	Professional fundraising fees (Part IX, column (A), line 11e).....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f)....	117,352,792	111,138,584
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	230,529,467	232,331,776
19	Revenue less expenses. Subtract line 18 from line 12.......	29,371,192	37,310,555
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	299,701,221	312,160,743
21	Total liabilities (Part X, line 26).............	101,582,119	100,912,827
22	Net assets or fund balances. Subtract line 21 from line 20.....	198,119,102	211,247,916

Sign Here

	Signature of officer	Date

	Type or print name and title.


4a	(Code: ) (Expenses $ 192,253,270 including grants of $ 5,901,915 ) (Revenue $ 258,810,532 )
	SEE STATEMENT 1

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses$ 192,253,270

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	4,362,856	313,508

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512, 513, or 514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d		207,884
e	Government grants (contributions)1e

f	All other contributions, gifts, grants, and similar amounts not included above1f		2,075
g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			209,959
			Business Code
2a	NET PATIENT SVCS REV		624,100	253,487,160	253,487,160
b
c
d
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			253,487,160
3	Investment income (including dividends, interest
	and other similar amounts).....			7,383,285			7,383,285
4	Income from investment of tax-exempt bond proceeds..			0
5	Royalties............			0
		(i) Real	(ii) Personal
6a	Gross rents	173,567
b	Less: rental expenses
c	Rental income or (loss)	173,567
d	Net rental income or (loss).......			173,567			173,567
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	57,858
b	Less: cost or other basis and sales expenses	65,558
c	Gain or (loss)	-7,700
d	Net gain or (loss)..........			-7,700			-7,700
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ...
	a		50,910
b	Less: direct expenses ...b		28,981
c	Net income or (loss) from fundraising events..			21,929			21,929
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...			0
10a	Gross sales of inventory, less returns and allowances .
	a		462,378
b	Less: cost of goods sold ..b		230,739
c	Net income or (loss) from sales of inventory..			231,639			231,639
Miscellaneous Revenue			Business Code
11a	PHARMACY SALES		900,099	3,042,033	3,042,033
b	MISC OTHER		900,099	1,835,135	1,835,135
c	CAFETERIA SALES		900,099	2,386,576			2,386,576
d	All other revenue ....			878,748	446,204	432,544
e	Total. Add lines 11a–11d ......			8,142,492
12	Total revenue. See Instructions....			269,642,331	258,810,532	432,544	10,189,296


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing ..........				1	0
2	Savings and temporary cash investments .......			18,074,285	2	12,815,151
3	Pledges and grants receivable, net .........				3	0
4	Accounts receivable, net .........			34,126,285	4	36,328,385
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........				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 ..........				6	0
7	Notes and loans receivable, net .............			2,177,213	7	1,125,196
8	Inventories for sale or use ..............			4,046,227	8	3,990,290
9	Prepaid expenses and deferred charges ............			1,127,545	9	993,064
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	236,019,457
b	Less: accumulated depreciation. .....	10b	123,360,531	112,221,955	10c	112,658,926
11	Investments—publicly traded securities ..........				11	0
12	Investments—other securities. See Part IV, line 11 ......				12	0
13	Investments—program-related. See Part IV, line 11 ..				13	0
14	Intangible assets .........			3,286,277	14	3,211,894
15	Other assets. See Part IV, line 11 ...........			124,641,434	15	141,037,837
16	Total assets. Add lines 1 through 15 (must equal line 34)...			299,701,221	16	312,160,743
17	Accounts payable and accrued expenses .			21,556,744	17	19,980,534
18	Grants payable ..........				18
19	Deferred revenue ..........			4,938,374	19	4,792,314
20	Tax-exempt bond liabilities ..........				20
21	Escrow or custodial account liability. Complete Part IV of Schedule D..				21
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........				22
23	Secured mortgages and notes payable to unrelated third parties ..			53,368,857	23	52,984,920
24	Unsecured notes and loans payable to unrelated third parties ....				24
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.....			21,718,144	25	23,155,059
26	Total liabilities. Add lines 17 through 25.....			101,582,119	26	100,912,827
	Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....			197,443,470	27	210,639,277
28	Temporarily restricted net assets .....			675,632	28	608,639
29	Permanently restricted net assets .....				29
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances .....			198,119,102	33	211,247,916
34	Total liabilities and net assets/fund balances .....			299,701,221	34	312,160,743