TY 2012 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) SISTER JANICE SCHNEIDER OSF........................................................................ BOARD VICE-CHAIRPERSON	1.0 .......................	X	X	0	0	0
(2) MARYANN REESE........................................................................ PRESIDENT & CEO	60.0 .......................	X	X	0	428,003	92,918
(3) WILLIAM S LYKE........................................................................ BOARD CHAIRPERSON	1.0 .......................	X	X	0	0	0
(4) THOMAS M EGAN........................................................................ BOARD SECRETARY	1.0 .......................	X	X	0	0	0
(5) REV JAMES E DEITERS........................................................................ BOARD MEMBER	1.0 .......................	X		0	0	0
(6) STEPHANIE STRANO-MAINE........................................................................ BOARD MEMBER	1.0 .......................	X		0	0	0
(7) JIM CLANAHAN MD........................................................................ BOARD MEMBER	1.0 .......................	X		0	0	0
(8) JACQUELYN M CLEMENT PHD........................................................................ BOARD MEMEBER	1.0 .......................	X		0	0	0
(9) SISTER MARYBETH CULNAN OSF........................................................................ BOARD MEMBER	1.0 .......................59.0	X		0	0	0
(10) J DAVID MCCAUSLAND........................................................................ BOARD MEMBER	1.0 .......................	X		0	0	0
(11) RICHARD J THOMAN........................................................................ BOARD MEMBER	1.0 .......................	X		0	0	0
(12) ANWAR KHAN MD........................................................................ BOARD MEMBER	1.0 .......................	X		40,008	0	0
(13) ANN M CARR........................................................................ TREASURER	.25 .......................59.75		X	0	272,146	138,031
(14) MARK REIFSTECK........................................................................ DIVISION CEO	19.0 .......................41.0		X	0	495,721	98,441
(15) JOHNNY E WATKINS........................................................................ DIVISION CFO	19.0 .......................41.0		X	274,329	0	45,867
(16) LESLIE LOVSHIN........................................................................ CHIEF FINANCIAL OFFICER	60.0 .......................		X	156,068	0	20,152
(17) SHELLEY HARRIS........................................................................ CHIEF NURSING OFFICER	60.0 .......................		X	170,108	0	61,782

(A) Name and business address	(B) Description of services	(C) Compensation
PROFESSIONAL THERAPY SERVICES INC, 2810 FRANK SCOTT PKWY WEST SUITE 8BELLEVILLEIL62223	Physical Therapy	3,192,926
SODEXO OPERATIONS LLC, 4880 Payshere CircleCHICAGOIL60674	Food service	1,579,948
SLU CARE, 1402 S Grand BlvdST LOUISMO63104	Physician services	1,241,443
AMPHION MEDICAL SOLUTIONS, 8301 EXCELSIOR DRIVEMADISONWI53717	TRANSCRIPTION SERVIC	668,457
SOUTHERN IL CARDIOVASCULAR, 211 S 3RD STBELLEVILLEIL62220	CARDIOVASC SERVICES	630,000
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 34

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 ....	1,283,483	674,547	608,936
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	51,786,337	46,326,327	5,460,010
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	5,395,626	4,778,576	617,050
9	Other employee benefits .......	10,112,998	8,524,415	1,588,583
10	Payroll taxes ...........	3,777,926	3,345,878	432,048
11	Fees for services (non-employees):
a	Management ......	2,889,198		2,889,198
b	Legal .........	561,173		561,173
c	Accounting ...........	0
d	Lobbying ...........	33,420	33,420
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........	25,590,647	22,303,948	3,286,699
12	Advertising and promotion ....	115,725		115,725
13	Office expenses .......	1,004,854	789,517	215,337
14	Information technology ......	10,348,903	513,452	9,835,451
15	Royalties ..	0
16	Occupancy ...........	3,716,790	3,716,790
17	Travel ............	138,717	81,232	57,485
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0
19	Conferences, conventions, and meetings ....	40,560	35,349	5,211
20	Interest ...........	857,165		857,165
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization .....	8,864,301	7,036,670	1,827,631
23	Insurance ..............	3,202,511	469,645	2,732,866
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MEDICAL SUPPLIES	21,304,346	21,304,346
b	PROVISION FOR BAD DEBTS	17,624,150	17,624,150
c	LICENSE AND TAXES	7,129,066	7,128,118	948
d	MAINTENANCE & REPAIRS	3,651,868	3,340,414	311,454
e	All other expenses	577,934	185,801	392,133
25	Total functional expenses. Add lines 1 through 24e	180,007,698	148,212,595	31,795,103	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 Check if Schedule O contains a response to any question in this Part X ...............
	1	Cashnon-interest-bearing .............	0	1	0
2	Savings and temporary cash investments .........	-4,023,125	2	2,288,153
3	Pledges and grants receivable, net ...........	7,247,610	3	2,684,512
4	Accounts receivable, net .............	32,423,111	4	27,297,099
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
		0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
		0	6	0
7	Notes and loans receivable, net .............	101,817	7	297,060
8	Inventories for sale or use ..............	2,566,401	8	2,421,397
9	Prepaid expenses and deferred charges ..........	1,016,709	9	678,601
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	205,761,675
b	Less: accumulated depreciation .....	10b	145,497,797	62,250,125	10c	60,263,878
11	Investments—publicly traded securities ..........	16,615,232	11	13,255,350
12	Investments—other securities. See Part IV, line 11 .....	0	12	0
13	Investments—program-related. See Part IV, line 11 .....	3,944,776	13	4,331,971
14	Intangible assets ...............	0	14	0
15	Other assets. See Part IV, line 11 ...........	472,696	15	217,158
16	Total assets. Add lines 1 through 15 (must equal line 34)......	122,615,352	16	113,735,179
	17	Accounts payable and accrued expenses .........	15,389,849	17	15,865,587
18	Grants payable .................	0	18	0
19	Deferred revenue ................	9,199	19	0
20	Tax-exempt bond liabilities .............	62,791,810	20	68,436,234
21	Escrow or custodial account liability. Complete Part IV of Schedule D..	0	21	0
22	Loans and other 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....................	49,451,525	25	33,470,106
26	Total liabilities. Add lines 17 through 25.........	127,642,383	26	117,771,927
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............	-11,327,023	27	-10,926,920
28	Temporarily restricted net assets ...........	6,226,005	28	6,798,100
29	Permanently restricted net assets ...........	73,987	29	92,072
	Organizations that do not follow SFAS 117 (ASC 958), 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 ...........	-5,027,031	33	-4,036,748
34	Total liabilities and net assets/fund balances ........	122,615,352	34	113,735,179

- TIN:

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

2012

Open to Public
Inspection

Name of the organization

ST ELIZABETH'S HOSPITAL OF THE HOSPITAL
SISTERS OF THE THIRD ORDER OF ST FRANCIS

Employer identification number

37-0663567

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 described in 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. See section 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 - Non-functionally integrated

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


Total

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2012

Page 2

Part II

Support Schedule for Organizations Described in Sections 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) 2008	(b) 2009	(c) 2010	(d) 2011	(e) 2012	(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) 2008	(b) 2009	(c) 2010	(d) 2011	(e) 2012	(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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
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 2012 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2011 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2012. 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—2011. If the organization did not check a 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—2012. 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—2011. 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) 2012

Page 3

Part III

Support Schedule for Organizations Described in Section 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) 2008	(b) 2009	(c) 2010	(d) 2011	(e) 2012	(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) 2008	(b) 2009	(c) 2010	(d) 2011	(e) 2012	(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.)..

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 2012 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2011 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2011 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2012. 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—2011. 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) 2012

Page 4

Part IV

Supplemental Information. Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and 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) 2012

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

2012

Name of the organization

ST ELIZABETH'S HOSPITAL OF THE HOSPITAL
SISTERS OF THE THIRD ORDER OF ST FRANCIS

Employer identification number

37-0663567

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) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Page 2

Name of organization ST ELIZABETH'S HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCIS

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) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Page 3

Name of organization ST ELIZABETH'S HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCIS

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) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Page 4

Name of organization
ST ELIZABETH'S HOSPITAL OF THE HOSPITAL
SISTERS OF THE THIRD ORDER OF ST FRANCIS

Employer identification number

37-0663567

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) (2012)

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

2012

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, Part V, line 35c (Proxy Tax), then
Round Bullet

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

Name of the organization

ST ELIZABETH'S HOSPITAL OF THE HOSPITAL
SISTERS OF THE THIRD ORDER OF ST FRANCIS

Employer identification number

37-0663567

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2012

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 SchCMd Bullet

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 SchCMd Bullet

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) 2009	(b) 2010	(c) 2011	(d) 2012	(e) Total

2a	Lobbying nontaxable 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) 2012

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

33,420

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

33,420

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, line 5; Part II-A (affiliated group list); Part II-A, line 2; and Part ll-B, line 1. Also, complete this part for any additional information.

Identifier	Return Reference	Explanation
DESCRIPTION OF OTHER LOBBYING ACTIVITIES	SCHEDULE C, PART II-B, QUESTION 1I	ST. ELIZABETH'S HOSPITAL ("THE HOSPITAL") IS A MEMBER OF THE CATHOLIC HEALTH ASSOCIATION ("CHA"), THE ILLINOIS HEALTH ASSOCIATION ("IHA"), THE NATIONAL ASSOCIATION FOR HOME CARE AND HOSPICE, AND THE AMERICAN HEALTH ASSOCIATION ("AHA"). AS A MEMBER OF THESE ORGANIZATIONS, THE HOSPITAL PAYS DUES, PART OF WHICH ARE ATTRIBUTABLE TO LOBBYING FEES PAID BY THE ORGANIZATIONS. THE AMOUNT LISTED ABOVE IS THE AMOUNT ATTRIBUTABLE TO THE HOSPITAL FROM ITS DUES PAID.

Schedule C (Form 990 or 990EZ) 2012

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

2012

Open to Public Inspection

Name of the organization

ST ELIZABETH'S HOSPITAL OF THE HOSPITAL
SISTERS OF THE THIRD ORDER OF ST FRANCIS

Employer identification number

37-0663567

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 section 170(h)(4)(B)(ii)? .......................................

Yes No

In Part XIII, 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 XIII, 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 Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2012

Page 2

Part III

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

Using the organization’s acquisition, 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 XIII.

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 XIII 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 XIII. Check here if the explanation has been provided in Part XIII ........

Part V

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

		(a)Current year	(b)Prior year	b (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 current year end balance (line 1g, column (a)) 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 XIII 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 .................	3,630,755		3,630,755
b	Buildings ................	118,768,466	82,385,041	36,383,425
c	Leasehold improvements ............	359,390	209,365	150,025
d	Equipment ................	72,855,752	57,395,352	15,460,400
e	Other .................	10,147,312	5,508,039	4,639,273
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				60,263,878

Schedule D (Form 990) 2012

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









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

Part X

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

1.(a) Description of liability		(b) Book value
Federal income taxes		0
ACCRUED BENEFIT LIABILITY		21,639,040
RETIREMENT OBLIGATION ASBESTOS		8,487,877
SELF INSURANCE COST		3,343,189






Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		33,470,106
2. Fin 48 (ASC 740) Footnote. In Part XIII, 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 (ASC 740). Check here if the text of the footnote has been provided in Part XIII .....................................................

Schedule D (Form 990) 2012

Page 4

Part XI 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 XIII.) ............	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 XIII.) ...........	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 XII 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 XIII.) ............	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 XIII.) ............	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 XIII

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, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Identifier	Return Reference	Explanation
FIN 48 (ASC 740 FOOTNOTE)	SCHEDULE D, PART X, LINE 2	HSHS HAS ADOPTED ASC SUBTOPIC 740-10, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES - AN INTERPRETATION OF FASB STATEMENT NO. 109. ASC SUBTOPIC 740-10 ADDRESSES THE DETERMINATION OF HOW TAX BENEFITS CLAIMED OR EXPECTED TO BE CLAIMED ON A TAX RETURN SHOULD BE RECORDED IN THE CONSOLIDATED FINANCIAL STATEMENTS. UNDER ASC SUBTOPIC 740-10, HSHS MUST RECOGNIZE THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY THE TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE TAX BENEFITS RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS FROM SUCH A POSITION ARE MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50% LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT. ASC SUBTOPIC 740-10 ALSO PROVIDES GUIDANCE ON DERECOGNITION, CLASSIFICATION, INTEREST, AND PENALTIES ON INCOME TAXES, ACCOUNTING IN INTERIM PERIODS AND REQUIRES INCREASED DISCLOSURES. AT THE DATE OF ADOPTION, AND AS OF JUNE 30, 2013 AND 2012, HSHS DOES NOT HAVE A LIABILITY FOR UNRECOGNIZED TAX BENEFITS.

Schedule D (Form 990) 2012

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

2012

Open to Public Inspection

Name of the organization

ST ELIZABETH'S HOSPITAL OF THE HOSPITAL
SISTERS OF THE THIRD ORDER OF ST FRANCIS

Employer identification number

37-0663567

Part I

Financial Assistance 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) as a factor in determining 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 as a factor in determining 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 600 %

If the organization used factors other than FPG in determining 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, as a factor in determining 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

Financial Assistance and Means-Tested Government Programs		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) ..			4,398,861		4,398,861	2.710 %
b	Medicaid (from Worksheet 3, column a) ....			28,199,365	18,468,242	9,731,123	5.990 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) .
d	Total Financial Assistance and Means-Tested Government Programs .			32,598,226	18,468,242	14,129,984	8.700 %
Other Benefits		32	8,395	337,219		337,219	0.210 %
e	Community health improvement services and community benefit operations (from Worksheet 4) ..	32	8,395	337,219		337,219	0.210 %
f	Health professions education (from Worksheet 5) ..	7	1,100	2,393,055	584,365	1,808,690	1.110 %
g	Subsidized health services (from Worksheet 6) ..
h	Research (from Worksheet 7)	1	4,289	176,908		176,908	0.110 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8)	7	3,642	62,740		62,740	0.040 %
j	Total. Other Benefits ..	47	17,426	2,969,922	584,365	2,385,557	1.470 %
k	Total. Add lines 7d and 7j .	47	17,426	35,568,148	19,052,607	16,515,541	10.170 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2012

Schedule H (Form 990) 2012

Page

Part II

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

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support	7	875	42,567	42,567	0.030 %
4	Environmental improvements
5	Leadership development and training for community members	2	320	1,726	1,726
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other	1	350	218	218
10	Total	10	1,545	44,511	44,511	0.030 %

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. Explain in Part VI the methodology used by the organization to estimate this amount. ......

17,624,150

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

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

50,336,141

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

48,493,111

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

1,843,030

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(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %
1MEM & ST ELIZ'S	HEALTHCARE	50.000 %
2HEALTHCARE SVS
3SOUTHERN ILLINOIS	FACILITATE CARDIOVASCULAR SVS	50.000 %
4CARDIOVASCULAR FAC
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2012

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?1 Name, address, and primary website address
1	St Elizabeth's Hospital 211 South 3rd Street Belleville,IL62220	X

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices

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

	St Elizabeth's Hospital
Name of hospital facility or facility reporting group

For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A)

Yes

Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9....................

Yes

If “Yes,” indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Part VI)

Indicate the tax year the hospital facility last conducted a CHNA: 20 12

In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? 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 ....................

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................

Did the hospital facility make its CHNA report widely available to the public? .............

Yes

If “Yes,” indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website

Available upon request from the hospital facility

Other (describe in Part VI)

If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):

Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA

Execution of the implementation strategy

Participation in the development of a community-wide plan

Participation in the execution of a community-wide plan

Inclusion of a community benefit section in operational plans

Adoption of a budget for provision of services that address the needs identified in the CHNA

Prioritization of health needs in its community

Prioritization of services that the hospital facility will undertake to meet health needs in its community

Other (describe in Part VI)

Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ...........................

If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ......

If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2012

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Part VFacility Information (continued)

Financial Assistance Policy			Yes	No
9	Did the hospital facility have in place during the tax year a written financial assistance policy that:
	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?	9	Yes
10	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........	10	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 150.% If "No," explain in Part VI the criteria the hospital facility used.
11	Used FPG to determine eligibility for providing discounted care?.................	11	Yes
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 600.% If "No," explain in Part VI the criteria the hospital facility used.
12	Explained the basis for calculating amounts charged to patients?.................	12	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)
13	Explained the method for applying for financial assistance?...................	13	Yes
14	Included measures to publicize the policy within the community served by the hospital facility?.......	14	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 website
b	The policy was attached to 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 on admission to the hospital facility
f	The policy was available upon request
g	Other (describe in Part VI)
Billing and Collections
15	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?.......	15	Yes
16	Check all of the following 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)
17	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?..........	17		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)

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the patients regarding the patients’ bills

Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Part VI)

Policy Relating to Emergency Medical Care

Yes

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?..........

Yes

If “No,” indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)

Other (describe in Part VI)

Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)

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.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Part VI)

During the tax year, did the hospital facility charge any FAP-eligible individuals 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? ............................

If “Yes,” explain in Part VI.

During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? .........................

If “Yes,” explain in Part VI.

Schedule H (Form 990) 2012

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) 2012

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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; Part V, Section A; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
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.
8	Facility reporting group(s). If applicable, for each hospital facility in a facility reporting group provide the descriptions required for Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.

Identifier	ReturnReference	Explanation
PART I, LINE 3C		Not applicable, St. Elizabeth's Hospital follows FPG to determine eligibility for providing charity and discounted care to low-income, uninsured and underinsured individuals.
PART I, LINE 6A		The hospital's community benefit report can be accessed at: http://steliz.org/our-hospital/community-benefit/. Part I, Line 7, Column (F) The percentage of charity care and certain other benefits at cost as a percent of total expenses less bad debt is 10.17%. The amount of bad debt removed when calculating Part I, Line 7, Column (F) was $17,624,150.
PART I, LINE 7		The calculation of cost is based on the charges for these services multiplied by the overall cost to charge ratio based on the hospital's financial statements to determine the actual cost of these services.
PART II		Under Community Building Activities, St. Elizabeth's Hospital provides the following community support: Bridges Connections District 201: This program is designed to help special needs students learn marketable skills through on the job training; up to three students receive two hours of supervised job training. Each student progresses through a three phase program. As they progress through each phase of the program, the Hospital absorbs an increasing percentage of the cost. This program enhances this high risk population's ability to be a productive part of our community. Food, clothing, school supply drives and Elizabeth's Garden: Throughout the year, these programs are supported by hospital colleagues to meet community need. Items are donated to local agencies that work with the poor and/or to local food pantries, in turn reducing the burden of government. In FY2013, colleagues donated 2,100 pounds of clothing, 220 pounds of school supplies and 346 pounds of food to a variety of community social service agencies. Mentoring at Henry Raab Elementary School: The school selects students from low income, at risk families who are in need of an adult role model. Directors/Managers spend one-on-one time with their assigned student to both encourage growth and offer assistance with school work and relationship building. This enhances the learning experience of these children, which will increase their chances of graduating and improve their health outcomes. Disaster Preparedness: St. Elizabeth's Hospital has made a significant investment in emergency management preparedness by initially training 15 colleagues in National Incident Management System and Incident Command System. The hospital participates in numerous emergency management drills in cooperation with our local, region and state partners in addition to our required two annual drills. Pathways Alternative High School: Assisted with an outdoor adventure program for Pathways Alternative High School, a high school for students with significant emotional or behavioral issues. Students scaled a climbing tower to develop confidence and interaction skills with adults and their peers. Under Community Building Activities, St. Elizabeth's Hospital also provides the following for leadership development/training for community members: BASIC Initiative: BASIC (Belleville Achieves Strength in Character) is a partnership of schools, the City of Belleville, and the business community to strengthen character in our youth and in the community. BASIC encourages youth and adults to be productive citizens in our community.
PART III, LINE 4		Bad debt expense of HSHS is described on pages 18 and 19 of the audited financial statements, a copy of which is attached to the return.
PART III, LINE 8		The hospital continually strives to provide excellent patient care in the most cost effective manner. In FY2013, St. Elizabeth's Hospital had no Medicare shortfall. The amount reported comes from our most recently filed Medicare Cost Report.
PART III, LINE 9B		EVERY EFFORT IS MADE PRIOR TO, DURING AND AFTER PROVISION OF MEDICAL SERVICES TO DETERMINE WHETHER A PATIENT IS ELIGIBLE FOR CHARITY/COMMUNITY CARE AND TO ASSIST THE PATIENT IN COMPLETING THE APPLICATION AND PROVIDING ADEQUATE DOCUMENTATION. IF THE PATIENT QUALIFIED FOR CHARITY/COMMUNITY CARE FOR THE FULL BALANCE OF THEIR ACCOUNT, THE ENTIRE AMOUNT IS WRITTEN OFF TO CHARITY/COMMUNITY CARE AND HENCE NO DEBT COLLECTION IS PURSUED. IF THE PATIENT QUALIFIED FOR CHARITY/COMMUNITY CARE FOR A PORTION OF THEIR ACCOUNT BALANCE, THAT PORTION IS WRITTEN OFF TO CHARITY/COMMUNITY CARE, WITH THE PATIENT BEING RESPONSIBLE FOR THE REMAINDER OF THE BALANCE. ADDITIONALLY, REASONABLE EFFORT WILL BE MADE TO OBTAIN THIRD-PARTY OR GOVERNMENT PAYER REIMBURSEMENT ON BEHALF OF THE PATIENT. IF THOSE EFFORTS ARE NOT FRUITFUL, AN OFFER WILL BE EXTENDED TO THE PATIENT TO MAKE INSTALLMENT PAYMENTS ON THEIR BALANCE. ONLY AT SUCH POINT THAT THE PATIENT DEFAULTS ON INSTALLMENT PAYMENTS OR REFUSES TO COOPERATE WITH THE HOSPITAL'S EFFORTS TO BE REIMBURSED WILL THE ACCOUNT BE SENT TO COLLECTIONS. FOR ADDITIONAL INFORMATION, SEE RESPONSE TO QUESTION VI, 3. Part V, Section B, 1J During Fiscal Year 2012 (July 1, 2011 to June 30, 2012), a Community Health Needs Assessment (CHNA)was conducted by St. Elizabeths Hospital. The hospitals primary service area, considered part of the greater Metropolitan St. Louis Area, includes both urban and rural areas. The 2012 CHNA process identified and the Board of Directors approved the following three strategic initiatives: . Access to healthcare for the underserved and uninsured . Mental health - decrease depression and rate of suicide . Chronic disease - improve management of diabetes
PART V, LINE 3		IN MARCH 2012, ST. ELIZABETH'S HOSPITAL HOSTED FIVE TWO-HOUR COMMUNITY ENGAGEMENT SESSIONS WITH 10 TO 15 PARTICIPANTS PER SESSION. PARTICIPANTS WERE INVITED BASED ON THEIR AWARENESS AND EXPERTISE IN THE HEALTHCARE NEEDS OF OUR COMMUNITY. EMPHASIS WAS PLACED ON REPRESENTATION OF THE UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS AS WELL AS POPULATIONS WITH CHRONIC DISEASE. NINETY PEOPLE WERE INVITED TO PARTICIPATE. FIFTY-EIGHT PEOPLE ATTENDED ONE OF THE SESSIONS. THE FOLLOWING DESCRIBES THOSE WHO PARTICIPATED AND THE SPECIAL NEED AREAS THEY REPRESENTED ARE SHOWN IN ITALICS: PHYSICIANS (ER, PRIMARY CARE PHYSICIANS, DENTISTS, UROLOGIST) - CHRONIC DISEASE, UNDERSERVED, LOW INCOME, MINORITY PRACTICING NURSES, RETIRED NURSES, HOSPICE NURSES, UNIVERSITY NURSE EDUCATORS, PARISH NURSES - CHRONIC DISEASE BUSINESS LEADERS CIVIC LEADERS (MAYOR'S OFFICE, CHAMBER OF COMMERCE, ALDERMEN) LEGAL COMMUNITY (LAWYER AND JUDGE, ADVISOR FOR THE LEGAL AID SOCIETY) - LOW INCOME, MINORITY HEALTH AGENCIES (AMERICAN CANCER, CALL FOR HELP, FIRST RESPONDERS/EMS) - CHRONIC DISEASE, UNDERSERVED, MINORITY, LOW INCOME COMMUNITY SERVICE AGENCY DIRECTORS - UNDERSERVED, MINORITY, LOW INCOME SCHOOLS REPRESENTATION (PRIMARY AND SECONDARY REPRESENTATION) - UNDERSERVED, MINORITY, LOW INCOME MENTAL HEALTH AGENCY DIRECTORS (INCLUDING ALCOHOL AND DRUG ADDICTION EXPERTS) - UNDERSERVED, MINORITY, LOW INCOME PARENTS OF SPECIAL NEEDS CHILDREN - UNDERSERVED HISPANIC SERVICE AGENCY - UNDERSERVED, MINORITY, LOW INCOME RELIGIOUS LEADERS - INNER CITY AND RURAL - MINORITY, LOW INCOME AGENCY FOR THE AGING - MINORITY MILITARY COMMANDER FOR SCOTT AIR FORCE BASE HEALTH SERVICES COMMUNITY INPUT WAS ALSO OBTAINED THROUGH A HOUSEHOLD SURVEY.
PART V, LINE 4		ST. ELIZABETH'S HOSPITAL CONDUCTED THE COMMUNITY HEALTH NEEDS ASSESSMENT IN COLLABORATION WITH THE ST. CLAIR COUNTY HEALTH DEPARTMENT, KARLA SMITH FOUNDATION AND 708 MENTAL HEALTH BOARD.
PART V, LINE 5C		The CHNA Report is posted on our Hospital website at: http://steliz.org/our-hospital/community-benefit. In addition, the report is posted on our Hospital Intranet Mission page for our colleagues and was shared with the St. Clair County Health Care Commission at their quarterly meeting in July, 2012.
PART V, LINE 7		The St. Elizabeth's Hospital Board of Directors approved the Community Benefit Implementation Strategy based on the FY2012 CHNA. The approved Implementation Strategy was executed in our FY2013. Based on hospital capabilities, resources, severity of the need, and other factors, St. Elizabeth's addressed three areas: . Improve access to healthcare, especially for those who are uninsured or underinsured . Mental health, reduce the rate of depression and suicide in the adult population in the County . Chronic disease, educate and empower diabetics to live a healthier lifestyle The following additional needs were identified and were not addressed directly by the hospital in FY2013 for the reasons indicated. . Mental health - Appropriate services for uninsured: this was partly addressed as a corollary of the Mental Health Suicide/Depression initiative. . Consolidation of community health/resource information: St. Elizabeth's Hospital lacks the expertise to develop and maintain this data base. United Way maintained a data base in their "211" system. . Develop responsibility for one's healthcare: St. Elizabeth's Hospital addresses this issue on a case by case basis (not community level) through our Social Service Department . Geriatric population (access medical/psychiatric): St. Elizabeth's Hospital provides inpatient and outpatient care as part of the Behavioral Healthcare Service line to this population. The hospital lacks adequate space to establish a separate Geriatric-psych program. Addressing the lack of geriatric trained physicians is beyond the scope of this facility. . Violence prevention and safety: This need is an identified need in the IPLAN (Illinois Project for Local Assessment of Needs). The St. Clair County Health Department is the lead agency addressing this need. St. Elizabeth's Hospital lacks the ability to address this issue in any meaningful way. . Lung Cancer and COPD: This need is an identified need in the IPLAN. This issue is being addressed by the hospital, St. Clair County Health Department and other community based programs. . Material and Child Health as related to Infant Mortality, Teen Pregnancy and STD/HIV: This need is an identified need in the IPLAN . The hospital currently has a level 2 NICU with pediatrician on the medical staff, but lacks the required resources to further enhance programs for maternal and child health at this time. PART V, LINE 12h Yes, the Financial Assistance Policy contains a detailed description of the Purpose, Definitions and Guidelines for financial assistance. PART V, LINE 14g Yes, section I of the Financial Assistance Policy describes the "Communication of the Financial Assistance Program to Patients" in detail.
2, NEEDS ASSESSMENT		Traditionally, St. Elizabeth's Hospital works closely with the St. Clair County Health Department and participates in developing the County's IPLAN. The IPLAN is a community health assessment and planning process that is conducted every five years by the local health jurisdictions in Illinois. In the past, the IPLAN was used to help determine the hospital's community benefit improvement strategies. In FY2012, a team consisting of a Hospital Administrative Consultant, the Director of Mission Integration and the Director of Pastoral Care facilitated the CHNA for the hospital in collaboration with the St. Clair County Health Department. St. Elizabeth's Hospital's parent organization, Hospital Sisters Health System (HSHS), established a goal for all 13 of its hospitals to complete a CHNA by the end of Fiscal Year 2012. HSHS selected Leede Research, a marketing research firm specializing in health care information, to complete an independent health needs assessment survey of our community. Leede utilized a set of standard health assessment questions and locally defined custom questions. In December 2011, Leede completed 400 telephone surveys in the hospital's primary service area. St. Elizabeth's FY2012 CHNA integrated the following data sources to develop our implementation strategy: . Leede Research Survey . St. Clair County Health Department IPLAN . Missouri Hospital Association - Assessing the Health of Communities . University of Wisconsin County Health Rankings . Dignity Health Community Need Index In March 2012, St. Elizabeth's hosted five two-hour Community Engagement sessions with 10 to 15 participants per session. Participants were invited based on their awareness and expertise in the healthcare needs of our community. Emphasis was placed on representation of underserved, low-income and minority populations as well as populations with chronic disease. Ninety people were invited to participate. Fifty-eight people attended at least one of the sessions. Each session identified the five most significant health needs in our service area, utilizing all of the health data provided, the needs identified in a brainstorming session and the participants' personal expertise to formulate their table's top five health needs. 1. Access to Health Care . Clinics for uninsured . Lack of Primary Care Providers . Insurance costs 2. Education . Healthy living . Healthcare resources . End of Life 3. Mental Health/Addictions 4. Chronic Issues . Diabetes . Cardiac/Pulmonary . Obesity 5. Services . Geriatric . Special needs . Mother/Child The 16 member Community Benefit Steering Committee evaluated the data sources and the Community Engagement Groups results with the hospital's mission and resources. The goal was to determine the needs of our community that could best be addressed by St. Elizabeth's Hospital. This committee represented clinical specialties from the hospital as well as experts from the community, (Director of Community Health, St. Clair County Health Department; Executive Director, St. Clair County 708 Mental Health Board; President Karla Smith Foundation, Suicide and Family Support Group; Pastor, St. Paul's United Church of Christ in Lebanon, IL ). Using four criteria, the Steering Committee members rank ordered the list of health needs identified by the Community Engagement Groups: . Meets the mission of the Hospital . The magnitude of the need . The feasibility or available resources to address those needs . The severity of the health need in our community The Steering Committee identified three primary needs: . Access to healthcare, especially for those who are uninsured or underinsured . Mental health, reduce the rate of depression and suicide in the adult population in the County . Chronic disease, educate and empower diabetics to live a healthier lifestyle Hospital colleagues and community members were assigned to each of the top three health needs. Each committee then focused on one specific priority to define the implementation strategy, taking into account the assets in the community available to help address the health need. Goals, objectives, and indicators were then developed to measure success. St. Elizabeth's Hospital Board of Directors, which includes representation from Religious Leaders, Community Service, Education, Advocacy, Physicians, Expertise in Governance, Business, Organization and Planning, reviewed the FY2013 Community Benefit Implementation Strategy for addressing priorities identified in the most recent CHNA. This report was approved by the Board of Directors Executive Committee on May 25, 2012. The Community Health Needs and associated implementation strategy was used to guide our efforts in FY2013.
3, PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE		The Patient Access Department provides each patient with information about the Christian Assistance Program (CAP) available at St. Elizabeth's Hospital. Patients receive a contact phone number for further assistance. Information about the Christian Assistance Program is also available on the hospital's web site along with the application form and contact numbers. The hospital has a representative on site to assist patients who may be eligible for Medicaid assistance through the Illinois Department of Public Assistance. The hospital representative works with patients and assists them with the application process. Patients determined ineligible for Medicaid are given a CAP Application form and instruction letter with a phone number to contact for further help in making application for assistance. Assistance is provided as needed. Each bill that a patient receives has information about the Christian Assistance Program and a phone number to contact for help in applying. Patients who come to the Cashier's Office are given information about payment options, including the Christian Assistance Program. Even after an account is sent to a collection agency and/or anytime in the process they believe a patient may be eligible for Christian Assistance, the account is returned to the hospital and evaluated for Christian Assistance.
4, COMMUNITY INFORMATION		Belleville, the County Seat for St. Clair County, has a population of 43,756. St. Clair County has a population of 270,259. In St. Clair County, 10% of the population lives in rural communities. The median household income is $49,634 compared to the National income of $53,271. 19.4% of population lives below the poverty line. 27.4% of families earn less than $25,000 a year. Families living below the poverty level was 9.3% compared to National average of 9.2%. In St. Clair County, 8.2% of the population is covered by Medicaid compared to 7.5% for the State. Percent of uninsured adults, non-seniors in the County is 12% compared to 16% for the State of Illinois. The 2013 County Health Rankings rates St. Clair County for Health Factors at 88 out of 102 counties in Illinois (one is best, 102 is worst ranking). (Data from county Health Rankings and US Census data) The primary service area for St. Elizabeth's Hospital covers most of St. Clair County. The secondary service area extends into Monroe, Clinton, Randolph and Madison Counties. Total population of the primary and secondary service area is 353,346 (2010 Census). St. Elizabeth's Hospital also serves as a referral hospital in Hospital Sisters Health System's Southern Illinois Division which includes St. Joseph's Hospital in Highland, St. Joseph's Hospital in Breese and St. Anthony's Memorial Hospital in Effingham. St. Elizabeth's has served this community since its founding in 1875 by the Hospital Sisters of St. Francis. The hospital currently staffs 260 inpatient beds. The hospital employs 1,349 colleagues. Inpatient admissions for Fiscal Year 2013 were 11,361. The Emergency Department had 27,749 visits and admitted 6.322 to inpatient services. The Urgicare Center in O'Fallon, an offsite facility, had 19,440 visits. Total Outpatient visits for the hospital were 161,310. St. Elizabeth's Hospital is a recognized Accredited Chest Pain Center since 2004. The Center received the American Heart Association Mission Life Line Bronze Award for overall Cardiac Care. The Intensive Care Unit for the past five years has been recognized to be in the Top 10% in the nation.
5, PROMOTION OF COMMUNITY HEALTH		St. Elizabeth's Hospital offers hope to our community in the tradition of the Hospital Sisters of St. Francis. As a healing ministry of the Catholic Church and an affiliate of the Hospital Sisters Health System (HSHS), St. Elizabeth's is committed to delivering high quality, compassionate, and cost-effective health care services to all. The hospital was founded 136 years ago to bring a healing presence and improve the health of our community, especially for people who are sick, poor, and disadvantaged. Because of the hospital's mission and tradition, it is organized to promote the health of St. Clair County and surrounding areas. The hospital is governed by a Board of Directors, the majority of whom reside in the hospital's primary service area and who are neither employees nor contractors of the hospital (nor family members thereof). The Board ensures that St. Elizabeth's Hospital is responding to community need. During the last fiscal year, for example, the Board reviewed the Community Health Needs Assessment and approved an implementation strategy for addressing identified needs. Our Advisory Board and Friends Board consist of persons who reside in our primary service area. Members of these Boards participated in the Community Engagement Groups that were integral in development of the CHNA. Also consistent with its exempt purpose, St. Elizabeth's Hospital has an open medical staff with privileges available to all qualified physicians in the area. In addition, the hospital operates an emergency department that is open 24 hours to all persons regardless of their ability to pay. As a not-for-profit hospital, St. Elizabeth's Hospital reinvests surplus funds into the mission of the organization and health of the community rather than distributing them as profits to shareholders or individuals. Funds not committed to ongoing operations are generally used to upgrade facilities, secure new technologies, improve patient care, and support initiatives designed to promote health and ensure access for all. For example, St. Elizabeth's Hospital is currently working with its parent organization, Hospital Sisters Health System, to continuously enhance quality and improve coordination of care both inside the hospital and with a growing number of physician partners. Supported by investments in information technology, this "care integration" strategy is designed to better coordinate care, improve health outcomes, create new efficiencies, and help ensure that patients (especially those with chronic conditions) get well and stay well. St. Elizabeth's also devotes significant resources to access for patients who cannot afford care, along with other community benefits. In fiscal year 2013, St. Elizabeth's provided over $16.5 million in community benefit services, including charity care at cost, unpaid costs of Medicaid and other public programs, and a range of diverse programs designed to enhance access and improve community health. Additionally, during this period, St. Elizabeth's provided $5.2 million (at cost) in uncompensated care to patients that did not qualify for charity care or public assistance. St. Elizabeth's Hospital provides a range of community benefits that flows from our mission and long-standing commitment to our community. In many cases, these programs would not exist without the leadership role played by St. Elizabeth's Hospital. These programs relieve a burden that would otherwise be carried by government. Several of these programs and activities are designed to respond to our FY2012 Community Health Needs Assessment, which surfaced the following priority needs for attention from the hospital in collaboration with other community organizations: Access to healthcare, especially for those who are uninsured or underinsured: In this new program, St. Elizabeth's is enhancing access to care by working in the new Health Insurance Marketplace (HIM) under the Affordable Care Act. In conjunction with our parent organization Hospital Sisters Health System, the hospital applied for a grant to host at least one In-Person Counselor (IPC), but did not receive. We are planning to provide a community access location within our facility for the HIM staffed by partner organizations with IPC's and Navigators in addition to planned Certified Application Counselors funded by St. Elizabeth's. St. Elizabeth has been active in coordination of efforts around the HIM. Mental health, reduce the rate of depression and suicide in the adult population in the County: In this new program, St. Elizabeth's is partnering with the Karla Smith Foundation (support service for families coping with mental illness and suicide), the local mental health board, Call for Help (provides crisis intervention), local hospice programs under the guidance of the St. Clair County Health Department IPLAN to deploy a depression and suicide risk assessment tool known as QPR (Question, Persuade and Refer). Several members of the partnership have been trained as a Certified QPR Gatekeeper Instructor and are deploying the education in St. Clair County. A St. Elizabeth's Colleague will be trained as a Certified QPR Gatekeeper Instructor in FY14 to increase the pool of certified QPR educators. Chronic disease, educate and empower diabetics to live a healthier lifestyle: For four years St. Elizabeth's has offered outpatient nutrition counseling to help persons with diabetes manage their illness. The 1:1 nutrition counseling session met the individual needs of patients. In 2010 it was identified that there were many people in need of support services who could not afford the cost of the 1:1 counseling sessions. A monthly diabetic education support group was started and the program is offered at no cost. Topics include: carbohydrate counting, stress management, cardiovascular disease, medication management, pain management, exercise and foot care. In January 2012 the Outpatient Dietitian collaborated with the Cardiac Rehab Department and added an exercise component to the Diabetic Support Group. Twice a week the Diabetic Support Group now offers a one hour exercise session in the Cardiac Rehab Gym, followed by a half-hour of yoga. The combination of education and exercise is designed to enhance better outcomes for this patient population. Twenty-one people have joined the exercise group. On average 16 people participate each week in the exercise/yoga session. Ongoing Community Health Programs Breast Health Awareness Month October is Breast Health Awareness month. Annually, St. Elizabeth's Hospital works together to enhance community awareness and connect with civic and community leaders in an effort to educate and raise awareness of the importance of breast health. In FY2013, "Now is the Time" flyers promoting breast health awareness events were available in the hospital, Urgicare Center, and downtown Belleville and O'Fallon; a "Real Men Wear Pink" campaign was launched in the media; and the hospital partnered with the local newspaper and area businesses to promote a "Pink Passion Spa Day," an event hosted at the hospital for women to learn about breast and women's health in a warm and comforting environment. The event included bra fittings, wig and skin care information, mini-manicures, chair massages, women's physical therapy, nutrition information, healthy cooking demo, breast health information and on-site mammogram appointment scheduling. A radiologist, a surgeon, and two OB/GYN physicians were present to answer questions. The Food and Nutrition Department demonstrated healthy cooking ideas and a dietitian was present to answer questions about healthy eating. A healthy Mediterranean themed buffet and drinks were served. More than 70 women participated in the event. As a result of the hospital's Breast Health Awareness month programming, the St. Clair County Health Department reported that 18 women presented to their Breast and Cervical Cancer program for mammograms. Heart2Heart Month February is Heart2Heart Month at St. Elizabeth's Hospital. In FY2013, a mock STEMI drill was held at Sam's Club in O'Fallon to promote awareness of early intervention. The mock drill was comprised of the hospital's cardiac team, the O'Fallon EMS and Sam's Club employees. Shoppers at Sam's Club witnessed a public medical drill that recreated a person having an ST-Elevation Myocardial Infarction (STEMI), also known as a heart attack. This mock chest pain drill helped our hospital and EMS measure response time and practice appropriate medical protocols. St. Elizabeth's colleagues were on hand to share heart health information as part of the mock drill. Mentoring Future Healthcare Professionals St. Elizabeth's Hospital is committed to helping to prepare future healthcare professionals. Students from local Community Colleges and Universities participate in clinical training in the following areas: Nursing, Behavioral Healthcare, Respiratory, Physical & Occupational Therapy, Pharmacy, Radiology, Surgery, Patient
6, AFFILIATED HEALTH CARE SYSTEM.		St. Elizabeth's Hospital in Belleville, Illinois is an affiliate of Hospital Sisters Health System (HSHS), a health care ministry that includes 13 hospitals, scores of community-based health centers and clinics, and hundreds of physician partners across Illinois and Wisconsin. The Mission of HSHS is "to reveal and embody Christ's healing love for all people through our high quality Franciscan health care ministry." We live our Mission by providing holistic healing to all who seek our care, as well as through Community Benefit. Working collaboratively with others in the communities we serve, our Community Benefit initiatives are strategically and successfully expanding access to care, improving the health status of residents, and furthering medical education and knowledge. In FY2013, our 13 hospitals responded to needs identified in each of their Community Health Needs Assessments (CHNAs) completed in FY2012. The information gathered from these assessments was used to develop new and enhance existing Community Benefit programs and services that best addressed community needs. Included among the many priority needs identified in our CHNAs were chronic disease prevention and management, obesity, adequate food and nutrition, mental health, and access to health care services. HSHS hospitals are proactively addressing these and other needs through patient, provider and community education, preventative screenings, self-management classes, and new or enhanced clinical services. Across HSHS, we collectively provided $185.6 million in Community Benefit (or 10.2% of total hospital expenses) in FY2013. Included in this amount was $45.9 million provided for Financial Assistance (i.e. Charity Care) and $104.2 million for unreimbursed care provided under the Medicaid program. In addition, HSHS hospitals committed significant resources to care for Medicare patients. The cost of providing services to primarily elderly beneficiaries of the Medicare program - in excess of governmental and managed care contract payments - was $152.3 million. HSHS hospitals also recorded $107.1 million in uncollectible accounts. In addition to the dollars invested in our Community Benefit programs, HSHS also continues to reinvest any surplus revenue from operations and investments into new medical technology, facility infrastructure and health care services in our communities. By doing do, we ensure we are able to meet the ongoing demand for high quality, efficient and easily accessible health care. Recognizing that the health care delivery model in the United States is evolving, HSHS remains focused on implementing our Care Integration strategy. Care Integration coordinates the delivery of care around the needs of each patient. During FY2013, we made significant progress with this strategy as we further implemented interoperable health information technologies, expanded the number of Medical Homes, and strengthened our alignment with physicians. Greater access to care As a Franciscan health care ministry, HSHS is deeply committed to serving those who are most in need. We not only provide care to every patient who walks through our doors, but also reach out beyond the walls of our hospitals and clinics to care for those in our communities. Our efforts to ensure residents in the communities we serve receive the right care at the right time in the right setting often involve partnering with others to achieve this goal. Across our two-state System, there are numerous examples of HSHS collaborating with other organizations to enhance access to care for those in need. From 2006 to 2009, the United States saw a 16% increase in individuals seeking dental care at hospital emergency rooms. With the support of St. Mary's Hospital Medical Center and St. Vincent Hospital in Green Bay, Wisconsin, the NEW Dental Clinic on the campus of Northeast Wisconsin Technical College expanded in FY2013 and was able to accommodate up to 6,000 visits. The clinic provides dental services to low-income and uninsured persons including the homeless in Brown County. St. Francis Hospital in Litchfield, Illinois partnered with Lewis & Clark Community College to bring their mobile health unit to the Litchfield area; the unit provides dental exams and screenings, x-rays and dental hygiene to those in need. In western Wisconsin, St. Joseph's Hospital in Chippewa Falls works closely with the Chippewa Health Improvement Partnership (CHIP) to support the Open Door Clinic. The free medical clinic provides health care for those without insurance coverage. This past year, the clinic received a total of 2,672 patient visits, an 11% increase from the prior year. With more than 166 individuals volunteering, the clinic provided more than 6,751 hours (including 753 provider hours and 675 nursing hours) of service to individuals. The Open Door Clinic is an example of HSHS providing leadership and support to a community-based program designed to meet the needs of those less fortunate. In southeast Illinois, area residents can get help filling a prescription through the long-term collaboration between St. Anthony's Memorial Hospital in Effingham and Catholic Charities. Last year, St. Anthony's helped underwrite the cost of prescription medications for more than 280 residents. In southwest Illinois, St. Joseph's Hospital in Highland enhanced their offerings to their senior population based on their CHNA. "Senior Renewal" is an outpatient counseling program for senior adults who may be facing emotional and physical problems unique to the aging process such as feelings of loneliness, isolation and anxiety. Clients receive an intensive level of treatment without inpatient hospitalization through counseling strategies and education. In addition, in collaboration with the Illinois Department of Insurance, St. Joseph's Hospital participates in the Senior Health Insurance Program (SHIP), a free health insurance counseling service for Medicare beneficiaries and their caregivers. In addition to programs such as these, HSHS makes sure that those who need financial assistance for care receive it. Our Financial Assistance (i.e. Charity Care) program covers 100% of hospital charges for individuals and families who earn less than 200% of the federal poverty level. HSHS Financial Assistance programs have a sliding scale, in some instances providing up to a 60% discount on charges for those earning up to 600% of the federal poverty level. Counselors are available in our hospitals to explain our financial assistance policies to patients, provide them with assistance in filling out a simple application form, or help them enroll in publicly funded health care programs. Better community health As part of our Mission to embody Christ's healing love, we understand that we have a responsibility to improve the overall quality of life in our communities by supporting initiatives that promote health and wellness. We recognize we are most successful when we work together with a wide array of public and private organizations that share our commitment to improving lives. By doing so, we maximize our efforts and reduce the duplication of services. HSHS hospitals also understand we need to listen closely to the residents of the communities we serve to ensure the health care needs of all are being met. To that end, each of our 13 hospitals completed Community Health Needs Assessments (CHNA) during FY2012. The information gathered from these assessments is being used to help us develop new, and enhance existing, programs and services that best address the needs of the community. Among the many priority needs identified from the CHNAs include metabolic and cardiovascular disease management, adequate food and nutrition, and mental health. HSHS hospitals are addressing these and other needs by proactively offering educational opportunities, preventative screenings, and new or enhanced clinical services. In partnership with the Sangamon County Health Department (SCDH) and local farmers, St. John's Hospital in Springfield, Illinois took a lead role in bringing a Farmers Market to the east side of Springfield. The East Side Farmers Market addresses three community needs: childhood obesity, childhood poverty (26% of children in Sangamon County live in poverty vs. 18% in the state) and providing fresh produce to persons living in a known "food desert." WIC Cooking Classes are also offered in tandem with the East Side Farmers Market to teach participants how to prepare fresh produce. The Farmers Market and cooking classes are hosted at the SCDH. St. Mary's Hospital in Streator, Illinois teamed up with the Streator YMCA to offer a 12 week weight loss program - Healthy You - to motivate 282 participants (nearly double the participants from last year) to lose weight and maintain a healthy lifestyle. The program included aerobics classes, cooking classes, and a maintenance program to encourage participants to weigh in monthly. A total of 191 participants comple
STATE FILING OF COMMUNITY BENEFIT REPORT	990 SCHEDULE H, PART VI	IL,

Schedule H (Form 990) 2012

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

2012

Open to Public Inspection

Name of the organization

ST ELIZABETH'S HOSPITAL OF THE HOSPITAL
SISTERS OF THE THIRD ORDER OF ST FRANCIS

Employer identification number

37-0663567

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

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

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

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

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

Yes

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

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

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

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

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

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

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

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

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

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

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

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

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

Cat. No. 50053T

Schedule J (Form 990) 2012

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 (E) amounts for that individual.

(A) Name and Title		(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 and Title		(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)MARYANN REESEPRESIDENT & CEO	(i) (ii)	0 308,148	0 70,214	0 49,641	0 66,859	0 26,952	0 521,814	0 0
(2)ANN M CARRTREASURER	(i) (ii)	0 193,454	0 29,440	0 49,252	0 121,170	0 17,686	0 411,002	0 18,215
(3)MARK REIFSTECKDIVISION CEO	(i) (ii)	0 397,173	0 66,854	0 31,694	0 74,658	0 30,647	0 601,026	0 0
(4)JOHNNY E WATKINSDIVISION CFO	(i) (ii)	242,237 0	31,702 0	390 0	36,688 0	10,141 0	321,158 0	0
(5)LESLIE LOVSHINCHIEF FINANCIAL OFFICER	(i) (ii)	125,612 0	17,233 0	13,223 0	3,540 0	17,312 0	176,920 0	0
(6)SHELLEY HARRISCHIEF NURSING OFFICER	(i) (ii)	155,887 0	13,441 0	780 0	34,967 0	27,583 0	232,658 0	0
(7)ADAM THACKERADMIN DIRECTOR PTCS & PL	(i) (ii)	137,912 0	0 0	17,000 0	2,852 0	688 0	158,452 0	0
(8)SHELLY HARKINS MDCHIEF MEDICAL OFFICER	(i) (ii)	246,980 0	0	14,361 0	11,295 0	20,583 0	293,219 0	0
(9)JAMES RUSHFORDPHYSICIAN	(i) (ii)	319,617 213,559	0 0	12,535 902	28,278 0	12,355 9,170	372,785 223,631	0
(10)DONALD JOHNSTONPHYSICIAN	(i) (ii)	321,087 261,660	0 0	420 22,536	20,204 0	12,601 9,170	354,312 293,366	0
(11)JAMES BURKEDIVISION VP OF LEGAL SERVICES	(i) (ii)	215,078 0	0	780 0	12,171 0	27,484 0	255,513 0	0
(12)AMY BALLANCEVICE PRES BUSINESS DEVELOPMENT	(i) (ii)	121,906 0	0 0	7,569 0	4,059 0	25,820 0	159,354 0	0 0
(13)COREY J HASTINGSDIVISION CONTROLLER	(i) (ii)	118,101 0	0 0	7,344 0	4,205 0	25,291 0	154,941 0	0 0
(14)SUSAN BEELERADMIN DIRECTOR - PATIENT CARE	(i) (ii)	129,154 0	0 0	390 0	18,060 0	9,602 0	157,206 0	0 0

Schedule J (Form 990) 2012

Page 3

Part III

Supplemental Information

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

Identifier	Return Reference	Explanation
SCHEDULE J, PART I, LINE 1A	Tax Indemnification and Gross-up Payments	Tax gross-ups were paid by HSHS to Ann Carr for $11 during the year. The fair value of this was included in her annual reported income. SCHEDULE J, PART I, LINE 3 PLEASE SEE RESPONSE TO FORM 990, PART VI, LINE 15 IN SCHEDULE O. PLEASE SEE RESPONSE TO FORM 990, PART VI, LINE 15 IN SCHEDULE O.
ANN M. CARR	SCHEDULE J, PART I, LINE 4B	ANN M. CARR PARTICIPATED IN A SERP DURING THE YEAR IN THE AMOUNT OF $42,817.
MARYANN L. REESE	SCHEDULE J, PART I, LINE 4B	MARYANN L. REESE PARTICIPATED IN A SERP DURING THE YEAR IN THE AMOUNT OF $40,277.
MARK REIFSTECK	SCHEDULE J, PART I, LINE 4B	MARK REIFSTECK PARTICIPATED IN A SERP DURING THE YEAR IN THE AMOUNT OF $48,937.

Schedule J (Form 990) 2012

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

2012

Open to Public
Inspection

Name of the organization

ST ELIZABETH'S HOSPITAL OF THE HOSPITAL
SISTERS OF THE THIRD ORDER OF ST FRANCIS

Employer identification number

37-0663567

Identifier	Return Reference	Explanation
ORGANIZATION'S MISSION	FORM 990, PART III, LINE 1	THE MISSION OF ST. ELIZABETH'S HOSPITAL IS TO REVEAL AND EMBODY CHRIST'S HEALING LOVE FOR ALL PEOPLE THROUGH OUR HIGH QUALITY FRANCISCAN HEALTH CARE MINISTRY. IN THE PERFORMANCE OF ITS MISSION, ST. ELIZABETH'S HOSPITAL WILL FOSTER THE VALUES OF RESPECT, CARE, COMPETENCE AND JOY. RESPECT IS THE FRANCISCAN RESPECT FOR LIFE FROM CONCEPTION TO DEATH AND FOR THE DIGNITY OF EACH INDIVIDUAL PERSON. IT IS A COMMITMENT TO FREEING AND EMPOWERING EACH PERSON TO DEVELOP TO HIS OR HER FULL POTENTIAL. CARE EMBODIES THE CONCERN, COMPASSION, AND SENSITIVITY WITH WHICH WE CARE FOR PATIENTS, CLIENTS, EMPLOYEES AND CO-WORKERS. MANY TIMES IT IS THOUGHT OF AS BEDSIDE BEHAVIOR, BUT IT BELONGS IN BUSINESS OFFICES, CAFETERIAS AND BOARDROOMS. COMPETENCE MEANS THAT OUR WORK IS PERFORMED AND ST. ELIZABETH'S IS MANAGED WITH THE HIGHEST LEVEL OF SKILL AND ABILITY. WE ARE COMMITTED TO RECRUITING AND DEVELOPING PEOPLE WHO ARE COMPETENT IN THEIR WORK AND WHOSE VALUES REFLECT OUR OWN. OUR VALUES ARE AN INTEGRAL PART OF OUR SYSTEM'S STRATEGIC PLAN, WHICH PROVIDES THE OVERALL FRAMEWORK FOR LOCAL ACTIVITIES. JOY IS THE MANNER IN WHICH OUR EMPLOYEES AND ALL WHO JOIN US IN OUR MINISTRY SEEK TO PERFORM THEIR WORK -- THE PERSONAL FULFILLMENT OF CARING FOR OTHERS. IT IS AN ESSENTIAL INGREDIENT IN BRINGING A SENSE OF HOPE TO THOSE WHO SUFFER.
PROGRAM SERVICES	FORM 990, PART III, LINE 4A	Surgical Services (Expense $42,685,388 Revenue $34,541,431) Our highly trained and experienced surgeons perform surgical and non-surgical procedures in a variety of areas and represent a wide range of specialties, including: cardiothoracic, orthopedic, plastic surgery, neurosurgery, podiatry and more. Your surgical team will perform your surgery using the latest technology and least invasive procedures possible in one of our 16 new surgery suites. Our board certified anesthesiologists and certified nurse anesthetists provide excellent anesthesia care. During FY 2013, St. Elizabeth's Hospital had 4,195 surgical cases. PROGRAM SERVICES FORM 990, PART III, LINE 4B Cardiac Services (Expense $21,154,968 Revenue $20,275,320) St. Elizabeth's provides comprehensive cardiovascular services from diagnosis to surgery to rehabilitation and wellness. St. Elizabeth's is accredited by the Society of Chest Pain Centers, a professional organization focused on improving care for patients with acute coronary syndromes and teaching the public to recognize and react to the early symptoms of a possible heart attack. This accreditation attests that St. Elizabeth's meets strict criteria for recognizing and treating patients who come to the emergency room with heart attack symptoms. We are also a heart attack receiving center. Currently, more than 5 area hospitals send their patients to us for heart attack care. Our patients benefit from our highly credentialed physicians and state-of-the-art technologies, as well as our commitment to superior patient outcomes. Some of the services provided included: Cardiac catheterization, stent placement, stress testing, pacemaker, implantable cardioverter defibrillator (ICD), electrocardiography, coronary artery bypass graft (open heart) surgery and cardiac rehabilitation. During FY 2013, St. Elizabeth's Hospital had 11,801 cardiac cases. PROGRAM SERVICES FORM 990, PART III, LINE 4C Rehabilitation Services (Expense $9,681,018 Revenue $8,643,105) St. Elizabeth's Hospital's comprehensive rehabilitation unit provides the care that maximizes the patient's capabilities. We assist in achieving full recovery potential allowing patients to live as independently as possible. We support patients families by providing them with the education, resources and encouragement needed to achieve positive outcomes. Our comprehensive integrated inpatient rehabilitation program is accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF). We are one of the few accredited rehab facilities in Southern Illinois and the only one available in St. Clair County. The rehabilitation unit is accredited to provide services to those adults who have been affected by stroke, amputation, arthritis, spinal cord injury, joint replacement, hip fracture, neurological disease, and more. When admitted to our program, patients are treated by a multi-disciplinary team of caring professionals. During FY 2013 our Rehabilitation Unit performed 4,505 cases.
PROGRAM SERVICES	FORM 990, PART III, LINE 4D	Other Program Services (Expense $74,691,221 Revenue $96,851,792) Health Care Services St. Elizabeth's delivers a comprehensive array of healthcare services to both inpatients and outpatients. Our accredited programs have consistently demonstrated quality outcomes that positively impact our patients, their families and the entire community. We provide quality medical healthcare regardless of race, creed, sex, national origin, handicap, age, or ability to pay. Although reimbursement for services rendered is critical to the operation and stability of St. Elizabeth's Hospital, it is recognized that not all individuals possess the ability to purchase essential medical services. It is our mission to serve the sick, especially the poor, with quality healthcare services and healthcare education. We have further defined our mission of identifying those who are at greatest health risk, the elderly, children, those coping with mental illness, and those with less means who are dependent on quality healthcare. St. Elizabeth's Hospital currently staffs 260 inpatient beds. The hospital employs 1,661 colleagues. Inpatient admissions for Fiscal Year 2013 were 11,361. The Emergency Department had 27,749 visits and admitted 6,322 to inpatient services. The Urgi-Center in O'Fallon, an offsite facility, had 19,440 visits. Total Outpatient visits for the hospital were 161,310. Community Benefit Charity and Government Means-Tested Program: During the period, St. Elizabeth's provided in excess of $13,561,291 million to support our commitment to the community. Included in this total was charity care provided to individuals unable to afford their care. The cost of charity care was $3,830,168. St. Elizabeth's Hospital also provided care to persons covered by governmental programs at or below cost. This resulted in providing $9,731,123 to Medicaid patients which was not reimbursed. Also, included in the total was the extensive number of free educational programs, screenings, clinical services and consultations provided at a reduced fee or at no charge to other healthcare agencies and human service agencies in our service area. To the extent that reimbursement was below cost, St. Elizabeth's Hospital recognized these expenses as a cost of fulfilling its mission for the entire community. Other Benefits: St. Elizabeth's Hospital takes a proactive role in educating its communities on wellness programs, sponsoring health screenings, collaborating with the local health district in targeting local health concerns, and organizing support groups. Included in the above Community Benefit figures are initiatives aimed at improving access and promoting health for the people of Belleville and surrounding communities. The total other benefits reported value $2,429,937. In addition to the Community Benefit total, St. Elizabeth's provided 5.1 million (at cost) in uncompensated care to patients that did not qualify for charity care or public assistance.
TAX EXEMPT BONDS	FORM 990, PART IV, LINE 24	ST. ELIZABETH'S HOSPITAL HOLDS A LIABILITY ON ITS BOOKS FOR TAX-EXEMPT BONDS, WHICH IS AN ALLOCATION FROM ITS SOLE CORPORATE MEMBER, HOSPITAL SISTERS SERVICES, INC. AS A RESULT, THIS QUESTION WAS ANSWERED NO, AND SCHEDULE K WILL BE COMPLETED ON THE HOSPITAL SISTERS SERVICES, INC. FORM 990.
RIGHTS OF MEMBERS TO ELECT GOVERNING BODY	FORM 990, PART VI, LINEs 6 & 7A	THE SENIOR GOVERNING BODY OF ST. ELIZABETH'S HOSPITAL (THE CORPORATION) IS THE MEMBER OF THE CORPORATION, WHICH IS HOSPITAL SISTERS HEALTH SERVICES, INC. ("HSSI"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. PURSUANT TO SECTION 2.3 OF THE CORPORATION'S BYLAWS, HSSI HAS THE RIGHT TO APPOINT AND REMOVE THE CORPORATION'S BOARD OF DIRECTORS, CHAIRPERSON OF THE BOARD AND PRESIDENT.
MEMBER RESERVED POWERS	FORM 990, PART VI, LINE 7B	RESPONSIBILITY FOR THE POLICY AND OPERATIONS OF ST. ELIZABETH'S HOSPITAL (THE "CORPORATION") IS VESTED IN ITS BOARD OF DIRECTORS, EXCEPT WITH RESPECT TO SPECIFIC POWERS RESERVED IN THE CORPORATION'S BYLAWS TO THE CORPORATION'S MEMBER, HOSPITAL SISTERS HEALTH SERVICES, INC. ("HSSI"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE MEMBER OF HSSI IS HOSPITAL SISTERS HEALTH SYSTEM ("HSHS"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE MEMBERS OF HSHS ARE THE INDIVIDUAL SISTERS WHO FROM TIME TO TIME ARE THE DULY ELECTED PROVINCIAL SUPERIOR AND PROVINCIAL COUNCILORS, RESPECTIVELY OF THE AMERICAN PROVINCE OF THE HOSPITAL SISTERS OF ST. FRANCIS ("AMERICAN PROVINCE"). THE AMERICAN PROVINCE IS THE UNITED STATES ORGANIZATION OF THE CONGREGATION OF THE HOSPITAL SISTERS OF THE THIRD ORDER REGULAR OF ST. FRANCIS, A RELIGIOUS INSTITUTE OF THE ROMAN CATHOLIC CHURCH. THE GOVERNANCE AND OPERATIONS OF THE CORPORATION ARE SUBJECT TO HSSI'S RIGHT TO EXERCISE THESE RESERVED POWERS WITH RESPECT TO THE CORPORATION AND ORGANIZATIONS OF WHICH THE CORPORATION IS EITHER, DIRECTLY OR INDIRECTLY, A CONTROLLING MEMBER OR A CONTROLLING SHAREHOLDER ("AFFILIATES"). HSSI'S RIGHT TO EXERCISE CERTAIN OF THESE RESERVED POWERS IS, IN TURN, SUBJECT TO THE APPROVAL OF HSHS AND HSHS' MEMBERS. THE RESERVED POWERS INCLUDE ALL RIGHTS GRANTED TO HSSI BY LAW AND THE RIGHT TO: (A) ADOPT, APPROVE AMENDMENTS TO, OR AMEND ANY STATEMENT OF PHILOSOPHY, MISSION, MISSION INTEGRATION OR VALUES OR ANY NAME, LOGO, OR MARK OF THE CORPORATION OR OF ANY AFFILIATE; (B) ADOPT, APPROVE AMENDMENTS TO, OR AMEND THE ARTICLES OF INCORPORATION OF THE CORPORATION OR OF ANY AFFILIATE; (C) ADOPT, APPROVE AMENDMENTS TO, OR AMEND THE BYLAWS OF THE CORPORATION OR OF ANY AFFILIATE; (D) APPOINT AND REMOVE THE BOARD OF DIRECTORS, ANY ONE OR MORE OF THE DIRECTORS OF THE CORPORATION OR OF ANY AFFILIATE, AND THE CHAIRPERSON AND PRESIDENT OF THE CORPORATION OR OF ANY AFFILIATE; (E) APPROVE THE RECOMMENDATION OF THE BOARD OF DIRECTORS TO APPOINT OR REMOVE THE BOARD OF DIRECTORS, ANY ONE OR MORE DIRECTORS OF THE CORPORATION OR OF ANY AFFILIATE, OR THE CHAIRPERSON AND PRESIDENT OF THE CORPORATION OR OF ANY AFFILIATE. (F) WITH RESPECT TO THE CORPORATION OR ANY AFFILIATE, APPROVE THE PURCHASE, SALE, ALIENATION, EXCHANGE, LEASE OR ENCUMBRANCE OF ANY REAL PROPERTY OF THE CORPORATION OR OF ANY AFFILIATE, WHICH PROPERTY HAS A VALUE IN EXCESS OF LIMITS SET FROM TIME TO TIME BY HSSI; (G) APPROVE THE OPERATING AND CAPITAL BUDGETS OF THE CORPORATION OR OF ANY AFFILIATE, AND ANY DEVIATIONS BY THE CORPORATION OR OF ANY AFFILIATE FROM SUCH BUDGETS IN AN AMOUNT OR PERCENTAGE SPECIFIED BY HSSI FROM TIME TO TIME; (H) APPROVE THE STRATEGIC PLAN AND GOALS OF THE CORPORATION OR OF ANY AFFILIATE; (I) APPROVE THE SALE OF SUBSTANTIALLY ALL OF THE ASSETS OF THE (II) CORPORATION OR OF ANY AFFILIATE; (J) APPROVE THE MERGER OR DISSOLUTION OF THE CORPORATION OR OF ANY AFFILIATE; (K) ADOPT OR AMEND THE PLAN FOR MINISTRY EDUCATION AND GOVERNANCE FOR THE CORPORATION AND ITS AFFILIATES; (L) APPROVE THE CORPORATION'S MISSION ACCOUNTABILITY REPORTS AND THOSE OF ANY AFFILIATE; (M) APPROVE THE FINANCIAL POLICIES AND PROCEDURES OF THE CORPORATION OR OF ANY AFFILIATE AND APPROVE ANY DEVIATIONS FROM SUCH POLICIES AND PROCEDURES BY THE CORPORATION OR ANY AFFILIATE; AND (N) ADOPT POLICIES TO IMPLEMENT THE RESERVED POWERS OF HSSI.
FORM 990 REVIEW PROCESS	FORM 990, PART VI, LINE 11b	THE HOSPITAL EMPLOYS KPMG TO ASSIST IN THE OVERALL PREPARATION, REVIEW AND ELECTRONIC SUBMISSION OF ITS FORM 990. KPMG PROVIDES GUIDANCE IN IDENTIFYING CRITICAL ERRORS IN THE RETURN SUBMISSION AND FEEDBACK ON QUANTITATIVE AND QUALITATIVE RESPONSES. ADDITIONALLY, THE HOSPITAL CFO PERFORMS A THOROUGH REVIEW OF THE RETURN AND REVIEWS IT WITH THE HOSPITAL CEO AND/OR SENIOR LEADERS BEFORE PRESENTING IT IN ITS ENTIRETY TO THE HOSPITAL BOARD FOR QUESTIONING AND REVIEW PRIOR TO THE RETURN'S SIGNING AND SUBMISSION TO THE IRS.
CONFLICT OF INTEREST POLICY	FORM 990, PART VI, LINE 12C	A REVISED CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY HAS BEEN USED SINCE JANUARY, 2009 TO ESTABLISH THE PRACTICE OF MANAGING CONFLICTS OF INTEREST USING A SYSTEM-WIDE PROTOCOL FOR DISCLOSURE STATEMENTS. IN ACCORDANCE WITH OUR CONFLICT OF INTEREST POLICY ALL COVERED PERSONS HAVE A DUTY TO COMPLY WITH THE CONFLICT OF INTEREST POLICY FOR ANY CONTRACT, TRANSACTION, RELATIONSHIP OR ACTIVITY CONTEMPLATED, ENTERED INTO OR CONDUCTED AT HSHS. THE POLICY DEFINES COVERED PERSONS AS A.) BOARD MEMBERS, BOARD COMMITTEE MEMBERS, OFFICERS, BOARD DESIGNEES, SENIOR MANAGEMENT, MEMBERS OF ANY COMMITTEE THAT OVERSEES THE APPROVAL OF PHARMACEUTICALS AND MEDICAL DEVICES, ANY OTHER INDIVIDUAL WHO HOLDS A POSITION OF TRUST AND B.) NON-EMPLOYED MEMBERS OF THE MEDICAL STAFF WHO ALSO EITHER: 1) HOLD PAID OR UNPAID MEDICAL ADMINISTRATIVE POSITIONS, SUCH AS CHAIRS OF CLINICAL DEPARTMENTS, SECTION AND DIVISION CHIEFS, DIRECTORS OF SPECIAL CARE UNITS, DIRECTORS OF RESEARCH OR INDIVIDUALS WHO OTHERWISE DIRECT OR MATERIALLY INFLUENCE RESEARCH; OR 2) HAVE PROCUREMENT RESPONSIBILITY, OR THE AUTHORITY EFFECTIVELY TO RECOMMEND SUCH PROCUREMENT. ON AN ANNUAL BASIS HSHS DISCLOSES A COPY OF THE CONFLICT OF INTEREST POLICY (AND ALL CORRESPONDING PROCEDURES, GUIDELINES, FORMS AND TOOLS), TO ALL COVERED PERSONS AND ADVISES ALL COVERED PERSONS IN WRITING OF ANY SUBSTANTIVE CHANGES TO THIS POLICY AND SUCH RELATED MATERIALS. THE COVERED PERSONS ARE REQUIRED TO REVIEW AND COMPLETE THE CORRESPONDING CONFLICT OF INTEREST STATEMENT. THE SYSTEM OFFICE VICE PRESIDENT, SYSTEM RESPONSIBILITY, VICE PRESIDENT, RISK & COMPLIANCE OR MEMBERS OF THE AUDIT AND INTEGRITY COMMITTEE ("COMMITTEE") ARE AVAILABLE TO ANSWER ANY QUESTIONS A COVERED PERSON MAY HAVE. IN ADDITION, IF, AT ANY TIME AFTER SUBMITTING AN ANNUAL CONFLICT OF INTEREST STATEMENT, A COVERED PERSON BECOMES AWARE OF AN INTEREST THAT HE OR SHE WOULD HAVE HAD TO DISCLOSE AT THE ANNUAL INTERVAL, THE COVERED PERSON SHALL PROMPTLY DISCLOSE THE INTEREST TO THE COMMITTEE USING THE HSHS CONFLICT OF INTEREST DISCLOSURE STATEMENT. COMPLETED CONFLICT OF INTEREST STATEMENTS ARE SUBMITTED TO THE COMMITTEE OF HSHS WHICH IS RESPONSIBLE FOR IDENTIFYING, ASSESSING, AND MANAGING CONFLICTS OF INTEREST THAT ARISE IN THE COURSE OF CONDUCTING THE AFFAIRS OF HSHS. IF THE COMMITTEE DETERMINES THAT A CONFLICT OF INTEREST EXISTS, HSHS SHALL NOT ENGAGE IN OR ENTER INTO A PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT OR ACTIVITY UNLESS THE COMMITTEE OR, WHERE NECESSARY, THE BOARD OF DIRECTORS (ACTING THROUGH ITS DISINTERESTED MEMBERS), HAS INVESTIGATED ALTERNATIVES TO THE PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT OR ACTIVITY AND, IN THE ABSENCE OF ALTERNATIVES THAT ARE IN THE BEST INTERESTS OF HSHS, HAS DETERMINED: 1. THAT, REGARDLESS OF WHETHER THE COVERED PERSON PARTICIPATES IN THE IMPLEMENTATION OF THE PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY; 2. THE CONTRACT, TRANSACTION, ARRANGEMENT OR ACTIVITY IS IN THE BEST INTERESTS OF HSHS; 3. THE CONTRACT, TRANSACTION, ARRANGEMENT OR ACTIVITY IS FAIR AND REASONABLE FROM THE PERSPECTIVE OF HSHS;AND 4. HSHS CANNOT OBTAIN A MORE ADVANTAGEOUS CONTRACT, TRANSACTION, ARRANGEMENT OR ACTIVITY WITH REASONABLE EFFORTS UNDER THE CIRCUMSTANCES. IN DETERMINING WHETHER A CONTRACT, TRANSACTION OR ARRANGEMENT IS FAIR AND REASONABLE TO HSHS, THE COMMITTEE SHALL CONSIDER, WHERE APPLICABLE: 1. APPRAISALS OR OTHER INDEPENDENT VALUATIONS OF THE FAIR MARKET VALUE OF THE CONTRACT, TRANSACTION OR ARRANGEMENT; 2. INFORMATION REGARDING COMPARABLE CONTRACTS, TRANSACTIONS OR ARRANGEMENTS BETWEEN UNRELATED PARTIES; 3. OFFERS FROM COMPARABLE COMPETING ENTITIES; AND/OR 4. STUDIES OF COMPARABLE COMPENSATION ARRANGEMENTS. IN ANY CASE IN WHICH THE COMMITTEE FINDS, AFTER TAKING THE STEPS DESCRIBED ABOVE, THAT HSHS SHOULD PARTICIPATE IN A PROPOSED TRANSACTION OR ARRANGEMENT DESPITE THE EXISTENCE OF A CONFLICT OF INTEREST, THE COMMITTEE SHALL DEVELOP, IMPLEMENT, MONITOR, AND ENFORCE COMPLIANCE WITH, A CONFLICT MANAGEMENT PLAN FOR MANAGING THE CONFLICT OF INTEREST AS IT CONSIDERS NECESSARY FOR SUCH FINDINGS TO REMAIN VALID THROUGHOUT THE LIFE OF THE CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT OR ACTIVITY. ALL CONFLICT MANAGEMENT PLANS SHALL: 1. STATE THAT THE COMMITTEE WILL OVERSEE, MONITOR AND ENFORCE COMPLIANCE WITH THE PLAN THROUGHOUT THE COURSE OF THE STUDY AND SPECIFY MEANS FOR DOING SO, INCLUDING, WITHOUT LIMITATION, THAT THE APPROPRIATE INDIVIDUALS MUST PROVIDE THE COMMITTEE WITH WRITTEN REPORTS PERTAINING TO COMPLIANCE WITH THE CONFLICT MANAGEMENT PLAN, THAT THE COMMITTEE SHALL HAVE THE RIGHT TO AUDIT THE STUDY FOR SUCH COMPLIANCE AND THE RIGHT TO IMPOSE SANCTIONS FOR NON-COMPLIANCE; 2. STATE THAT THE PLAN MUST BE SHARED WITH THE COVERED PERSON OR PERSONS WHOSE INTERESTS IT WAS DEVELOPED TO MANAGE; 3. STATE THAT THE PLAN MUST BE SHARED WITH, AND PERIODIC REPORTS ON COMPLIANCE WITH THE PLAN MUST BE PROVIDED TO, THE BOARD, SENIOR MANAGEMENT AND/OR GOVERNMENT AGENCIES; AND 4. PROVIDE FOR SUCH OTHER MANAGEMENT STEPS AND MECHANISMS THE COMMITTEE CONSIDERS NECESSARY AND APPROPRIATE. IN ADDITION TO THE COMMITTEE, THE SYSTEM OFFICE VICE PRESIDENTS OF SYSTEM RESPONSIBILITY AND RISK & COMPLIANCE MAY RETAIN SUCH INDEPENDENT ADVISORS OR EXPERTS AS DEEMED NECESSARY TO ASSIST IN MAKING ITS DETERMINATIONS AND DECISIONS. IF THE COMMITTEE DETERMINES THAT THE CONTEMPLATED TRANSACTION, RELATIONSHIP ARRANGEMENT OR ACTIVITY CANNOT PROCEED DUE TO A CONFLICT OF INTEREST, THE COMMITTEE SHALL INFORM THE APPLICABLE COVERED PERSON OR DECISION-MAKING BODY OF SUCH DETERMINATION WITHIN ONE WEEK OF THE COMMITTEE MEETING AT WHICH THE CONTEMPLATED TRANSACTION WAS DISCUSSED. THE COMMITTEE SHALL DOCUMENT ITS REJECTION OF THE CONTEMPLATED TRANSACTION IN THE COMMITTEE'S MEETING MINUTES.
WHISTLEBLOWER POLICY	FORM 990, PART VI, LINE 13	PROVISIONS WITHIN THE CORPORATE COMPLIANCE HOTLINE AND CONFLICT OF INTEREST POLICY PROVIDE PROTECTIONS FOR WHISTLEBLOWER TYPE ACTIVITIES.
COMPENSATION PROCESS	FORM 990, PART VI, LINE 15	THE COMPENSATION COMMITTEE (COMMITTEE) IS COMPRISED OF INDEPENDENT MEMBERS OF THE BOARD OF DIRECTORS. THE COMMITTEE DEVELOPS A COMPENSATION PHILOSOPHY FOR THE SYSTEM AND ALL AFFILIATES. THE COMMITTEE SELECTS AND HIRES THE INDEPENDENT COMPENSATION CONSULTANT TO DEVELOP COMPARABILITY DATA AND ADVISE THE COMMITTEE DURING ITS DELIBERATIONS REGARDING ALL ELEMENTS OF TOTAL COMPENSATION FOR ALL DISQUALIFIED INDIVIDUALS. INTEGRATED HEALTHCARE STRATEGIES ("IHS"), THE CONSULTANTS UTILIZED BY THE COMMITTEE, USE DATA FROM MULTIPLE TAX-EXEMPT PEER GROUP SOURCES TO DETERMINE SALARY RANGES, INCENTIVE OPPORTUNITY RANGES AND BENEFITS FOR THE DISQUALIFIED INDIVIDUALS. IHS THEN ASSISTS THE COMMITTEE IN PREPARING CONTEMPORANEOUS DOCUMENTATION OF ALL ACTIONS. EACH COMMITTEE MEETING IS CONDUCTED WITH THE INTENT TO CREATE A REBUTTABLE PRESUMPTION OF REASONABLENESS FOR ALL ELEMENTS OF EXECUTIVE TOTAL COMPENSATION FOR THE DISQUALIFIED INDIVIDUALS. THE CHAIRMAN MAKES THIS DECLARATION AND ALSO INQUIRES IF THERE ARE ANY CONFLICTS OF INTEREST BY ANY ATTENDEES. ANY CONFLICTS ARE DISCLOSED AND THE COMMITTEE THEN ACTS IN A MANNER TO AVOID ANY CONFLICTED INDIVIDUAL PARTICIPATING IN ANY MANNER WHERE A CONFLICT MIGHT EXIST. AT THE END OF THE MEETING, THE COMMITTEE PREPARES CONTEMPORANEOUS MINUTES THAT RECORD ALL ACTIONS TAKEN DURING THE MEETING. JOINT VENTURES FORM 990 PART VI, LINE 16B HOSPITAL SISTERS HEALTH SYSTEM ADOPTED A JOINT VENTURE COMPLIANCE PROGRAM POLICY EFFECTIVE ON JANUARY 1, 2012 FOR ALL SYSTEM HOSPITALS, INCLUDING ST. ELIZABETH'S HOSPITAL. THE OVERALL PURPOSE OF THE POLICY IS TO PROVIDE PRACTICAL GUIDELINES FOR ETHICAL BUSINESS CONDUCT, TO ACHIEVE COMPLIANCE, AND TO DETECT AND PREVENT VIOLATIONS OF APPLICABLE LAWS. THE POLICY REQUIRES ST. ELIZABETH'S HOSPITAL, AND ALL HSHS HOSPITALS, TO EVALUATE THEIR PARTICIPATION IN JOINT VENTURE ARRANGEMENTS, INCLUDING UNDER APPLICABLE FEDERAL TAX LAWS, AND TO SAFEGUARD ST. ELIZABETH'S HOSPITAL'S TAX EXEMPT STATUS WITH RESPECT TO ANY JOINT VENTURE ARRANGEMENTS.
DISCLOSURE: DOCUMENTS AVAILABLE TO THE PUBLIC	FORM 990, PART VI, LINE 19	BOARD-APPROVED FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE GENERAL PUBLIC AT THIS TIME.
POOLED INVESTMENT ACCOUNT	FORM 990, PART X, LINE 11	PARTICIPATION IN THE POOLED FUND IS LIMITED TO THE 501(C)(3) HOSPITALS AND RELATED HEALTH SERVICES ORGANIZATIONS SPONSORED BY HOSPITAL SISTERS HEALTH SYSTEM. THE POOLED ACCOUNT CONSISTS OF CASH, EQUITY AND DEBT SECURITIES THAT ARE PUBLICLY TRADED. IN ACCORDANCE WITH THE PROVISIONS OF SFAS NO. 124 "ACCOUNTING FOR CERTAIN INVESTMENTS HELD BY NOT-FOR-PROFIT ORGANIZATIONS", INVESTMENTS IN EQUITY SECURITIES WITH READILY DETERMINABLE VALUES AND ALL INVESTMENTS IN DEBT SECURITIES ARE REPORTED AT FAIR VALUE ON THE BALANCE SHEET. INCOME, REALIZED AND UNREALIZED GAINS AND LOSSES ARE POOLED AND ALLOCATED TO THE PARTICIPANTS. INDIVIDUAL COMPONENTS OF ASSETS AND REVENUE ARE NOT IDENTIFIED TO THE PARTICIPANTS.
OTHER CHANGES IN NET ASSETS OR FUND BALANCES	FORM 990, PART XI, LINE 5	SWAP PAYMENTS (517,635) CHANGES IN PENSION 16,927,520 CHANGE IN FAIR VALUE OF INTEREST RATE SWAP 5,673,358 AFFILIATE TRANSFER (4,548,500) BOND REALLOCATION (1,833,743) INCREASE IN TEMPORARILY RESTRICTED ASSETS 143,727 PERMANENTLY RESTRICTED NET INCOME 18,086 Loss on Extinguishment of Debt (369,927) ------------- TOTAL OTHER CHANGES IN NET ASSETS OR FUND BALANCES 15,492,886 =============
OTHER FEES FOR SERVICES FOR NON-EMPLOYEES	FORM 990 PART IX LINE 11G	DESCRIPTION:PURCHASED SERVICES TOTAL FEES:21155819
OTHER FEES FOR SERVICES FOR NON-EMPLOYEES	FORM 990 PART IX LINE 11G	DESCRIPTION:PROFESSIONAL SERVICES TOTAL FEES:4434828

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2012

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

2012

Open to Public Inspection

Name of the organization

ST ELIZABETH'S HOSPITAL OF THE HOSPITAL
SISTERS OF THE THIRD ORDER OF ST FRANCIS

Employer identification number

37-0663567

Part I

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

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) End-of-year assets	(f) Direct controlling entity
(1) SPRINGFIELD HEALTH PARTNERS LLC 4936 LAVERNA ROAD SPRINGFIELD,IL62707 37-1364419	HEALTHCARE	IL	0	HSHS MG
(2) KIARA CLINICAL INTEGRATION NETWORK LLC 4936 LAVERNA RD SPRINGFIELD,IL62707 26-1417684	HEALTHCARE	IL	0	KIARA INC
(3) PHYSICIAN CLINICAL INTEGRATION NETWORK 4936 LAVERNA ROAD SPRINGFIELD,IL62707 37-1668647	HEALTHCARE	IL	0	KCIN

Part II

Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" to 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 entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1) HOSPITAL SISTERS HEALTH SYSTEM 4936 LAVERNA ROAD SPRINGFIELD,IL62707 37-1058692	HEALTHCARE	IL	501(C)(3)	11A	NA		No
(2) HOSPITAL SISTERS SERVICES INC 4936 LAVERNA ROAD SPRINGFIELD,IL62707 37-1163402	HEALTHCARE	IL	501(C)(3)	11A	HSHS		No
(3) HOSPITAL SISTERS OF ST FRANCIS FDTN 4936 LAVERNA ROAD SPRINGFIELD,IL62707 37-1186514	HEALTHCARE	IL	501(C)(3)	11A	HSHS		No
(4) HSHS SELF INSURANCE TRUST FUND 4936 LAVERNA ROAD SPRINGFIELD,IL62707 37-1120626	INSURANCE	IL	501(C)(3)	11A	HSHS		No
(5) HSHS HEALTH CARE PLAN TRUST FUND 4936 LAVERNA ROAD SPRINGFIELD,IL62707 37-1137724	HEALTHCARE	IL	501(C)(9)	N/A	HSHS		No
(6) HOSPITAL SISTERS HEALTHCARE - WEST INC 2661 COUNTY HIGHWAY I CHIPPEWA FALLS,WI54729 51-0157933	HEALTHCARE	WI	501(C)(3)	11A	HSSI		No
(7) SACRED HEART HOSPITAL 900 WEST CLAIREMONT AVENUE EAU CLAIRE,WI54701 39-0807060	HEALTHCARE	WI	501(C)(3)	3	HSSI		No
(8) ST ANTHONY'S HOSPITAL 503 N MAPLE STREET EFFINGHAM,IL62401 37-0661233	HEALTHCARE	IL	501(C)(3)	3	HSSI		No
(9) ST JOHN'S HOSPITAL 800 EAST CARPENTER STREET SPRINGFIELD,IL62769 37-0661238	HEALTHCARE	IL	501(C)(3)	3	HSSI		No
(10) ST FRANCIS HOSPITAL 1215 FRANCISCAN DRIVE LITCHFIELD,IL62056 37-0661236	HEALTHCARE	IL	501(C)(3)	3	HSSI		No
(11) ST JOSEPH'S HOSPITAL 9515 HOLY CROSS LANE BREESE,IL62230 37-1208459	HEALTHCARE	IL	501(C)(3)	3	HSSI		No
(12) ST JOSEPH'S HOSPITAL 1515 MAIN STREET HIGHLAND,IL62249 37-0663568	HEALTHCARE	IL	501(C)(3)	3	HSSI		No
(13) ST JOSEPH'S HOSPITAL 2661 COUNTY HIGHWAY 1 CHIPPEWA FALLS,WI54729 39-0810545	HEALTHCARE	WI	501(C)(3)	3	HSSI		No
(14) ST MARY'S HOSPITAL 1800 E LAKE SHORE DRIVE DECATUR,IL62521 36-2169181	HEALTHCARE	IL	501(C)(3)	3	HSSI		No
(15) ST MARY'S HOSPITAL 111 SPRING STREET STREATOR,IL61364 36-2169181	HEALTHCARE	IL	501(C)(3)	3	HSSI		No
(16) ST NICHOLAS HOSPITAL 3100 SUPERIOR AVENUE SHEBOYGAN,WI53081 39-0808480	HEALTHCARE	WI	501(C)(3)	3	HSSI		No
(17) ST VINCENT HOSPITAL 835 S VAN BUREN GREEN BAY,WI54301 39-0817529	HEALTHCARE	WI	501(C)(3)	3	HSSI		No
(18) ST MARY'S HOSPITAL MEDICAL CENTER 1726 SHAWANO AVENUE GREEN BAY,WI54303 39-0818682	HEALTHCARE	WI	501(C)(3)	3	HSSI		No
(19) HSHS MEDICAL GROUP INC 3215 EXECUTIVE PARK DRIVE SPRINGFIELD,IL62703 26-3956318	HEALTHCARE	IL	501(C)(3)	11A	HSSI		No
(20) HSHS WISCONSIN MEDICAL GROUP INC 3215 EXECUTIVE PARK DRIVE SPRINGFIELD,IL62703 26-4515959	HEALTHCARE	WI	501(C)(3)	11A	HSSI		No
(21) ORANGE CROSS AMBULANCE INC 919 ASHLAND AVE SHEBOYGAN,WI53081 39-1860942	HEALTHCARE	WI	501(C)(3)	9	ST NICHOLAS		No
(22) WISCONSIN UPPER PEN ONC MNGMT SERVICES 835 S VAN BUREN GREEN BAY,WI54304 39-1677100	HEALTHCARE	WI	501(C)(3)	3	ST VINCENT		No
(23) UNITY LIMITED PARTNERHSHIP 2366 OAK RIDGE CIRCLE DE PERE,WI54115 39-1750729	HEALTHCARE	WI	501(C)(3)	9	HSSI		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2012

Page 2

Part III

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) MEMORIAL AND ST ELIZABETH'S HEALTHCARE 4000 NORTH ILLINOIS STREET SWANSEA,IL62226 37-1312961	HEALTHCARE	IL	NA	RELATED	1,416,092	4,344,686		No	0		No	50.000 %
(2) PRAIRIE HEART INSTITUTE - CARBONDALE LL 800 EAST CARPENTER STREET SPRINGFIELD,IL62769 37-1321197	HEALTHCARE	IL	ST JOHN'S	RELATED				No	0
(3) NORTHEAST WISCONSIN RADIATION THERAPY SE 1821 S WEBSTER AVENUE SUITE 300 GREEN BAY,WI543079047 26-3749065	HEALTHCARE	WI	HSSI	RELATED				No	0
(4) PAIN CENTER OF WISCONSIN 4131 W LOOMIS ROAD SUITE 300 GREENFIELD,WI53221 26-3155343	HEALTHCARE	WI	ST VINCENT	RELATED				No	0
(5) SURGERY CENTER OF SHEBOYGAN LLC 3141 SAEMANN AVE SHEBOYGAN,WI53081 26-0822209	HEALTHCARE	WI	ST NICHOLAS	RELATED				No	0
(6) PREVEA VENTURES LLC 2710 EXECUTIVE DR GREEN BAY,WI54304 20-3775127	HEALTHCARE	WI	HSSI	RELATED				No	0
(7) CARPENTER STREET HOTEL LLC 36-	HOTEL	IL	LASANTE INC	RELATED				No	0
(8) SPRINGFIELD URGENT CARE REAL E		IL	LASANTE INC	RELATED				No	0
(9) PRAIRIE HEART INSTITUTE MANAGEMENT LLC 4936 Laverna Road Springfield,IL62707 26-1417684	Medical	IL	HSHS	Related	0	0		No			No

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" to 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	(i) Section 512(b)(13) controlled entity?
(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	Yes	No
(1) KIARA INC 4936 LAVERNA RD SPRINGFIELD,IL62707 37-1163401	HEALTHCARE	IL	HSHS	C CORP				No
(2) LASANTE WISCONSIN INC 4936 LAVERNA RD SPRINGFIELD,IL62707 39-1572196	HEALTHCARE	IL	KIARA INC	C CORP				No
(3) LASANTE INC 4936 LAVERNA RD SPRINGFIELD,IL62707 37-1163400	HEALTHCARE	IL	KIARA INC	C CORP				No
(4) PRAIRIE CARDIOVASCULAR 619 EAST MASON SUITE 4P57 SPRINGFIELD,IL62701 37-1071858	HEALTHCARE	IL	KIARA INC	C CORP				No
(5) PREVEA HEALTH SERVICES 2710 EXECUTIVE DR GREEN BAY,WI54304 39-1839351	HEALTHCARE	WI	HSSI	C CORP				No
(6) PREVEA CLINIC INC 2710 EXECUTIVE DR GREEN BAY,WI54304 39-1839349	HEALTHCARE	WI	HSSI	C CORP				No
(7) PREVEA HEALTH NETWORK 2710 EXECUTIVE DR GREEN BAY,WI54304 39-2000537	HEALTHCARE	WI	HSSI	C CORP				No
(8) RENAISSANCE QUALITY INSURANCE PO Box 1159 KY1-1102 GRAND CAYMAN,CAYMAN ISLANDSKY1-1102 CJ 98-0669953	INSURANCE	CJ	HSSI	C CORP	0	0		No
(9) OJV INC 4936 LAVERNA RD SPRINGFIELD,IL62707 46-0873384	HEALTHCARE	IL	LASANTE	C CORP	0	0		No

Schedule R (Form 990) 2012

Page 3

Part V

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

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

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 or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

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

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

Yes

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

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

f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

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

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

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

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

Yes

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

Yes

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

Yes

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

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

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

(a) Name of other organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved

Schedule R (Form 990) 2012

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to 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) 2012

Page 5

Part VII

Supplemental Information

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

Identifier	Return Reference	Explanation
TRANSACTIONS WITH RELATED ENTITIES	FORM 990 SCHEDULE R, PART V, LINE 2	THE TRANSACTIONS REPORTED IN QUESTION 1 ARE BETWEEN RELATED 501(C)(3) PUBLIC CHARITIES AND ARE NOT REPORTED IN THIS SECTION.

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: TO REVEAL AND EMBODY CHRIST'S HEALING LOVE FOR ALL PEOPLE THROUGH OUR HIGH QUALITY FRANCISCAN HEALTH CARE MINISTRY.
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	1,661
6	Total number of volunteers (estimate if necessary) .............	6	244
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	26,082
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	2,338

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	317,879	443,646
9	Program service revenue (Part VIII, line 2g) .........	167,054,450	160,336,773
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	-2,523,354	636,187
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	2,058,748	3,432,337
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	166,907,723	164,848,943
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)	73,654,386	72,356,370
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–24e)....	107,971,159	107,651,328
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	181,625,545	180,007,698
19	Revenue less expenses. Subtract line 18 from line 12.......	-14,717,822	-15,158,755
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	122,615,352	113,735,179
21	Total liabilities (Part X, line 26).............	127,642,383	117,771,927
22	Net assets or fund balances. Subtract line 21 from line 20.....	-5,027,031	-4,036,748

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 42,685,388 including grants of $ ) (Revenue $ 34,541,431 )
	CARDIAC SERVICES - SEE SCHEDULE O

4b	(Code: ) (Expenses $ 21,154,968 including grants of $ ) (Revenue $ 20,275,320 )
	SURGICAL SERVICES - SEE SCHEDULE O

4c	(Code: ) (Expenses $ 9,681,018 including grants of $ ) (Revenue $ 8,643,105 )
	REHABILITATION SERVICES - SEE SCHEDULE O

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 74,691,221 including grants of $ ) (Revenue $ 96,876,917 )
4e	Total program service expenses148,212,595

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)				(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) ADAM THACKER........................................................................ ADMIN DIRECTOR PTCS & PL	19.0 .......................41.0	X			154,912	0	2,852
(19) SHELLY HARKINS MD........................................................................ CHIEF MEDICAL OFFICER	60.0 .......................	X			261,341	0	31,164
(20) MARGARET LUNA........................................................................ DIVISION CHIEF PEOPLE OFFICER	19.0 .......................41.0	X			126,901	0	14,861
(21) JAMES BURKE........................................................................ DIVISION VP OF LEGAL SERVICES	19.0 .......................41.0		X		215,858	0	38,693
(22) AMY BALLANCE........................................................................ VICE PRES BUSINESS DEVELOPMENT	19.0 .......................41.0		X		129,475	0	29,212
(23) COREY J HASTINGS........................................................................ DIVISION CONTROLLER	19.0 .......................41.0		X		125,445	0	28,874
(24) SUSAN BEELER........................................................................ ADMIN DIRECTOR - PATIENT CARE	60.0 .......................		X		129,544	0	26,994
(25) JULIA SCHIMMELPFENNIG........................................................................ PHARMACY MANAGER	60.0 .......................		X		126,651		6,836
(26) JAMES RUSHFORD........................................................................ PHYSICIAN	60.0 .......................			X	332,152	214,461	48,895
(27) DONALD JOHNSTON........................................................................ PHYSICIAN	60.0 .......................			X	321,507	284,196	41,081

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	2,564,299	1,694,527	726,653

				(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		177,476
e	Government grants (contributions)1e		266,170

f	All other contributions, gifts, grants, and similar amounts not included above1f

g	Noncash contributions included in lines 1a-1f:$		0
h	Total. Add lines 1a-1f.......			443,646
			Business Code
2a	NET PATIENT REVENUE		900000	158,547,047	158,547,047
b	PHARMACY		446110	113,532	113,532
c	HEALTH PROGRAMS		900000	7,847	7,847
d	ONCOLOGY CENTER INCOME		900000	887,195	887,195
e	RENTAL INCOME-AFFILIATED ORGANIZATION		900099	781,152	781,152
f	All other program service revenue .
g	Total. Add lines 2a–2f........			160,336,773
3	Investment income (including dividends, interest, and other similar amounts).......			347,948			347,948
4	Income from investment of tax-exempt bond proceeds..			0
5	Royalties...........			0
		(i) Real	(ii) Personal
6a	Gross rents	1,372,581
b	Less: rental expenses	1,289,646
c	Rental income or (loss)	82,935	0
d	Net rental income or (loss).......			82,935			82,935
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory		221,887
b	Less: cost or other basis and sales expenses		293,697
c	Gain or (loss)	360,049	-71,810
d	Net gain or (loss)..........			288,239			288,239
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	ADMINISTRATION INCOME		900000	2,676,319			2,676,319
b	PURCHASE DISCOUNTS		900000	310,167			310,167
c	CAFETERIA SALES		722210	69,336			69,336
d	All other revenue ....			293,580		26,082	267,498
e	Total. Add lines 11a–11d ......			3,349,402
12	Total revenue. See Instructions......			164,848,943	160,336,773	26,082	4,042,442


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing .............			0	1	0
2	Savings and temporary cash investments .........			-4,023,125	2	2,288,153
3	Pledges and grants receivable, net ...........			7,247,610	3	2,684,512
4	Accounts receivable, net .............			32,423,111	4	27,297,099
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
				0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
				0	6	0
7	Notes and loans receivable, net .............			101,817	7	297,060
8	Inventories for sale or use ..............			2,566,401	8	2,421,397
9	Prepaid expenses and deferred charges ..........			1,016,709	9	678,601
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	205,761,675
b	Less: accumulated depreciation .....	10b	145,497,797	62,250,125	10c	60,263,878
11	Investments—publicly traded securities ..........			16,615,232	11	13,255,350
12	Investments—other securities. See Part IV, line 11 .....			0	12	0
13	Investments—program-related. See Part IV, line 11 .....			3,944,776	13	4,331,971
14	Intangible assets ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			472,696	15	217,158
16	Total assets. Add lines 1 through 15 (must equal line 34)......			122,615,352	16	113,735,179
17	Accounts payable and accrued expenses .........			15,389,849	17	15,865,587
18	Grants payable .................			0	18	0
19	Deferred revenue ................			9,199	19	0
20	Tax-exempt bond liabilities .............			62,791,810	20	68,436,234
21	Escrow or custodial account liability. Complete Part IV of Schedule D..			0	21	0
22	Loans and other 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....................			49,451,525	25	33,470,106
26	Total liabilities. Add lines 17 through 25.........			127,642,383	26	117,771,927
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			-11,327,023	27	-10,926,920
28	Temporarily restricted net assets ...........			6,226,005	28	6,798,100
29	Permanently restricted net assets ...........			73,987	29	92,072
	Organizations that do not follow SFAS 117 (ASC 958), 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 ...........			-5,027,031	33	-4,036,748
34	Total liabilities and net assets/fund balances ........			122,615,352	34	113,735,179