TY 2013 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) DANIEL PERRYMAN........................................................................ BOARD PRESIDENT/HOSPITAL CEO	49.00 .......................1.00	X	X	0	358,887	95,226
(2) DONA MCGRAW........................................................................ VICE CHAIRMAN	1.00 .......................0	X	X	0	0	0
(3) JOHN FASSERO........................................................................ SECRETARY	1.00 .......................0	X	X	0	0	0
(4) LONNIE BATHURST........................................................................ CHAIRMAN (PARTIAL YEAR)	1.00 .......................0	X	X	0	0	0
(5) TOM FRANZEN........................................................................ CHAIRMAN	1.00 .......................0	X	X	0	0	0
(6) CHRIS POIROT MD........................................................................ BOARD MEMBER (PARTIAL YEAR)	1.00 .......................0	X		0	0	0
(7) MIKE FLEMING........................................................................ BOARD MEMBER	1.00 .......................0	X		0	0	0
(8) PAUL KAY MD........................................................................ BOARD MEMBER	1.00 .......................0	X		0	0	0
(9) PETER MANNIX........................................................................ BOARD MEMBER	1.00 .......................0.00	X		0	375,256	132,833
(10) ROGER WUJEK MD........................................................................ BOARD MEMBER	1.00 .......................0	X		0	0	0
(11) SISTER JANICE SCHNIEDER OSF........................................................................ BOARD MEMBER	1.00 .......................1.00	X		0	0	0
(12) SISTER MARGUERITE COOK OSF........................................................................ BOARD MEMBER (PARTIAL YEAR)	1.00 .......................0	X		0	0	0
(13) ANN M CARR........................................................................ TREASURER	.25 .......................61.75		X	0	318,955	255,068
(14) CAROL JACO........................................................................ COO/CNO	50.00 .......................0		X	193,842	0	61,998
(15) DAVID OLEJNICZAK........................................................................ Interim CEO	10.00 .......................65.00		X	0	403,341	89,256
(16) DIANE LINDSAY........................................................................ CFO	50.00 .......................0		X	174,462	0	111,233
(17) EVERT J KUIPER........................................................................ Central Illinois Division CEO	16.00 .......................59.00		X	0	158,209	0

(A) Name and business address	(B) Description of services	(C) Compensation
ILLNOIS EMERGENCY PHYSICIANSPO BOX 793TRAVERSE CITYMI49685	ER PHYSICIANS	1,308,827
HENSON ROBINSONPO BOX 13137SPRINGFIELDIL62791	CONST CONTRACTOR	622,350
HELMCAMP CONSTRUCTION CO707 BERKSHIRE BLVDEAST ALTONIL62024	CONST CONTRACTOR	615,085
AMSOL ANESTHETISTS OF LITCHFIELD LLCPO BOX 6633HIGH POINTNC27262	CRNA SERVICES	473,089
ORTHOPAEDIC CENTER OF IL1301 S KOKE MILL RDSPRINGFIELDIL62711	ORTHO SURGEON	408,589
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 11

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	2,000	2,000
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 ....	375,277	197,625	177,652
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	10,460,558	7,643,082	2,817,476
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	965,993	698,876	267,117
9	Other employee benefits .......	2,107,976	1,525,076	582,900
10	Payroll taxes ...........	718,156	519,571	198,585
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	18,465		18,465
c	Accounting ...........	41,246		41,246
d	Lobbying ...........	0
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) ........	2,523,070	904,463	1,618,607	0
12	Advertising and promotion ....	71,360		71,360
13	Office expenses .......	95,101	47,672	47,429
14	Information technology ......	1,348,796	1,011,597	337,199
15	Royalties ..	0
16	Occupancy ...........	867,681	269,397	598,284
17	Travel ............	24,522	8,701	15,821
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0
19	Conferences, conventions, and meetings ....	58,896	18,286	40,610
20	Interest ...........	475,696	475,696
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization .....	1,973,639	776,490	1,197,149
23	Insurance ..............	421,826	316,370	105,456
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	SUPPLIES (MEDICAL & OFFICE)	2,414,105	2,212,661	201,444
b	PROVISION FOR BAD DEBT	2,543,911	2,543,911
c	MAINTENANCE AND REPAIRS	1,105,648	752,796	352,852
d	MEDICAL PROFESSIONAL FEES	2,666,434	2,666,434	0
e	All other expenses	2,412,915	1,967,885	445,030	0
25	Total functional expenses. Add lines 1 through 24e	33,693,271	24,558,589	9,134,682	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).	0

Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
	1	Cash–non-interest-bearing .............	2,382,170	1	6,694,146
2	Savings and temporary cash investments .........		2
3	Pledges and grants receivable, net ...........	44	3	37
4	Accounts receivable, net .............	2,002,705	4	756,408
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 .............	63,683	7	60,992
8	Inventories for sale or use ..............	387,459	8	384,208
9	Prepaid expenses and deferred charges ..........	297,521	9	226,370
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	54,080,604
b	Less: accumulated depreciation .....	10b	30,479,652	22,542,328	10c	23,600,952
11	Investments—publicly traded securities ..........	23,535,908	11	26,150,927
12	Investments—other securities. See Part IV, line 11 .....	0	12	0
13	Investments—program-related. See Part IV, line 11 .....	0	13	0
14	Intangible assets ...............		14
15	Other assets. See Part IV, line 11 ...........	153,620	15	95,979
16	Total assets. Add lines 1 through 15 (must equal line 34)......	51,365,438	16	57,970,019
	17	Accounts payable and accrued expenses .........	3,993,438	17	6,217,597
18	Grants payable .................		18
19	Deferred revenue ................		19	12,167
20	Tax-exempt bond liabilities .............	10,185,695	20	10,077,568
21	Escrow or custodial account liability. Complete Part IV of Schedule D..		21
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 ..		23
24	Unsecured notes and loans payable to unrelated third parties ....		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................	8,118,968	25	7,512,828
26	Total liabilities. Add lines 17 through 25.........	22,298,101	26	23,820,160
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............	26,065,767	27	30,823,712
28	Temporarily restricted net assets ...........	2,378,182	28	2,077,966
29	Permanently restricted net assets ...........	623,388	29	1,248,181
	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 ...........	29,067,337	33	34,149,859
34	Total liabilities and net assets/fund balances ........	51,365,438	34	57,970,019

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SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

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

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

See separate instructions.
right arrow

Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public
Inspection

Name of the organization

ST FRANCIS HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCIS

Employer identification number

37-0661236

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) 2013

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) 2009	(b) 2010	(c) 2011	(d) 2012	(e) 2013	(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) 2009	(b) 2010	(c) 2011	(d) 2012	(e) 2013	(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 2013 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2012 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2013. 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—2012. 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—2013. 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—2012. 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) 2013

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) 2009	(b) 2010	(c) 2011	(d) 2012	(e) 2013	(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) 2009	(b) 2010	(c) 2011	(d) 2012	(e) 2013	(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 2013 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2012 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2012 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2013. 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—2012. 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) 2013

Page 4

Part IV

Supplemental Information. 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) 2013

Additional Data

Software ID:	13000248
Software Version:	2013v3.1

- 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.

Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Name of the organization

ST FRANCIS HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCIS

Employer identification number

37-0661236

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 for 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 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 its Form 990PF, Part I, line 2, 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) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Page 2

Name of organization ST FRANCIS 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, RESTRICTEDRESTRICTED	$RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Page 3

Name of organization ST FRANCIS 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) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Page 4

Name of organization
ST FRANCIS HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCIS

Employer identification number

37-0661236

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) (2013)

Additional Data

Software ID:	13000248
Software Version:	2013v3.1

- 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. SchCMd Bullet

Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

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 FRANCIS HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCIS

Employer identification number

37-0661236

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) 2013

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) 2010	(b) 2011	(c) 2012	(d) 2013	(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) 2013

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

18,586

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

18,586

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

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.

Return Reference	Explanation
Schedule C, Part II-B, Line 1, Description of the activities reported on Lines 1a through 1i	THE HOSPITAL PAYS MEMBERSHIP DUES TO DIFFERENT ASSOCIATIONS AND A PERCENTAGE OF THOSE DUES ARE DEDICATED TO LOBBYING EXPENSES. THE ASSOCIATIONS ST FRANCIS PAYS ARE AS FOLLOWS: - AMERICAN HOSPITAL ASSOCIATION ("AHA") AT 23.65% LOBBYING EXPENSE - CATHOLIC HEALTH ASSOCIATION ("CHA") AT 3.31% LOBBYING EXPENSE - ILLINOIS HOSPITAL ASSOCIATION ("IHA") AT 39.00% LOBBYING EXPENSE - NATIONAL ASSOCIATION FOR HOME CARE & HOSPICE AT 15.00% LOBBYING EXPENSE THE TOTAL AMOUNT OF ANNUAL DUES PAID TO EACH ASSOCIATION IS MULTIPLIED BY THE PERCENTAGE OF DUES ALLOCATED TO LOBBYING EXPENSE TO CALCULATE THE TOTAL LOBBYING EXPENDITURES PAID.

Return Reference

Explanation

Schedule C, Part II-B, Line 1, Description of the activities reported on Lines 1a through 1i

THE HOSPITAL PAYS MEMBERSHIP DUES TO DIFFERENT ASSOCIATIONS AND A PERCENTAGE OF THOSE DUES ARE DEDICATED TO LOBBYING EXPENSES. THE ASSOCIATIONS ST FRANCIS PAYS ARE AS FOLLOWS: - AMERICAN HOSPITAL ASSOCIATION ("AHA") AT 23.65% LOBBYING EXPENSE - CATHOLIC HEALTH ASSOCIATION ("CHA") AT 3.31% LOBBYING EXPENSE - ILLINOIS HOSPITAL ASSOCIATION ("IHA") AT 39.00% LOBBYING EXPENSE - NATIONAL ASSOCIATION FOR HOME CARE & HOSPICE AT 15.00% LOBBYING EXPENSE THE TOTAL AMOUNT OF ANNUAL DUES PAID TO EACH ASSOCIATION IS MULTIPLIED BY THE PERCENTAGE OF DUES ALLOCATED TO LOBBYING EXPENSE TO CALCULATE THE TOTAL LOBBYING EXPENDITURES PAID.

Schedule C (Form 990 or 990EZ) 2013

Additional Data

Software ID:	13000248
Software Version:	2013v3.1

- 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. SchDMd Bullet

Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public Inspection

Name of the organization

ST FRANCIS HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCIS

Employer identification number

37-0661236

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) 2013

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. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	99,383		99,383
b	Buildings ................	32,852,928	14,712,302	18,140,626
c	Leasehold improvements ............			0
d	Equipment ................	18,324,434	14,651,038	3,673,396
e	Other .................	2,803,859	1,116,312	1,687,547
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				23,600,952

Schedule D (Form 990) 2013

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11b. 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. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment		(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. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11d. 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. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability		(b) Book value
Federal income taxes		0
SETTLEMENT VALUE OF INTEREST RATE SWAP PROGRAM		560,089
RETIRE OBLIGATION - ASBESTOS		877,147
ACCRUED BENEFIT LIABILITY		6,075,592






Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		7,512,828
2. Liability for uncertain tax positions 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) 2013

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
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. Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
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

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.

Return Reference	Explanation
Schedule D, Part X, Line 2, FIN 48 (ASC 740) footnote	HSHS AND THE FOUNDATION ARE ILLINOIS NOT FOR PROFIT ORGANIZATIONS AS DESCRIBED IN SECTION 501(C) (3) OF THE INTERNAL REVENUE CODE (THE CODE) AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. DEFERRED TAX ASSETS AND LIABILITIES ARE RECOGNIZED FOR THE FUTURE TAX CONSEQUENCES ATTRIBUTABLE TO DIFFERENCES BETWEEN THE CONSOLIDATED FINANCIAL STATEMENT CARRYING AMOUNTS OF EXISTING ASSETS AND LIABILITIES AND THEIR RESPECTIVE TAX BASIS AND OPERATING LOSS AND TAX CREDIT CARRYFORWARDS. DEFERRED TAX ASSETS AND LIABILITIES ARE MEASURED USING THE ENACTED TAX RATES EXPECTED TO APPLY TO TAXABLE INCOME IN THE YEARS IN WHICH THOSE TEMPORARY DIFFERENCES ARE EXPECTED TO BE RECOVERED OR SETTLED. THE EFFECT ON DEFERRED TAX ASSETS AND LIABILITIES OF A CHANGE IN TAX RATES IS RECOGNIZED IN INCOME IN THE PERIOD THAT INCLUDES THE ENACTMENT DATE. IN ASSESSING THE REALIZABILITY OF DEFERRED TAX ASSETS, MANAGEMENT CONSIDERS WHETHER IT IS MORE LIKELY THAN NOT THAT SOME PORTION OR ALL OF THE DEFERRED TAX ASSETS WILL NOT BE REALIZED. THE ULTIMATE REALIZATION OF DEFERRED TAX ASSETS IS DEPENDENT UPON THE GENERATION OF FUTURE TAXABLE INCOME DURING THE PERIODS IN WHICH THOSE TEMPORARY DIFFERENCES BECOME DEDUCTIBLE. MANAGEMENT CONSIDERS PROJECTED FUTURE TAXABLE INCOME AND TAX PLANNING STRATEGIES IN MAKING THIS ASSESSMENT. BASED UPON THE LEVEL OF HISTORICAL TAXABLE LOSSES AND PROJECTIONS FOR FUTURE TAXABLE LOSSES OVER THE PERIODS FOR WHICH THE DEFERRED TAX ASSETS ARE DEDUCTIBLE, MANAGEMENT BELIEVES IT IS MORE LIKELY THAN NOT THAT KIARA, INC. WILL NOT REALIZE THE MAJORITY OF THE BENEFITS OF THESE DEDUCTIBLE DIFFERENCES. THE DEFERRED TAX ASSETS ATTRIBUTABLE TO THE NET OPERATING LOSS CARRYFORWARDS NOT REALIZED AS OF JUNE 30, 2014 AND 2013 HAVE BEEN FULLY RESERVED IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS DUE TO THE UNCERTAINTY OF REALIZATION. HSHS RECOGNIZES 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. AS OF JUNE 30, 2014 AND 2013, HSHS DOES NOT HAVE ANY LIABILITIES FOR UNRECOGNIZED TAX BENEFITS.

Return Reference

Explanation

Schedule D, Part X, Line 2, FIN 48 (ASC 740) footnote

HSHS AND THE FOUNDATION ARE ILLINOIS NOT FOR PROFIT ORGANIZATIONS AS DESCRIBED IN SECTION 501(C) (3) OF THE INTERNAL REVENUE CODE (THE CODE) AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. DEFERRED TAX ASSETS AND LIABILITIES ARE RECOGNIZED FOR THE FUTURE TAX CONSEQUENCES ATTRIBUTABLE TO DIFFERENCES BETWEEN THE CONSOLIDATED FINANCIAL STATEMENT CARRYING AMOUNTS OF EXISTING ASSETS AND LIABILITIES AND THEIR RESPECTIVE TAX BASIS AND OPERATING LOSS AND TAX CREDIT CARRYFORWARDS. DEFERRED TAX ASSETS AND LIABILITIES ARE MEASURED USING THE ENACTED TAX RATES EXPECTED TO APPLY TO TAXABLE INCOME IN THE YEARS IN WHICH THOSE TEMPORARY DIFFERENCES ARE EXPECTED TO BE RECOVERED OR SETTLED. THE EFFECT ON DEFERRED TAX ASSETS AND LIABILITIES OF A CHANGE IN TAX RATES IS RECOGNIZED IN INCOME IN THE PERIOD THAT INCLUDES THE ENACTMENT DATE. IN ASSESSING THE REALIZABILITY OF DEFERRED TAX ASSETS, MANAGEMENT CONSIDERS WHETHER IT IS MORE LIKELY THAN NOT THAT SOME PORTION OR ALL OF THE DEFERRED TAX ASSETS WILL NOT BE REALIZED. THE ULTIMATE REALIZATION OF DEFERRED TAX ASSETS IS DEPENDENT UPON THE GENERATION OF FUTURE TAXABLE INCOME DURING THE PERIODS IN WHICH THOSE TEMPORARY DIFFERENCES BECOME DEDUCTIBLE. MANAGEMENT CONSIDERS PROJECTED FUTURE TAXABLE INCOME AND TAX PLANNING STRATEGIES IN MAKING THIS ASSESSMENT. BASED UPON THE LEVEL OF HISTORICAL TAXABLE LOSSES AND PROJECTIONS FOR FUTURE TAXABLE LOSSES OVER THE PERIODS FOR WHICH THE DEFERRED TAX ASSETS ARE DEDUCTIBLE, MANAGEMENT BELIEVES IT IS MORE LIKELY THAN NOT THAT KIARA, INC. WILL NOT REALIZE THE MAJORITY OF THE BENEFITS OF THESE DEDUCTIBLE DIFFERENCES. THE DEFERRED TAX ASSETS ATTRIBUTABLE TO THE NET OPERATING LOSS CARRYFORWARDS NOT REALIZED AS OF JUNE 30, 2014 AND 2013 HAVE BEEN FULLY RESERVED IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS DUE TO THE UNCERTAINTY OF REALIZATION. HSHS RECOGNIZES 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. AS OF JUNE 30, 2014 AND 2013, HSHS DOES NOT HAVE ANY LIABILITIES FOR UNRECOGNIZED TAX BENEFITS.

Schedule D (Form 990) 2013

Additional Data

Software ID:	13000248
Software Version:	2013v3.1

- 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.
MediumBullet

Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public Inspection

Name of the organization

ST FRANCIS HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCIS

Employer identification number

37-0661236

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 %

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) ..		1,462	821,327		821,327	2.640 %
b	Medicaid (from Worksheet 3, column a) ....			8,282,608	8,088,713	193,895	0.620 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) .					0	0 %
d	Total Financial Assistance and Means-Tested Government Programs .	0	1,462	9,103,935	8,088,713	1,015,222	3.260 %
Other Benefits		15	741	147,954	4,070	143,884	0.460 %
e	Community health improvement services and community benefit operations (from Worksheet 4) ..	15	741	147,954	4,070	143,884	0.460 %
f	Health professions education (from Worksheet 5) ..					0	0 %
g	Subsidized health services (from Worksheet 6) ..					0	0 %
h	Research (from Worksheet 7)					0	0 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8)	4	17,493	145,397	11,993	133,404	0.430 %
j	Total. Other Benefits ..	19	18,234	293,351	16,063	277,288	0.890 %
k	Total. Add lines 7d and 7j .	19	19,696	9,397,286	8,104,776	1,292,510	4.150 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2013

Schedule H (Form 990) 2013

Page

Part II

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

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense
1	Physical improvements and housing					0
2	Economic development					0
3	Community support					0
4	Environmental improvements					0
5	Leadership development and training for community members					0
6	Coalition building	2	28	272		272
7	Community health improvement advocacy					0
8	Workforce development					0
9	Other					0
10	Total	2	28	272	0	272

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. ......

2,543,911

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. ......

79,098

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).....

12,660,744

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

12,858,143

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

-197,399

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 %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2013

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, primary website address, and state license number
1	ST FRANCIS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCI S 1215 FRANCISCAN DRIVE LITCHFIELD,IL62056 HTTP://WWW.STFRANCIS-LITCHFIELD.ORG/ 2336	X	X	X

Schedule H (Form 990) 2013

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 FRANCIS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCI
Name of hospital facility or facility reporting group	S

If reporting on Part V, Section B for a single hospital facility 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 11

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests 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 (list url): http://www.stfrancis-litchfield.org/sfl/Needs-Assessment.aspx

Other website (list url):

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 as of the end of the tax year):

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) 2013

Page

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: 200% 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: 300% 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	Residency
i	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 individual’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 Section C)
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 individual’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 Section C)

Schedule H (Form 990) 2013

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 individuals regarding the individuals’ bills

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

Other (describe in Section C)

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 individual 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 individual an amount equal to the gross charge for any service provided to that individual? .........................

If "Yes," explain in Part VI.

Schedule H (Form 990) 2013

Page

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B.Provide descriptions required for Part V, Section B, lines 1j, 3, 4, 5d, 6i, 7, 10, 11, 12i, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22. If applicable, provide separate descriptions for each facility in a facility reporting group, designated by "Facility A," "Facility B," etc.
Form and Line Reference	Explanation
Schedule H, Part V Sec B, Line 3, Community Served by Needs Assessment	(1) - ST. FRANCIS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST. FRANCIS: THE HOSPITAL TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH. THE HOSPITAL TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY THROUGH EXTENSIVE PHONE SURVEYS AND THE CONVENING OF A COMMUNITY ADVISORY COMMITTEE, COMPRISED OF COMMUNITY MEMBERS, PUBLIC OFFICIALS AND HOSPITAL REPRESENTATIVES TO ASSIST WITH THE COMMUNITY HEALTH NEEDS ASSESSMENT. SIXTY SEVEN PERCENT OF RESPONDENTS TO THE TELEPHONE SURVEY WERE AGES 18-54. ALMOST SIXTY PERCENT WERE MARRIED. FORTY FOUR PERCENT OF THOSE RESPONDED THAT THEY HAD CHILDREN LIVING AT HOME, WITH FIFTY PERCENT OF THOSE CHILDREN BETWEEN THE AGES OF 11-16. THE MAJORITY OF RESPONDENTS WERE CAUCASIAN WITH ONLY THREE PERCENT OF OTHER RACES REPRESENTED. MORE THAN NINETY SIX PERCENT OF THE POPULATION FOR BOTH MACOUPIN AND MONTGOMERY COUNTIES THAT THE HOSPITAL SERVES ARE CAUCASIAN. THE EDUCATION LEVEL OF RESPONDENTS VARIED WITH THIRTY PERCENT ACHIEVING HIGH SCHOOL OR EQUIVALENT, THIRTY SEVEN PERCENT HAVING SOME COLLEGE OR TECHNICAL SCHOOL EDUCATION, AND TWENTY ONE PERCENT HAVING GRADUATED FROM COLLEGE. ONLY NINE PERCENT OF THE SURVEYED POPULATION HELD AN ADVANCED OR PROFESSIONAL DEGREE. APPROXIMATELY FORTY PERCENT OF RESPONDENTS REPORTED AN ANNUAL INCOME OF $35,000 OR LESS AND FORTY TWO PERCENT REPORTED AN ANNUAL INCOME OF $35,000 OR LESS, AND FORTY TWO PERCENT REPORTED AN ANNUAL INCOME OF $35,000 TO $75,000. NINETEEN PERCENT REPORTED ANNUAL INCOME OF GREATER THAN $75,000. SIXTY FOUR PERCENT OF TELEPHONE SURVEY RESPONDENTS WERE FEMALE AND THIRTY SIX PERCENT MALE. IN ORDER TO PROVIDE REPRESENTATION OF ALL ASPECTS OF OUR COMMUNITY, A CROSS SECTION OF COMMUNITY MEMBERS WERE IDENTIFIED BY THE ST. FRANCIS HOSPITAL INTERNAL NEEDS ASSESSMENT TEAM AND INVITED TO PARTICIPATE IN THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS. REPRESENTATIVES FROM LAW ENFORCEMENT, EDUCATION, PUBLIC HEALTH, RELIGIOUS ORGANIZATIONS, THE MEDICAL AND DENTAL FIELDS, SERVICE ORGANIZATIONS, AS WELL AS STATE SENATOR AND STATE REPRESENTATIVE OFFICES RECEIVED A PERSONAL PHONE CALL AND EMAIL INVITATION TO ASSIST WITH THE NEEDS ASSESSMENT PROCESS. LETTERS OF INVITATION WERE ALSO MAILED. REPRESENTATIVES FROM THESE FIELDS AND FROM THE HOSPITAL (INCLUDING A HOSPITAL BOARD MEMBER) FORMED THE COMMUNITY ADVISORY COMMITTEE. COMMUNITY ADVISORY COMMITTEE MEMBER: 1. ST FRANCIS HOSPITAL INTERNAL NEEDS ASSESSMENT TEAM: CHIEF EXECUTIVE OFFICER HOSPITAL BOARD MEMBER COMMUNITY OUTREACH FACILITATOR ADMINISTRATIVE DIRECTOR OF ANCILLARY SERVICES DIRECTOR OF FINANCIAL SERVICES MARKETING COORDINATOR DIRECTOR OF DEVELOPMENT 2. LOCAL AND COUNTY LAW ENFORCEMENT: LITCHFIELD CHIEF OF POLICE-120 E, RYDER, LITCHFIELD, IL 3. DIRECTOR MONTGOMERY COUNTY HEALTH DEPARTMENT- RT. 185 HILLSBORO IL 4. DIRECTOR MACOUPIN COUNTY HEALTH DEPARTMENT-805 N. BROAD ST. CARLINVILLE, IL 5. STATE REPRESENTATIVE WAYNE ROSENTHAL - 324A N. STATE ST., LITCHFIELD, IL 6. STATE SENATOR SAM MCCANN - 220 N. BROAD ST., CARLINVILLE, IL. 7. MINISTER OF FIRST BAPTIST CHURCH, 608 N. VAN BUREN, LITCHFIELD, IL 8. ST. FRANCIS HOSPITAL AUXILIARY, LITCHFIELD, IL. 9. STUDENT COUNCIL REPRESENTATIVE FROM LITCHFIELD HIGH SCHOOL, LITCHFIELD, IL THE FOLLOWING PERSONS WERE ALSO INVITED TO PARTICIPATE BUT WERE UNABLE TO ATTEND: MACOUPIN CO. SHERIFF, LITCHFIELD HIGH SCHOOL GUIDANCE COUNSELOR, HEARTS UNITED SERVICE ORGANIZATION DIRECTOR, HOLY FAMILY CHURCH, 410 S. STATE ST. LITCHFIELD, IL, MINISTER AND PHYSICIAN, LOCAL REPRESENTATIVE, LOCAL DENTAL PROVIDER THE DIRECTORS OF BOTH COUNTY HEALTH DEPARTMENTS, MACOUPIN COUNTY HEALTH DEPARTMENT AND MONTGOMERY COUNTY HEALTH DEPARTMENT, ARE VERY AWARE OF THE NEEDS OF THE UNINSURED AND LOW INCOME OR MINORITY POPULATIONS AS THESE ARE THE TARGET POPULATIONS THAT THEY SERVE. BOTH COUNTY HEALTH DEPARTMENT DIRECTORS WERE FULLY ENGAGED WITH THE NEEDS ASSESSMENT PROCESS AND PROVIDED VALUABLE INSIGHT INTO THE PRIMARY AND CHRONIC DISEASE NEEDS OF THE UNINSURED AND LOW INCOME POPULATIONS.;
Schedule H, Part V Sec B, Line 5a, Hospital Facility's Website (list URL)	(1) - ST. FRANCIS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST. FRANCIS: HTTP://WWW.STFRANCIS-LITCHFIELD.ORG/SFL/NEEDS-ASSESSMENT.ASPX;
Schedule H, Part V Sec B, Line 7, Needs not addressed in Needs Assessment	(1) - ST. FRANCIS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST. FRANCIS: THE TOP HEALTH CARE NEEDS IDENTIFIED IN OUR COMMUNITY INCLUDED: ELEVATED BLOOD PRESSURE, ELEVATED CHOLESTEROL, DENTAL CARE, DIABETES, TOBACCO USE, MENTAL HEALTH, ALCOHOL USE, HEALTH SCREENINGS AND TEEN SUBSTANCE ABUSE. AS A HEALTH CARE PROVIDER, ST. FRANCIS HOSPITAL ELECTED TO FOCUS ON THE FOLLOWING AREAS BECAUSE WE HAVE EXPERIENCE CARING FOR PATIENTS WITH DIABETES AND ELEVATED BLOOD PRESSURE AS WELL AS PROVIDING MEDICAL CARE RELATED TO DENTAL HEALTH AND TEEN SUBSTANCE ABUSE. 1. DIABETES 2. TEEN SUBSTANCE ABUSE 3. DENTAL CARE 4. ELEVATED BLOOD PRESSURE ST. FRANCIS HOSPITAL DID NOT TAKE THE LEAD ON THE FOLLOWING ISSUES AS THEY WERE ADDRESSED BY ORGANIZATIONS IN THE COMMUNITY WITH SUPPORT FROM THE HOSPITAL: ALCOHOL USE, TOBACCO USE, MENTAL HEALTH, ELEVATED CHOLESTEROL, AND HEALTH SCREENINGS. ST. FRANCIS HOSPITAL REFERRED PERSONS TO AGENCIES WHICH HAVE EXISTING PROGRAMS IN PLACE. AREA OF NEED: ALCOHOL USE WHO WILL ADDRESS: MONTGOMERY COUNTY HEALTH DEPARTMENT & MACOUPIN COUNTY HEALTH DEPARTMENT APPROACH THAT WILL BE TAKEN TO ADDRESS THE AREA OF NEED: MONTGOMERY COUNTY HEALTH DEPARTMENT AND MACOUPIN COUNTY HEALTH DEPARTMENT AS WELL AS THE CONTINUING RECOVERY CENTER IN IRVING, IL ARE PROVIDING SERVICES FOR THOSE WITH ALCOHOL ABUSE NEEDS; THEREFORE, ST. FRANCIS HOSPITAL WILL NOT BE TAKING ACTION IN THIS AREA SINCE IT LACKS THE EXPERTISE, EQUIPMENT, OR QUALIFIED STAFF TO ADDRESS THIS NEED. ST. FRANCIS HOSPITAL WILL REFER TO THESE AGENCIES WHICH HAVE EXISTING PROGRAMS IN PLACE. AREA OF NEED: TOBACCO USE WHO WILL ADDRESS: MONTGOMERY COUNTY HEALTH DEPARTMENT & MACOUPIN COUNTY HEALTH DEPARTMENT AS WELL AS STATE OF ILLINOIS APPROACH THAT WILL BE TAKEN TO ADDRESS THE AREA OF NEED: BOTH MONTGOMERY COUNTY HEALTH DEPARTMENT AND MACOUPIN COUNTY HEALTH DEPARTMENT ARE PROVIDING SERVICES FOR TOBACCO CESSATION; THEREFORE, ST. FRANCIS HOSPITAL WILL NOT BE TAKING ACTION IN THIS AREA SINCE IT LACKS THE EXPERTISE, EQUIPMENT, OR QUALIFIED STAFF TO ADDRESS THIS NEED. MONTGOMERY COUNTY HEALTH DEPARTMENT ALSO PROVIDES CLASSES TO SIXTH AND SEVENTH GRADERS IN ALL FOUR COUNTY SCHOOL DISTRICTS REGARDING TOBACCO USE, ALCOHOL, AND DRUGS. ST. FRANCIS HOSPITAL WILL REFER TO THE COUNTY HEALTH DEPARTMENTS WHICH HAVE EXISTING PROGRAMS IN PLACE AND WILL ALSO REFER INDIVIDUALS TO THE ILLINOIS QUIT LINE. AREA OF NEED: MENTAL HEALTH WHO WILL ADDRESS: MONTGOMERY COUNTY HEALTH DEPARTMENT & MACOUPIN COUNTY HEALTH DEPARTMENT APPROACH THAT WILL BE TAKEN TO ADDRESS THE AREA OF NEED: MONTGOMERY COUNTY HEALTH DEPARTMENT AND MACOUPIN COUNTY HEALTH DEPARTMENT AS WELL AS THE BEHAVIORAL HEALTH DEPARTMENT AT ST. JOHN'S HOSPITAL ARE PROVIDING SERVICES FOR THOSE WITH MENTAL HEALTH NEEDS; THEREFORE, ST. FRANCIS HOSPITAL WILL NOT BE TAKING ACTION IN THIS AREA SINCE IT LACKS THE EXPERTISE, EQUIPMENT, OR QUALIFIED STAFF TO ADDRESS THIS NEED. ST. FRANCIS HOSPITAL WILL REFER TO THESE AGENCIES WHICH HAVE EXISTING PROGRAMS IN PLACE. AREA OF NEED: ELEVATED CHOLESTEROL WHO WILL ADDRESS: ST. FRANCIS HOSPITAL AND COMMUNITY PARTNERS APPROACH THAT WILL BE TAKEN TO ADDRESS THE AREA OF NEED: A VARIETY OF FREE CHOLESTEROL SCREENINGS ARE CURRENTLY AVAILABLE THROUGH BOTH COUNTY HEALTH DEPARTMENTS AND ST. FRANCIS HOSPITAL AT VARIOUS HEALTH FAIRS AND PROGRAMS THROUGHOUT THE YEAR. ACTION PLAN: REDUCED COST CHOLESTEROL TESTING WAS OFFERED IN 2013 AND 2014 AT A COMMUNITY HEALTH FAIR PROVIDED BY ST. FRANCIS HOSPITAL. AREA OF NEED: HEALTH SCREENINGS WHO WILL ADDRESS: ST. FRANCIS HOSPITAL AND COMMUNITY PARTNERS APPROACH THAT WILL BE TAKEN TO ADDRESS THE AREA OF NEED: A VARIETY OF FREE HEALTH SCREENINGS ARE CURRENTLY AVAILABLE THROUGH BOTH COUNTY HEALTH DEPARTMENTS AND ST. FRANCIS HOSPITAL AT VARIOUS HEALTH FAIRS AND PROGRAMS THROUGHOUT THE YEAR. A VARIETY OF REDUCED COST LABORATORY SCREENINGS, AND OTHER FREE SCREENINGS INCLUDING RESPIRATORY SCREENINGS, BODY MASS INDEX, ORAL HEALTH SCREENINGS, BALANCE, AND FLEXIBILITY WERE PROVIDED AT A COMMUNITY HEALTH FAIR SPONSORED BY ST. FRANCIS HOSPITAL . ;
Schedule H, Part V Sec B, Line 14g, Other ways hospital publicized Financial Assistance Policy	(1) - ST FRANCIS HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCIS: COMMUNICATION/NOTIFICATION ABOUT FINANCIAL ASSISTANCE AVAILABILITY FROM HSHS INCLUDES THE FOLLOWING: A. FINANCIAL ASSISTANCE APPLICATIONS: THE FINANCIAL ASSISTANCE APPLICATION IS PROVIDED TO PATIENTS UPON REQUEST AND THROUGHOUT THE REGISTRATION AND POSTREGISTRATION PROCESS. THIS APPLICATION COMPLIES WITH CURRENT ILLINOIS AND WISCONSIN STATUTES AND ANY APPLICABLE FEDERAL STATUTES. B. POSTERS: THE AVAILABILITY OF FINANCIAL ASSISTANCE PROGRAM IS ADVERTISED ON POSTER-SIZED SIGNAGE LOCATED IN ADMISSIONS, OUTPATIENT, WAITING ROOM AREAS. A TOLL-FREE PHONE NUMBER IS INCLUDED. C. BROCHURES: BROCHURES OUTLINING THE FINANCIAL ASSISTANCE PROGRAM, APPLICATION PROCESS AND TOLL-FREE PHONE NUMBER ARE AVAILABLE AT ALL PATIENT REGISTRATION DESKS AND IN ALL WAITING AREAS. D. INTERNET: THE AVAILABILITY OF FINANCIAL ASSISTANCE PROGRAM AND ILLINOIS UNINSURED DISCOUNT ACT OF 2009 ARE POSTED ON THE HSHS INTERNET HOME PAGE. E. PATIENT STATEMENTS: EACH BILL, INVOICE OR OTHER SUMMARY OF CHARGES TO AN UNINSURED PATIENT INCLUDES WITH IT, OR ON IT, A PROMINENT STATEMENT THAT AN UNINSURED PATIENT WHO MEETS CERTAIN INCOME REQUIREMENTS MAY QUALIFY FOR AN UNINSURED DISCOUNT AND INFORMATION REGARDING HOW AN UNINSURED PATIENT MAY APPLY FOR CONSIDERATION UNDER THE HSHS FINANCIAL ASSISTANCE PROGRAM. IN ADDITION, REFERRAL OF PATIENTS MAY BE MADE BY ANY MEMBER OF THE HSHS STAFF OR MEDICAL STAFF, INCLUDING PHYSICIANS, NURSES, FINANCIAL COUNSELORS, SOCIAL WORKERS, CASE MANAGERS, CHAPLAIN'S, AND RELIGIOUS SPONSORS. A REQUEST FOR FINANCIAL ASSISTANCE MAY BE MADE BY THE PATIENT OR A FAMILY MEMBER, CLOSE FRIEND, OR ASSOCIATE OF THE PATIENT, SUBJECT TO APPLICABLE PRIVACY LAWS.;

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Section D. 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) 2013

Page

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs 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.

Form and Line Reference	Explanation
Schedule H, Part V Sec B, Line 3, Community Served by Needs Assessment	(1) - ST. FRANCIS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST. FRANCIS: THE HOSPITAL TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH. THE HOSPITAL TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY THROUGH EXTENSIVE PHONE SURVEYS AND THE CONVENING OF A COMMUNITY ADVISORY COMMITTEE, COMPRISED OF COMMUNITY MEMBERS, PUBLIC OFFICIALS AND HOSPITAL REPRESENTATIVES TO ASSIST WITH THE COMMUNITY HEALTH NEEDS ASSESSMENT. SIXTY SEVEN PERCENT OF RESPONDENTS TO THE TELEPHONE SURVEY WERE AGES 18-54. ALMOST SIXTY PERCENT WERE MARRIED. FORTY FOUR PERCENT OF THOSE RESPONDED THAT THEY HAD CHILDREN LIVING AT HOME, WITH FIFTY PERCENT OF THOSE CHILDREN BETWEEN THE AGES OF 11-16. THE MAJORITY OF RESPONDENTS WERE CAUCASIAN WITH ONLY THREE PERCENT OF OTHER RACES REPRESENTED. MORE THAN NINETY SIX PERCENT OF THE POPULATION FOR BOTH MACOUPIN AND MONTGOMERY COUNTIES THAT THE HOSPITAL SERVES ARE CAUCASIAN. THE EDUCATION LEVEL OF RESPONDENTS VARIED WITH THIRTY PERCENT ACHIEVING HIGH SCHOOL OR EQUIVALENT, THIRTY SEVEN PERCENT HAVING SOME COLLEGE OR TECHNICAL SCHOOL EDUCATION, AND TWENTY ONE PERCENT HAVING GRADUATED FROM COLLEGE. ONLY NINE PERCENT OF THE SURVEYED POPULATION HELD AN ADVANCED OR PROFESSIONAL DEGREE. APPROXIMATELY FORTY PERCENT OF RESPONDENTS REPORTED AN ANNUAL INCOME OF $35,000 OR LESS AND FORTY TWO PERCENT REPORTED AN ANNUAL INCOME OF $35,000 OR LESS, AND FORTY TWO PERCENT REPORTED AN ANNUAL INCOME OF $35,000 TO $75,000. NINETEEN PERCENT REPORTED ANNUAL INCOME OF GREATER THAN $75,000. SIXTY FOUR PERCENT OF TELEPHONE SURVEY RESPONDENTS WERE FEMALE AND THIRTY SIX PERCENT MALE. IN ORDER TO PROVIDE REPRESENTATION OF ALL ASPECTS OF OUR COMMUNITY, A CROSS SECTION OF COMMUNITY MEMBERS WERE IDENTIFIED BY THE ST. FRANCIS HOSPITAL INTERNAL NEEDS ASSESSMENT TEAM AND INVITED TO PARTICIPATE IN THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS. REPRESENTATIVES FROM LAW ENFORCEMENT, EDUCATION, PUBLIC HEALTH, RELIGIOUS ORGANIZATIONS, THE MEDICAL AND DENTAL FIELDS, SERVICE ORGANIZATIONS, AS WELL AS STATE SENATOR AND STATE REPRESENTATIVE OFFICES RECEIVED A PERSONAL PHONE CALL AND EMAIL INVITATION TO ASSIST WITH THE NEEDS ASSESSMENT PROCESS. LETTERS OF INVITATION WERE ALSO MAILED. REPRESENTATIVES FROM THESE FIELDS AND FROM THE HOSPITAL (INCLUDING A HOSPITAL BOARD MEMBER) FORMED THE COMMUNITY ADVISORY COMMITTEE. COMMUNITY ADVISORY COMMITTEE MEMBER: 1. ST FRANCIS HOSPITAL INTERNAL NEEDS ASSESSMENT TEAM: CHIEF EXECUTIVE OFFICER HOSPITAL BOARD MEMBER COMMUNITY OUTREACH FACILITATOR ADMINISTRATIVE DIRECTOR OF ANCILLARY SERVICES DIRECTOR OF FINANCIAL SERVICES MARKETING COORDINATOR DIRECTOR OF DEVELOPMENT 2. LOCAL AND COUNTY LAW ENFORCEMENT: LITCHFIELD CHIEF OF POLICE-120 E, RYDER, LITCHFIELD, IL 3. DIRECTOR MONTGOMERY COUNTY HEALTH DEPARTMENT- RT. 185 HILLSBORO IL 4. DIRECTOR MACOUPIN COUNTY HEALTH DEPARTMENT-805 N. BROAD ST. CARLINVILLE, IL 5. STATE REPRESENTATIVE WAYNE ROSENTHAL - 324A N. STATE ST., LITCHFIELD, IL 6. STATE SENATOR SAM MCCANN - 220 N. BROAD ST., CARLINVILLE, IL. 7. MINISTER OF FIRST BAPTIST CHURCH, 608 N. VAN BUREN, LITCHFIELD, IL 8. ST. FRANCIS HOSPITAL AUXILIARY, LITCHFIELD, IL. 9. STUDENT COUNCIL REPRESENTATIVE FROM LITCHFIELD HIGH SCHOOL, LITCHFIELD, IL THE FOLLOWING PERSONS WERE ALSO INVITED TO PARTICIPATE BUT WERE UNABLE TO ATTEND: MACOUPIN CO. SHERIFF, LITCHFIELD HIGH SCHOOL GUIDANCE COUNSELOR, HEARTS UNITED SERVICE ORGANIZATION DIRECTOR, HOLY FAMILY CHURCH, 410 S. STATE ST. LITCHFIELD, IL, MINISTER AND PHYSICIAN, LOCAL REPRESENTATIVE, LOCAL DENTAL PROVIDER THE DIRECTORS OF BOTH COUNTY HEALTH DEPARTMENTS, MACOUPIN COUNTY HEALTH DEPARTMENT AND MONTGOMERY COUNTY HEALTH DEPARTMENT, ARE VERY AWARE OF THE NEEDS OF THE UNINSURED AND LOW INCOME OR MINORITY POPULATIONS AS THESE ARE THE TARGET POPULATIONS THAT THEY SERVE. BOTH COUNTY HEALTH DEPARTMENT DIRECTORS WERE FULLY ENGAGED WITH THE NEEDS ASSESSMENT PROCESS AND PROVIDED VALUABLE INSIGHT INTO THE PRIMARY AND CHRONIC DISEASE NEEDS OF THE UNINSURED AND LOW INCOME POPULATIONS.;
Schedule H, Part V Sec B, Line 5a, Hospital Facility's Website (list URL)	(1) - ST. FRANCIS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST. FRANCIS: HTTP://WWW.STFRANCIS-LITCHFIELD.ORG/SFL/NEEDS-ASSESSMENT.ASPX;
Schedule H, Part V Sec B, Line 7, Needs not addressed in Needs Assessment	(1) - ST. FRANCIS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST. FRANCIS: THE TOP HEALTH CARE NEEDS IDENTIFIED IN OUR COMMUNITY INCLUDED: ELEVATED BLOOD PRESSURE, ELEVATED CHOLESTEROL, DENTAL CARE, DIABETES, TOBACCO USE, MENTAL HEALTH, ALCOHOL USE, HEALTH SCREENINGS AND TEEN SUBSTANCE ABUSE. AS A HEALTH CARE PROVIDER, ST. FRANCIS HOSPITAL ELECTED TO FOCUS ON THE FOLLOWING AREAS BECAUSE WE HAVE EXPERIENCE CARING FOR PATIENTS WITH DIABETES AND ELEVATED BLOOD PRESSURE AS WELL AS PROVIDING MEDICAL CARE RELATED TO DENTAL HEALTH AND TEEN SUBSTANCE ABUSE. 1. DIABETES 2. TEEN SUBSTANCE ABUSE 3. DENTAL CARE 4. ELEVATED BLOOD PRESSURE ST. FRANCIS HOSPITAL DID NOT TAKE THE LEAD ON THE FOLLOWING ISSUES AS THEY WERE ADDRESSED BY ORGANIZATIONS IN THE COMMUNITY WITH SUPPORT FROM THE HOSPITAL: ALCOHOL USE, TOBACCO USE, MENTAL HEALTH, ELEVATED CHOLESTEROL, AND HEALTH SCREENINGS. ST. FRANCIS HOSPITAL REFERRED PERSONS TO AGENCIES WHICH HAVE EXISTING PROGRAMS IN PLACE. AREA OF NEED: ALCOHOL USE WHO WILL ADDRESS: MONTGOMERY COUNTY HEALTH DEPARTMENT & MACOUPIN COUNTY HEALTH DEPARTMENT APPROACH THAT WILL BE TAKEN TO ADDRESS THE AREA OF NEED: MONTGOMERY COUNTY HEALTH DEPARTMENT AND MACOUPIN COUNTY HEALTH DEPARTMENT AS WELL AS THE CONTINUING RECOVERY CENTER IN IRVING, IL ARE PROVIDING SERVICES FOR THOSE WITH ALCOHOL ABUSE NEEDS; THEREFORE, ST. FRANCIS HOSPITAL WILL NOT BE TAKING ACTION IN THIS AREA SINCE IT LACKS THE EXPERTISE, EQUIPMENT, OR QUALIFIED STAFF TO ADDRESS THIS NEED. ST. FRANCIS HOSPITAL WILL REFER TO THESE AGENCIES WHICH HAVE EXISTING PROGRAMS IN PLACE. AREA OF NEED: TOBACCO USE WHO WILL ADDRESS: MONTGOMERY COUNTY HEALTH DEPARTMENT & MACOUPIN COUNTY HEALTH DEPARTMENT AS WELL AS STATE OF ILLINOIS APPROACH THAT WILL BE TAKEN TO ADDRESS THE AREA OF NEED: BOTH MONTGOMERY COUNTY HEALTH DEPARTMENT AND MACOUPIN COUNTY HEALTH DEPARTMENT ARE PROVIDING SERVICES FOR TOBACCO CESSATION; THEREFORE, ST. FRANCIS HOSPITAL WILL NOT BE TAKING ACTION IN THIS AREA SINCE IT LACKS THE EXPERTISE, EQUIPMENT, OR QUALIFIED STAFF TO ADDRESS THIS NEED. MONTGOMERY COUNTY HEALTH DEPARTMENT ALSO PROVIDES CLASSES TO SIXTH AND SEVENTH GRADERS IN ALL FOUR COUNTY SCHOOL DISTRICTS REGARDING TOBACCO USE, ALCOHOL, AND DRUGS. ST. FRANCIS HOSPITAL WILL REFER TO THE COUNTY HEALTH DEPARTMENTS WHICH HAVE EXISTING PROGRAMS IN PLACE AND WILL ALSO REFER INDIVIDUALS TO THE ILLINOIS QUIT LINE. AREA OF NEED: MENTAL HEALTH WHO WILL ADDRESS: MONTGOMERY COUNTY HEALTH DEPARTMENT & MACOUPIN COUNTY HEALTH DEPARTMENT APPROACH THAT WILL BE TAKEN TO ADDRESS THE AREA OF NEED: MONTGOMERY COUNTY HEALTH DEPARTMENT AND MACOUPIN COUNTY HEALTH DEPARTMENT AS WELL AS THE BEHAVIORAL HEALTH DEPARTMENT AT ST. JOHN'S HOSPITAL ARE PROVIDING SERVICES FOR THOSE WITH MENTAL HEALTH NEEDS; THEREFORE, ST. FRANCIS HOSPITAL WILL NOT BE TAKING ACTION IN THIS AREA SINCE IT LACKS THE EXPERTISE, EQUIPMENT, OR QUALIFIED STAFF TO ADDRESS THIS NEED. ST. FRANCIS HOSPITAL WILL REFER TO THESE AGENCIES WHICH HAVE EXISTING PROGRAMS IN PLACE. AREA OF NEED: ELEVATED CHOLESTEROL WHO WILL ADDRESS: ST. FRANCIS HOSPITAL AND COMMUNITY PARTNERS APPROACH THAT WILL BE TAKEN TO ADDRESS THE AREA OF NEED: A VARIETY OF FREE CHOLESTEROL SCREENINGS ARE CURRENTLY AVAILABLE THROUGH BOTH COUNTY HEALTH DEPARTMENTS AND ST. FRANCIS HOSPITAL AT VARIOUS HEALTH FAIRS AND PROGRAMS THROUGHOUT THE YEAR. ACTION PLAN: REDUCED COST CHOLESTEROL TESTING WAS OFFERED IN 2013 AND 2014 AT A COMMUNITY HEALTH FAIR PROVIDED BY ST. FRANCIS HOSPITAL. AREA OF NEED: HEALTH SCREENINGS WHO WILL ADDRESS: ST. FRANCIS HOSPITAL AND COMMUNITY PARTNERS APPROACH THAT WILL BE TAKEN TO ADDRESS THE AREA OF NEED: A VARIETY OF FREE HEALTH SCREENINGS ARE CURRENTLY AVAILABLE THROUGH BOTH COUNTY HEALTH DEPARTMENTS AND ST. FRANCIS HOSPITAL AT VARIOUS HEALTH FAIRS AND PROGRAMS THROUGHOUT THE YEAR. A VARIETY OF REDUCED COST LABORATORY SCREENINGS, AND OTHER FREE SCREENINGS INCLUDING RESPIRATORY SCREENINGS, BODY MASS INDEX, ORAL HEALTH SCREENINGS, BALANCE, AND FLEXIBILITY WERE PROVIDED AT A COMMUNITY HEALTH FAIR SPONSORED BY ST. FRANCIS HOSPITAL . ;
Schedule H, Part V Sec B, Line 14g, Other ways hospital publicized Financial Assistance Policy	(1) - ST FRANCIS HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCIS: COMMUNICATION/NOTIFICATION ABOUT FINANCIAL ASSISTANCE AVAILABILITY FROM HSHS INCLUDES THE FOLLOWING: A. FINANCIAL ASSISTANCE APPLICATIONS: THE FINANCIAL ASSISTANCE APPLICATION IS PROVIDED TO PATIENTS UPON REQUEST AND THROUGHOUT THE REGISTRATION AND POSTREGISTRATION PROCESS. THIS APPLICATION COMPLIES WITH CURRENT ILLINOIS AND WISCONSIN STATUTES AND ANY APPLICABLE FEDERAL STATUTES. B. POSTERS: THE AVAILABILITY OF FINANCIAL ASSISTANCE PROGRAM IS ADVERTISED ON POSTER-SIZED SIGNAGE LOCATED IN ADMISSIONS, OUTPATIENT, WAITING ROOM AREAS. A TOLL-FREE PHONE NUMBER IS INCLUDED. C. BROCHURES: BROCHURES OUTLINING THE FINANCIAL ASSISTANCE PROGRAM, APPLICATION PROCESS AND TOLL-FREE PHONE NUMBER ARE AVAILABLE AT ALL PATIENT REGISTRATION DESKS AND IN ALL WAITING AREAS. D. INTERNET: THE AVAILABILITY OF FINANCIAL ASSISTANCE PROGRAM AND ILLINOIS UNINSURED DISCOUNT ACT OF 2009 ARE POSTED ON THE HSHS INTERNET HOME PAGE. E. PATIENT STATEMENTS: EACH BILL, INVOICE OR OTHER SUMMARY OF CHARGES TO AN UNINSURED PATIENT INCLUDES WITH IT, OR ON IT, A PROMINENT STATEMENT THAT AN UNINSURED PATIENT WHO MEETS CERTAIN INCOME REQUIREMENTS MAY QUALIFY FOR AN UNINSURED DISCOUNT AND INFORMATION REGARDING HOW AN UNINSURED PATIENT MAY APPLY FOR CONSIDERATION UNDER THE HSHS FINANCIAL ASSISTANCE PROGRAM. IN ADDITION, REFERRAL OF PATIENTS MAY BE MADE BY ANY MEMBER OF THE HSHS STAFF OR MEDICAL STAFF, INCLUDING PHYSICIANS, NURSES, FINANCIAL COUNSELORS, SOCIAL WORKERS, CASE MANAGERS, CHAPLAIN'S, AND RELIGIOUS SPONSORS. A REQUEST FOR FINANCIAL ASSISTANCE MAY BE MADE BY THE PATIENT OR A FAMILY MEMBER, CLOSE FRIEND, OR ASSOCIATE OF THE PATIENT, SUBJECT TO APPLICABLE PRIVACY LAWS.;

Schedule H (Form 990) 2013

Additional Data

Software ID:	13000248
Software Version:	2013v3.1

- 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, line 23.
SchJMediumBullet

Attach to Form 990. SchJMediumBullet

See separate instructions.
SchJMediumBullet

Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public Inspection

Name of the organization

ST FRANCIS HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCIS

Employer identification number

37-0661236

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
directors, trustees, officers, including 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) 2013

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)DANIEL PERRYMANBOARD PRESIDENT/HOSPITAL CEO	(i) (ii)	0 271,119	0 50,074	0 37,694	0 78,714	0 16,512	0 454,113	0 30,938
(2)PETER MANNIXBOARD MEMBER	(i) (ii)	0 300,679	0 60,005	0 14,572	0 104,695	0 28,138	0 508,089	0 0
(3)ROBERT RITZFORMER DIVISIONAL PRESIDENT/CEO	(i) (ii)	0 308,684	0 0	0 279,929	0 51,520	0 14,758	0 654,891	0 210,511
(4)ANN M CARRTREASURER	(i) (ii)	0 223,926	0 38,138	0 56,891	0 236,713	0 18,355	0 574,023	0 24,602
(5)LARRY J RAGELDIVISIONAL CFO	(i) (ii)	0 290,797	0 62,273	0 44	0 67,000	0 21,518	0 441,632	0 0
(6)CAROL JACOCOO/CNO	(i) (ii)	174,487 0	19,355 0	0 0	53,979 0	8,019 0	255,840 0	0 0
(7)DIANE LINDSAYCFO	(i) (ii)	157,104 0	17,358 0	0 0	98,443 0	12,790 0	285,695 0	0 0
(8)DAVID OLEJNICZAKINTERIM CEO	(i) (ii)	0 386,853	0 16,444	0 44	0 67,541	0 21,715	0 492,597	0 0
(9)SHERRI A GREENWOODDIVISION CHIEF NURSING OFFICER	(i) (ii)	0 223,850	0 6,174	0 44	0 40,406	0 21,332	0 291,806	0 0
(10)EVERT J KUIPERCENTRAL ILLINOIS DIVISION CEO	(i) (ii)	0 2,250	0 100,000	0 55,959	0 0	0 0	0 158,209	0 0
(11)KATHRYN KNOBLOCHDIRECTOR OF ANCILLARY SERVICES	(i) (ii)	112,088 0	2,950 0	0 0	67,248 0	0 0	182,286 0	0 0
(12)JILL MOUTRIAPHARMACIST	(i) (ii)	129,526 0	0 0	0 0	45,588 0	6,719 0	181,833 0	0 0

Schedule J (Form 990) 2013

Page 3

Part III

Supplemental Information

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.

Return Reference

Explanation

Schedule J, Part I, Line 3, Arrangement used to establish the top management official's compensation

PLEASE SEE RESPONSE TO FORM 990, PART VI, LINE 15A IN SCHEDULE O.

Schedule J, Part I, Line 4b, Supplemental nonqualified retirement plan

HSHS EXECUTIVES ELIGIBLE TO PARTICIPATE IN SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) ARE DEFINED IN THE SERP PLAN DOCUMENTS. THE SERP WAS ESTABLISHED TO PROVIDE ADDITIONAL RETIREMENT BENEFITS TO ENSURE REASONABLE MARKET COMPETITIVE BENEFITS IN ACCORDANCE WITH THE HSHS EXECUTIVE COMPENSATION PHILOSOPHY ESTABLISHED BY THE HSHS COMPENSATION COMMITTEE. THE PLAN PROVIDES A DEFINED RETIREMENT CONTRIBUTION TO PARTICIPANTS COMMENCING ON JANUARY 1, 2008, EQUAL TO A PERCENTAGE OF COMPENSATION AS DEFINED IN THE SERP PLAN DOCUENTS FOR THE PLAN YEAR. PARTICIPANTS CONSTRUCTIVELY RECEIVE A DISTRIBUTION FROM THE PLAN NO LATER THAN MARCH 15TH OF THE CALENDAR YEAR FOLLOWING THE CALENDAR YEAR IN WHICH AN AMOUNT IS VESTED AND TAXABLE PURSUANT TO A VESTING SCHEDULE AS SPECIFIED IN THE PLAN DOCUMENT. THE ACTUAL DISTRIBUTION OF THE VESTED BENEFIT UNDER THE PLAN IS PAID IN A SINGLE LUMP SUM TO THE PARTICIPANT OR THE PARTICIPANT'S BENEFICIARY UPON THE EARLIER OF THE PARTICIPANT'S TERMINATION OF EMPLOYMENT, DEATH, OR TOTAL AND PERMANENT DISABILITY. THE FOLLOWING INTERESTED PERSONS CONSTRUCTIVELY RECEIVED DEFERRALS TO THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2013; THESE DEFERRALS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (C). ANN M. CARR -- $28,503 ROBERT RITZ -- $N/A DANIEL PERRYMAN -- $32,522 DAVID OLEJNICZAK -- $20,617 PETER MANNIX -- $37,052 THE FOLLOWING INTERESTED PERSONS RECEIVED DISTRIBUTIONS FROM THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2013; THESE PAYMENTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III) AND SCHEDULE J, PART II, COLUMN (F), AS APPLICABLE. ANN M. CARR -- $24,602 ROBERT RITZ -- $210,511 DANIEL PERRYMAN -- $30,938

Schedule J (Form 990) 2013

Additional Data

Software ID:	13000248
Software Version:	2013v3.1

- 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.
MediumBullet

Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public
Inspection

Name of the organization

ST FRANCIS HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCIS

Employer identification number

37-0661236

Return Reference	Explanation
FORM 990, PART III, LINE 4D, PROGRAM SERVICE ACCOMPLISHMENTS	THE COMMUNITY BENEFIT CONTRIBUTION OF ST. FRANCIS HOSPITAL INCLUDES PROGRAMS AND ACTIVITIES THAT IMPROVE ACCESS TO HEALTH CARE AND IMPROVE HEALTH IN OUR COMMUNITIES. IN ORDER TO PORTRAY THE FULL BREADTH OF OUR CONTRIBUTION, OUR COMMUNITY BENEFIT INFORMATION IS DESCRIBED BELOW: SECTION 1 - QUALITATIVE DESCRIPTION OF COMMUNITY BENEFIT: DURING THE FISCAL YEAR ENDED JUNE 30, 2014 ST. FRANCIS HOSPITAL OPERATED AS A CRITICAL ACCESS HOSPITAL. THE HOSPITAL PROVIDED 4,664 ADULT, PEDIATRIC, AND SKILLED NURSING DAYS OF CARE AND ACCOMMODATED 47,321 OUTPATIENT VISITS DURING THE FISCAL YEAR. QUALITY MEDICAL SERVICES WERE PROVIDED TO ALL PATIENTS REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR FINANCIAL STATUS. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF THE HOSPITAL, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES. ST. FRANCIS HOSPITAL'S MISSION IS TO REVEAL AND EMBODY CHRIST'S HEALING LOVE FOR ALL PEOPLE THROUGH OUR HIGH QUALITY FRANCISCAN HEALTH CARE MINISTRY. TO ACCOMPLISH THE MISSION, THE HOSPITAL PROVIDES CARE TO THE POOR, ELDERLY, AND THE NEEDY OF THE COMMUNITY THROUGH VARIOUS PROGRAMS AND SERVICES. THESE ACTIVITIES INCLUDE WELLNESS PROGRAMS, COMMUNITY EDUCATION, COMMUNITY SUPPORT ACTIVITIES, AND PROGRAMS SPECIFICALLY DESIGNED FOR THE ELDERLY, HANDICAPPED AND MEDICALLY UNDERSERVED. BENEFITS FOR THE POOR INCLUDE SERVICES PROVIDED TO PERSONS WHO CANNOT AFFORD HEALTH CARE BECAUSE OF INADEQUATE RESOURCES AND WHO ARE UNINSURED OR UNDERINSURED. THESE BENEFITS ARE PROVIDED IN THE FORM OF CHARITY CARE FOR THOSE WHO CANNOT AFFORD TO PAY THROUGH THE HOSPITAL'S UNINSURED DISCOUNT PROGRAM AND THROUGH PUBLIC PROGRAMS SUCH AS MEDICAID. ST. FRANCIS PROVIDES CHARITY CARE THROUGH ITS CHRISTIAN CARE PROGRAM. THE CHRISTIAN CARE PROGRAM IS DESIGNED TO ENSURE THAT THE RESOURCES USED TO ASSIST PATIENTS ARE PROVIDED FOR THOSE WHO ARE UNABLE TO PAY FOR THEIR MEDICAL CARE. FINANCIAL ASSISTANCE IS DETERMINED BY COMPARING THE APPLICANT'S GROSS FAMILY INCOME TO THE MOST RECENT FEDERAL POVERTY GUIDELINES. IN ORDER TO QUALIFY FOR ASSISTANCE APPLICANTS MUST COMPLETE AN APPLICATION FORM, PROVIDE DOCUMENTATION OF CURRENT FAMILY INCOME, DOCUMENTATION OF MEDICAL EXPENSES AND AVAILABLE ASSETS, AND PROVIDE EVIDENCE OF INVESTIGATION OF ALL OTHER MEANS OF ASSISTANCE. APPLICATIONS ARE REVIEWED BY THE HOSPITAL'S CHRISTIAN CARE COMMITTEE AND SELECTION FOR ASSISTANCE IS DETERMINED BY THE HOSPITAL'S AVAILABLE FUNDS AND THE ELIGIBILITY OF THE APPLICANT. ALL UNINSURED PATIENTS ARE ALLOWED A DISCOUNT OF AT LEAST 10% FROM THE CHARGES BILLED FOR THE PATIENTS' HOSPITAL SERVICES. IN ACCORDANCE WITH THE STATE OF ILLINOIS PUBLIC ACT 095-0965, ST. FRANCIS PROVIDES UNINSURED PATIENTS THE ABILITY TO APPLY FOR FURTHER DISCOUNTS. UNDER THE HOSPITAL UNINSURED PATIENT DISCOUNT ACT, UNINSURED PATIENTS MAY BE ELIGIBLE FOR DISCOUNTS ENSURING THAT THEY PAY NO MORE THAN 135% OF THE COST OF THE SERVICES PROVIDED. BENEFITS FOR THE BROADER COMMUNITY INCLUDE SERVICES PROVIDED TO NEEDY POPULATIONS THAT MAY NOT QUALIFY AS POOR BUT NEED SPECIAL SERVICES AND SUPPORT. ST. FRANCIS PROVIDES THESE BENEFITS THROUGH THE PROVISION OF UNBILLED SERVICES FOR COMMUNITY MEMBERS. NON-BILLED COMMUNITY SERVICES INCLUDE THE COST OF HEALTH EDUCATION AND COMMUNITY HEALTH CLINICS AND SCREENINGS. SPECIFIC SERVICES PROVIDED BY ST. FRANCIS INCLUDE: - ASSISTANCE WITH COMMUNITY BLOOD DRIVES, KIDNEY MOBILE, DENTAL CARE, AND FRESH FRUIT PROGRAM - EMPLOYEE SPEAKERS AT HEALTH FAIRS, SCHOOLS, AND OTHER COMMUNITY ORGANIZATIONS - NUTRITIONAL MANAGEMENT CONSULTING SERVICES AND EDUCATIONAL MATERIALS - EDUCATIONAL SEMINARS FOR THE GENERAL PUBLIC ON SENIOR FITNESS PROGRAMS, BREAST CANCER AWARENESS, DIABETES, CARDIAC REHABILITATION, CONGESTIVE HEART FAILURE, ELDER ABUSE, STROKE, AND DRUG PREVENTION - SCREENINGS FOR COLORECTAL CANCER, HYPERTENSION, CHOLESTEROL, AND OBESITY - DONATION OF MEDICAL SUPPLIES AND USED EQUIPMENT TO MISSIONS IN UNDERDEVELOPED COUNTRIES - DONATION OF CASH AND SUPPLIES TO LOCAL AGENCIES - EDUCATIONAL SESSIONS FOR HEALTHCARE PROVIDERS ON BLOOD BORNE PATHOGENS, STRESS MANAGEMENT, AND CPR - ST. CLARE FOOD PANTRY TO PROVIDE FOOD FOR NEEDY FAMILIES QUANITFIABLE COMMUNITY BENEFIT: THE FINANCIAL INFORMATION IN THIS REPORT WAS PREPARED IN ACCORDANCE WITH THE CATHOLIC HEALTH ASSOCIATIONS (CHA) COMMUNITY BENEFIT REPORTING GUIDELINES. THESE GUIDELINES RECOMMEND THE FOLLOWING: - REPORT CHARITY CARE AT COST, NOT CHARGES - DO NOT INCLUDE BAD DEBT, CONTRACTUAL ALLOWANCES, AND PROMPT PAY DISCOUNTS AS PART OF CHARITY CARE EXPENSE - DO NOT COUNT A MEDICARE SHORTFALL AS A COMMUNITY BENEFIT - REPORT THE NET EXPENSE FOR COMMUNITY SERVICES, I.E. THE TOTAL COMMUNITY BENEFIT EXPENSE MINUS ANY ASSOCIATED REVENUE FROM PATIENTS, PAYERS, AND EXTERNAL SOURCES THE CHA REPORTING GUIDELINES REFLECT A CONSERVATIVE APPROACH TO REPORTING QUANTIFIABLE COMMUNITY BENEFIT. THE GOAL OF THE GUIDELINES IS TO PRODUCE COMMUNITY BENEFIT FINANCIAL REPORTS THAT REFLECT TRUE COSTS AND THAT DESCRIBE COMMUNITY BENEFIT ACTIVITIES THAT INCREASE ACCESS AND AWARENESS TO HEALTH CARE AND IMPROVE COMMUNITY HEALTH. IN ADDITION, THE HOSPITAL COMMITTED SIGNIFICANT RESOURCES TO SERVING THE MEDICARE POPULATION. THE COST (DETERMINED USING THE COST REPORT) OF PROVIDING SERVICES TO PRIMARILY ELDERLY BENEFICIARIES OF THE MEDICARE PROGRAM, IN EXCESS OF GOVERNMENTAL PAYMENTS, WAS $56,097 FOR THE YEAR ENDED JUNE 30, 2014. THE HOSPITAL ALSO COMMITTED SIGNIFICANT RESOURCES TO SERVING THE MEDICAID POPULATION. THE COST OF PROVIDING SERVICES TO PREGNANT WOMEN AND THEIR NEWBORNS WAS $1,339,513 FOR THE YEAR ENDED JUNE 30, 2014. ST. FRANCIS HOSPITAL IS THE ONLY HOSPITAL BETWEEN SPRINGFIELD AND MARYVILLE THAT OFFERS MATERNITY SERVICES. THE STATE OF ILLINOIS (THE STATE) RENEWED AN ASSESSMENT PROGRAM TO ASSIST IN FINANCING OF ITS MEDICAID PROGRAM IN DECEMBER OF 2006 FOR THE STATE'S FISCAL YEARS ENDED JUNE 30, 2006, 2007, 2008, 2009, 2010, 2011 AND 2012. THE PROGRAM WAS APPROVED IN 2008 AND HAS BEEN RENEWED EACH YEAR SINCE. PURSUANT TO THIS PROGRAM, HOSPITALS WITHIN THE STATE ARE REQUIRED TO REMIT PAYMENT TO THE STATE OF ILLINOIS MEDICAID PROGRAM UNDER AN ASSESSMENT FORMULA APPROVED BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS). THE ASSESSMENT PROGRAM ALSO PROVIDES HOSPITALS WITHIN THE STATE WITH ADDITIONAL MEDICAID REIMBURSEMENT BASED ON FUNDING FORMULAS, ALSO APPROVED BY CMS. THE NET EFFECT OF THE 2014 ASSESSMENT AND REIMBURSEMENT INCLUDED IN THE HOSPITAL'S 2014 STATEMENT OF OPERATIONS IS $3 MILLION.
Form 990, Part VI, Sec A, Line 6, Classes of members or stockholders	THE SENIOR GOVERNING BODY OF ST. FRANCIS HOSPITAL (THE CORPORATION) IS THE MEMBER OF THE CORPORATION, WHICH IS HOSPITAL SISTERS SERVICES, INC. ("HSSI"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE.
Form 990, Part VI, Sec A, Line 7a, Members or stockholders electing members of governing body	PURSUANT TO SECTION 2.3 OF THE CORPORATION'S BYLAWS, THE ORGANIZATION'S MEMBER, HOSPITAL SISTERS SERVICES, INC. ("HSSI"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, HAS THE RIGHT TO APPOINT AND REMOVE THE CORPORATION'S BOARD OF DIRECTORS, CHAIRPERSON OF THE BOARD, AND PRESIDENT.
Form 990, Part VI, Sec A, Line 7b, Decisions requiring approval by members or stockholders	RESPONSIBILITY FOR THE POLICY AND OPERATIONS OF ST. FRANCIS 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 SERVICES, INC. ("HSSI"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE MEMBER OF HSSI IS HOSPITAL SISTERS HEALTH SYSTEM ("HSHS"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE MEMBERS OF HSHS ARE THE INDIVIDUAL SISTERS WHO, FROM TIME TO TIME, ARE THE DULY ELECTED PROVINCIAL SUPERIOR AND PROVINCIAL COUNCILORS, RESPECTIVELY OF THE AMERICAN PROVINCE OF THE HOSPITAL SISTERS OF ST. FRANCIS ("AMERICAN PROVINCE"). THE AMERICAN PROVINCE IS THE UNITED STATES ORGANIZATION OF THE CONGREGATION OF THE HOSPITAL SISTERS OF THE THIRD ORDER REGULAR OF ST. FRANCIS, A RELIGIOUS INSTITUTE OF THE ROMAN CATHOLIC CHURCH. THE GOVERNANCE AND OPERATIONS OF THE CORPORATION ARE SUBJECT TO HSSI'S RIGHT TO EXERCISE THESE RESERVED POWERS WITH RESPECT TO THE CORPORATION AND ORGANIZATIONS OF WHICH THE CORPORATION IS EITHER, DIRECTLY OR INDIRECTLY, A CONTROLLING MEMBER OR A CONTROLLING SHAREHOLDER ("AFFILIATES"). HSSI'S RIGHT TO EXERCISE CERTAIN OF THESE RESERVED POWERS IS, IN TURN, SUBJECT TO THE APPROVAL OF HSHS AND HSHS' MEMBERS. THE RESERVED POWERS INCLUDE ALL RIGHTS GRANTED TO HSSI BY LAW AND THE RIGHT TO: (A) ADOPT, APPROVE AMENDMENTS TO, OR AMEND ANY STATEMENT OF PHILOSOPHY, MISSION, MISSION INTEGRATION OR VALUES, OR ANY NAME, LOGO, OR MARK OF THE CORPORATION OR OF ANY AFFILIATE; (B) ADOPT, APPROVE AMENDMENTS TO, OR AMEND THE ARTICLES OF INCORPORATION OF THE CORPORATION OR OF ANY AFFILIATE; (C) ADOPT, APPROVE AMENDMENTS TO, OR AMEND THE BYLAWS OF THE CORPORATION OR OF ANY AFFILIATE; (D) APPOINT AND REMOVE THE BOARD OF DIRECTORS, ANY ONE OR MORE OF THE DIRECTORS OF THE CORPORATION OR OF ANY AFFILIATE, AND THE CHAIRPERSON AND PRESIDENT OF THE CORPORATION OR OF ANY AFFILIATE; (E) APPROVE THE RECOMMENDATION OF THE BOARD OF DIRECTORS TO APPOINT OR REMOVE THE BOARD OF DIRECTORS, ANY ONE OR MORE DIRECTORS OF THE CORPORATION OR OF ANY AFFILIATE, OR THE CHAIRPERSON AND PRESIDENT OF THE CORPORATION OR OF ANY AFFILIATE. (F) WITH RESPECT TO THE CORPORATION OR ANY AFFILIATE, APPROVE THE PURCHASE, SALE, ALIENATION, EXCHANGE, LEASE, OR ENCUMBRANCE OF ANY REAL PROPERTY OF THE CORPORATION OR OF ANY AFFILIATE, WHICH PROPERTY HAS A VALUE IN EXCESS OF LIMITS SET FROM TIME TO TIME BY HSSI; (G) APPROVE THE OPERATING AND CAPITAL BUDGETS OF THE CORPORATION OR OF ANY AFFILIATE, AND ANY DEVIATIONS BY THE CORPORATION OR OF ANY AFFILIATE FROM SUCH BUDGETS IN AN AMOUNT OR PERCENTAGE SPECIFIED BY HSSI FROM TIME TO TIME; (H) APPROVE THE STRATEGIC PLAN AND GOALS OF THE CORPORATION OR OF ANY AFFILIATE; (I) APPROVE THE SALE OF SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION OR OF ANY AFFILIATE; (J) APPROVE THE MERGER OR DISSOLUTION OF THE CORPORATION OR OF ANY AFFILIATE; (K) ADOPT OR AMEND THE PLAN FOR MINISTRY EDUCATION AND GOVERNANCE FOR THE CORPORATION AND ITS AFFILIATES; (L) APPROVE THE CORPORATION'S MISSION ACCOUNTABILITY REPORTS AND THOSE OF ANY AFFILIATE; (M) APPROVE THE FINANCIAL POLICIES AND PROCEDURES OF THE CORPORATION OR OF ANY AFFILIATE, AND APPROVE ANY DEVIATIONS FROM SUCH POLICIES AND PROCEDURES BY THE CORPORATION OR ANY AFFILIATE; AND (N) ADOPT POLICIES TO IMPLEMENT THE RESERVED POWERS OF HSSI.
Form 990, Part VI, Sec B, Line 11b, Review of form 990 by governing body	THE HOSPITAL EMPLOYS CROWE HORWATH TO ASSIST IN THE OVERALL PREPARATION, REVIEW AND ELECTRONIC SUBMISSION OF ITS FORM 990. CROWE HORWATH 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.
Form 990, Part VI, Sec B, Line 12c, Conflict of interest policy	THE ORGANIZATION IS SUBJECT TO THE CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY ("POLICY") OF HOSPITAL SISTERS HEALTH SYSTEM, AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. A REVISED CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY HAVE BEEN IMPLEMENTED SINCE JANUARY 2009 TO MANAGE CONFLICTS OF INTEREST USING A SYSTEM-WIDE PROTOCOL FOR DISCLOSURE STATEMENTS. IN ACCORDANCE WITH THE ORGANIZATON'S CONFLICT OF INTEREST POLICY, ALL COVERED PERSONS HAVE A DUTY TO COMPLY WITH THE CONFLICT OF INTEREST POLICY FOR ANY CONTRACT, TRANSACTION, RELATIONSHIP, OR ACTIVITY CONTEMPLATED, ENTERED INTO, OR CONDUCTED AT HSHS OR ITS AFFILIATES. THE POLICY DEFINES COVERED PERSONS AS BOARD MEMBERS, BOARD COMMITTEE MEMBERS, OFFICERS, BOARD DESIGNEES, SENIOR MANAGEMENT, MEMBERS OF ANY COMMITTEE THAT OVERSEES THE APPROVAL OF PHARMACEUTICALS AND MEDICAL DEVICES, AND ANY OTHER INDIVIDUAL WHO HOLDS A POSITION OF TRUST. ON AN ANNUAL BASIS, HSHS DISCLOSES A COPY OF THE CONFLICT OF INTEREST POLICY (AND ALL CORRESPONDING PROCEDURES, GUIDELINES, FORMS, AND TOOLS) TO ALL COVERED PERSONS, AND ADVISES ALL COVERED PERSONS IN WRITING OF ANY SUBSTANTIVE CHANGES TO THIS POLICY AND SUCH RELATED MATERIALS. COVERED PERSONS ARE REQUIRED TO REVIEW AND COMPLETE THE CORRESPONDING CONFLICT OF INTEREST STATEMENT. THE SYSTEM OFFICE VICE PRESIDENT - SYSTEM RESPONSIBILITY, VICE PRESIDENT - RISK & COMPLIANCE, OR MEMBERS OF THE AUDIT AND INTEGRITY COMMITTEE ("COMMITTEE") ARE AVAILABLE TO 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 IS REQUIRED PROMPTLY TO DISCLOSE THE INTEREST TO THE COMMITTEE USING THE HSHS CONFLICT OF INTEREST DISCLOSURE STATEMENT. COMPLETED CONFLICT OF INTEREST STATEMENTS ARE SUBMITTED TO THE COMMITTEE, WHICH IS RESPONSIBLE FOR IDENTIFYING, ASSESSING, AND MANAGING CONFLICTS OF INTEREST THAT ARISE IN THE COURSE OF CONDUCTING THE AFFAIRS OF HSHS AND ITS AFFILIATES. IF THE COMMITTEE DETERMINES THAT A CONFLICT OF INTEREST EXISTS, THE CONFLICT OF INTEREST POLICY REQUIRES HSHS NOT TO ENGAGE IN, OR ENTER INTO, A PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY UNLESS THE COMMITTEE OR, WHERE NECESSARY, THE BOARD OF DIRECTORS (ACTING THROUGH ITS DISINTERESTED MEMBERS), HAS INVESTIGATED ALTERNATIVES TO THE PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY AND, IN THE ABSENCE OF ALTERNATIVES THAT ARE IN THE BEST INTERESTS OF HSHS, HAS DETERMINED: 1. THAT, REGARDLESS OF WHETHER THE COVERED PERSON PARTICIPATES IN THE IMPLEMENTATION OF THE PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY; 2. THE CONTRACT, TRANSACTION, ARRANGEMENT, OR ACTIVITY IS IN THE BEST INTERESTS OF HSHS; 3. THE CONTRACT, TRANSACTION, ARRANGEMENT, OR ACTIVITY IS FAIR AND REASONABLE FROM THE PERSPECTIVE OF HSHS; AND 4. HSHS CANNOT OBTAIN A MORE ADVANTAGEOUS CONTRACT, TRANSACTION, ARRANGEMENT, OR ACTIVITY WITH REASONABLE EFFORTS UNDER THE CIRCUMSTANCES. IN DETERMINING WHETHER A CONTRACT, TRANSACTION, OR ARRANGEMENT IS FAIR AND REASONABLE TO HSHS, THE COMMITTEE SHALL CONSIDER, WHERE APPLICABLE: 1. APPRAISALS OR OTHER INDEPENDENT VALUATIONS OF THE FAIR MARKET VALUE OF THE CONTRACT, TRANSACTION, OR ARRANGEMENT; 2. INFORMATION REGARDING COMPARABLE CONTRACTS, TRANSACTIONS, OR ARRANGEMENTS BETWEEN UNRELATED PARTIES; 3. OFFERS FROM COMPARABLE COMPETING ENTITIES; AND/OR 4. STUDIES OF COMPARABLE COMPENSATION ARRANGEMENTS. IN ANY CASE IN WHICH THE COMMITTEE FINDS, AFTER TAKING THE STEPS DESCRIBED ABOVE, THAT HSHS SHOULD PARTICIPATE IN A PROPOSED TRANSACTION OR ARRANGEMENT DESPITE THE EXISTENCE OF A CONFLICT OF INTEREST, THE COMMITTEE SHALL DEVELOP, IMPLEMENT, MONITOR, AND ENFORCE COMPLIANCE WITH, A CONFLICT MANAGEMENT PLAN FOR MANAGING THE CONFLICT OF INTEREST AS IT CONSIDERS NECESSARY FOR SUCH FINDINGS TO REMAIN VALID THROUGHOUT THE LIFE OF THE CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY. ALL CONFLICT MANAGEMENT PLANS SHALL: 1. STATE THAT THE COMMITTEE WILL OVERSEE, MONITOR, AND ENFORCE COMPLIANCE WITH THE PLAN THROUGHOUT THE COURSE OF THE STUDY, AND SPECIFY MEANS FOR DOING SO, INCLUDING, WITHOUT LIMITATION, THAT THE APPROPRIATE INDIVIDUALS MUST PROVIDE THE COMMITTEE WITH WRITTEN REPORTS PERTAINING TO COMPLIANCE WITH THE CONFLICT MANAGEMENT PLAN, THAT THE COMMITTEE SHALL HAVE THE RIGHT TO AUDIT THE STUDY FOR SUCH COMPLIANCE, AND THE RIGHT TO IMPOSE SANCTIONS FOR NON-COMPLIANCE; 2. STATE THAT THE PLAN MUST BE SHARED WITH COVERED PERSON WHOSE INTERESTS IT WAS DEVELOPED TO MANAGE; 3. STATE THAT THE PLAN MUST BE SHARED WITH, AND PERIODIC REPORTS ON COMPLIANCE WITH THE PLAN MUST BE PROVIDED TO, THE BOARD, SENIOR MANAGEMENT, AND/OR GOVERNMENT AGENCIES; AND 4. PROVIDE FOR SUCH OTHER MANAGEMENT STEPS AND MECHANISMS THE COMMITTEE CONSIDERS NECESSARY AND APPROPRIATE. IN ADDITION TO THE COMMITTEE, THE SYSTEM OFFICE VICE PRESIDENTS OF SYSTEM RESPONSIBILITY AND RISK & COMPLIANCE MAY RETAIN SUCH INDEPENDENT ADVISORS OR EXPERTS AS DEEMED NECESSARY TO ASSIST IN MAKING ITS DETERMINATIONS AND DECISIONS. IF THE COMMITTEE DETERMINES THAT THE CONTEMPLATED TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY CANNOT PROCEED DUE TO A CONFLICT OF INTEREST, THE COMMITTEE SHALL INFORM THE APPLICABLE COVERED PERSON OR DECISION-MAKING BODY OF SUCH DETERMINATION WITHIN ONE WEEK OF THE COMMITTEE MEETING AT WHICH THE CONTEMPLATED TRANSACTION WAS DISCUSSED. THE COMMITTEE SHALL DOCUMENT ITS REJECTION OF THE CONTEMPLATED TRANSACTION IN THE COMMITTEE'S MEETING MINUTES.
FORM 990, PART VI, LINE 13, WHISTLEBLOWER POLICY	PROVISIONS WITHIN THE CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY PROVIDE PROTECTIONS FOR WHISTLEBLOWER TYPE ACTIVITIES.
Form 990, Part VI, Sec B, Line 15a, Process to establish compensation of top management official	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.
Form 990, Part VI, Sec B, Line 15b, Process to establish compensation of other employees	PLEASE SEE RESPONSE TO FORM 990, PART VI, LINE 15A.
FORM 990, PART VI, LINE 16B, JOINT VENTURES	HOSPITAL SISTERS HEALTH SYSTEM ADOPTED A JOINT VENTURE COMPLIANCE PROGRAM POLICY EFFECTIVE ON JANUARY 1, 2012 FOR ALL SYSTEM HOSPITALS, INCLUDING ST. FRANCIS 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. FRANCIS HOSPITAL, AND ALL HSHS HOSPITALS, TO EVALUATE THEIR PARTICIPATION IN JOINT VENTURE ARRANGEMENTS, INCLUDING UNDER APPLICABLE FEDERAL TAX LAWS, AND TO SAFEGUARD ST. FRANCIS HOSPITAL'S TAX EXEMPT STATUS WITH RESPECT TO ANY JOINT VENTURE ARRANGEMENTS.
Form 990, Part VI, Sec C, Line 19, Required documents available to the public	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.
FORM 990, PART X, LINE 11, POOLED INVESTMENT ACCOUNT	ST. FRANCIS HOSPITAL'S CASH RESERVES ARE INVESTED IN A POOLED INVESTMENT ACCOUNT. PARTICIPATION IN THE POOLED FUND IS LIMITED TO THE 501(C)(3) HOSPITALS AND RELATED HEALTH SERVICES ORGANIZATIONS SPONSORED BY THE HOSPITAL SISTERS HEALTH SYSTEM. THE POOLED ACCOUNT CONSISTS OF CASH, AND 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.
Form 990 , Part XI, Line 9, Other changes in net assets or fund balances	TRANSFERS TO AFFILIATES - -1251692; PENSION-OTHER THAN NET PERIODIC COSTS - 41634; CHANGE IN FAIR VALUE OF INTEREST RATE SWAP - -25172; SWAP PAYMENTS - -87002; CHANGE IN TEMPORARILY RESTRICTED NET ASSETS - -347585; CHANGE IN PERMANENTLY RESTRICTED NET ASSETS - 624793;

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2013

Additional Data

Software ID:	13000248
Software Version:	2013v3.1

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

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

Attach to Form 990. MediumBullet

See separate instructions.
MediumBullet

Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public Inspection

Name of the organization

ST FRANCIS HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCIS

Employer identification number

37-0661236

Part I

Identification of Disregarded Entities Complete if the organization answered "Yes" on 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)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity
(1) SPRINGFIELD HEALTH PARTNERS LLC 4936 LAVERNA ROAD SPRINGFIELD,IL62707 37-1364419	HEALTHCARE (DISSOLVED 03/22/13)	IL	0	0	HSHS MG
(2) KIARA CLINICAL INTEGRATION NETWORK LLC 4936 LAVERNA ROAD SPRINGFIELD,IL62707 26-1417684	HEALTHCARE	IL	-3,651,339	7,292,316	HSSI
(3) PHYSICIAN CLINICAL INTEGRATION NETWORK LLC 4936 LAVERNA ROAD SPRINGFIELD,IL62707 37-1668647	HEALTHCARE	IL	-779,271	1,233,121	KCIN

Part II

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled 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)	11 - Type III - FI	NA		No
(2) HOSPITAL SISTERS OF ST FRANCIS FDTN 4936 LAVERNA ROAD SPRINGFIELD,IL62707 37-1186514	HEALTHCARE	IL	501(C)(3)	9	HSHS	Yes
(3) HSHS HEALTHCARE PLAN TRUST FUND 4936 LAVERNA ROAD SPRINGFIELD,IL62707 37-1137724	HEALTHCARE	IL	501(C)(9)	N/A	HSHS	Yes
(4) HSHS SELF INSURANCE TRUST 4936 LAVERNA ROAD SPRINGFIELD,IL62707 37-1120626	INSURANCE	IL	501(C)(3)	11 - Type I	HSHS	Yes
(5) HOSPITAL SISTERS HEALTHCARE WEST INC 2661 COUNTY HIGHWAY 1 CHIPPEWA FALLS,WI54729 51-0157933	HEALTHCARE	WI	501(C)(3)	11 - Type III - FI	HSSI	Yes
(6) SACRED HEART HOSPITAL 990 WEST CLAIREMONT AVENUE EAU CLAIRE,WI54701 39-0807060	HEALTHCARE	WI	501(C)(3)	3	HSSI	Yes
(7) ST ANTHONY'S HOSPITAL 503 N MAPLE STREET EFFINGHAM,IL62401 37-0661233	HEALTHCARE	IL	501(C)(3)	3	HSSI	Yes
(8) ST ELIZABETH'S HOSPITAL 211 SOUTH THIRD STREET BELLEVILLE,IL62220 37-0663567	HEALTHCARE	IL	501(C)(3)	3	HSSI	Yes
(9) ST NICHOLAS HOSPITAL 3100 SUPERIOR AVENUE SHEBOYGAN,WI53081 39-0808480	HEALTHCARE	WI	501(C)(3)	3	HSSI	Yes
(10) ST JOHN'S HOSPITAL 800 EAST CARPENTER STREET SPRINGFIELD,IL62769 37-0661238	HEALTHCARE	IL	501(C)(3)	3	HSSI	Yes
(11) ST JOSEPH'S HOSPITAL 9515 HOLY CROSS LANE BREESE,IL62230 37-1208459	HEALTHCARE	IL	501(C)(3)	3	HSSI	Yes
(12) ST JOSEPH'S HOSPITAL 2661 COUNTY HIGHWAY 1 CHIPPEWA FALLS,WI54729 39-0810545	HEALTHCARE	WI	501(C)(3)	3	HSSI	Yes
(13) ST MARY'S HOSPITAL 1800 E LAKE SHORE DRIVE DECATUR,IL62521 37-0661244	HEALTHCARE	IL	501(C)(3)	3	HSSI	Yes
(14) ST MARY'S HOSPITAL 111 SPRING STREET STREATOR,IL61364 36-2169181	HEALTHCARE	IL	501(C)(3)	3	HSSI	Yes
(15) ST MARY'S MEDICAL CENTER 1762 SHAWANO AVENUE GREEN BAY,WI54303 39-0818682	HEALTHCARE	WI	501(C)(3)	3	HSSI	Yes
(16) ST VINCENT HOSPITAL 835 S VAN BUREN GREEN BAY,WI51301 39-0817529	HEALTHCARE	WI	501(C)(3)	3	HSSI	Yes
(17) ST JOSEPH'S HOSPITAL 12866 TROXLER AVENUE HIGHLAND,IL62249 37-0663568	HEALTHCARE	IL	501(C)(3)	3	HSSI	Yes
(18) HOSPITAL SISTERS SERVICES INC 4936 LAVERNA ROAD SPRINGFIELD,IL62707 37-1163402	HEALTHCARE	IL	501(C)(3)	11 - Type III - FI	HSHS	Yes
(19) HSHS MEDICAL GROUP INC 3215 EXECUTIVE PARK DRIVE SPRINGFIELD,IL62703 26-3956318	HEALTHCARE	IL	501(C)(3)	11 - Type III - FI	HSSI	Yes
(20) HSHS WISCONSIN MEDICAL GROUP INC 3215 EXECUTIVE PARK DRIVE SPRINGFIELD,IL62703 26-4515959	HEALTHCARE	WI	501(C)(3)	11 - Type III - FI	HSSI	Yes
(21) ORANGE CROSS AMBULANCE INC 919 ASHLAND AVENUE SHEBOYGAN,WI53081 39-1860942	HEALTHCARE	WI	501(C)(3)	9	ST NICHOLAS	Yes
(22) WISCONSIN UPPER PENINSULA ONCOLOGY MGMT 835 S VAN BUREN GREEN BAY,WI54301 39-1677100	HEALTHCARE	WI	501(C)(3)	3	ST VINCENT	Yes
(23) UNITY LIMITED PARTNERSHIP 2366 OAK RIDGE CIRCLE DE PERE,WI54115 39-1750729	HEALTHCARE	WI	501(C)(3)	9	HSSI	Yes
(24) PRAIRIE EDUCATION & RESEARCH COOPERATIVE 317 NORTH 5TH STREET SPRINGFIELD,IL62701 37-1157915	HEALTHCARE	IL	501(C)(3)	4	HSSI	Yes
(25) COMMUNITY MEMORIAL HOSPITAL 855 S MAIN STREET OCONTO FALLS,WI54154 39-0848401	HEALTHCARE	WI	501(C)(3)	3	HSSI (SEE PART VII)	Yes

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

Cat. No. 50135Y

Schedule R (Form 990) 2013

Page 2

Part III

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(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 V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) MEMORIAL AND ST ELIZABETH'S HEALTHCARE CANCER TREATMENT CENTER 4000 NORTH ILLINOIS STREET SWANSEA,IL62226 37-1312961	HEALTHCARE	IL	ST ELIZABETH'S	RELATED	599,299	4,931,271		No			No	0 %
(2) PRAIRIE HEART INSTITUTE ST JOHN'S 800 EAST CARPENTER STREET SPRINGFIELD,IL62769 37-1321197	HEALTHCARE	IL	HSHS	RELATED	-1,018	47,055		No			No	0 %
(3) NORTHEAST WISCONSIN RADIATION THERAPY SERVICES LLC 1726 SHAWANO AVE GREEN BAY,WI543079047 26-3749065	HEALTHCARE	WI	SMGB	RELATED	147,184	514,563		No		Yes		0 %
(4) PAIN CENTER OF WISCONSIN 4131 W LOOMIS ROAD SUITE 300 GREENFIELD,WI53221 26-3155343	HEALTHCARE	WI	ST VINCENT	RELATED	1,752,500	1,353,813		No			No	0 %
(5) SURGERY CENTER OF SHEBOYGAN LLC 3141 SAEMANN AVENUE SHEBOYGAN,WI53081 26-0822209	HEALTHCARE	WI	ST NICHOLAS (SOLD 1114)	RELATED	155,892	0		No			No	0 %
(6) CARPENTER STREET HOTEL LLC 525 NORTH SIXTH STREET SPRINGFIELD,IL62702 36-4128127	HOTEL	IL	LASANTE INC	N/A
(7) SPRINGFIELD URGENT CARE REAL ESTATE LLC PO BOX 19456 SPRINGFIELD,IL727949456 03-0413258	RENTAL REAL ESTATE	IL	LASANTE INC	N/A
(8) PRAIRIE HEART INSTITUTE MANAGEMENT COMPANY LLC 4936 LAVERNA ROAD SPRINGFIELD,IL62707 26-1479945	MEDICAL	IL	HSHS	RELATED	-7,553	9,078		No		Yes		0 %

Part IV

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(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 ROAD SPRINGFIELD,IL62707 37-1163401	HEALTHCARE	IL	HSHS	C CORPORATION	-23,279,067	45,045,072	0 %	Yes
(2) LASANTE WISCONSIN INC 4936 LAVERNA ROAD SPRINGFIELD,IL62707 39-1572196	HEALTHCARE	IL	KIARA INC	C CORPORATION				Yes
(3) LASANTE INC 4936 LAVERNA ROAD SPRINGFIELD,IL62707 37-1163400	HEALTHCARE	IL	KIARA INC	C CORPORATION				Yes
(4) PRAIRIE CARDIOVASCULAR 619 EAST MASON SUITE 4P57 SPRINGFIELD,IL62701 37-1071858	HEALTHCARE	IL	KIARA INC	C CORPORATION				Yes
(5) PREVEA HEALTH SERVICES INC 2710 EXECUTIVE DRIVE GREEN BAY,WI54304 39-1839351	HEALTHCARE	WI	HSSI	C CORPORATION	2,912,268	45,322,060	0 %	Yes
(6) PREVEA CLINIC INC 2710 EXECUTVE DRIVE GREEN BAY,WI54304 39-1839349	HEALTHCARE	WI	PHSI	C CORPORATION				Yes
(7) RENAISSANCE QUALITY INSURANCE LTD PO BOX 1159 GRAND CAYMANKY1-1102 CJ 98-0669953	INSURANCE	CJ	HSSI	C CORPORATION	0	100,258,139	0 %	Yes
(8) OJV INC 4936 LAVERNA ROAD SPRINGFIELD,IL62707 46-0873384	HEALTHCARE	IL	LASANTE INC	C CORPORATION				Yes
(9) STREATORLAND QUALITY CARE PHO LLC 111 SPRING STREET STREATOR,IL61364 36-4105007	HEALTHCARE	IL	ST MARY'S STREATOR	C CORPORATION	-3,136	20,601	0 %	Yes

Schedule R (Form 990) 2013

Page 3

Part V

Transactions With Related Organizations Complete if the organization answered "Yes" on 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) . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

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

Yes

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

Yes

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

Yes

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

Schedule R (Form 990) 2013

Page 4

Part VI

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

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

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

Schedule R (Form 990) 2013

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference

Explanation

PART II, COLUMN (F), DIRECT CONTROLLING ENTITY (CMH)

ON SEPTEMBER 1, 2014, HSSI BECAME THE SOLE CORPORATE MEMBER OF COMMUNITY MEMORIAL HOSPITAL (CMH) IN OCONTO FALLS, WISCONSIN. EFFECTIVE ON THE ACQUISITION DATE, CMH BECAME A CATHOLIC ENTITY AND THE HOSPITAL NAME WAS CHANGED TO ST. CLARE MEMORIAL HOSPITAL, INC. PREVIOUS TO THE ACQUISITION, TWO HSSI AFFILIATES HELD A COMBINED 24% MINORITY INTEREST IN CMH. REVISED GOVERNING DOCUMENTS ARE CONSISTENT WITH HSHS POLICIES APPLICABLE TO AFFILIATES. HSSI WILL RETAIN CERTAIN RESERVE POWERS OVER ST. CLARE MEMORIAL HOSPITAL, INC. CONSISTENT WITH OTHER HSSI SUBSIDIARIES.

PART V, LINE 2, TRANSACTIONS WITH RELATED ENTITIES

ANY TRANSACTIONS LISTED ON SCHEDULE R, PART V, LINE 1 AND NOT ON SCHEDULE R, PART V, LINE 2 ARE BETWEEN RELATED 501(C)(3) ORAGNIZATIONS AND DO NOT REQUIRE REPORTING ON THIS SECTION.

Schedule R (Form 990) 2013

Additional Data

Software ID:	13000248
Software Version:	2013v3.1

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	9
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	7
5	Total number of individuals employed in calendar year 2013 (Part V, line 2a) ......	5	272
6	Total number of volunteers (estimate if necessary) .............	6	45
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	7,427
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	-276

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	685,508	846,297
9	Program service revenue (Part VIII, line 2g) .........	33,943,159	36,126,500
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	868,352	1,280,473
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	400,629	476,857
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	35,897,648	38,730,127
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	2,000	2,000
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)	15,084,192	14,627,960
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)....	17,244,938	19,063,311
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	32,331,130	33,693,271
19	Revenue less expenses. Subtract line 18 from line 12.......	3,566,518	5,036,856
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	51,365,438	57,970,019
21	Total liabilities (Part X, line 26).............	22,298,101	23,820,160
22	Net assets or fund balances. Subtract line 21 from line 20.....	29,067,337	34,149,859

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 19,226,988 including grants of $ ) (Revenue $ 29,903,340 )
	SEE SCHEDULE O - OUTPATIENT ACUTE CARE

4b	(Code: ) (Expenses $ 4,586,799 including grants of $ ) (Revenue $ 5,348,488 )
	SEE SCHEDULE O - INPATIENT MEDICAL/SURGICAL

4c	(Code: ) (Expenses $ 733,099 including grants of $ ) (Revenue $ 867,245 )
	SEE SCHEDULE O - MATERNITY/GYNECOLOGY SERVICES

	(Code: ) (Expenses $ 11,703 including grants of $ 2,000 ) (Revenue $ )
	OTHER PROGRAM SERVICES CONDUCTED IN FURTHERANCE OF THE HOSPITAL'S MISSION AND TAX-EXEMPT PURPOSE.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 11,703 including grants of $ 2,000 ) (Revenue $ )
4e	Total program service expenses24,558,589

(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) GERALD PAULE........................................................................ DIVISION CHIEF FINANCIAL OFFICER	10.00 .......................65.00	X			0	0	0
(19) LARRY J RAGEL........................................................................ DIVISIONAL CFO	3.75 .......................71.00	X			0	353,114	88,518
(20) REBECCA PUCLIK........................................................................ DIVISIONAL CHIEF PEOPLE OFFICER	10.00 .......................65.00	X			0	78,965	32,766
(21) SHERRI A GREENWOOD........................................................................ DIVISION CHIEF NURSING OFFICER	5.00 .......................55.00	X			0	230,068	61,738
(22) JILL MOUTRIA........................................................................ PHARMACIST	40.00 .......................0		X		129,526	0	52,307
(23) KATHRYN KNOBLOCH........................................................................ DIRECTOR OF ANCILLARY SERVICES	45.00 .......................0		X		115,038	0	67,248
(24) ROBERT RITZ........................................................................ FORMER DIVISIONAL PRESIDENT/CEO	0.00 .......................0.00			X	0	588,613	66,278

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	612,868	2,865,408	1,114,469

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512-514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d		598,952
e	Government grants (contributions)1e		30,317

f	All other contributions, gifts, grants, and similar amounts not included above1f		217,028

g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			846,297
			Business Code
2a	NET PATIENT SERVICE REVENUE		900099	36,119,073	36,119,073
b	LAB		621500	7,427		7,427
c				0
d				0
e				0
f	All other program service revenue .			0	0	0	0
g	Total. Add lines 2a–2f........			36,126,500
3	Investment income (including dividends, interest, and other similar amounts).......			147,956			147,956
4	Income from investment of tax-exempt bond proceeds..			0
5	Royalties...........			0
		(i) Real	(ii) Personal
6a	Gross rents	92,110
b	Less: rental expenses	114,064
c	Rental income or (loss)	-21,954	0
d	Net rental income or (loss).......			-21,954			-21,954
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	1,132,517
b	Less: cost or other basis and sales expenses
c	Gain or (loss)	1,132,517	0
d	Net gain or (loss)..........			1,132,517			1,132,517
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	SPECIALTY PHYSICIAN PMTS FOR STAFF		900099	370,615			370,615
b	REGIONAL REFERRAL RECEIPTS		900099	18,565			18,565
c				0
d	All other revenue ....			109,631	0	0	109,631
e	Total. Add lines 11a–11d ......			498,811
12	Total revenue. See Instructions......			38,730,127	36,119,073	7,427	1,757,330


				(A) Beginning of year		(B) End of year
1	Cash–non-interest-bearing .............			2,382,170	1	6,694,146
2	Savings and temporary cash investments .........				2
3	Pledges and grants receivable, net ...........			44	3	37
4	Accounts receivable, net .............			2,002,705	4	756,408
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 .............			63,683	7	60,992
8	Inventories for sale or use ..............			387,459	8	384,208
9	Prepaid expenses and deferred charges ..........			297,521	9	226,370
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	54,080,604
b	Less: accumulated depreciation .....	10b	30,479,652	22,542,328	10c	23,600,952
11	Investments—publicly traded securities ..........			23,535,908	11	26,150,927
12	Investments—other securities. See Part IV, line 11 .....			0	12	0
13	Investments—program-related. See Part IV, line 11 .....			0	13	0
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			153,620	15	95,979
16	Total assets. Add lines 1 through 15 (must equal line 34)......			51,365,438	16	57,970,019
17	Accounts payable and accrued expenses .........			3,993,438	17	6,217,597
18	Grants payable .................				18
19	Deferred revenue ................				19	12,167
20	Tax-exempt bond liabilities .............			10,185,695	20	10,077,568
21	Escrow or custodial account liability. Complete Part IV of Schedule D..				21
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 ..				23
24	Unsecured notes and loans payable to unrelated third parties ....				24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................			8,118,968	25	7,512,828
26	Total liabilities. Add lines 17 through 25.........			22,298,101	26	23,820,160
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			26,065,767	27	30,823,712
28	Temporarily restricted net assets ...........			2,378,182	28	2,077,966
29	Permanently restricted net assets ...........			623,388	29	1,248,181
	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 ...........			29,067,337	33	34,149,859
34	Total liabilities and net assets/fund balances ........			51,365,438	34	57,970,019