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) John Mitchelson Chair	1.0	X	X			0	0	0
(2) Randall Cason President & CEO	50.0	X				0	335,849	47,127
(3) Tammy Battaglia MD Trustee	1.0	X				0	0	0
(4) Marty Beezley Trustee	1.0	X				0	0	0
(5) Susanne Daniels Trustee	1.0	X				0	0	0
(6) Chuck Hosman Trustee	1.0	X				0	0	0
(7) Sr Marie Veronica Janousek Trustee	1.0	X				0	15,132	0
(8) Rodney Odgers MD Trustee	1.0	X				0	0	0
(9) Richard Oler Trustee	1.0	X				0	0	0
(10) Steve Scott Trustee	1.0	X				0	0	0
(11) Vince VanBecelaere Trustee	1.0	X				0	0	0
(12) Wendell Wilkinson Trustee	1.0	X				0	0	0
(13) Randall Peterson Trustee; Term. 4/20/12	1.0	X				0	640,820	135,270
(14) Drew Talbott Secretary	50.0		X			149,888	0	31,521
(15) Debra Cartwright Treasurer/VP Finance/CFO	50.0		X			205,085	0	31,845
(16) Bill Aquino VP Planning & Development	50.0			X		166,950	0	29,706
(17) Riaz Baqir Physician	50.0				X	456,902	0	25,909

(A) Name and business address	(B) Description of services	(C) Compensation
Rehabcare Group Inc PO Box 502096 ST LOUIS,MO63150	Staffing	687,881
Pittsburg Emergency Physicians LLC 8717 W 110th St Ste 500 OVERLAND PARK,KS66210	Staffing	509,993
DeWitt and Associates Inc PO Box 3378 GS SPRINGFIELD,MO65808	Construction	3,935,126
Regional Medical Laboratory of SEK 2401 S Tucker Suite 5 PITTSBURG,KS63150	Staffing	462,217
HMN Architects Inc 7400 W 110th Street Suite 200 OVERLAND PARK,KS66210	Construction	447,529
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 12

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.	(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to governments and organizations in the United States. See Part IV, line 21	0
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	0
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16	0
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	775,374		775,374
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	0
7	Other salaries and wages	36,385,312	33,317,577	3,067,735
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	774,915	665,725	109,190
9	Other employee benefits .......	5,968,222	5,258,686	709,536
10	Payroll taxes ...........	2,364,405	2,094,458	269,947
11	Fees for services (non-employees):
a	Management ......	1,196,989	57,985	1,139,004
b	Legal .........	4,101		4,101
c	Accounting ...........	0
d	Lobbying ...........	0
e	Professional fundraising. See Part IV, line 17..	0
f	Investment management fees ......	0
g	Other ..........	9,198,265	6,455,247	2,743,018
12	Advertising and promotion ....	359,289	5,083	354,206
13	Office expenses .......	15,922,052	15,410,850	511,202
14	Information technology ......	5,016,192	971	5,015,221
15	Royalties ..	0
16	Occupancy ...........	1,076,280	1,069,524	6,756
17	Travel ............	227,393	161,761	65,632
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0
19	Conferences, conventions, and meetings ....	55,782	42,176	13,606
20	Interest ...........	519,475		519,475
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization .....	3,906,478	3,700,413	206,065
23	Insurance ..............	728,899	196,294	532,605
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	MEMBERSHIP DUES	405,524	129,449	276,075
b	SOCIAL EVENTS	116,280	34,871	81,409
c	VEHICLE FUEL & MAINTENANCE	105,066	48,001	57,065
d	INCOME TAX EXPENSE	55,746	55,746
e
f	All other expenses	330,082	80,985	249,097
25	Total functional expenses. Add lines 1 through 24f	85,492,121	68,785,802	16,706,319	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 ..........	18,824,000	1	5,959,773
2	Savings and temporary cash investments .......	22,803,154	2	37,644,556
3	Pledges and grants receivable, net .........	0	3	0
4	Accounts receivable, net .........	10,033,207	4	12,891,873
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........	0	5	0
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........	0	6	0
7	Notes and loans receivable, net .............	0	7	0
8	Inventories for sale or use ..............	1,957,745	8	2,195,332
9	Prepaid expenses and deferred charges ............	333,627	9	184,608
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	86,517,390
b	Less: accumulated depreciation. .....	10b	48,767,183	33,674,501	10c	37,750,207
11	Investments—publicly traded securities ..........	0	11	0
12	Investments—other securities. See Part IV, line 11 ......	0	12	0
13	Investments—program-related. See Part IV, line 11 ..	0	13	0
14	Intangible assets .........	0	14	0
15	Other assets. See Part IV, line 11 ...........	1,336,821	15	19,504,156
16	Total assets. Add lines 1 through 15 (must equal line 34)...	88,963,055	16	116,130,505
	17	Accounts payable and accrued expenses .	11,036,349	17	7,145,573
18	Grants payable ..........	0	18	0
19	Deferred revenue ..........	0	19	5,915
20	Tax-exempt bond liabilities ..........	0	20	0
21	Escrow or custodial account liability. Complete Part IV of Schedule D..	0	21	0
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........	0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	0	23	0
24	Unsecured notes and loans payable to unrelated third parties ....	0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.....	106,643	25	19,218,168
26	Total liabilities. Add lines 17 through 25.....	11,142,992	26	26,369,656
		Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....	77,820,063	27	89,760,849
28	Temporarily restricted net assets .....	0	28	0
29	Permanently restricted net assets .....	0	29	0
	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 .....	77,820,063	33	89,760,849
34	Total liabilities and net assets/fund balances .....	88,963,055	34	116,130,505

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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

Via Christi Hospital Pittsburg Inc

Employer identification number

48-0543778

Part I

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Type I

Type II

Type III - Functionally integrated

Type III - Other

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

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

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

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

Yes

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

11g(i)

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

11g(ii)

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

11g(iii)

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

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


Total

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2011

Page 2

Part II

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

Section A. Public Support

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

Section B. Total Support

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

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

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

Section C. Computation of Public Support Percentage

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

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

16a

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

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

17a

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

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

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

Schedule A (Form 990 or 990-EZ) 2011

Page 3

Part III

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

Section A. Public Support

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

Section B. Total Support

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

Section C. Computation of Public Support Percentage

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

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

Section D. Computation of Investment Income Percentage

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

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

19a

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

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

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

Schedule A (Form 990 or 990-EZ) 2011

Page 4

Part IV

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

Facts And Circumstances Test

Explanation

Schedule A (Form 990 or 990-EZ) 2011

Additional Data

Software ID:
Software Version:

- 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

Via Christi Hospital Pittsburg Inc

Employer identification number

48-0543778

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 Via Christi Hospital Pittsburg Inc
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 Via Christi Hospital Pittsburg Inc
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
Via Christi Hospital Pittsburg Inc

Employer identification number

48-0543778

Part III

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

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

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

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

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

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

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

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

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

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

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

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

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

Complete if the organization is described below.
SchCMd Bullet

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

See separate instructions.

OMB No. 1545-0047

2011

Open to Public
Inspection

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

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

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

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

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

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

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

Name of the organization

Via Christi Hospital Pittsburg Inc

Employer identification number

48-0543778

Part I-A

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

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

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

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

Part I-B

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

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

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

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

Yes No

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

Yes No

If "Yes," describe in Part IV.

Part I-C

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

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

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

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

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

Yes No

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

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

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2011

Page 2

Part II-A

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

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

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

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

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

2a	Lobbying non-taxable amount

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

c	Total lobbying expenditures

d	Grassroots nontaxable amount

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

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2011

Page 3

Part II-B

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

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

(a)

Yes

(b)

Amount

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

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

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

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

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

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

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

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

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

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

Yes

10,224

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

10,224

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
Lobbying Activities	Part II-B, Question 1i	Via Christi Hospital Pittsburg, Inc. pays dues to the Kansas Hospital Association (KHA), the American Heart Association (AHA), the Catholic Health Association (CHA), and the Pittsburg Chamber of Commerce (Chamber) who are involved in lobbying activities. For fiscal 2012 it was determined that 15.0% (KHA), 24.42% (AHA), 3.0% (CHA), and 5.0% (Chamber) of the dues were used for lobbying activites. Dues % Lobbying Total AHA 14,137 24.42% 3,452 KHA 41,467 15.00% 6,220 CHA 17,919 3.00% 538 Chamber 288 5.00% 14 ------ ----- 73,811 10,224

Schedule C (Form 990 or 990EZ) 2011

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

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

Attach to Form 990. SchDMd Bullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

Via Christi Hospital Pittsburg Inc

Employer identification number

48-0543778

Part I

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

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

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

Yes No

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

Yes No

Part II

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

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

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

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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


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

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

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

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

Yes No

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

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

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

Yes No

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

Part III

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

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

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

(i)

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

(ii)

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

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

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

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

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

Cat. No. 52283D

Schedule D (Form 990) 2011

Page 2

Part III

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

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

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

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

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

Yes No

Part IV

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

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

Yes No

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


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

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

Yes No

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

Part V

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

		(a)Current Year	(b)Prior Year	(c)Two Years Back	(d)Three Years Back	(e)Four Years Back
1a	Beginning of year balance ....
b	Contributions ........
c	Net investment earnings, gains, and losses ...
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........
f	Administrative expenses ....
g	End of year balance ......

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

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

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

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

Yes

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

3a(i)

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

3a(ii)

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

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

Part VI

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

Description of property		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	168,788		168,788
b	Buildings ................	43,447,785	15,977,916	27,469,869
c	Leasehold improvements ............
d	Equipment ................	41,033,241	32,154,203	8,879,038
e	Other .................	1,867,576	635,064	1,232,512
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				37,750,207

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) MEDICAID/MEDICARE SETTLEMENT				115,247
(2) SETTLEMENT RECEIVABLE				1,725,428
(3) RELATED PARTY RECEIVABLES				16,553,279
(4) OTHER CURRENT ASSETS				965,619
(5) INVESTMENT IN RML OF SEK				144,583




Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				19,504,156

Part X

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

1.(a) Description of Liability		(b) Book value
Federal Income Taxes		0
ASSET RETIREMENT OBLIGATION		116,964
VCHS NOTE PAYABLE		18,000,000
PENSION DEPOSITS PAYABLE		1,101,204






Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		19,218,168
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
FIN 48 (ASC 740) Footnote	Part X, Question 2	The organization follows the FIN 48 policy of Via Christi Health, Inc. (VCH) and the policy is provided in the VCH consolidated audited financial statements. With the exception of certain subsidiaries, all of the entities in the Health System are organizations under Section 501(c)(3) of the Internal Revenue Code and are generally exempt from payment of income taxes on related income pursuant to Section 501(a) of the Internal Revenue Code. Subsidiaries which are for-profit organizations are subject to federal and state income taxes. Accounting principles generally accepted in the United States of America require the Health Systems management to evaluate tax positions taken by the Health System and its subsidiaries and recognize a tax liability (or asset) if an uncertain position has been taken that more likely than not would not be sustained upon examination by the Internal Revenue Service. Management has analyzed the tax positions by the Health System and its subsidiaries, and has concluded that as of September 30, 2012 and 2011, there were no uncertain tax positions taken or expected to be taken that would require recognition of a liability (or asset) or disclosure in the financial statements. Tax assets and liabilities are recognized for the future tax consequences attributable to differences between the financial statement carrying amounts of existing assets and liabilities and their respective tax bases and operating loss and tax credit carryforwards. Income tax expense or benefit is included in other nonoperating gains and losses in the consolidated statements of operations and changes in net assets. Deferred tax assets and liabilities are measured using enacted tax rates expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in income in the period that includes the enactment date.

Schedule D (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H (Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

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

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

Via Christi Hospital Pittsburg Inc

Employer identification number

48-0543778

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

Yes

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

Yes

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

Financial Assistance and Certain Other Community Benefits at Cost

	(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) ..	7,147,000	0	7,147,000	8.360 %
b Medicaid (from Worksheet 3, column a) .....	10,980,000	10,370,000	610,000	0.710 %
c Costs of other means-tested government programs (from Worksheet 3, column b) .
dTotal Financial Assistance and Means-Tested Government Programs .....	18,127,000	10,370,000	7,757,000	9.070 %
Other Benefits e Community health improvement services and community benefit operations (from (Worksheet 4) ....	293,399	2,588	290,811	0.340 %
f Health professions education (from Worksheet 5) ..	14,711		14,711	0.020 %
g Subsidized health services (from Worksheet 6) ..	63,623	27,945	35,678	0.040 %
h Research (from Worksheet 7)	12,834		12,834	0.020 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) ....	99,601		99,601	0.120 %
jTotal Other Benefits ...	484,168	30,533	453,635	0.540 %
kTotal. Add lines 7d and 7j. ..	18,611,168	10,400,533	8,210,635	9.610 %

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
1	Physical improvements and housing
2	Economic development	400	400
3	Community support	3,919	3,919
4	Environmental improvements
5	Leadership development and training for community members	116	116
6	Coalition building	104	104
7	Community health improvement advocacy
8	Workforce development	819	819
9	Other
10	Total	5,358	5,358

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........

2,245,803

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

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

Section B. Medicare

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

28,424,669

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

30,128,782

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

-1,704,113

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 %
1RML of SEK	Laboratory Services	50.000 %
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2011

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest) How many hospital facilities did the organization operate during the tax year?1 Name and address		Other (Describe)
1	Via Christi Hospital Pittsburg Inc 1 Mt Carmel Way Pittsburg,KS66762	X	X	X	Level III Trauma Ctr Cancer Center Heart Center

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)

Via Christi Hospital Pittsburg Inc

Name of Hospital Facility:

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

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

Schedule H (Form 990) 2011

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

Schedule H (Form 990) 2011

Page

Part VFacility Information (continued)

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

Schedule H (Form 990) 2011

Page

Part VFacility Information (continued)

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

Schedule H (Form 990) 2011

Page

Part VI

Supplemental Information

Complete this part to provide the following information.

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

Identifier	ReturnReference	Explanation
ANNUAL COMMUNITY BENEFIT REPORT	PART I, Question 6b	A community benefit update that includes data from Via Christi Hospital Pittsburg, Inc. (VCH-P) is printed in Via Christi Health's annual report. This annual report is released in various formats to the public and is available at the Via Christi Health website at www.viachristi.org/about-us or upon request. In addition, VCH-P makes public presentations, when invited, on the findings of the latest health needs assessment.
COMMUNITY BENEFIT PROGRAMS	PART I, Question 7	For examples of some of the community benefit programs provided by Via Christi Hospital Pittsburg, Inc. see the Schedule O footnote for Part III, Statement of Program Services.
COMMUNITY BUILDING ACTIVITIES	PART II	Community building activities are essential roles for health care organizations in that they address many of the underlying determinants of health. Research has consistently shown that when the socioeconomic factors influencing health are explored, health care actually plays a smaller role proportionately. A report in the Journal of American Medical Association and the Center for Disease Control suggests that the determinants impacting health are as follows: lifestyle and behaviors, 50%; environment, 20%; genetics and human biology, 20%; and health care, 10%. Community building activities help to address the other determinants outside of the role traditionally played by health care organizations. The hospital provides timely and specific resources to help community organizations through donations to fulfill their missions of improving the well-being of the community and contributing to its overall health status in ways that may differ from direct clinical services provided by the hospital. These activities are almost exclusively done in partnership with other community organizations, which are better suited to address identified community needs. Listed below are just a few of the Community Building activities reported by our hospital during FY2012. This is not a complete listing but a sampling of how the hospital participates in the health of the community through its Community Building activities. Chamber of Commerce - Via Christi Hospital Pittsburg, Inc. (VCH-P) hosts an annual chamber coffee to update chamber members on health challenges in the area, community needs that have been addressed by the hospital during the last year, new health services that have come into town, or services that may have relocated. This event gives chamber members, especially those who are employers, new information to share with their employees to increase service awareness or introduce services to people who have moved into the area. VCH-P involvement improves awareness of health related services and gives them an opportunity to collect additional data on possible gaps that can be incorporated into future health assessments. Crawford County Leadership Program - Staff participated and graduated from this leadership program. The purpose is to network with community leaders to get a better understanding of area needs and how their participation can assist in addressing those needs. Participants look at time, talent, and resources they or their employers can bring to bear on the identified needs. VCH-P involvement improves awareness of health related services to those involved in leadership position and also gives them another informal way of collecting data on possible gaps for future health assessments. Conference Room Usage by Non-Health Related Organizations - VCH-P offers a conference room for civic groups who are engaged in supporting community efforts or whose mission is to advance the quality of life for others (e.g. Kiwanis, Rotary, etc). These groups meet for free at the hospital thus saving their resources to address community needs. By offering this donated space, VCH-P ensures that these groups have more money to carry on their mission of promoting economic development of the area or a better quality of life for those who live in the Pittsburg area. High School Students Shadowing and In-Class Presentations - VCH-P organized a shadowing experience for high school students interested in the Cancer Center. These high school students were interested in learning more about careers that are available to work with cancer patients. By hosting these experiences, VCH-P is hopeful that students will be challenged to enter health care careers. Research has shown that when youth have direct exposure to professionals who serve in their areas of interest, they are more likely to succeed with current studies. In addition, staff has gone out to area schools to give presentations on specific health professions during career days. These presentations are useful in promoting awareness about health careers and allow students to ask questions on educational requirements and potential employment opportunities. Youth Leadership Program - In partnership with Pittsburg's Chamber of Commerce, VCH-P staff partnered with sixth graders in the five county area elementary schools. Staff worked with students through activities and discussions on various aspects of leadership. The involvement of VCH-P's staff time is to ensure young children know the importance of leadership and how they can use these skills to enrich the lives of others (e.g. reduce the effects of bullying or improve healthier choices through peer examples). Participation on the State's Trauma Registry Subcommittee - Staff participate on the State's subcommittee. The trauma registry provides the mechanism to collect data and evaluate trauma care and allows researchers the ability to analyze patient data for quality improvement, injury control, and resource utilization of local, state, and national level. While hospitals are required to maintain a trauma registry, there is no requirement that staff serve on State level committees. By participating at this level, VCH-P saves the State additional staffing money plus ensures that quality data is being collected through their involvement of monitoring patient outcomes.
BAD DEBT EXPENSE	PART III, LINE 3	The organization has no suitable basis for estimating bad debt expense that would be attributable to patients eligible under the organization's charity care policy.
Audit Note on Bad Debt Expense	Part III, Section A, Question 4	The provision for bad debt expense is based upon management's assessment of expected net collections considering economic conditions, historical experience, trends in 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 payer 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 Health System follows established guidelines for placing certain past-due patient balances with collection agencies, subject to terms of certain restrictions on collection efforts as determined by the Health System. Accounts receivable are written off after collections efforts have been followed in accordance with the Health System's policies. VCH-P reports bad debt in accordance with generally accepted accounting principles (GAAP). Healthcare Financial Management Statement 15 is followed to the extent that it aligns with the guidelines set forth by GAAP. Bad debt expense at cost is determined using the same cost-to-charge ratio that is used for charity care and Medicaid shortfall. VCH-P follows the guidance from CHA and does not consider bad debt as a community benefit.
Medicare Shortfall	PART III, Section B, Question 8	VCH-P follows the CHA guidelines regarding Medicare and does not include it as community benefit.
Debt Collection Policy	Part III, Section C, Question 9b	It is the policy of VCH-P to promote socially just practices for billing and collections for all patients receiving care. The policy is intended to further the VCH-P mission by requiring ethical conduct in billing and collecting self-pay balances from patient/guarantor's regardless of ability to pay. The policy ensures that prior to turning an account over to a Third Party Collection Agent (Agent) for collection activity, VCH-P will perform a reasonable review of each account to verify that the patient/guarantor is not potentially eligible for any government assistance program (e.g., Medicaid, Medicare, etc.) and would likely not qualify for charity care. VCH-P will direct its staff and Agents to periodically assess each patient/guarantor's ability to pay or to determine eligibility for charity care. The review and assessment should include but may not be limited to the following: a. Ensure the patient/guarantor has been notified of VCH's financial assistance policy; b. Ensure the patient/guarantor was offered a financial assistance application; c. Ensure documentation of any known extraordinary financial circumstances of the patient/guarantor or if they are medically indigent.
Financial Assistance Policy	Part V, Question 13g	The full policy is not posted in each of these areas; however, reference to the policy is posted and the policy is immediately available to anyone who requests it.
Needs Assessment	Part VI, Question 2	Ministry representatives are involved with numerous coalitions that periodically assess community needs (e.g. Early Childhood Development Taskforce, Family Resource Center, Personal Action Toward Health Coalition for Seniors, Pittsburg Area Community Outreach, Project Warmth, Community Health Center of Southeast Kansas, United Way, and others) and in FY2011 conducted their own health assessment. Secondary data, other community assessments, and one-on-one interviews with community leaders, social service providers, health care providers, and government representatives are used to conduct the assessment.
Patient Education of Eligibility for Financial Assistance	Part VI, Question 3	The VCH-P financial assistance staff is trained on how to qualify patients for Medicaid, SCHIP, and other such income-based programs. During the patient's registration, admissions, and discharge processes, VCH-P staff attempt to identify patients who may be eligible for charity or discounted care through the charity care policy. In addition, VCH-P uses a percentage of the Federal Poverty Guidelines (FPG) to determine free and discounted care.
Community Information	PART VI, Question 4	The primary counties for Pittsburg ministries include Crawford and Cherokee Counties. Crawford County has a land area of 590 square miles and Cherokee County has a land area of 588 square miles. Crawford County has an estimated 2011 population of 39,220 compared to Cherokee County's 21,385. The population demographics for Crawford County include: 92.6% white; 2.3% Black; 1.0% American Indian; 1.4% Asian; and 4.7% persons of Hispanic or Latino origin. Cherokee County demographics include: 90.7% white; 0.8% Black; 3.9% American Indian; 0.4% Asian; and 2.2% persons of Hispanic or Latino origin. Approximately 5.8% of the Crawford County residents and 2.6% of the Cherokee County residents reported using a language other than English in their homes. High school graduation rates, for the years 2007-2011, were 88.7% in Crawford County and 85.8% in Cherokee County. A bachelor's degree or higher was reported by 27.8% of Crawford County residents and 13.4% for Cherokee County residents. Median household income for Crawford County residents for the years 2007-2011 was $36,043 compared to $41,513 for Cherokee County. Median value of owner-occupied housing units for the same time period was $85,200 for Crawford County and $71,400 for Cherokee County. According to Quick Facts from the US Census, 19.1% of Crawford County lived below the poverty level between the years 2007-2011. This is higher than the 12.6% identified for the State of Kansas. Cherokee County is also above the State of Kansas' level as 15.4% of their residents suggest that they live below the poverty level. VCH-P is the only hospital facility in the City of Pittsburg. There are other hospitals in neighboring communities, but they offer fewer services. In order to find a similar medical facility, patients would need to travel to Joplin, Missouri or Tulsa, Oklahoma for emergency care. Kansas reported in 2011 that 13.3% of all residents were persons 65 years of age and older. This compares to 14.0% for Crawford and 16.1% for Cherokee Counties. Thus services for a growing aging population need to be monitored in future assessments.
Promotion of Community Health	PART VI, Question 5	VCH-P and its affiliates enrich the communities in which they operate as well as the broader community, improving medicine through research, educating physicians and other health care providers, and providing care and support to people in need. VCH-P further supports this mission with a community board, open medical staff, and an emergency room available to patients regardless of ability to pay. Community representation on the Governing Body - The Board of Trustees is the governing body of VCH-P. The majority of its members are external members comprised of persons who reside in or around Sedgwick County. The board has overall responsibility for the charitable mission of the organization as set forth in its Articles of Incorporation and Bylaws. Trustees are selected based on their expertise, experience, and other criteria established by the nominating committee of the Board of Trustees. Areas of expertise and experience include such areas as health care, finance, education, and local government. The Board actively debates and sets policy and strategic direction for the ministry but does not get involved in issues related to daily operations. The Board takes a balanced approach when addressing community and business/financial concerns. The Board is also the primary group for determining the use of surplus funds generated by the organization, which are reinvested in the ministry in order to allow the ministry to sustain its mission and prepare for the future. Targeted Population Health Fairs and Screenings are conducted annually for children, seniors, and the broader community. Screenings include blood pressure checks, eye exams, hearing tests, feet exams, sport physicals, bone density, BMI, pre-concussion testing, and recommendations for establishing a medical home. During FY 2012, VCH-P Staff held or participated in health fairs given at government offices, local businesses, area churches, Pittsburg State University Family Day, area high schools, senior villages, and at the Aging Expo. In addition, the Cancer Center staff held a skin cancer screening and was involved in circulating hemocult kits for colorectal cancer screenings. The Sports Medicine staff provided high school wellness/sports medicine physicals at a discounted rate of $10 per student. Community Boards/Committees/Coalitions - VCH-P staff serve on various not-for-profit boards, committees, and coalitions to keep informed about community needs and to share resources and expertise with various groups as they work to achieve their missions. In FY 2012, VCH-P served with the following: Pittsburg State University School of Nursing Advisory Board; Local Emergency Preparedness Committee; Live Well Health and Wellness Committee of Crawford County; Elm Acres Foundation Board; Crawford County Community Coalition; Angels Among Us, and Pittsburg Ministerial Alliance Association. CareVan, a popular transportation program owned and operated by VCH-P, provides non-emergency medical transportation assistance to elderly and handicap individuals. In FY 2012, VCH-P's CareVan provided 8,876 trips at a cost of $222,802. Health Profession Education of area physicians, nurses, physician assistants, nursing students and other health care professionals who are either looking for continuing education credits, wanting more hands-on training, or are in need of field practicum placements, etc. are welcomed at VCH-P for additional training opportunities. Over 180 students spent time at VCH-P getting hands-on experience in a learning environment during FY 2012. In-Kind Donations through staff assistance of other not-for-profit organizations in meeting their missions and/or sharing of hospital space to conduct health related not-for-profit business are other ways that VCH-P gives back to the community. In FY 2012, VCH-P participated with a number of groups like American Red Cross On-Site Blood Drive, Pittsburg Corporate Challenge, Community Foundation of Southeast Kansas, and various civic groups. In addition, VCH-P partnered with the Salvation Army and Wesley House to collect food and clothing donations from area residents; prepare ready-to-eat pies for the Lion's Club chili feed; provide assistance with purchasing medications for indigent patients when other resources aren't available; prepare 225 servings of ready-to-eat potato soup for Project Warmth; provide athletic training to St Mary's High School trainers and during games; and provide sharps disposal container for the public. Community Education - VCH-P staff prepared and provided educational opportunities for the community on a variety of topics. During FY 2012, presentations were made on child car seat installations; pain management for people with arthritis; breast cancer awareness; skin cancer, colorectal cancer; childbirth preparation classes; rural trauma team class; women heart health; and smoking cessation and/or smoking prevention. Overall, VCH-P's combined community benefit programs (not counting unpaid reimbursement of Medicare or bad debt) accounted for $8.2 million to the geographical area of Pittsburg, Kansas for FY 2012.
Affiliated Health Care System	Part VI, Question 6	VCH-P is an affiliate of Via Christi Health, Inc. (VCH). VCH's affiliates are large multi-faceted, integrated, not-for-profit ministries including Hospital and Non-Hospital ministries (Physician Group Practices, Hospital organizations, Research, Home Health, Durable Medical Equipment, and Senior Facilities). These ministries work together to care for patients, joined by common systems and a philosophy of serving as a healing presence with special concern for our neighbors especially those who are vulnerable. This community benefit happens through its focus on patient care, education and research. The organizations work together to serve their communities at the local, regional and state level.
State Filing of Community Benefit Report	Part VI, Question 7	Kansas does not require hospitals to file community benefit reports but Via Christi Health, Inc. distributes our community benefit totals and activities annually in press releases as well as in our annual report.

Schedule H (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

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

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

Attach to Form 990. SchJMediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

Via Christi Hospital Pittsburg Inc

Employer identification number

48-0543778

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....

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? ....

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

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

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

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

Yes

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

Yes

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Cat. No. 50053T

Schedule J (Form 990) 2011

Page 2

Part II

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

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

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

(A) Name		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(A) Name		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(1) Drew Talbott	(i) (ii)	126,392 0	20,374 0	3,122 0	20,827 0	10,694 0	181,409 0	0 0
(2) Debra Cartwright	(i) (ii)	174,581 0	27,046 0	3,458 0	23,617 0	8,228 0	236,930 0	0 0
(3) Randall Cason	(i) (ii)	0 263,363	0 67,645	0 4,841	0 36,004	0 11,123	0 382,976	0 0
(4) Randall Peterson	(i) (ii)	0 502,186	0 124,597	0 14,037	0 125,809	0 9,461	0 776,090	0 0
(5) Bill Aquino	(i) (ii)	139,956 0	22,476 0	4,518 0	21,302 0	8,404 0	196,656 0	0 0
(6) Riaz Baqir	(i) (ii)	443,933 0	0 0	12,969 0	0 0	25,909 0	482,811 0	0 0
(7) Ali Hammad	(i) (ii)	745,462 0	133,371 0	23,750 0	0 0	32,056 0	934,639 0	0 0
(8) Bashar Marji	(i) (ii)	656,810 0	271,476 0	2,305 0	0 0	28,749 0	959,340 0	0 0
(9) Boban Mathew	(i) (ii)	504,321 0	0 0	143,094 0	0 0	33,993 0	681,408 0	0 0
(10) Danny Reveal	(i) (ii)	540,668 0	0 0	16,994 0	0 0	28,736 0	586,398 0	0 0
(11) Connie McCune	(i) (ii)	60,864 0	18,484 0	115,292 0	139 0	1,040 0	195,819 0	0 0

Schedule J (Form 990) 2011

Page 3

Part III

Supplemental Information

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

Identifier	Return Reference	Explanation
Severance Paid by the Filing Organization	PART I, QUESTION 4a	Connie McCune $106,608.68
Supplemental Non-Qualified Retirement Plan	PART I, QUESTION 4B	Paid by the Filing Organization: Bill Aquino $ 8,818.41 Debra Cartwright $ 10,622.16 Drew Talbott $ 7,985.83 Paid by a Related Organization: Randall Peterson $105,226.91 Randall Cason $ 21,348.92

Schedule J (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

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

Attach to Form 990 or 990-EZ.

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization

Via Christi Hospital Pittsburg Inc

Employer identification number

48-0543778

Identifier	Return Reference	Explanation
Statement of Program Services	Part III	Via Christi Hospital Pittsburg, Inc. (VCH-P) is a member of Via Christi Health (VCH). As a Catholic health system, VCH has its origins in faith-based responses to health needs of our communities, with a particular concern for those living in poverty and who are vulnerable. In addition to typical inpatient and outpatient services, VCH operates primary care clinics, a low income neighborhood outreach clinic, specialty hospitals and centers, home medical services, therapy centers, and long-term care villages. The obligation to reach out to those in need and to improve community health flows directly from VCH's identity as a faith-based healing ministry. VCH continues its tradition in providing community benefit because we are committed to: o Promoting and defending human dignity o Caring for persons living in poverty and other vulnerable populations o Promoting the common good o Stewarding resources responsibly According to the VCH mission statement, "As a part of Via Christi Health, we share this Mission: Inspired by the Gospel and our Catholic tradition, we serve as a healing presence with special concern for our neighbors who are vulnerable." The financial information in this report was prepared in accordance with the Catholic Health Association's (CHA) A Guide for Planning and Reporting Community Benefit Guidelines. Per these Guidelines, we report the net expense for community benefit services (i.e. the total community benefit expense minus any associated revenue from patients, residents, payers, and other external sources). The CHA Guidelines reflect a conservative approach to reporting quantifiable community benefit. The goal of the Guidelines is to produce community benefit financial reports that reflect true costs and that describe community benefit activities that increase access to health care and improve community health for all. The following are VCH-P definitions for quantifiable community benefits reports. Charity Care - Free or discounted health services provided to persons who cannot afford to pay and who meet VCH's criteria for financial assistance. Charity care is reported in terms of costs, not charges. Charity care does not include bad debt. Government Sponsored Means-Tested Health Care - Includes unpaid costs of public programs for low-income persons - the shortfall created when VCH receives payments that are less than the cost of caring for public program beneficiaries. This payment shortfall is not the same as a contractual allowance, which is the full difference between charges and government payments. Health Professions Education - Helping to prepare future health care professionals is a distinguishing characteristic of not-for-profit health care and constitutes a significant community benefit. This category includes programs and financial assistance for physicians and medical students, nurses and nursing students, interns, and other health professionals. For fiscal year ended September 30, 2012 -------------------------------------------------------------- Community Benefit (VCH-P and Subsidiaries): 1. Charity care, at cost $7.1 million 2. Government sponsored health care, net expense $0.6 million Unpaid cost of public indigent care programs (includes Medicaid, SCHIP, other safety net programs; does not include Medicare shortfall) 3. Community Benefit Programs, net expense $0.5 million 4. Total Quantifiable Community Benefit $8.2 million Listed below are just a few of the community benefit programs offered by VCH-P. This is not a complete listing but a sampling of how the hospital gives back to the community while meeting current needs. VCH-P and its affiliates enrich the communities in which they operate as well as the broader community, improving medicine through research, educating physicians and other health care providers, and providing care and support to people in need. VCH-P further supports this mission with a community board, open medical staff, and an emergency room available to patients regardless of ability to pay. Community representation on the Governing Body - The Board of Trustees is the governing body of VCH-P. The majority of its members are external members comprised of persons who reside in or around Sedgwick County. The board has overall responsibility for the charitable mission of the organization as set forth in its Articles of Incorporation and Bylaws. Trustees are selected based on their expertise, experience, and other criteria established by the nominating committee of the Board of Trustees. Areas of expertise and experience include such areas as health care, finance, education, and local government. The Board actively debates and sets policy and strategic direction for the ministry but does not get involved in issues related to daily operations. The Board takes a balanced approach when addressing community and business/financial concerns. The Board is also the primary group for determining the use of surplus funds generated by the organization, which are reinvested in the ministry in order to allow the ministry to sustain its mission and prepare for the future. Targeted Population Health Fairs and Screenings are conducted annually for children, seniors, and the broader community. Screenings include blood pressure checks, eye exams, hearing tests, feet exams, sport physicals, bone density, BMI, pre-concussion testing, and recommendations for establishing a medical home. During FY 2012, VCH-P Staff held or participated in health fairs given at government offices, local businesses, area churches, Pittsburg State University Family Day, area high schools, senior villages, and at the Aging Expo. In addition, the Cancer Center staff held a skin cancer screening and was involved in circulating hemocult kits for colorectal cancer screenings. The Sports Medicine staff provided high school wellness/sports medicine physicals at a discounted rate of $10 per student. Community Boards/Committees/Coalitions - VCH-P staff serve on various not-for-profit boards, committees, and coalitions to keep informed about community needs and to share resources and expertise with various groups as they work to achieve their missions. In FY 2012, VCH-P served with the following: Pittsburg State University School of Nursing Advisory Board; Local Emergency Preparedness Committee; Live Well Health and Wellness Committee of Crawford County; Elm Acres Foundation Board; Crawford County Community Coalition; Angels Among Us, and Pittsburg Ministerial Alliance Association. CareVan, a popular transportation program owned and operated by VCH-P, provides non-emergency medical transportation assistance to elderly and handicap individuals. In FY 2012, VCH-P's CareVan provided 8,876 trips at a cost of $222,802. Health Profession Education of area physicians, nurses, physician assistants, nursing students and other health care professionals who are either looking for continuing education credits, wanting more hands-on training, or are in need of field practicum placements, etc. are welcomed at VCH-P for additional training opportunities. Over 180 students spent time at VCH-P getting hands-on experience in a learning environment during FY 2012. In-Kind Donations through staff assistance of other not-for-profit organizations in meeting their missions and/or sharing of hospital space to conduct health related not-for-profit business are other ways that VCH-P gives back to the community. In FY 2012, VCH-P participated with a number of groups like American Red Cross On-Site Blood Drive, Pittsburg Corporate Challenge, Community Foundation of Southeast Kansas, and various civic groups. In addition, VCH-P partnered with the Salvation Army and Wesley House to collect food and clothing donations from area residents; prepare ready-to-eat pies for the Lion's Club chili feed; provide assistance with purchasing medications for indigent patients when other resources aren't available; prepare 225 servings of ready-to-eat potato soup for Project Warmth; provide athletic training to St Mary's High School trainers and during games; and provide sharps disposal containers for the public. Community Education - VCH-P staff prepared and provided educational opportunities for the community on a variety of topics. During FY 2012, presentations were made on child car seat installations; pain management for people with arthritis; breast cancer awareness; skin cancer, colorectal cancer; childbirth preparation classes; rural trauma team class; women heart health; and smoking cessation and/or smoking prevention.
FORM 990 REVIEW	PART VI, SECTION B, QUESTION 11B	A COPY OF FORM 990 IS PROVIDED TO THE BOARD OF TRUSTEES VIA A SECURE EMAIL PRIOR TO FILING WITH THE IRS.
CONFLICT OF INTEREST POLICY	PART VI, SECTION B, QUESTION 12C	THE CONFLICT OF INTEREST POLICY IS MONITORED/ENFORCED AS PART OF THE SYSTEM-WIDE PROCEDURES AND IS NOT HANDLED AT THE ORGANIZATION LEVEL. THE POLICY IS MONITORED AND ENFORCED AS FOLLOWS: 1) AT TIME OF APPOINTMENT AND ANNUALLY THEREAFTER, ALL INTERESTED PERSONS, INCLUDING BOARD AND COMMITTEE MEMBERS, COMPLETE A DISCLOSURE STATEMENT WHICH ADDRESSES ACTUAL OR POTENTIAL CONFLICTS OF INTEREST; 2) THE DISCLOSURE STATEMENT IS COMPLETED ELECTRONICALLY, AND THE RETURN OF THE COMPLETED STATEMENT IS A CONDITION OF CONTINUED APPOINTMENT, EMPLOYMENT, OR PARTICIPATION WITH THE ORGANIZATION; 3) ALL ACTUAL OR POTENTIAL CONFLICTS ARE REVIEWED, INVESTIGATED, AND RESOLVED BY THE CHIEF GOVERNANCE OFFICER AND THE CORPORATE RESPONSIBILITY OFFICER, WITH THE RESULTS SHARED WITH THE CHIEF EXECUTIVE OF THE ORGANIZATION; AND 4) PERIODIC REVIEWS ARE CONDUCTED BY GOVERNANCE, COMPLIANCE, AND INTERNAL AUDIT TO ENSURE THE ORGANIZATION IS OPERATING CONSISTENT WITH THE POLICY AND ENFORCING THE POLICY'S TERMS.
COMPENSATION REVIEW	PART VI, SECTION B, QUESTIONs 15A & 15B	Via Christi Hospital Pittsburg, Inc. uses the policies established by Via Christi Health, Inc. (VCH). VCH has established a common philosophy, strategy, and processes for executive compensation. Through the oversight of the VCH Executive Compensation Committee, executive compensation is competitively positioned at its stated market position when compared to the compensation paid by relevant organizations (comparably-sized health systems, hospitals, and long-term care providers). VCH recognizes its responsibility to ensure that its executive compensation program is appropriate in view of its mission and tax-exempt status and that its compensation levels and expenditures are reasonable and not excessive. To ensure these ends, the VCH Executive Compensation Committee has established and approved the executive compensation philosophy for VCH and all related entities. It will also approve all changes in the compensation package for VCH executives in advance. On an annual basis, the Committee conducts a comprehensive review of total compensation for all executives. It also reviews and approves "off-cycle" compensation transactions as needed. In their review, the Committee considers the following factors: * Market data from independent compensation surveys and sources that reflect comparable positions in organizations of similar size and scope; * Difficulties in recruiting and retaining executives; * Skills, experience, and performance history of individual executives; * Critical business or strategic issues that the organization may face; and * Market position for total compensation. The adequacy, competitiveness, and cost of the VCH total executive compensation program are reviewed on an ongoing basis and changes are made as the Committee determines appropriate. The executive compensation program will be maintained such that it will fall within the safe harbor guidelines established by the Intermediate Sanctions regulations. The Committee also employs the services of an independent compensation consultant to prepare market analysis to aid and support the Committee's actions, provide documentation of market trends for budget setting purposes, review annual compensation changes to ensure "reasonableness" and provide attestation, and provide consultation on all executive compensation issues. The Committee also relies on third-party validation of performance measures used in the determination of compensation.
GOVERNING DOCUMENTS	PART VI, SECTION C, QUESTION 19	VIA CHRISTI HOSPITAL PITTSBURG, INC.'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
MEMBERS	PART VI, SECTION A, Questions 6, 7a, & 7b	VIA CHRISTI HEALTH, INC. IS THE SOLE MEMBER. THE MEMBER MAY APPROVE AND REMOVE INDIVIDUALS ON THE BOARD OF TRUSTEES. ARTICLE 2 OF THE BYLAWS PROVIDE THE MEMBER WITH THE FOLLOWING POWERS: DEFINE, APPROVE, CHANGE, OR INTERPRET THE MISSION, VALUES, PURPOSE, AND PHILOSPHY OF THE CORPORATION; APPROVE THE ARTICLES OF INCORPORATION, THE BYLAWS, AND ANY AMENDMENTS THERETO OF THE CORPORATION; APPOINT AND REMOVE THE MEMBERS OF THE BOARD OF TRUSTEES OF THE CORPORATION; APPOINT AND REMOVE THE PRESIDENT AND CEO OF THE CORPORATION; SUBJECT TO CANONICAL REQURIEMENTS, ESTABLISH THE OVERALL DEBT LIMIT FOR THE CORPORATION AND APPROVE THE INCURRENCE OF DEBT IN EXCESS OF THAT LIMIT; APPROVE THE DISSOLUTION, MERGER, CONSOLIDATION, OR SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF VIA CHRISTI HOSPITAL PITTSBURG, INC.; APPROVE AND REMOVE, WITH OR WITHOUT CAUSE, THE INDEPENDENT AUDITING FIRM FOR VIA CHRISTI HOSPITAL PITTSBURG, INC.; RECEIVE AND APPROVE OPERATING AND CAPITAL BUDGETS AND FINANCIAL REPORTS OF VIA CHRISTI HOSPITAL PITTSBURG, INC.; APPROVE FINANCING THROUGH PARTICIPATION IN THE OBLIGATED GROUP OF VIA CHRISTI HEALTH SYSTEM; AND REVIEW AND APPROVE REAL AND PERSONAL PROPERTY TRANSACTIONS CONSISTENT WITH PROVISION OF CANON LAW.
RECONCILIATION OF NET ASSETS	PART XI, QUESTION 5	Unrealized Gain 2,403,108 Pension Adjustment 4,036,868 Partnership Adjustment (101,803) Sponsorship Fee (163,576) Transfer from Mt. Carmel 410,000 ----------- Total 6,584,597
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:Randall Peterson TITLE:Trustee; Term. 4/20/12 HOURS:49

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2011

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

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

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

Via Christi Hospital Pittsburg Inc

Employer identification number

48-0543778

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	Hlth Sys Gov	MO	501(c)(3)	11-I	NA		No
(2) Catholic Care Center Inc 6700 E 45th St N Wichita,KS67226 48-1067110	Rtrmnt Home	KS	501(c)(3)	9	NA		No
(3) Cornerstone Assisted Living Inc 2622 W Central Suite 100 Wichita,KS67203 48-1241079	Rtrmnt Home	KS	501(c)(3)	9	NA		No
(4) Gerard House Inc 3144 N Hood Wichita,KS67204 48-1049532	Shelter	KS	501(c)(3)	7	NA		No
(5) Marian Health System Inc 1923 South Utica Avenue Tulsa,OK74104 36-3659989	Hospital Supp	DE	501(c)(3)	11-I	NA		No
(6) Mercy Community Health Foundation Inc 1823 College Avenue Manhattan,KS66502 48-1152279	Foundation	KS	501(c)(3)	9	MRHC		No
(7) Mercy Regional Health Center Inc 1823 College Avenue Manhattan,KS66502 48-1186704	Hospital	KS	501(c)(3)	3	NA		No
(8) Mercy Regional Home Medical Services LLC 2439 Claflin Road Manhattan,KS66502 43-2024491	Home Medical	KS	501(c)(3)	11-III FI	NA		No
(9) Mount Carmel Foundation Inc 1102 E Centennial Drive Pittsburg,KS66762 48-0961283	Foundation	KS	501(c)(3)	11-I	VCH-Pitt	Yes
(10) Salina Regional Home Medical Services 520 S Santa Fe Ave Suite 140 Salina,KS67401 43-1948057	Home Medical	KS	501(c)(3)	11-III O	NA		No
(11) St Johns Inc 2225 Canterbury Drive Hays,KS67601 20-2828680	Rtrmnt Home	KS	501(c)(3)	9	NA		No
(12) Via Christi Clinic Services 8200 E Thorn Drive Suite 300 Wichita,KS67226 27-3984287	Med Clinic	KS	501(c)(3)	11-I	NA		No
(13) Via Christi Foundation Inc 723 N McLean Blvd Wichita,KS67203 48-1173588	Foundation	KS	501(c)(3)	11-III FI	NA		No
(14) Via Christi Health Partners Inc 8200 E Thorn Drive Suite 300 Wichita,KS67226 48-0958974	Mgmt Co	KS	501(c)(3)	9	NA		No
(15) Via Christi Health Inc 8200 E Thorn Drive Suite 300 Wichita,KS67226 48-1172107	Hospital Supp	KS	501(c)(3)	9	NA		No
(16) Via Christi Healthcare Outreach Program 2622 W Central Suite 100 Wichita,KS67203 48-1236589	Pace Communit	KS	501(c)(3)	9	NA		No
(17) Via Christi Home Health Wichita Inc 555 S Washington Wichita,KS67211 48-1046371	Home Health	KS	501(c)(3)	9	NA		No
(18) Via Christi Hospital Wichita St Teresa 14800 W St Teresa Wichita,KS67235 27-1965272	Hospital	KS	501(c)(3)	3	NA		No
(19) Via Christi Hospitals Wichita Inc 929 N St Francis Wichita,KS67214 48-1172106	Hospital	KS	501(c)(3)	3	NA		No
(20) VC Immediate Care Mother Mary Anne Inc 929 N St Francis Wichita,KS67214 20-8374099	Med Clinic	KS	501(c)(3)	9	NA		No
(21) Via Christi InMyHome Inc 2622 W Central Suite 100 Wichita,KS67203 27-1889960	Hlth Agency	KS	501(c)(3)	9	NA		No
(22) Via Christi Property Services Inc 1100 N St Francis Suite 240 Wichita,KS67214 48-0948571	Property Mgmt	KS	501(c)(4)	N/A	NA		No
(23) Via Christi Rehabilitation Hospital Inc 1151 N Rock Road Wichita,KS67206 48-1158274	Rehab	KS	501(c)(3)	3	NA		No
(24) Via Christi Village Georgetown Inc 1655 S Georgetown Wichita,KS67218 48-1129325	Rtrmnt Home	KS	501(c)(3)	9	NA		No
(25) Via Christi Village Manhattan Inc 2800 Willowgrove Rd Manhattan,KS66502 48-1078862	Rtrmnt Home	KS	501(c)(3)	9	NA		No
(26) Via Christi Village McLean Inc 777 N McLean Blvd Wichita,KS67203 48-1247723	Rtrmnt Home	KS	501(c)(3)	9	NA		No
(27) Via Christi Village Ponca City Inc 1601 Academy Road Ponca City,OK74604 73-1153337	Rtrmnt Home	OK	501(c)(3)	9	NA		No
(28) Via Christi Village Pittsburg Inc 1502 E Centennial Dr Pittsburg,KS66762 74-3070971	Rtrmnt Home	KS	501(c)(3)	9	NA		No
(29) Via Christi Villages Inc 2622 W Central Suite 100 Wichita,KS67206 48-0559086	Mgmt Co	KS	501(c)(3)	11-III FI	NA		No
(30) Wamego Hospital Association 711 Genn Drive Wichita,KS66547 72-1526400	Hospital	KS	501(c)(3)	3	MRHC		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2011

Page 2

Part III

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) Ambulatory Surgery Center LP 8200 E Thorn Drive Suite 300 Wichita,KS67226 48-1007220	Surgery Ctr	KS	NA	N/A	0	0		No	0		No	0 %
(2) AMS Diagnostics LLC 8200 E Thorn Drive Suite 300 Wichita,KS67226 48-1223653	Radiology Svc	KS	NA	N/A	0	0		No	0		No	0 %
(3) Kansas Surgery and Recovery Ctr 8200 E Thorn Drive Suite 300 Wichita,KS67226 48-1148580	Surgery Ctr	KS	NA	N/A	0	0		No	0		No	0 %
(4) Mercy Imaging LLC 8200 E Thorn Drive Suite 300 Wichita,KS67226 48-1251984	Diagnostic Im	KS	na	N/A	0	0		No	0		No	0 %
(5) MR Imaging Center LLC 8200 E Thorn Drive Suite 300 Wichita,KS67226 48-1000538	Radiology Svc	KS	NA	N/A	0	0		No	0		No	0 %
(6) PFI LLC 8200 E Thorn Drive Suite 300 Wichita,KS67226 72-1557076	Med Chem Mfg	KS	NA	Related	66,008	13,173		No	0		No	3.165 %
(7) Preferred PET Imaging of KS LLC 8200 E Thorn Drive Suite 300 Wichita,KS67226 48-1250123	Diagnostic Im	KS	NA	N/A	0	0		No	0		No	0 %
(8) St Joseph MRI LLC 8200 E Thorn Drive Suite 300 Wichita,KS67226 48-1007220	Medical Svcs	KS	NA	N/A	0	0		No	0		No	0 %
(9) Via Christi Cyberknife LLC 8200 E Thorn Drive Suite 300 Wichita,KS67226 35-4588711	Radiology Svc	KS	NA	N/A	0	0		No	0		No	0 %

Part IV

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership
(1) Affiliated Medical Services Lab Inc 2916 E Central Wichita,KS67214 48-1239522	Medical Lab	KS	na	C Corp	0	0	0 %
(2) Integrated Healthcare Systems Inc 3311 East Murdock Wichita,KS67208 48-0941549	Clinic Svcs	KS	NA	C Corp	0	0	0 %
(3) Sunflower Assurance LTD PO Box 1085 Grand Cayman KY1-1102 CJ 98-0223159	Insurance Co	CJ	NA	Foreign Corp	0	0	0 %
(4) Via Christi Clinic PA 3311 East Murdock Wichita,KS67208 48-0993446	Prof Assoc	KS	NA	C Corp	0	0	0 %
(5) VCH Iowa PC 8200 E Thorn Drive Suite 300 Wichita,KS67226 27-3983977	Holding Co	IA	NA	Trust	0	0	0 %
(6) VCH Iowa PC Trust 8200 E Thorn Drive Suite 300 Wichita,KS67226 27-6937322	Ben Trust	IA	NA	Trust	0	0	0 %

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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

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

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

Yes

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

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

Yes

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of other organization	(b) Transaction type(a-r)	(c) Amount involved	(d) Method of determining amount involved
(1) Mount Carmel Foundation	r	400,000	FMV
(1)
(2)
(3)
(4)
(5)
(6)

Schedule R (Form 990) 2011

Page 4

Part VI

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

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

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

Schedule R (Form 990) 2011

Page 5

Part VII

Supplemental Information

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

Identifier	Return Reference	Explanation
Related Tax Exempt Organizations	Part II	VIA CHRISTI HOSPITAL PITTSBURG, INC. IS CONTROLLED BY VIA CHRISTI HEALTH, INC. VIA CHRISTI HEALTH, INC. IS JOINTLY SPONSORED AND CONTROLLED BY ASCENSION HEALTH AND MARIAN HEALTH SYSTEM, WHICH IN TURN ARE SPONSORED BY THE SISTERS OF THE SORROWFUL MOTHER, FOUR PROVINCES OF THE DAUGHTERS OF CHARITY, THE CONGREGATION OF ST. JOSEPH, AND THE SISTERS OF ST. JOSEPH OF CARONDELET. DUE TO SUCH SPONSORSHIP AND CONTROL, AND IN THE INTEREST OF INCREASED CLARITY AND TRANSPARENCY, BOTH ASCENSION HEALTH AND MARIAN HEALTH SYSTEM ARE BEING LISTED AS RELATED ORGANIZATIONS ON SCHEDULE R.

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: Inspired by the Gospel and our Catholic tradition, we serve as a healing presence with special concern for our neighbors who are vulnerable.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a).....	3	12
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	952
6	Total number of volunteers (estimate if necessary) ....	6	109
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ..	7a	295,593
b	Net unrelated business taxable income from Form 990-T, line 34 ..	7b	99,038

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	166,641	182,308
9	Program service revenue (Part VIII, line 2g) .........	87,055,068	87,021,247
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	1,633,130	1,689,366
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	2,181,871	1,955,389
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	91,036,710	90,848,310
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	44,715,790	46,268,228
16a	Professional fundraising fees (Part IX, column (A), line 11e).....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f)....	35,908,636	39,223,893
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	80,624,426	85,492,121
19	Revenue less expenses. Subtract line 18 from line 12.......	10,412,284	5,356,189
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	88,963,055	116,130,505
21	Total liabilities (Part X, line 26).............	11,142,992	26,369,656
22	Net assets or fund balances. Subtract line 21 from line 20.....	77,820,063	89,760,849

Sign Here

	Signature of officer	Date

	Type or print name and title.


4a	(Code: ) (Expenses $ 68,785,802 including grants of $ ) (Revenue $ 87,967,873 )
	As a part of Via Christi Health, Inc. we share this Mission: Inspired by the Gospel and our Catholic tradition, we serve as a healing presence with special concern for our neighbors who are vulnerable. An expanded description of the organization's program services can be found on Schedule O.

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$ 68,785,802

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	4,211,716	991,801	426,091

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)			(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) Ali Hammad Physician	50.0	X		902,583	0	32,056
(19) Bashar Marji Physician	50.0	X		930,591	0	28,749
(20) Boban Mathew Physician	50.0	X		647,415	0	33,993
(21) Danny Reveal Physician	50.0	X		557,662	0	28,736
(22) Connie McCune Former VP HR; Term. 1/28/11	0.0		X	194,640	0	1,179

				(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
e	Government grants (contributions)1e		175,205

f	All other contributions, gifts, grants, and similar amounts not included above1f		7,103
g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			182,308
			Business Code
2a	PATIENT SERVICE REVENUE		621,110	85,060,396	85,060,396
b	LABORATORY SERVICES		621,500	260,851	144,932	115,919
c	MEANINGFUL USE REVENUE		621,110	1,700,000	1,700,000
d
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			87,021,247
3	Investment income (including dividends, interest
	and other similar amounts).....			956,463			956,463
4	Income from investment of tax-exempt bond proceeds..			0
5	Royalties............			0
		(i) Real	(ii) Personal
6a	Gross rents	205,611
b	Less: rental expenses	134,343
c	Rental income or (loss)	71,268
d	Net rental income or (loss).......			71,268			71,268
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	774,133	1,931
b	Less: cost or other basis and sales expenses		43,161
c	Gain or (loss)	774,133	-41,230
d	Net gain or (loss)..........			732,903			732,903
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...			0
10a	Gross sales of inventory, less returns and allowances .
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..			0
Miscellaneous Revenue			Business Code
11a	CAFETERIA		900,099	434,718			434,718
b	CATERING		722,320	139,794		40,560	99,234
c	DURABLE MEDICAL EQUIPMENT		621,610	50,716		50,716
d	All other revenue ....			1,258,893	991,277	88,398	179,218
e	Total. Add lines 11a–11d ......			1,884,121
12	Total revenue. See Instructions....			90,848,310	87,896,605	295,593	2,473,804


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing ..........			18,824,000	1	5,959,773
2	Savings and temporary cash investments .......			22,803,154	2	37,644,556
3	Pledges and grants receivable, net .........			0	3	0
4	Accounts receivable, net .........			10,033,207	4	12,891,873
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........			0	5	0
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........			0	6	0
7	Notes and loans receivable, net .............			0	7	0
8	Inventories for sale or use ..............			1,957,745	8	2,195,332
9	Prepaid expenses and deferred charges ............			333,627	9	184,608
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	86,517,390
b	Less: accumulated depreciation. .....	10b	48,767,183	33,674,501	10c	37,750,207
11	Investments—publicly traded securities ..........			0	11	0
12	Investments—other securities. See Part IV, line 11 ......			0	12	0
13	Investments—program-related. See Part IV, line 11 ..			0	13	0
14	Intangible assets .........			0	14	0
15	Other assets. See Part IV, line 11 ...........			1,336,821	15	19,504,156
16	Total assets. Add lines 1 through 15 (must equal line 34)...			88,963,055	16	116,130,505
17	Accounts payable and accrued expenses .			11,036,349	17	7,145,573
18	Grants payable ..........			0	18	0
19	Deferred revenue ..........			0	19	5,915
20	Tax-exempt bond liabilities ..........			0	20	0
21	Escrow or custodial account liability. Complete Part IV of Schedule D..			0	21	0
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........			0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..			0	23	0
24	Unsecured notes and loans payable to unrelated third parties ....			0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.....			106,643	25	19,218,168
26	Total liabilities. Add lines 17 through 25.....			11,142,992	26	26,369,656
	Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....			77,820,063	27	89,760,849
28	Temporarily restricted net assets .....			0	28	0
29	Permanently restricted net assets .....			0	29	0
	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 .....			77,820,063	33	89,760,849
34	Total liabilities and net assets/fund balances .....			88,963,055	34	116,130,505